Grading of LV systolic function by speckle tracking

Abstract Background Rheumatic heart disease remains a considerable cause of cardiovascular morbidity and mortality in developing countries and mitral stenosis is the most common valve affection of rheumatic heart disease worldwide.The left ventricular ejection fraction is the most widely used index of contractile function, but due to the visual component, assessment of endocardial excursion is subjective leading to inter-observer variability.Speckle-tracking echocardiography is an imaging technique developed as a method to objectively quantify myocardial function and analyzes cardiac motion and deformation by tracking naturally occurring speckle patterns in the myocardium. Objective To evaluate the effect of the severity of mitral stenosis on LV systolic function as assessed by speckle tracking. Patients and Methods This study was a case-control study involving 80 individuals which included 60 patients having mitral stenosis who presented to the outpatient clinics of Ain Shams University Hospitals and 20 healthy volunteers, The patients suffering from mitral stenosis were subdivided into 3 sub-groups: GROUP(1) 20 Patients having severe mitral stenosis (MV Area less than 1 cm²) GROUP (2) 20 Patients having moderate mitral stenosis (MV Area more than 1 cm² and less than 1.5 cm²) GROUP(3) 20 Patients having mild mitral stenosis (MV Area more than 1.5 cm²) A Control group involved 20 healthy volunteers recruited from health care workers in Ain Shams University hospitals. Results Study included 60 patients,16 males (26.7%) and 44 females (73.3%), with mean age of 41.30 ± 8.64 years. Patients living in rural Areas were 34 (57.7%) while those in urban areas were 26 (43.3%).Which was significant.There was no significant difference between gender or habitat and the severity of mitral Stenosis.There was a strong significance between the duration of the disease and its severity. The more the duration of mitral Stenosis, the more severe the mitral stenosis.A strong positive relation was noticed between the severity of mitral stenosis and both RVSP and LA diameter, while a strong negative relation between severity of mitral stenosis and GLPS. GLPS was affected in severe mitral stenosis only. Conclusion Subtle LV systolic dysfunction is present in large number of patients with severe mitral stenosis even in patients with normal ejection fraction by conventional 2D echocardiography.There was a significant relationship between the duration of mitral stenosis and its severity. The longer the duration of mitral stenosis, the more severe the mitral stenosis.Speckle tracking echocardiography (STE) can play a great role in identification of higher risk subgroups in whom earlier and more aggressive intervention could have a significant impact on their prognosis.

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New Echocardiographic Findings Correlate with Intramyocardial Inflammation in Endomyocardial Biopsies of Patients with Acute Myocarditis and Inflammatory Cardiomyopathy

Mediators of Inflammation ◽

10.1155/2013/875420 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 33

Author(s):

Felicitas Escher ◽

Mario Kasner ◽

Uwe Kühl ◽

Johannes Heymer ◽

Ursula Wilkenshoff ◽

...

Keyword(s):

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Acute Myocarditis ◽

Left Ventricular ◽

Inflammatory Cardiomyopathy ◽

Lv Systolic Function ◽

Lymphocytic Infiltrates ◽

Fractional Shortening

Background. The diagnosis of acute myocarditis (AMC) and inflammatory cardiomyopathy (DCMi) can be difficult. Speckle tracking echocardiography with accurate assessments of regional contractility could have an outstanding importance for the diagnosis.Methods and Results.N=25patients with clinically diagnosed AMC who underwent endomyocardial biopsies (EMBs) were studied prospectively. Speckle tracking imaging was examined at the beginning and during a mean follow-up period of 6.2 months. In the acute phase patients had markedly decreased left ventricular (LV) systolic function (mean LV ejection fraction (LVEF)40.4±10.3%). At follow-up inn=8patients, inflammation persists, correlating with a significantly reduced fractional shortening (FS,21.5±6.0%) in contrast to those without inflammation in EMB (FS32.1±7.1%,P<0.05). All AMC patients showed a reduction in global systolic longitudinal strain (LS,−8.36±−3.47%) and strain rate (LSR,0.53±0.29 1/s). At follow-up, LS and LRS were significantly lower in patients with inflammation, in contrast to patients without inflammation (−9.4±1.4versus−16.8±2.0%,P<0.0001;0.78±0.4versus1.3±0.3 1/s). LSR and LS correlate significantly with lymphocytic infiltrates (for CD3r=0.7,P<0.0001, and LFA-1r=0.8,P<0.0001).Conclusion. Speckle tracking echocardiography is a useful adjunctive assisting tool for evaluation over the course of intramyocardial inflammation in patients with AMC and DCMi.

