Normal ranges of left ventricular strain: a meta-analysis.
By T. Yingchoncharoen, S. Agarwal, Z. Popović, T. Marwick. Journal of the American Society of Echocardiography, 2013
864 citations recorded by the source corpus.
BACKGROUND The definition of normal values of left ventricular global longitudinal strain (GLS), global circumferential strain, and global radial strain is of critical importance to the clinical application of this modality. The investigators performed a meta-analysis of normal ranges and sought to identify factors that contribute to reported variations. METHODS MEDLINE, Embase, and the Cochrane Library database were searched through August 2011 using the key terms "strain," "speckle tracking," "left ventricle," and "echocardiography" and related phrases. Studies were included if the articles reported left ventricular strain using two-dimensional speckle-tracking echocardiography in healthy normal subjects, either in the control group or as a primary objective of the study. Data were combined using a random-effects model, and effects of demographic, hemodynamic, and equipment variables were sought in a meta-regression. RESULTS The search identified 2,597 subjects from 24 studies. Reported normal values of GLS varied from -15.9% to -22.1% (mean, -19.7%; 95% CI, -20.4% to -18.9%). Normal global circumferential strain varied from -20.9% to -27.8% (mean, -23.3%; 95% CI, -24.6% to -22.1%). Global radial strain ranged from 35.1% to 59.0% (mean, 47.3%; 95% CI, 43.6% to 51.0%). There was significant between-study heterogeneity and inconsistency. The source of variation was sought between studies using meta-regression. Blood pressure, but not age, gender, frame rate, or equipment, was associated with variation in normal GLS values. CONCLUSIONS The narrowest confidence intervals from this meta-analysis were for GLS and global circumferential strain, but individual studies have shown a broad range of strain in apparently normal subjects. Variations between different normal ranges seem to be associated with differences in systolic blood pressure, emphasizing that this should be considered in the interpretation of strain.
Subfields: Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, Radiology, Nuclear Medicine and Imaging
View Paper: https://www.semanticscholar.org/paper/9a0d7ec5c7dec5ee8b2b2d8295ee8b552c567c91
How researchers see this paper
The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.
In Cardiology and Cardiovascular Medicine
In Pulmonary and Respiratory Medicine
In Radiology, Nuclear Medicine and Imaging
Citations in the corpus
- Myocardial strain imaging: how useful is it in clinical decision making? (2015, background): “shortening, systolic strain is load dependant and therefore blood pressure should be considered when interpreting measurements of strain.(3,6) Other sources of variation in strain are age and gender.”
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. (2015, methodology): “Normal values for GLS depend on the definition of the measurement position in the myocardium, the vendor, and the version of the analysis software, resulting in considerable heterogeneity in the published literature.(27,32,33) It is the consensus of this writing committee that differences among vend”
- Assessment of Left Ventricular Function by Echocardiography: The Case for Routinely Adding Global Longitudinal Strain to Ejection Fraction. (2018, methodology): “(17) Meta-analysis 2,597 Healthy controls N/A Determination of reference range 15.”
- Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. (2014, background): “9%) (68) underpin the use of a normal cutoff exceeding 19%.”