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Lee, Shin, Lee, Chung, Shim, Kang, Moon, Ahn, Choi, and Shin: Global Circumferential Strain by 2-Dimensional Speckle Tracking Method for the Evaluation of the Left Ventricular Function
Original Article
Korean Circulation Journal

Korean Circulation Journal 2008; 38(7): 379-386.

Published online: 31 July 2008

DOI: https://doi.org/10.4070/kcj.2008.38.7.379

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

Seok In Lee, BS1, Mi-Seung Shin, MD1, Jun-Seung Lee, MD2, Wook-Jin Chung, MD1, Eun-Ok Shim, RN1, Woong Chol Kang, MD1, Chan Il Moon, MD1, Tae Hoon Ahn, MD1, In Suck Choi, MD1, Eak Kyun Shin, MD1

1Division of Cardiology, Department of Internal Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea.

2Division of Nephrology, Department of Internal Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea.

Correspondence: Mi-Seung Shin, MD, Division of Cardiology, Department of Internal Medicine, Gachon University of Medicine and Science, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea. Tel: 82-32-460-3054, Fax: 82-32-469-1906, msshin@gilhospital.com

Received 21 November 2007       Revised 6 March 2008       Accepted 3 April 2008

Copyright © 2008 The Korean Society of Cardiology

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.

Keywords: Echocardiography, Strains, Ventricular end diastolic volume

Figures and Tables

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.
kcj-38-379-g003
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.
kcj-38-379-g005
Table 1
Baseline characteristics of the study subjects (n=69)
kcj-38-379-i001

BSA: body surface area, MR: mitral regurgitation, AR: aortic regurgitation, LV hypertrophy: diastolic thickness of left ventricular posterior wall ≥12 mm, DM: diabetes mellitus, HTN: hypertension

Table 2
Comparison of body weight, blood pressure, and heart rate between pre- and post-hemodialysis
kcj-38-379-i002

BW: body weight, SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate per minute

Table 3
Comparison of echocardiographic parameters between pre- and post-hemodialysis
kcj-38-379-i003

EDV: end diastolic volume (preload), ESV: end systolic volume, EF: ejection fraction, E: peak E wave velocity, A: peak A wave velocity, DT: deceleration time, E': mitral annular peak early diastolic velocity, A': mitral annular peak late diastolic velocity, S': mitral annular peak systolic velocity, LVMI: left ventricular mass index, MFS: midwall fractional shortening

Table 4
Comparison of circumferential and longitudinal strains between pre- and post-hemodialysis
kcj-38-379-i004

GCS: global circumferential strain, GLS: global longitudinal strain

Table 5
Correlation among mitral annular peak systolic velocity (S'), midwall fractional shortening (MFS), ejection fraction (EF), global circumferential strain (GCS), and global longitudinal strain (GLS)
kcj-38-379-i005

A) Pre-hemodialysis, B) Post-hemodialysis, C) Including pre- and post-hemodialysis

Table 6
Sensitivity and specificity of global circumferential strain (GCS) obtained by the speckle tracking method to detect normal left ventricular ejection fraction (EF, 55%) in 69 patients with end-stage renal disease (total 138 measurements including pre- and post-hemodialysis). Patients are divided according to the mean GCS (19.1%) of normal persons (n=25)
kcj-38-379-i006

Sensitivity: 93.9%, specificity: 41.0%

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