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P1381 The utility of left ventricle deformation in patients with myocarditis with midle-range and preserved ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.814 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

G Krljanac ◽

I Veljic ◽

A Ristic ◽

R Maksimovic ◽

I Milinkovic ◽

...

Keyword(s):

Heart Failure ◽

Speckle Tracking ◽

Systolic Function ◽

Acute Myocarditis ◽

Deformation Analysis ◽

Mechanical Dispersion ◽

Middle Range ◽

Myocardial Deformation Imaging ◽

Lv Systolic Function ◽

Insight Into

Abstract Background Predicting malignant ventricular arrhythmias and heart failure in patients (pts) with acute myocarditis and middle-range and preserved EF is challenge Aim: to define whether quantification of myocardial mechanics in early, acute phase of myocarditis offers more information to predict six months outcome of patients.Methods: In the 36 consecutive pts with myocarditis, middle age 32.86 ± 12.04yr, 75% males, echocardiography exam was done 1-3 day of diseases, including conventional parameters and comprehensive speckle tracking LV deformation analysis with longitudinal (L), circumferential (C) strain (S;%), strain rate (SR, 1/sec) and rotational LV mechanics. Results: The most patients were present as infarct-like myocarditis (80.56%), the others patients were present as heart failure-like (11.11%) and arrhythmia-like myocarditis (8.33%). At admission 27 (90%) pts had chest pain, 20 (66.7%) pts had ECG changes, 15 (50%) pts had symptoms of heart failure, 5 (16.7%) pts had arrhythmias. Amount of edema and fibrosis assessed by cardiovascular magnetic resonance (CMR) and echo correlate significantly. Classical and conventional parameters of LV systolic function, and deformation were not significantly different between groups. However, mechanical dispersion index (IMD) of global LS and systolic S were significantly different between groups (p < 0.05). Conclusion: Myocardial deformation imaging, like speckle tracking echocardiography, offers deeper insight into complex mechanical abnormalities during not only LV contraction but LV relaxation in longitudinal directions in patients with acute myocarditis. Infarct-like Arrhythmia-like Heart failure-like p EF (%) 57.5 ± 5.42 54.7 ± 12.9 58.3 ± 6.8 NS GLS endo (%) -20.8 ± 2.59 -19.78 ± 2.27 -17.36 ± 5.65 NS GLS (mid (%) -18.31 ± 2.4 -17.31 ± 1.52 -15.3 ± 5.10 NS GLS epi (%) -16.15 ± 2.28 -15.20 ± 0.92 -13.55 ± 4.68 NS IMD LS (ms) 37.04 ± 7.71 33.04 ± 6.58 60.75 ± 38.56 0.008 CS endo (%) -26.39 ± 6.93 -21.59 ± 3.88 -25.17 ± 6.48 NS CS mid (%) -17.32 ± 6.77 -13.03 ± 2.07 -15.95 ± 4.41 NS CS epi (%) -10.99 ± 6.89 -7.13 ± 0.72 -9.53 ± 2.73 NS IMD CS (ms) 47.69 ± 8.86 41.43 ± 23.92 41.01 ± 20.51 NS IMD SL peak S* 12.27 (21) 13.96 (4) 20.28 (84) 0.042 *Median and range values are presented.

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Abstract 2431: Global Strain with Speckle Tracking Method is Next Generation Index of Left Ventricular Systolic Function

Circulation ◽

10.1161/circ.118.suppl_18.s_725-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Hideaki Kanzaki ◽

Makoto Amaki ◽

Takuya Hasegawa ◽

Takahiro Ohara ◽

Kazuhiko Hashimura ◽

...

