Relationship of multidirectional myocardial strain with radial thickening and ejection fraction and impact of left ventricular hypertrophy: A study in a community-based cohort

Background Left ventricular (LV) systolic strain provides additional prognostic value to LV ejection fraction (LVEF) and wall motion analysis. However, the relationship between myocardial multidirectional strain and LVEF, and the effect of LV hypertrophy on this relationship, are not completely understood especially in unselected populations. Methods LV global longitudinal (ε_L) and circumferential (ε_C) systolic strain analysis was performed by two-dimensional speckle tracking echocardiography in 215 participants from a community-based study. LV radial wall thickening was measured as global radial strain (ε_R), and LVEF was assessed by biplane Simpson's method. Results ε_R was significantly associated with ε_C (β = -0.56, P < 0.01) and with ε_L (β = -0.18, P < 0.01). The contribution of ε_L to ε_R was especially evident in subjects with lower ε_C and in presence of LV hypertrophy (β = -0.30, P < 0.01). ε_L and ε_C were significantly associated with LVEF (β = -0.36 and β = -0.49, both P < 0.01) independent of LV mass and other confounders, and their interaction significantly improved the prediction of LVEF (R²-change = 0.14) but not of ε_R (R²-change = 0.002). Conclusions ε_R is mainly related to ε_C with a smaller contribution of ε_L, which becomes especially evident in subjects with lower ε_C and in presence of LV hypertrophy. Therefore, radial thickening may not detect subclinical LV longitudinal function reduction in normal ventricles and when ε_C is preserved. While a reduction in ε_L has a limited impact on ε_R, it exerts a greater effect on global LVEF, therefore for a more accurate LVEF prediction both ε_L and ε_C need to be considered.