title: Circumferential and longitudinal strain in 3 myocardial layers in normal subjects and in patients with regional left ventricular dysfunction.
abstract: BACKGROUND
  The left ventricle is not homogenous and is composed of 3 myocardial layers. Until recently, magnetic resonance imaging has been the only noninvasive technique for detailed evaluation of the left ventricular (LV) wall. The aim of this study was to analyze strain in 3 myocardial layers using speckle-tracking echocardiography.
  
  
  METHODS
  Twenty normal subjects and 21 patients with LV dysfunction underwent echocardiography. Short-axis (for circumferential) and apical (for longitudinal strain) views were analyzed using modified speckle-tracking software enabling the analysis of strain in 3 myocardial layers.
  
  
  RESULTS
  In normal subjects, longitudinal and circumferential strain was highest in the endocardium and lowest in the epicardium. Longitudinal endocardial and mid layer strain was highest in the apex and lowest in the base. Epicardial longitudinal strain was homogenous over the left ventricle. Circumferential 3-layer strain was highest in the apex and lowest in the base. In patients with LV dysfunction, strain was lower, with late diastolic or double peak.
  
  
  CONCLUSIONS
  Three-layer analysis of circumferential and longitudinal strain using speckle-tracking imaging can be performed on a clinical basis and may become an important method for the assessment of real-time, quantitative global and regional LV function.
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel. marina.leitman@gmail.com
authors.forename: Marina
authors.initials: M
authors.lastname: Leitman
authors.forename: Michael
authors.initials: M
authors.lastname: Lysiansky
authors.forename: Peter
authors.initials: P
authors.lastname: Lysyansky
authors.forename: Zvi
authors.initials: Z
authors.lastname: Friedman
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tyomkin
authors.forename: Therese
authors.initials: T
authors.lastname: Fuchs
authors.forename: Dan
authors.initials: D
authors.lastname: Adam
authors.forename: Ricardo
authors.initials: R
authors.lastname: Krakover
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016880:Anisotropy; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult