5 key points

• Normal value for global longitudinal strain±
  • Reported normal values of GLS varies from -15.9% to -22.1% (mean, -19.7%; 95% CI, -20.4% to -18.9%).
  • Normal global circumferential strain varies from -20.9% to -27.8% (mean, -23.3%; 95% CI, -24.6% to -22.1%).
  • Global radial strain ranges from 35.1% to 59.0% (mean, 47.3%; 95% CI, 43.6% to 51.0%).
• Variability in reapeted measurments in GLS±
  • Interobserver relative mean errors are 5.4% to 8.6%
  • Intraobserver relative mean errors are 4.9% to 7.3%
• Differences between vendors are small (approximaletely 3.7% strain units) but should nevertheless be taken into account. I reccommend using a single vendor for longitudinal follow up in individual patients
• In contrast to GLS, LV segmental longitudinal strain shows a higher variability on top of the known intervendor bias. The compariability of different software to follow segmental function varies considerably.
• Several clinical factors influence ragional and global strain values:
  • Age (lower deformation values in patients >60y)
  • Sex (lower deformation values in men)
  • Blood pressure (increase in blood pressure results in lower defromation values)

Cases

References

1. Farsalinos KE, Daraban AM, Ünlü S, Thomas JD, Badano LP, Voigt JU. Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors: The EACVI/ASE Inter-Vendor Comparison Study. J Am Soc Echocardiogr. 2015 Oct;28(10):1171-1181
2. Mirea O, Pagourelias ED, Duchenne J, Bogaert J, Thomas JD, Badano LP, Voigt JU; EACVI-ASE-Industry Standardization Task Force. Variability and Reproducibility of Segmental Longitudinal Strain Measurement: A Report From the EACVI-ASE Strain Standardization Task Force. JACC Cardiovasc Imaging. 2018 Jan;11(1):15-24.
3. Dalen H, Thorstensen A, Aase SA, Ingul CB, Torp H, Vatten LJ, Stoylen A. Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway. Eur J Echocardiogr. 2010 Mar;11(2):176-83. Epub 2009 Nov 28.
4. Thorstensen A, Dalen H, Amundsen BH, Aase SA, Stoylen A. Reproducibility in echocardiographic assessment of the left ventricular global and regional function, the HUNT study.  Eur J Echocardiogr. 2010 Mar;11(2):149-56. Epub 2009 Dec 3.
5. Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr. 2013 Feb;26(2):185-91.
6. Levy PT, Machefsky A, Sanchez AA, Patel MD, Rogal S, Fowler S, Yaeger L, Hardi A, Holland MR, Hamvas A, Singh GK. Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr. 2016 Mar;29(3):209-225.e6.
7. Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography. J Am Coll Cardiol. 2017 Feb 28;69(8):1043-1056.
8. Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt A):2751-68.
9. Teske AJ, De Boeck BW, Olimulder M, Prakken NH, Doevendans PA, Cramer MJ. Echocardiographic assessment of regional right ventricular function: a head-to-head comparison between 2-dimensional and tissue Doppler-derived strain analysis. J Am Soc Echocardiogr. 2008 Mar;21(3):275-83.