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

Marcio Silva Miguel Lima, Hector R Villarraga, Maria Cristina Donadio Abduch, Marta Fernandes Lima, Cecilia Beatriz Bittencourt Viana Cruz, João Cesar Nunes Sbano, Mariana Callil Voos, Wilson Mathias Junior, Jeane Mike Tsutsui, Marcio Silva Miguel Lima, Hector R Villarraga, Maria Cristina Donadio Abduch, Marta Fernandes Lima, Cecilia Beatriz Bittencourt Viana Cruz, João Cesar Nunes Sbano, Mariana Callil Voos, Wilson Mathias Junior, Jeane Mike Tsutsui

Abstract

Background: Estimative 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.

Objective: This study aims to check which one has the highest correlation with LVEF.

Methods: Patients 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.

Results: A 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).

Conclusion: GLS 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.

Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Example of global longitudinal strain analysis using speckle tracking echocardiography. GS: global longitudinal strain; AVC: aortic valve closure.
Figure 2
Figure 2
A: Representation of LV twist/torsion - clockwise rotation at the base and counterclockwise at the apex (view from the apex). B: Example of LV twist analysis (white line, LV twist; cyan line, apical rotation; pink line, basal rotation).
Figure 3
Figure 3
Correlation of different LV contraction parameters with LVEF (p

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