Feasibility of detecting early left ventricular systolic dysfunction using global area strain: a novel index derived from three-dimensional speckle-tracking echocardiography

Aims Area strain (AS), derived from three-dimensional speckle-tracking echocardiography (3D-STE), is a novel parameter integrating longitudinal and circumferential deformation. We sought to evaluate the ability of global AS to detect early left ventricular (LV) systolic dysfunction in patients with risk factors for heart failure (HF). Methods and results Standard echocardiography and 3D-STE were performed in 160 subjects with or without HF. Three-dimensional speckle-tracking echocardiography was measured with reliable tracking quality in 137 (86%) of the 160 subjects initially enrolled in this study: 30 healthy volunteers, 29, 37, 26, and 15 patients with Stage A, B, C, and D HF, respectively. Global strain values were automatically calculated by 3D wall motion tracking (3D-WMT) software. Although global longitudinal strain (LS), circumferential strain (CS), radial strain (RS), and LV ejection fraction (LVEF) showed the downward trend from normal controls to patients with Stage D HF, the difference did not reach statistical significance between normal controls and patients with Stage A HF. In contrast, we observed the progressive decrease in global AS from normal to Stage A HF to Stage D HF (P < 0.05). In addition, global AS showed an excellent correlation with LVEF, global LS and CS. The optimal cut-off value for global AS, to detect LV dysfunction (Simpson's rule-based LVEF <50%), was -29.23% at a sensitivity of 86.3% and at a specificity of 88.4%. Conclusion Global AS is a sensitive and reproducible parameter to detect early and subtle LV systolic dysfunction, showing greater feasibility than other conventional strain parameters.