Keyword(s):

Speckle Tracking ◽

Systolic Function ◽

Myocardial Strain ◽

Left Ventricular ◽

Peak Strain ◽

Anterior Myocardial Infarction ◽

Endocardial Border ◽

Global Strain ◽

Lv Systolic Function ◽

Bull's Eye

Background. Myocardial strain is an index of regional function, whereas global left ventricular (LV) systolic function is generally assessed with ejection fraction (EF). Recent development of speckle tracking analysis software allows angle-independent and less time-consuming measurement of whole LV strain. Our objective was to assess whether the method is useful as another index of global LV systolic function. Methods. In 54 patients (LVEF 36±19%, 7–72%), digital gray-scales cine-loops were acquired from the apical 4-, 2-chamber, and long-axis views (GE Vivid7). After defining a region of interest (ROI) by tracing the LV endocardial border with several points at each view, a bull’s eye map was automatically constructed based on longitudinal strain and an averaged value of systolic peak strain was easily determined (EchoPAC Dimension AFI, GE). The strain value multiplied by −1 was used as global strain. Nineteen of the 54 patients underwent dobutamine stress and global strain value was calculated at baseline and during administration of 10 μg/kg/min. Results. Figure at left shows a bull’s eye strain map in a case of anterior myocardial infarction with regional dyskinetic wall motion. The blue area indicates the dyskinetic region. Despite of low dose, dobutamine increased global strain value (from 15.3 ± 5.3 to 17.1 ± 6.0, P <0.001) as well as LVEF. Figure at right shows global strain value was well correlated with LVEF ( r =0.917, P <0.001). Conclusion. Global strain is a new index which reflects the location, severity and extent of myocardial damage in addition to global LV systolic function.

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Evaluation of Left Ventricular Dysfunction in Patients with Isolated Mitral Valve Stenosis Using Speckle Tracking Echocardiography

European Heart Journal Supplements ◽

10.1093/eurheartj/suab069.007 ◽

2021 ◽

Vol 23 (Supplement_D) ◽

Author(s):

Mohamed ElGendi ◽

Mohamed Ayman ◽

Mohamed Sadaka ◽

Gehan Magdi

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Circumferential Strain ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Systolic Dysfunction ◽

Mean Value ◽

Left Ventricular ◽

2D Speckle Tracking ◽

Lv Systolic Function

Abstract Aim The aim was to evaluate left ventricular (LV) systolic function in patients with isolated mitral stenosis (MS) using 2D speckle tracking echocardiography. Methods 24 patients (39.50 ± 5.55 years, 17 females) with isolated MS (MVA: 1.35 ± 0.16 cm2) with preserved LV systolic function and sinus rhythm were compared to 12 matched healthy control subjects (36.42 ± 5.99 years, 8 females). Conventional echocardiography was performed to both groups. Longitudinal strain and Circumferential strain echocardiography were obtained. Peak systolic strain was measured from the mean strain proﬁle for a total of 17 segments of the LV for the longitudinal strain and 16 segments for the circumferential strain. Global longitudinal (G.L.) and circumferential strain (G.C.) were calculated separately as the average of the sum of the studied segments. Results The global longitudinal strain of the cases group ranged from -11 – -17% with a mean value of -14.67 ± -1.69% and that of the control group ranged from -15 – -20% with a mean value of -17.83 ± -1.53% with a statistically significant difference between the two groups. In our study, there was a negative but non-significant correlation between LV GLSS and LA diameter (r = -0.054, p = 0.802), Echo score (r = -0.018, p = 0.933) and PASP (r = 0.021, p = 0.922) in patients group. Also, the correlation was negative but non-significant between LV GCSS and LA diameter (r = -0.142, p = 0.507), Echo score (r = -0.200, p = 0.349) and PASP (r = -0.155, p = 0.471) in patients group. Conclusion • 2D speckle tracking echocardiography can detect subclinical LV systolic dysfunction which cannot be recognized by 2D conventional echocardiography. • Isolated rheumatic MS may be associated with subclinical LV systolic dysfunction.

