Longitudinal Displacement for Left Ventricular Function Assessment

Abstract

Background: Quantitative evaluation of myocardial function traditionally relies on parameters such as ejection fraction and strain. Strain, reflecting the relative change in the length of a myocardial segment over the cardiac cycle, has been extensively studied in various cardiac pathologies over the past two decades. However, the absolute length change, or longitudinal displacement, of myocardial segments during the cardiac cycle has received limited attention. This study aims to evaluate longitudinal displacement in two separate groups: healthy athletes and patients with left ventricular dysfunction, providing new insights into myocardial function assessment.

Methods: Echocardiographic examinations were performed on 30 healthy football players and 30 patients with left ventricular dysfunction using speckle-tracking imaging analysis. Global and regional peak longitudinal displacement values were calculated and compared with corresponding global and regional peak longitudinal strain measurements. A manual alternative for calculating global longitudinal strain was also proposed.

Results: An inverse correlation was found between regional longitudinal displacement and regional longitudinal strain. Longitudinal displacement was maximal in the basal segments and lowest in the apex of the left ventricle, exhibiting a reversed basal-to-apical gradient (17.6 ± 3.5 mm vs. 11.5 ± 2.9 mm vs. 4.22 ± 1.7 mm in basal, mid, and apical segments, respectively; p < 0.000001). Maximal longitudinal displacement was observed in the inferior and posterior walls of the left ventricle. In the 30 patients with left ventricular dysfunction, global longitudinal displacement was significantly lower than in healthy individuals (4.4 ± 1.7 mm vs. 11.7 ± 1.5 mm, p < 0.000001). Global longitudinal displacement and global longitudinal strain showed a strong negative correlation (r = -0.72, p < 0.000001). Manually calculated global longitudinal strain demonstrated good agreement with speckle-tracking-based global longitudinal strain.

Conclusions: Peak longitudinal displacement can be used to evaluate both regional and global myocardial function, similarly to peak longitudinal strain. Unlike strain, longitudinal displacement exhibits a reversed basal-to-apical gradient, with the highest values at the base of the left ventricle and the lowest at the apex. Global and regional longitudinal displacement is significantly reduced in patients with left ventricular dysfunction. Global longitudinal strain can be manually calculated using displacement measurements. Further studies are needed to evaluate peak longitudinal displacement in various cardiac pathologies.

Keywords: left ventricular function; longitudinal displacement; longitudinal strain; speckle tracking imaging.

Figure 1

4-chamber apical view. Regional longitudinal strain and displacement of a normal subject. (A) Regional peak systolic longitudinal strain has a negative direction. (B) Regional peak systolic longitudinal displacement has a positive direction.

Figure 2

Measurements of left ventricular length for manual global longitudinal strain calculation. Panels (A–C) display the measurements of the left ventricular length obtained from the apical 4-chamber, 2-chamber, and 3-chamber views, respectively, at diastole. Panels (D–F) show the corresponding measurements from the same apical views at systole.

Figure 3

Visual plot of regional longitudinal displacement and strain over the left ventricle across the healthy study population [Group 1]. (A) Regional peak systolic longitudinal displacement over the left ventricle is highest in the basal segments and lowest in the apical segments. (B) Regional peak systolic longitudinal strain is lowest in the basal segments and highest in the apical segments.

Figure 4

Regional peak systolic strain and longitudinal displacement of the left ventricle in a healthy study population [Group 1]. AS—antero-septal wall, S—septum, I—inferior wall, P—posterior wall, L—lateral wall, and A—anterior wall. Longitudinal displacement is highest in the inferior and posterior wall and lowest in the anterior septum. Longitudinal strain is highest in the inferior wall.

Figure 5

A visual plot of the normal peak longitudinal displacement and strain of 27-year-old football player. (A) Peak longitudinal displacement is highest in the basal segments and lowest in the apex. (B) Peak longitudinal strain is lowest in the basal segment and highest in the apex.

Figure 6

Distribution of global longitudinal displacement and global longitudinal strain in patients with left ventricular dysfunction [Group 2] versus healthy individuals [Group 1]. GLD-P, blue—global longitudinal displacement in patient group; GLS-P, orange—global longitudinal strain in patient group; GLD-N, gray—global longitudinal displacement in normal group; and GLS-N, yellow—global longitudinal strain in normal group. Global longitudinal displacement and strain were significantly lower in the patient group compared to the normal healthy individuals (4.4 ± 1.7 mm vs. 11.7 ± 1.5 mm, p < 0.000001 and −8.2 ± 2.3% vs. −18.8 ± 1.6%, p < 0.000001, respectively).

Figure 7

A visual plot of peak longitudinal displacement and strain in a 48-year-old man with anterior myocardial infarction and an ejection fraction of 35%. (A) Peak longitudinal displacement is very low (around 0) in the apical region (red), consistent with extensive apical myocardial infarction and involvement of other myocardial walls. Higher displacement is observed in the infero-posterolateral segments (green and brown). The average global longitudinal displacement is 3.4 mm. (B) Peak longitudinal strain is also very low in the corresponding apical segments, with better strain observed in the postero-lateral wall. The global longitudinal strain is −8.1%.

Figure 8

Bland–Altman plot for manual vs. automated global longitudinal strain. The plot shows the agreement between manual and automated GLS measurements. Red line: mean difference (−0.18%), green line: upper limit of agreement (1.92%), and orange line: lower limit of agreement (−2.29%). The Bland–Altman plot illustrates good overall agreement between manual and automated GLS methods, with a small mean difference (−0.18%). Most differences fall within the limits of agreement, confirming acceptable variability.