Global longitudinal strain or left ventricular twist and torsion? Which correlates best with ejection fraction?

Marcio Silva Miguel Lima, Hector R. Villarraga, Maria Cristina Donadio Abduch, Marta Fernandes Lima, Cecilia Beatriz Bittencourt Viana Cruz, João Cesar Nunes Sbano, Mariana Callil Voos, Wilson Mathias Junior, Jeane Mike Tsutsui

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Estimative of left ventricular ejection fraction (LVEF) is a major indication for echocardiography. Speckle tracking echocardiography (STE) allows analysis of LV contraction mechanics which includes global longitudinal strain (GLS) and twist/torsion, both the most widely used. Direct comparison of correlations between these novel parameters and LVEF has never been done before. Objective: This study aims to check which one has the highest correlation with LVEF. Methods: Patients with normal LVEF (> 0,55) and systolic dysfunction (LVEF <0,55) were prospectively enrolled, and underwent echocardiogram with STE analysis. Correlation of variables was performed by linear regression analysis. In addition, correlation among levels of LV systolic impairment was also tested. Results: A total of 131 patients were included (mean age, 46 ± 14y; 43%, men). LVEF and GLS showed a strong correlation (r = 0.95; r2 = 0.89; p < 0.001), more evident in groups with LV systolic dysfunction than those with preserved LVEF. Good correlation was also found with global longitudinal strain rate (r = 0.85; r2 = 0.73; p < 0.001). Comparing to GLS, correlation of LVEF and torsional mechanics was weaker: twist (r = 0.78; r2 = 0.60; p < 0.001); torsion (r = 0.75; r2 = 0.56; p < 0.001). Conclusion: GLS of the left ventricle have highly strong positive correlation with the classical parameter of ejection fraction, especially in cases with LV systolic impairment. Longitudinal strain rate also demonstrated a good correlation. GLS increments analysis of LV systolic function. On the other hand, although being a cornerstone of LV mechanics, twist and torsion have a weaker correlation with LV ejection, comparing to GLS.

Original languageEnglish (US)
Pages (from-to)23-29
Number of pages7
JournalArquivos brasileiros de cardiologia
Issue number1
StatePublished - Jul 2017


  • Doppler
  • Echocardiography
  • Left
  • Mechanical
  • Strain
  • Stroke Volume
  • Torsion
  • Torsion Abnormality
  • Ventricular Dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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