Trend and Linearity Determination of Left Ventricular Mechanics in Cardiovascular Risk Factor Population with Preserved Ejection Fraction

Figures

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  Figure 1. Classification steps of the study design. The flowchart outlines the selection and categorization process of the study population (n = 500) based on predefined exclusion criteria and cardiovascular risk factors

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  Figure 2. Illustration of 4DXStrain speckle tracking echocardiography (4DXStrainSTE). Representative image demonstrating the 4DXStrainSTE technique used to assess myocardial deformation. Strain parameters, including global longitudinal strain, global circumferential strain, and global radial strain, are derived from multiplanar apical and short-axis views. Corresponding strain rate values – GCSR and GRSR – are also computed using the same imaging planes. The color-coded tracking overlays and vector fields represent real-time myocardial motion across the cardiac cycle. GCS = Global circumferential strain, GCSR = Global circumferential strain rate, GLS = Global longitudinal strain, GRS = Global radial strain, GRSR = Global radial strain rate

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  Figure 3. Graphical representation of the nine left ventricle (LV) strain parameters. This figure illustrates the nine LV strain parameters analyzed using 4 dimensional XStrain speckle tracking echocardiography. Parameters include GLS, GCS, GRS, and their respective strain rates (GLSR, GCSR, GRSR), measured at basal, mid papillary, and apical levels. The graphs reflect distribution patterns, regional variations, and mean values across study groups. GLS = Global longitudinal strain, GCS = Global circumferential strain, GRS = Global radial strain, GLSR = Global longitudinal strain rate, GCSR = Global circumferential strain rate, GRSR = Global radial strain rate, LV = Left ventricle

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  Figure 4. Graphical illustration of the trend analysis of multiple left ventricular strain parameters across cardiovascular risk categories 1–4, highlighting the progressive decline in global longitudinal strain and global circumferential strain (GCS) at pap level with increasing risk burden. This figure depicts the trend analysis of MLVSP across four increasing CVR categories. A progressive decline in GLS and GCS at the mid-papillary level is evident with increasing CVR burden. The illustration emphasizes the inverse relationship between strain values and CV risk category, suggesting early subclinical myocardial dysfunction associated with higher risk stratification. Data are presented as mean values with standard error bars. GLS = Global longitudinal strain, GCS = Global circumferential strain, MLVSP = Multiple left ventricular strain parameters; CVR = Cardiovascular risk

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  Figure 5. Graphical illustration of Pearson’s correlation: (a) No correlation; (b) Weak Positive; (b) Moderate negative; (d) Weak negative. This figure demonstrates representative Pearson’s correlation plots illustrating the association between cardiovascular risk factors and key left ventricular (LV) strain parameters. (a) No correlation between selected variables; (b) illustrates a weak positive correlation; (c) Displays a moderate negative correlation; and (d) A weak negative correlation. Each scatter plot includes a fitted trendline with the Pearson correlation coefficient (r) indicated. These examples emphasize the variable strength and direction of associations among clinical and echocardiographic parameters. LV = Left ventricular, r = Pearson correlation coefficient

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  Figure 6. Graphical illustration of multivariate regression analysis of multiple left ventricular strain parameters across risk categories. This figure displays the multivariate regression plots for multiple left ventricular strain parameters across four cardiovascular risk categories. The analysis reveals significant associations between increasing risk burden and declining values in key strain indices, notably global longitudinal strain and global circumferential strain at the papillary level. The visual layout facilitates comparison of regression trends among parameters, indicating how strain metrics deteriorate with risk escalation. GCS = Global circumferential strain, GCSR = Global circumferential strain rate, GLS = Global longitudinal strain, GRS = Global radial strain, GRSR = Global radial strain rate, LV = Left ventricle, MLVSP = Multiple left ventricular strain parameters