Key result
Female sex links to steeper strain-volume slopes, with advancing age driving progressive loop uncoupling.
Why the study?
LV strain-volume loops provide insight into contraction-volume interactions, but characteristics and potential sex- and age-related differences in a healthy adult population needed description.
Do female sex and increasing age influence left ventricular strain-volume loop characteristics in a healthy adult population?
Cross-Sectional (n=125)
No
Do female sex and increasing age influence left ventricular strain-volume loop characteristics in a healthy adult population?
Absolute Event Rate: 0.18% vs 0.12%
p-value: p=0.003
The study demonstrates significant intrinsic sex and age-related variations in left ventricular strain-volume relationships, underscoring the necessity for age- and sex-specific reference values in clinical echocardiography.
May necessitate sex- and age-specific strain-volume reference values; extends prior coupling observations but remains hypothesis-generating.
BACKGROUND: By combining left ventricular (LV) global longitudinal strain (GLS) with LV volume during the cardiac cycle, LV strain-volume loops (SV-loops) can be generated. LV SV-loop derived parameters provide new insights into the interaction between cardiac contraction and volume in a variety of cardiac diseases and may even have prognostic value. The aim of this study is to describe SV-loops in a healthy adult population and investigate potential sex- and age-related differences of LV SV-loop characteristics. METHODS: In 125 healthy volunteers aged 18-72 years, apical 2-, 3- and 4-chamber views were acquired to measure GLS. Custom software was used to combine strain and volume data to construct SV-loops. Different parameters were derived: (i) linear slope of systolic strain-volume relation (S-Slope); (ii) linear slope of early-systolic strain-volume relation (ES-Slope); (iii) linear slope of early-diastolic strain-volume relation (ED-Slope); (iv) linear slope of late-diastolic strain-volume relation (LD-slope) and (v) uncoupling between systolic and diastolic strain-volume relation (UNCOUP). RESULTS: [0.06-0.18] respectively (p = 0.003). Low values for uncoupling between the systolic and diastolic strain-volume relation were observed, with a mean value of 0.34 ± 1.1. Additionally, UNCOUP was positively correlated with age (r = 0.4; p < 0.05). CONCLUSIONS: Higher values observed in systolic and early-diastolic strain-volume relation in females may reflect sex-specific differences in LV contraction. While the exact mechanisms remain unclear, these findings suggest potential variations in myocardial deformation patterns that warrant further investigation. Consistent with previous work, relative coupling of the systolic and diastolic strain-volume relationship was identified in our cohort of healthy individuals. However, with increasing age, higher values for uncoupling were observed, suggesting age-related alterations in ventricular mechanics that may contribute to changes in cardiac function over time.
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Zwaan et al. (2026) conducted a cross-sectional in Healthy adult population (n=125). Female sex and increasing age vs. Male sex and younger age was evaluated on Early-diastolic strain-volume relation (ED-slope) (p=0.003). Females exhibited higher values in systolic and early-diastolic strain-volume relationships compared to males, and increasing age correlated with a relative uncoupling of these relationships.
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