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The aim of this study was to evaluate the effect of foreshortening (FS) on quantitative parameters of 2D Speckle tracking. Regional longitudinal peak systolic strain (PSS) was measured in standardized data sets of the apical 4 and 5 chamber view (ChV) in patients with normal and pathological wall motion patterns.Methods: A standardized 4ChV and a FS 4ChV – defined by the so-called 5ChV were acquired using a Vivid E9 system in 25 patients with normal wall motion pattern and 20 patients with lateral or septal myocardial infarction (MI). The degree of FS was measured by the diastolic diameter of mitral annulus (DDMVA) and the diastolic and systolic length of the left ventricle applying monoplane Simpson`s rule. All these views were repeated three times for offline analysis. All regional PSS values measured in monoplane 2D loops in the lateral and septal region of 4 and 5ChV were analysed to detect the difference between the standard and the FS view in the normal and pathological subgroups.Results: Significant differences were found by the analysis of dimensions of the left ventricle between the standard 4 and 5ChV for the systolic and diastolic length of the left ventricle and the DDMVA in both subgroups. No significant PSS differences due to FS, however, were detected in patients with normal wall motion patterns (p>0.05, Paired Sample T-test). In contrast, the PSS values of the patients with MI were significantly lower in the ischaemic area of the standardized 4ChV than in 5ChV (-2±3 vs. -12±5, p≪0.05) (see figure).Conclusion:FS has no significant impaction in normal contracting hearts. In pathological situations, however, significant differences of PSS values due to ventricular enlargement and measuring PSS in the penumbra of the infarction zone will be detected leading to unreliable results.