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Prognostic Role of Left Ventricular Systolic Function Measured by Speckle Tracking Echocardiography in Septic Shock

BioMed Research International ◽

10.1155/2020/7927353 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Pham Dang Hai ◽

Nguyen Thanh Binh ◽

Nguyen Viet Quang Hien ◽

Nguyen Huy Hoang ◽

Vu Ngoc Hoan ◽

...

Keyword(s):

Septic Shock ◽

Mortality Rate ◽

Hospital Mortality ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Lv Systolic Function

Background. Left ventricular (LV) systolic dysfunction is common in septic shock. Global longitudinal strain (GLS) measured by speckle tracking echocardiography (STE) is a useful marker of intrinsic left ventricular systolic function. However, the association between left ventricular GLS and outcome in septic patients is not well understood. We performed this prospective study to investigate the prognostic value of LV systolic function utilizing speckle tracking echocardiography in patients with septic shock. Methods. All the patients with septic shock based on sepsis-3 definition admitted to the intensive care unit were prospectively studied with STE within 24 hours after the onset of septic shock. Baseline clinical and echocardiographic variables were collected. The primary outcome was in-hospital mortality. Results. During a 19-month period, 90 consecutive patients were enrolled in the study. The in-hospital mortality rate was 43.3%. Compared with survivors, nonsurvivors exhibited significantly less negative GLS ( − 13.1 ± 3.3 % versus − 15.8 ± 2.9 % ; p < 0.001 ), which reflected worse LV systolic function. The area under the ROC curves of GLS for the prediction of mortality was 0.76 (95% CI 0.67 to 0.87). Patients with GLS > − 14.1 % showed a significantly higher mortality rate (67.7% versus 15.6%; p < 0.0001 ; log ‐ rank = 23.3 ; p < 0.0001 ). In the multivariate analysis, GLS (HR, 1.27; 95% CI 1.07 to 1.50, p = 0.005 ) and SOFA scores (HR, 1.27; 95% CI 1.08 to 1.50, p = 0.004 ) were independent predictors of in-hospital mortality. Conclusions. Our study indicated that LV systolic function measured by STE might be associated with mortality in patients with septic shock.

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Speckle-tracking echocardiography in 3D mode in assessing the deformation of the myocardium and identifying subclinical cardiotoxicity during chemotherapy in breast cancer patients with arterial hypertension

Systemic Hypertension ◽

10.26442/2075082x.2020.3.200334 ◽

2020 ◽

Vol 17 (3) ◽

pp. 42-47

Author(s):

Ani A. Avalyan ◽

Marina A. Saidova ◽

Elena V. Oshchepkova ◽

Irina E. Chazova

Keyword(s):

Breast Cancer ◽

Arterial Hypertension ◽

Cancer Patients ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Three Dimensional ◽

Left Ventricular ◽

Breast Cancer Patients ◽

Lv Systolic Function

Aim.To study the possibilities of speckle-tracking echocardiography (STE) in 3D mode in assessing the strain of the myocardium and identifying subclinical cardiotoxicity during anthracycline-containing chemotherapy in breast cancer patients with arterial hypertension. Materials and methods.The study included 47 patients with triple negative breast cancer (BC) with AH and normotension. All patients underwent transthoracic echocardiography with an assessment of the left ventricular (LV) ejection fraction, also used STE in three-dimensional mode with an assessment of global longitudinal (GLS), circular (GCS), radial (GRS) strain and a new strain parameter strain area (GAS). Results.In patients with BC for a more accurate assessment of LV systolic function, it is advisable to use 3D echocardiography. In BC patients with AH, the initial parameters of LV strain were statistically significantly worse than in patients with normotension and further deterioration was observed after chemotherapy. To determine the sensitivity and specificity of the strain parameters from the 3D-STE data, an ROC analysis was performed. The most diagnostically significant parameter of strain, as a marker of cardiotoxicity, was the global area strain (GAS), which with a cut-off value -14.0% showed a sensitivity equal to 81.5% and a specificity of 73.3%, but the value this parameter of LV deformation requires further study. Conclusion.In BC patients with AH and normotension it is advisable to use the STE in 3D mode to analyze the strain and systolic function of the LV during antitumor treatment. The method is promising for identifying subclinical cardiotoxicity, but further research is needed to develop diagnostic criteria.

