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. 2023 Dec;16(12):1516-1531.
doi: 10.1016/j.jcmg.2023.08.011. Epub 2023 Nov 1.

Echocardiographic Reference Ranges of Global Longitudinal Strain for All Cardiac Chambers Using Guideline-Directed Dedicated Views

John Nyberg  1 , Even Olav Jakobsen  2 , Andreas Østvik  3 , Espen Holte  2 , Stian Stølen  4 , Lasse Lovstakken  1 , Bjørnar Grenne  2 , Havard Dalen  5
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Free article

Echocardiographic Reference Ranges of Global Longitudinal Strain for All Cardiac Chambers Using Guideline-Directed Dedicated Views

John Nyberg et al. JACC Cardiovasc Imaging. 2023 Dec.
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] JACC Cardiovasc Imaging. 2024 Feb;17(2):232. doi: 10.1016/j.jcmg.2023.12.003. JACC Cardiovasc Imaging. 2024. PMID: 38325964 No abstract available.

Abstract

Background: Myocardial deformation by echocardiographic strain imaging is a key measurement in cardiology, providing valuable diagnostic and prognostic information. Reference ranges for strain should be established from large healthy populations with minimal methodologic biases and variability.

Objectives: The aim of this study was to establish echocardiographic reference ranges, including lower normal limits of global strains for all 4 cardiac chambers, by guideline-directed dedicated views from a large healthy population and to evaluate the influence of subject-specific characteristics on strain.

Methods: In total, 1,329 healthy participants from HUNT4Echo, the echocardiographic substudy of the 4th wave of the Trøndelag Health Study, were included. Echocardiographic recordings specific for each chamber were optimized according to current recommendations. Two experienced sonographers recorded all echocardiograms using GE HealthCare Vivid E95 scanners. Analyses were performed by experts using GE HealthCare EchoPAC.

Results: The reference ranges for left ventricular (LV) global longitudinal strain and right ventricular free-wall strain were -24% to -16% and -35% to -17%, respectively. Correspondingly, left atrial (LA) and right atrial (RA) reservoir strains were 17% to 49% and 17% to 59%. All strains showed lower absolute values with higher age, except for LA and RA contractile strains, which were higher. The feasibility for strain was overall good (LV 96%, right ventricular 83%, LA 94%, and RA 87%). All chamber-specific strains were associated with age, and LV strain was associated with sex.

Conclusions: Reference ranges of strain for all cardiac chambers were established based on guideline-directed chamber-specific recordings. Age and sex were the most important factors influencing reference ranges and should be considered when using strain echocardiography.

Keywords: GLS; left atrium; left ventricle; right atrium; right ventricle.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the Centre for Innovative Ultrasound Solutions, The Central Norway regional health authority, the ProCardio Center for Innovation, St. Olavs University Hospital, Nord-Trøndelag Hospital Trust, grants from the Simon Fougner Hartmann Family Fund, Denmark, and the Norwegian University of Science and Technology. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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