Simultaneous Longitudinal Strain in All 4 Cardiac Chambers: A Novel Method for Comprehensive Functional Assessment of the Heart

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Simultaneous assessment of longitudinal strain (LS) by 2D speckle-tracking echocardiography in all 4 cardiac chambers has not yet been explored. Our goal was to study LS curves obtained simultaneously from all 4 cardiac chambers in healthy subjects to gain insight into interchamber functional relationships.

Methods and Results—

We studied 259 healthy subjects (age 44±15; 118 men) in whom it was possible to obtain apical 4-chamber views that contained the entire left and right ventricles and both atria in the same sector. 2D speckle-tracking echocardiography was performed in all 4 chambers in the same cardiac cycle, while considering the interventricular septum as part of the left ventricle and including the interatrial septum in the LS measurements for both atria. LS was measured over time using vendor-independent software (Epsilon), resulting in peak LS and time-to-peak strain. Strain curves of the right ventricle and right atrium were larger in magnitude than those of the left ventricle and left atrium, whereas time-to-peak values were shorter. LS for the ventricles peaked earlier than the LS for the corresponding atria. Peak systolic LS values were larger in magnitude in women than in men. For both atria, LS declined with age and time-to-peak increased. Left ventricle LS declined minimally with age, but right ventricle free-wall LS augmented with age until the sixth decade.


Simultaneous measurement of LS provides new insights into interchamber relationships. This new tool may prove useful in evaluating diseases that affect cardiac chambers differently.

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