Background Left ventricular global longitudinal strain (LVGLS) is an important parameter to evaluate left ventricular (LV) systolic function, which is more sensitive and reproducible than left ventricular ejection fraction (LVEF). However, whether LVGLS can be accurately measured with ultrasound enhancing agent (UEA) remains controversial. The aim of this study was to verify the feasibility and reproducibility of LVGLS in different contrast-enhanced echocardiography (CE) modes. Methods Two-dimensional speckle tracking echocardiography (2D-STE) was used to measure LVGLS on 75 patients included in this study. Patients were divided into optimal group (n = 33) and suboptimal group (n = 42) according to image quality. LVGLS measurements were performed in 2D mode, left ventricular opacification (LVO) mode, and myocardial contrast echocardiography (MCE) mode. 2D mode LVGLS measurements of the optimal group were used as a reference standard. The comparisons among different modes of each group included Bland-Altman analysis, linear regression and intra-class correlation (ICC). 20 patients were randomly selected from each group to analyze the inter- and intra-observer variability. Results The LVO and MCE modes of optimal group had similar LVGLS measurements with 2D mode (-14.30 ± 4.73%2D vs. -15.32 ± 4.78%LVO vs. -15.36 ± 5.41%MCE, ICC: 0.8142D−LVO vs. 0.7812D−MCE, P < 0.001). There was good agreement between LVO and MCE mode in two groups (ICC: 0.855optimal vs. 0.935suboptimal, P < 0.001). In suboptimal group, both LVO and MCE mode had poor agreement with 2D mode in terms of LVGLS measurements (-13.86 ± 5.46%2D vs. -15.39 ± 7.74%LVO vs. -15.66 ± 7.78%MCE, ICC: 0.7392D−LVO vs. 0.6872D−MCE, P < 0.001). CE improved inter-observer variability in suboptimal group (ICC: 0.6302D vs. 0.864LVO vs. 0.830MCE, P = 0.022, P < 0.001, P = 0.001, respectively). Conclusions It is feasible to measure LVGLS in different CE modes, even in patients with suboptimal acoustic windows, which can reduce the impact of image quality on LVGLS measurements.

Measuring left ventricular global longitudinal strain in different contrast-enhanced echocardiography modes: a feasibility study

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2026年7月1日

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Jiali Zhu,
Yajing Miao,
Hong Zhou,
Gaojie Han,
Jing Wang,
Qiaoli Tong,
Xuqian Zhang,
Xiaoxu Wang,
Hongning Yin

摘要

Background

Left ventricular global longitudinal strain (LVGLS) is an important parameter to evaluate left ventricular (LV) systolic function, which is more sensitive and reproducible than left ventricular ejection fraction (LVEF). However, whether LVGLS can be accurately measured with ultrasound enhancing agent (UEA) remains controversial. The aim of this study was to verify the feasibility and reproducibility of LVGLS in different contrast-enhanced echocardiography (CE) modes.

Methods

Two-dimensional speckle tracking echocardiography (2D-STE) was used to measure LVGLS on 75 patients included in this study. Patients were divided into optimal group (n = 33) and suboptimal group (n = 42) according to image quality. LVGLS measurements were performed in 2D mode, left ventricular opacification (LVO) mode, and myocardial contrast echocardiography (MCE) mode. 2D mode LVGLS measurements of the optimal group were used as a reference standard. The comparisons among different modes of each group included Bland-Altman analysis, linear regression and intra-class correlation (ICC). 20 patients were randomly selected from each group to analyze the inter- and intra-observer variability.

Results

The LVO and MCE modes of optimal group had similar LVGLS measurements with 2D mode (-14.30 ± 4.73%_2D vs. -15.32 ± 4.78%_LVO vs. -15.36 ± 5.41%_MCE, ICC: 0.814_2D−LVO vs. 0.781_2D−MCE, P < 0.001). There was good agreement between LVO and MCE mode in two groups (ICC: 0.855_optimal vs. 0.935_suboptimal, P < 0.001). In suboptimal group, both LVO and MCE mode had poor agreement with 2D mode in terms of LVGLS measurements (-13.86 ± 5.46%_2D vs. -15.39 ± 7.74%_LVO vs. -15.66 ± 7.78%_MCE, ICC: 0.739_2D−LVO vs. 0.687_2D−MCE, P < 0.001). CE improved inter-observer variability in suboptimal group (ICC: 0.630_2D vs. 0.864_LVO vs. 0.830_MCE, P = 0.022, P < 0.001, P = 0.001, respectively).

Conclusions

It is feasible to measure LVGLS in different CE modes, even in patients with suboptimal acoustic windows, which can reduce the impact of image quality on LVGLS measurements.