What is Left Ventricular Strain in Healthy Neonates? A Systematic Review and Meta-analysis

  • Umael KhanEmail author
  • Tom R. Omdal
  • Knut Matre
  • Gottfried Greve
Review Article


Reference values for left ventricular systolic strain in healthy neonates are necessary for clinical application of strain. The objectives of this systematic review were to identify echocardiographic studies that presented left ventricular strain values in healthy neonates, perform a meta-analysis for speckle tracking-derived global longitudinal strain, and identify areas that require further investigation. A structured search was applied to MEDLINE, Embase, and Cochrane Central Register of Clinical Trials in search of echocardiographic studies that presented left ventricular strain in healthy neonates. 244 studies were identified, of which 16 studies including speckle tracking and tissue Doppler strain in the longitudinal, radial, and circumferential directions passed the screening process. Out of these 16 studies, a meta-analysis was performed on the 10 studies that reported speckle tracking global longitudinal strain. Mean speckle tracking-derived global longitudinal strain was 21.0% (95% Confidence Interval 19.6–22.5%, strain given as positive values). When the studies were divided into subgroups, mean speckle tracking global longitudinal strain from the four-chamber view was 19.5% (95% Confidence Interval 18.0–21.0%) and that derived from all three apical views was 22.5% (95% CI 20.6–24.7%), indicating that global longitudinal strain from the four-chamber view is slightly lower than global longitudinal strain from all three apical views. Neonatal strain values were close to strain values in older subjects found in previous meta-analyses. Further studies are recommended that examine strain rate, segmental strain values, strain derived from short axis views, and strain in the first few hours after birth.


Meta-analysis Myocardial strain Speckle tracking echocardiography Tissue Doppler imaging Neonate 



We would like to thank Regina Küfner Lein, Librarian at the University Library of Bergen, for her invaluable contribution in identifying the appropriate databases and developing a search strategy.

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

246_2019_2219_MOESM1_ESM.pdf (42 kb)
Supplementary material 1 (PDF 43 kb)
246_2019_2219_MOESM2_ESM.pdf (65 kb)
Supplementary material 2 (PDF 66 kb)
246_2019_2219_MOESM3_ESM.pdf (53 kb)
Supplementary material 3 (PDF 53 kb)


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical ScienceUniversity of BergenBergenNorway
  2. 2.Department of Heart DiseaseHaukeland University HospitalBergenNorway
  3. 3.WestPaedResearch, Department of Clinical ScienceUniversity of BergenBergenNorway

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