Application of strain echocardiography in valvular heart diseases

Figures

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  Figure 1. A theoretical model of relationship between chamber geometry and strain. (a) In the left ventricle (LV) with increased wall thickness, less global longitudinal (GLS) and circumferential (GCS) shortening is required to maintain the same ejection fraction (EF). Data from Stokke et al. (20) (b) An increase in LV end-diastolic volume (EDV) with no change in stroke volume (SV) results in a decrease in deformation (1.), while increased SV leads to increased deformation (2.). Data from Marciniak et al. (19)

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  Figure 2. Global longitudinal strain (GLS) in patients with various degrees of aortic stenosis (AS) and preserved ejection fraction. (a) Patient with mild AS, (b) patient with moderate AS, and (c) patient with severe AS. Upper panels: recordings demonstrated maximal velocity and calculated aortic valve area. Lower panels: demonstrated bull’s eyes of peak systolic strain and value of the GLS for corresponding patients

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  Figure 3. Incremental prognostic value of left ventricular global longitudinal strain (GLS) to traditional risk factors (T) in predicting mortality in valve disease. (a) Aortic stenosis: traditional risk variables are New York Heart Association (NYHA) classification and additive EuroSCORE. Data from Kusonose et al. (33) (b) Aortic regurgitation: traditional risk variables are Society of Thoracic Surgeons score, right ventricular systolic pressure (RVSP), and indexed left ventricular end-systolic diameter (LV ESD). Data from Alashi et al. (4) (c) Mitral regurgitation: traditional risk variables are age, atrial fibrillation (AF), NYHA classification, estimated glomerular filtration rate, left ventricular end-diastolic diameter (LV EDD), left ventricular ejection fraction (LV EF), and right ventricular systolic pressure (RVSP). Data from Hiemstra et al. (42)

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  Figure 4. Normogram of estimated risk of death at 5 years for left ventricular global longitudinal strain (GLS) in valve diseases: (a) Aortic stenosis, (b) aortic regurgitation, and (c) mitral regurgitation. Solid blue line represents the 5-year parametric estimates of instantaneous risk of death, respectively, enclosed by 68% confidence interval (shaded area). The GLS value where the risk of death continuously increased is marked in every group by red dashed line. Data from Huded et al. (35), Alashi et al. (4), and Mentias et al. (30)