Relation of Global Longitudinal Strain with Tissue Doppler Mitral Annular Velocities and Left Ventricular Length

Abstract

Longitudinal left ventricular (LV) systolic function is impaired in heart failure with preserved ejection fraction (EF), with reductions reported in both global longitudinal strain (GLS) and the peak systolic velocity of mitral annular motion (s‘) using tissue Doppler imaging (TDI). However, the significance of GLS versus s’ is incompletely understood. To investigate whether LV end-diastolic length (LVEDL), mitral annular systolic excursion (MASE) and heart rate might moderate the relationship between GLS and s’ we studied subjects with a low peak early diastolic TDI velocity (e‘) but normal EF. GLS was measured using speckle tracking. TDI measurements were averages from the septal and lateral walls. There were 88 subjects of age 66±8 years, (31 males, 64 with hypertension and 54 with diabetes) with septal and lateral e’ < 6 cm/s. The body mass index (BMI) was 29.1±4.1 kg/m2, heart rate was 72±9/min, blood pressure was 137±17/80±10 mmHg, EF was 61±6%, GLS was -17.4±2.7%, septal and lateral s’ were 6.1±1.1 and 6.8±1.5 cm/s, respectively and septal and lateral e’ were 4.2±1.0 and 5.2±0.9 cm/s, respectively. On univariate analysis EF was correlated with GLS (r=-0.48) but not with s’, MASE or e’ (p>0.05 for all). However, both s’ and MASE became positive correlates of EF in combination with LVEDL, which was a significant inverse correlate of EF (p<0.05 for all). s’ was modestly correlated with MASE (r2 = 0.37), but the prediction of s’ was improved in a multivariate model with the addition of heart rate to MASE (r2 =0.52). e’ was correlated with s’ (r2=0.09), but was more closely correlated with MASE (r2=0.18). On multivariate analysis, GLS was inversely correlated with MASE and positively correlated with LVEDL and BMI (r2=0.38, p<0.01 for all). In conclusion, in subjects with low e‘, GLS is more closely related to MASE than to s’ and is independently related to MASE, LVEDL and BMI.