Relationship of Multidirectional Myocardial Strain with Radial Thickening and Ejection Fraction and Impact of Left Ventricular Hypertrophy: A Study in a Community‐Based Cohort

Background Left ventricular ( LV ) systolic strain provides additional prognostic value to LV ejection fraction ( LVEF ) and wall motion analysis. However, the relationship between myocardial multidirectional strain and LVEF , and the effect of LV hypertrophy on this relationship, are not completely understood especially in unselected populations. Methods LV global longitudinal (ε L ) and circumferential (ε C ) systolic strain analysis was performed by two‐dimensional speckle tracking echocardiography in 215 participants from a community‐based study. LV radial wall thickening was measured as global radial strain (ε R ), and LVEF was assessed by biplane Simpson's method. Results ε R was significantly associated with ε C (β = −0.56, P < 0.01) and with ε L (β = −0.18, P < 0.01). The contribution of ε L to ε R was especially evident in subjects with lower ε C and in presence of LV hypertrophy (β = −0.30, P < 0.01). ε L and ε C were significantly associated with LVEF (β = −0.36 and β = −0.49, both P < 0.01) independent of LV mass and other confounders, and their interaction significantly improved the prediction of LVEF (R 2 ‐change = 0.14) but not of ε R (R 2 ‐change = 0.002). Conclusions ε R is mainly related to ε C with a smaller contribution of ε L , which becomes especially evident in subjects with lower ε C and in presence of LV hypertrophy. Therefore, radial thickening may not detect subclinical LV longitudinal function reduction in normal ventricles and when ε C is preserved. While a reduction in ε L has a limited impact on ε R , it exerts a greater effect on global LVEF , therefore for a more accurate LVEF prediction both ε L and ε C need to be considered.