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Catecholamines Induce Left Ventricular Subclinical Systolic Dysfunction: A Speckle-Tracking Echocardiography Study

Cancers ◽

10.3390/cancers11030318 ◽

2019 ◽

Vol 11 (3) ◽

pp. 318 ◽

Cited By ~ 3

Author(s):

Jan Kvasnička ◽

Tomáš Zelinka ◽

Ondřej Petrák ◽

Ján Rosa ◽

Branislav Štrauch ◽

...

Keyword(s):

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Lv Function ◽

Echocardiographic Parameters ◽

Lv Systolic Function ◽

Lower Magnitude

Background: Pheochromocytomas (PHEO) are tumors arising from chromaffin cells from the adrenal medulla, having the ability to produce, metabolize and secrete catecholamines. The overproduction of catecholamines leads by many mechanisms to the impairment in the left ventricle (LV) function, however, endocardial measurement of systolic function did not find any differences between patients with PHEO and essential hypertension (EH). The aim of the study was to investigate whether global longitudinal strain (GLS) derived from speckle-tracking echocardiography can detect catecholamine-induced subclinical impairments in systolic function. Methods: We analyzed 17 patients (10 females and seven males) with PHEO and 18 patients (nine females and nine males) with EH. The groups did not differ in age or in 24-h blood pressure values. Results: The patients with PHEO did not differ in echocardiographic parameters including LV ejection fraction compared to the EH patients (0.69 ± 0.04 vs. 0.71 ± 0.05; NS), nevertheless, in spackle-tracking analysis, the patients with PHEO displayed significantly lower GLS than the EH patients (−14.8 ± 1.5 vs. −17.8 ± 1.7; p < 0.001). Conclusions: Patients with PHEO have a lower magnitude of GLS than the patients with EH, suggesting that catecholamines induce a subclinical decline in LV systolic function.

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Abstract 2490: Non-uniformity of Three-dimensional Left Ventricular Relaxation Abnormalities in Hypertensive Left Ventricular Hypertrophy by Speckle Tracking Global Strain Rate Imaging

Circulation ◽

10.1161/circ.116.suppl_16.ii_549 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Takeshi Takamura ◽

Kaoru Dohi ◽

Katsuya Onishi ◽

Naoki Fujimoto ◽

Tairo Kurita ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Strain Rate ◽

Speckle Tracking ◽

Ventricular Hypertrophy ◽

Systolic Function ◽

Left Ventricular ◽

Strain Rate Imaging ◽

Global Strain ◽

Lv Systolic Function ◽

Global Strain Rate

Background: We tested the hypothesis that global strain rate imaging can quantify and stratify the severity of left ventricular (LV) relaxation abnormality in patients with left ventricular hypertrophy (LVH) ranged from normal to reduced LV systolic function independently from longitudinal (L), circumferential (C), and radial axes (R). Methods: Fifty-seven patients with hypertensive LVH and thirty age matched controls (Control, EF 65 ± 5 %) had echo-study with speckle tracking strain and strain rate imaging from (L), (C), and (R). LVH were divided into two groups; normal EF (LVH-NEF) defined as EF ≥ 55% (n = 35, EF 64 = 5 %), and systolic dysfunction (LVH-SD) defined as EF < 55% (n = 22, EF 48 ± 8 %). Global peak systolic strain (PSS) and peak relaxation rate (PRR) were used as indices of global LV contraction and relaxation, respectively (Vivid 7 and EchoPAC, GE Electronic). Results: PSS was maintained in LVH-NEF but reduced in LVH-SD from all three perpendicular axes. PRR (L) was impaired in LVH-NEF and was further decreased in LVH-SD (0.95 ± 0.33* and 0.58 ± 0.24* † 1/s, *p <0.05 vs. Control and † p <0.05 vs. LVH-NEF, respectively)compared to Control (1.14 ± 0.30 1/s). PRR (C) was maintained in LVH-NEF but reduced in LVH-SD (1.24 ± 0.50 and 0.73 ± 0.36 1/s*, p <0.05 vs. Control) compared to Control (1.30 ± 0.48 1/s). PRR (R) was impaired in both LVH-NEF and LVH-SD in the same degrees (-1.53 ± 0.60* and -1.27 ± 0.64* 1/s, p <0.05 vs. Control: -2.08 ± 0.84 1/s). Conclusion: Speckle tracking strain rate imaging quantified and stratified the severity of LV relaxation abnormality in patients with LVH ranged from normal to reduced LV systolic function independently from all three perpendicular ventricular axes.

