title: Normal reference values of left ventricular strain using three-dimensional speckle tracking echocardiography: results from a multicentre study.
abstract: OBJECTIVE
  Three-dimensional (3D) speckle tracking echocardiography (3DSTE) has been shown to be an accurate and reliable clinical tool for the evaluation of global and regional left ventricular (LV) function through strain analysis, but the absence of normal values has precluded its widespread use in clinical practice. The aim of this prospective multicentre study was to establish normal reference values of LV strain parameters using 3DSTE in a large healthy population.
  
  
  RESULTS
  A total of 303 healthy subjects (156 males [51%], between 18 and 82 years of age, ejection fraction [EF] 61 ± 3%), stratified to provide approximately equal proportions of healthy subjects of 18-30, 31-40, 41-50, 51-60, and >60 years of age, underwent 3DSTE. Data were analysed for LV volumes, EF, mass, and global and regional circumferential, longitudinal, radial, and area strain. Significant but small differences between men and women were found for longitudinal and area strains, as well as between different age groups for all LV strain parameters. However, large differences in normal values were observed between different segments, walls, and levels of the LV for radial and longitudinal strains, whereas circumferential and area strains demonstrated generally consistent normal ranges across the LV.
  
  
  CONCLUSIONS
  Normal ranges of global and regional LV strain using 3DSTE have been established for clinical use. Differences in the magnitude of LV strain are present between men and women as well as different age groups. Moreover, there are differences between different segments, walls, and levels as part of the functional non-uniformity of the normal LV that necessitates the use of segment-specific normal ranges for radial and longitudinal strains. Circumferential and area strains demonstrate the most consistent normal ranges overall.
authors.affiliation: Department of Cardiology 5F 003, VU University Medical Center, 1117 De Boelelaan, 1081 HV Amsterdam, the Netherlands s.kleijn@vumc.nl.
authors.forename: Sebastiaan A
authors.initials: SA
authors.lastname: Kleijn
authors.affiliation: Tufts Medical Center, Boston, MA, USA.
authors.forename: Natesa G
authors.initials: NG
authors.lastname: Pandian
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.affiliation: Hospital Carlos III, Madrid, Spain.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Perez de Isla
authors.affiliation: Department of Cardiology 5F 003, VU University Medical Center, 1117 De Boelelaan, 1081 HV Amsterdam, the Netherlands.
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.affiliation: Luzerner Kantonsspital, Luzern, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Zuber
authors.affiliation: Hammersmith Hospital, London, UK.
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
authors.affiliation: University of Szeged, Szeged, Hungary.
authors.forename: Tamas
authors.initials: T
authors.lastname: Forster
authors.affiliation: Elisabethinen Hospital, Linz, Austria.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Nesser
authors.affiliation: University Hospital Freiburg, Freiburg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Geibel
authors.affiliation: Toshiba Medical Systems, Zoetermeer, the Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Gorissen
authors.affiliation: Hospital Ramón y Cajal University Alcala de Henares, Madrid, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D005062:European Union; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States; D016277:Ventricular Function, Left
keywords: Echocardiography; Left ventricular function; Speckle tracking; Three-dimensional imaging