Comparison of Left Ventricular Global Longitudinal Strain Measured with Real Time Triplane and 2-Dimensional Echocardiography in Patients with Atrial Fibrillation

Background: Left ventricular (LV) global longitudinal peak systolic strain (GLPS, also known as GLS) based on speckle tracking echocardiography (STE) is validated to evaluate global LV systolic function, particularly the global average GLPS (GLPS Avg , which is averaged from three apical longitudinal views). But its application is limited in patients with atrial fibrillation (AF) due to its variability of cycle lengths. A novel imaging technique, real time triplane echocardiography (3PE), allows simultaneous presentation of apical 4-, 2-, and 3- chamber views within one ultrasonic view. We compared GLPS measures using 3PE and conventional 2-dimensional echocardiography (2DE) in patients with AF. Methods: Patients with AF and a control group with sinus rhythm were enrolled prospectively. Three apical sectional GLPSs and GLPS Avg were measured with conventional 2D (2D-STE) and 3PE (3P-STE) modes. Comparison, correlation and agreement of measurements with both modes were made. Ten patients were selected randomly for reproducibility study. Results: (1) A total of 39 patients with AF and 38 control subjects were analyzed. Adequate apical 3PE views were acquired in most subjects (95%). Measurement of GLPSs with 3P-STE was more readily available than with 2D-STE in AF group (97.5% vs. 60.0%, P =000). (2) The GLPS s measured with 3P-STE was constantly lower than that of 2D-STE, but linearly correlated, with GLPS Avg revealing the best correlation ( r =0.86, P =0.00 in both groups). (3) The reproducibility of GLPS measured by 3P-STE was valid. Conclusions: Triplane echocardiography may extend the use of LV GLPS Avg to patients with AF for assessment of LV systolic function.