Estimating Left Ventricular Relaxation and Filling Pressure Using Speckle Tracking Strain

Hidekazu Tanaka
2016 Circulation Journal  
In this issue of the Journal, Hayashi et al 11 report on their prospective multicenter study conducted in 5 institutions in Japan to compare the correlation of TDI-and 2D speckle tracking-derived parameters with the time constant of LV pressure decay (τ) and LV mean diastolic pressure (LVMDP) in 77 patients with various cardiac diseases. The main findings of this study were that the correlation of e' with τ was weak, and that of peak global longitudinal strain (LS) was the strongest among the
more » ... speckle tracking-derived parameters. In addition, the ratio of E to peak global LS (E/LS) correlated well with invasively measured LVMDP, which is significantly better than E/A or E/e'. The receiver-operating characteristic analysis showed that E/LS had the largest area under the curve for distinguishing elevated LVMDP compared with E/e' and E/A. Global LS assessed by means of 2D speckle tracking strain is now widely used as a powerful prognostic marker, and in patients with various cardiac diseases 12-14 it enables the detection of subtle LV systolic myocardial dysfunction beyond conventional echocardiographic assessment. Moreover, global LS is associated with LV relaxation, and reduced global LS can coexist with LV diastolic dysfunction in heart failure patients with normal LVEF. 15 Because this study showed that global LS may be an important marker of early-stage LV diastolic dysfunction, E/LS should be evaluated in routine examinations as a parameter of LV filling pressure. As the next step, we need to investigate the utility of E/LS as a prognostic marker in a larger number of patients with various cardiac diseases.
doi:10.1253/circj.cj-16-0268 pmid:27026258 fatcat:7cbldf6crfd3hpkeznre7wuhmi