Ten Years of 2D Longitudinal Strain for Early Myocardial Dysfunction Detection: A Clinical Overview

Abstract

In recent years, the role of left ventricular ejection fraction (EF) as the gold standard parameter for the evaluation of systolic function has been questioned, and many efforts have been concentrated in the clinical validation of new noninvasive tools for the study of myocardial contractility. Improvement in the accuracy of speckle-tracking echocardiography has resulted in a large amount of research showing the ability of two-dimensional strain to overcome EF limitations in the majority of primary and secondary heart diseases. Currently, global longitudinal strain (GLS) is considered the most accurate and sensitive parameter for the assessment of early left ventricular dysfunction. This review summarizes the advantages that this measurement can provide in several clinical settings. Moreover, the important cautions that should be considered in making the choice to use GLS also are addressed. Finally, a special focus on bull's-eye polar maps for the assessment of regional changes of longitudinal function and the usefulness of these maps in the differential diagnosis of several diseases is provided.

Precocious Preclinical Cardiovascular Sonographic Markers in Metabolically Healthy and Unhealthy Childhood Obesity

“…Evaluation of GLS has assumed increasing importance in LV systolic function assessment as a reliable and reproducible index of myocardial contractility. GLS is able to early identify subclinical myocardial abnormalities differently from EF that is characterized by intrinsic limitations, as late reduction only in an advanced stage of CVD, poor reliability in patients with LV hypertrophy and volume reduction, inter-observer and intra-observer variability due to apical foreshortening (16). Accordingly, in our study EF did not differ between groups.…”

“…In this context, two parameters in obese patients' echocardiographic assessment became increasingly important: the left ventricular (LV) global longitudinal strain (GLS) and the epicardial adipose tissue (EAT). GLS is considered a reliable and reproducible parameter for the assessment of myocardial contractility (16). Strain imaging is able to early detect subclinical myocardial abnormalities in subjects affected by cardiovascular and metabolic diseases, showing a better diagnostic efficacy and prognostic value for predicting cardiovascular events compared to LV ejection fraction (EF) (17,18).…”

Cardiac Protection after Systemic Transplant of Dystrophin Expressing Chimeric (DEC) Cells to the mdx Mouse Model of Duchenne Muscular Dystrophy

“…Fractional shortening is a measure of cardiac contractility expressed as the percentage by which the left ventricle reduces in size longitudinally and is defined by the fractional shortening formula above. Longitudinal function has been shown to be an early marker of left ventricular diastolic dysfunction, and typically precedes [3][4][5]8]. Geometric changes such as increased relative ventricular wall thickness may allow for preserved ejection fraction in the setting of diastolic heart dysfunction despite depressed myocardial shortening in two orthogonal planes [4,8].…”

“…However, once the ventricular wall stiffens reaches the point where it can no longer be compliant with the blood from the atria, the diastolic dysfunction starts to worsen. This leads to systolic dysfunction and large drops in ejection fraction as heart failure symptoms become more prominent [2,3,9].…”

“…Dystrophin deficiency clinically manifests as skeletal and cardiac muscle weakness as myofibrils undergo damage, inflammation, and fibrosis [1]. Cardiomyopathy is a significant cause of morbidity and mortality in DMD patients [2][3][4]. Histopathological evidence suggests that the fibro-fatty replacement of cardiomyocytes is a significant pathophysiological mechanism in the development of cardiomyopathy in the mdx mice [5][6][7].…”