Korean Circ J.  2008 Jul;38(7):379-386. 10.4070/kcj.2008.38.7.379.

Global Circumferential Strain by 2-Dimensional Speckle Tracking Method for the Evaluation of the Left Ventricular Function

• Lee SI
• Shin MS
• Lee JS
• Chung WJ
• Shim EO
• Kang WC
• Moon CI
• Ahn TH
• Choi IS
• Shin EK

• KMID: 2225772
• DOI: http://doi.org/10.4070/kcj.2008.38.7.379

Abstract

BACKGROUND AND OBJECTIVES: The speckle tracking method using 2-dimensional (2D) echocardiography is not affected by the tethering of neighboring segments and angulation. Global circumferential strain (GCS) of the left ventricle (LV) has been suggested as a systolic index and correlated with LV contractility. The purpose of this study was to investigate whether acute changes in preload affect global circumferential strain and to evaluate the usefulness of GCS by the speckle tracking method.
SUBJECTS AND METHODS
2D echocardiography was performed in 69 patients with end-stage renal disease before and after hemodialysis to measure the LV end-diastolic volume and LV ejection fraction. 2D images were acquired from the short-axis view of the mid-LV for the evaluation of GCS.
RESULTS
Mean LV end-diastolic volume significantly decreased from 91.2+/-33.3 mL to 72.3+/-32.0 mL (p+/-0.05), and LV ejection fraction decreased from 63.6+/-13.1% to 60.0+/-11.2% (p=0.006) after hemodialysis. However, mean GCS showed no significant change after hemodialysis (17.2+/-5.3% vs. 16.6+/-4.7%, p=0.13). GCS was found to be well correlated with LV ejection fraction (r=0.54, p<0.05) and peak systolic mitral annular velocity (r=0.46, p=0.000), but not with LV preload (r=0.06, p=0.622).
CONCLUSION
GCS using the speckle tracking method is a useful index for the evaluation of LV systolic function because it is not affected by acute preload change and is correlated with LV ejection fraction and peak systolic mitral annular velocity.

Keyword

Echocardiography; Strains; Ventricular end diastolic volume

MeSH Terms

Echocardiography
Heart Ventricles
Humans
Kidney Failure, Chronic
Renal Dialysis
Sprains and Strains
Stroke Volume
Track and Field
Ventricular Function, Left

Figure

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  Fig. 1 Speckle tracking method using a 2D echocardiographic image. Automatic frame-by-frame tracking of natural acoustic markers around the traced line was used to measure the global circumferential strain along the selected region of interest at the level of the mid-LV.

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  Fig. 2 Correlation between left ventricular preload (end-diastolic volume, EDV) change and global circumferential strain (GCS) change.

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  Fig. 3 Correlation between ejection fraction (EF) and global circumferential strain (GCS). A: pre-hemodialysis. B: post-hemodialysis. C: including pre- and post-hemodialysis. Pre-GCS: GCS before hemodialysis, pre-EF: EF before hemodialysis, post-GCS: GCS after hemodialysis, post-EF: EF after hemodialysis.

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  Fig. 4 Correlation between global circumferential strain (GCS) and mitral annular peak systolic velocity (S') (upper graph) and midwall fractional shortening (lower graph).

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  Fig. 5 Receiver operating characteristic (ROC) curve of global circumferential strain (GCS) (area under the curve, AUC 0.765). Sensitivity was 72.7% and specificity was 54.3% when a cut-off GCS value of 17.11% was used to detect normal left ventricular ejection fraction.

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