Utility of Global Strain by Two-Dimensional and Three-Dimensional Speckle Tracking for Assessing Left Ventricular Diastolic Function: Comparison with Pressure Wire Analysis

Background and Objectives: We evaluated the utility of two-dimensional (2D) and three-dimensional (3D) left ventricular (LV) global myocardial deformity parameters for assessing LV diastolic function by comparing invasive measures of LV performance. Subjects and Methods: Echocardiography and LV pressure were assessed in 39 patients. Myocardial LV longitudinal, circumferential, and radial deformations, as well as area strain, were evaluated utilizing 2D and 3D speckle tracking software. The 2D early diastolic strain rate (2D-SRe) was measured from the 3 apical and 3 short axis views. The 3D diastolic index (3D-DI) was calculated by the % change of global strain during the first one-third of the diastolic period. LV end diastolic pressure (LVEDP) and the rate of LV pressure change (dP/dt) were collected using a pressure-conducted catheter and tau was calculated. Results: dP/dtmin were related to early mitral annular velocity (e'), $2D-SRe_{long}$, $2D-SRe_{radial}$, as well as $3D-DI_{long}$, and $3D-DI_{as}$. Additionally, LVEDP was associated with the ratio of mitral early diastolic velocity (E) to $2D-SRe_{long}$, 2D-SRecirc, $2D-SRe_{radial}$, $3D-DI_{long}$, $3D-DI_{circ}$, and $3D-DI_{as}$. $E/2DSR_{long}$, E/2D-SReradial, $E/3D-DI_{long}$, and $E/3D-DI_{as}$ were comparable with E/e' in predicting patients with elevated LVEDP. Among those patients with E/e' of 8 to 15, $E/3D-DI_{long}$ provided incremental value in identifying those with LVEDP ${\geq}15$mm Hg. Conclusion: $2D-SRe_{long}$, $2D-SRe_{radial}$, $3D-DI_{long}$, and $E/3D-DI_{as}$ were related to LV relaxation, and the ratios of E to those parameters were associated with LVEDP. In addition, among patients with indeterminate E/e', $E/3D-DI_{long}$ offered incremental value in predicting elevated LVEDP, suggesting it may provide supplementary information in the evaluation of LV diastolic function.