Global Longitudinal Strain or Left Ventricular Twist and Torsion? Which Correlates Best with Ejection Fraction?

Abstract

BackgroundEstimative of left ventricular ejection fraction (LVEF) is a major indication for echocardiography. Speckle tracking echocardiography (STE) allows analysis of LV contraction mechanics which includes global longitudinal strain (GLS) and twist/torsion, both the most widely used. Direct comparison of correlations between these novel parameters and LVEF has never been done before.ObjectiveThis study aims to check which one has the highest correlation with LVEF.MethodsPatients with normal LVEF (> 0,55) and systolic dysfunction (LVEF <0,55) were prospectively enrolled, and underwent echocardiogram with STE analysis. Correlation of variables was performed by linear regression analysis. In addition, correlation among levels of LV systolic impairment was also tested.ResultsA total of 131 patients were included (mean age, 46 ± 14y; 43%, men). LVEF and GLS showed a strong correlation (r = 0.95; r2 = 0.89; p < 0.001), more evident in groups with LV systolic dysfunction than those with preserved LVEF. Good correlation was also found with global longitudinal strain rate (r = 0.85; r2 = 0.73; p < 0.001). Comparing to GLS, correlation of LVEF and torsional mechanics was weaker: twist (r = 0.78; r2 = 0.60; p < 0.001); torsion (r = 0.75; r2 = 0.56; p < 0.001).ConclusionGLS of the left ventricle have highly strong positive correlation with the classical parameter of ejection fraction, especially in cases with LV systolic impairment. Longitudinal strain rate also demonstrated a good correlation. GLS increments analysis of LV systolic function. On the other hand, although being a cornerstone of LV mechanics, twist and torsion have a weaker correlation with LV ejection, comparing to GLS.

Changes in strain parameters at different deterioration levels of left ventricular function: A cardiac magnetic resonance feature-tracking study of patients with left ventricular noncompaction

“…The LV is composed of a complex three-layered myocardial structure leading to the longitudinal, circumferential and radial-directed deformation of the myocardium [24]. It is already known that the LV global strains strongly correlate with the EF; thus, the worsening of LV function is associated with decreased LV global strain parameters [10,25,26]. In our study, we found that the GLS, GCS and GRS gradually decreased as LV function worsened.…”

“…These conflicting results could be due to the non-linear relationship between LV ejection fraction and GLS, namely, there is a stronger correlation between these two parameters at lower EF, and the curve flattens when the EF is higher than 50%. Thus, in this latter case, GLS can vary more with less effect on LV EF [25,26].…”

Assessment of left ventricular twist by 3D ballistocardiography and seismocardiography compared with 2D STI echocardiography in a context of enhanced inotropism in healthy subjects

“…Left ventricular (LV) twist is the rotational movement of the LV along its longitudinal axis and results from the net difference between the torsional angles of the apical and basal rotations 11 – 13 . LV twist can robustly estimate myocardial function, expressed as LVEF 14 – 16 in some studies or dP/dt max in others 17 – 20 . LV untwisting rate provides the atrio-ventricular pressure gradients which assist cardiac chambers to fill during the early phase of relaxation 21 , 22 .…”

Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: A systematic review

“…GLS by STE has a strong positive correlation with LVEF, especially in LV systolic impairment. 12 Santoro et al 13 found that in severe MR, both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to SPAP suggesting GLS to be a powerful predictor of cardiac damage. In addition, GLS offers an angle-independent assessment of myocardial deformation, with recent reports showing better reproducibility and reliability compared with LVEF.…”