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Longitudinal strain measurement by 3D modelling from cine CMR: feasibility and comparison to 2D speckle tracking echocardiography

European Heart Journal ◽

10.1093/eurheartj/ehab724.0266 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D Zhao ◽

G M Quill ◽

K Gilbert ◽

V Y Wang ◽

T Sutton ◽

...

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Altman Analysis ◽

Strain Measurements ◽

2D Speckle Tracking ◽

Lv Systolic Function ◽

Longitudinal Strains ◽

Cine Cmr

Abstract Background Global longitudinal strain (GLS) has emerged as a sensitive index of left ventricular (LV) systolic function with greater prognostic value than LV ejection fraction (LVEF) in a variety of cardiac disorders. While GLS is routinely derived from 2D speckle tracking echocardiography (STE) and feature tracking in cardiac magnetic resonance (CMR) imaging, calculation of strain via 3D geometric modelling enables analyses of deformation that are independent of 2D image plane constraints. Purpose We sought to compare longitudinal strain measurements extracted from geometric 3D analysis of CMR against values obtained from conventional 2D-STE. Methods Consecutive 2D-echocardiography (2D-echo) and steady-state free precession multiplanar cine CMR scans were performed in 80 prospectively recruited participants (48 healthy controls with LVEF range 53–74%, 30 patients with non-ischaemic cardiac disease with LVEF range 25–77%, and 2 heart transplant recipients with LVEF 53% and 58%), <1 hour apart. Average endocardial peak GLS from 2D-STE was calculated offline using vendor-independent clinical software from apical triplane (2, 3 and 4-chamber) images for each of the standardised LV walls (anterior, anteroseptal, inferoseptal, inferior, inferolateral, anterolateral). Dynamic 3D geometric models of the LV were reconstructed from 3 long- and 6 short-axis CMR slices over one cardiac cycle. Corresponding longitudinal strain measurements were then evaluated by extracting analogous endocardial arc lengths (apex to base of each LV wall) from the 3D LV model. Finally, an average peak GLS was calculated as the mean of the peak longitudinal strains in each LV wall. Results GLS measured by 2D-STE ranged between −6.5% and −27.9% for the study population. A two-way mixed-effects intraclass correlation coefficient (ICC) for absolute agreement of 0.820 (95% CI: [0.720, 0.885]) demonstrated good correlation between average GLS obtained from 2D-STE and CMR. A Bland-Altman analysis revealed a minimal bias (<1%) and 95% limits of agreement (LOA) between −6.3% and 5.5% (Fig. 1), with no apparent proportional bias. Comparatively lower correlation and wider LOA between longitudinal strains from 2D-STE and CMR were observed for each LV wall (Table I). Conclusions Fully automated calculation of LV GLS can be obtained from geometric 3D CMR analysis. Average peak GLS from cine CMR exhibits good agreement with 2D-STE, despite showing only moderate agreement at each LV wall. The increased discrepancy in regional longitudinal strain may be attributed to subjective plane positioning in 2D-echo, which can be expected to improve with advances in 3D-STE. The calculation of GLS by 3D geometric modelling may enhance the diagnostic value of routine cine CMR examinations for LV systolic function assessment. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council (HRC) of New Zealand and National Heart Foundation (NHF) of New Zealand Figure 1. Bland-Altman analysis Table I. Regional correlations

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