Two-Dimensional Strain is more Precise than Conventional Measures of Left Ventricular Systolic Function in Pediatric Patients

  • Meghna D. PatelEmail author
  • Craig Myers
  • Kazuaki Negishi
  • Gautam K. Singh
  • Shafkat Anwar
Original Article


Ejection fraction (EF) and fractional shortening (FS) are standard methods of quantifying left ventricular (LV) systolic function. 2D global longitudinal strain (2D GLS) is a well-established, but underutilized method for LV function quantification. The aim of this study was to assess precision of GLS compared to EF & FS in pediatrics. Echocardiograms were prospectively analyzed by 2 blinded observers. FS, EF, and GLS were calculated following standard methods. Bland–Altman was applied to assess agreement. Intraclass correlation coefficient (ICC) was used to measure reliability. Coefficient of variation was used to demonstrate relative variability between methods. 103 pediatric echos were evaluated for inter-observer reproducibility, and 15 patients for intra-observer reproducibility. GLS had higher inter-observer agreement and reliability (bias 7%, 95% LOA − 3.4 to + 3.5, ICC 0.86 CI 0.80–0.90) compared to EF (bias 27%, 95% LOA − 18.9 to + 19.5; ICC 0.25 CI 0.07–0.43) and FS (bias 12%, 95% LOA − 11.9 to + 12.2; ICC 0.53 CI 0.38–0.66). GLS also had higher intra-observer agreement (bias 4%, 95% LOA − 3.6 to + 3.7; ICC 0.87 CI 0.66–0.96) compared to EF (bias 11%, 95% LOA − 14.9 to + 15.1; ICC 0.26 CI −  0.28–0.67) and FS (bias 12%, 95% LOA − 12.2 to + 12.5; ICC 0.38 CI − 0.15–0.74). GLS is a more precise method for quantifying LV function in pediatrics, with lower variability compared to EF and FS. GLS provides a more reliable evaluation of LV systolic function and should be utilized more widely in pediatrics.


Two-dimensional strain Echocardiography Left ventricular systolic function Cardiac deformation Pediatrics 



Global longitudinal Lagrangian strain


Intraclass correlation coefficient


Coefficient of variation


Two-dimensional speckle tracking echocardiography


Left ventricular





The authors wish to thank the sonographers and staff at the Heart Station, St. Louis Children’s Hospital for their contributions to echocardiographic acquisitions related to this study.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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


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Copyright information

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

Authors and Affiliations

  1. 1.Division of Cardiology, Department of PediatricsWashington University School of MedicineSt. LouisUSA
  2. 2.Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
  3. 3.Division of Pediatric Cardiology, Lucile Packard Children’s HospitalStanford UniversityPalo AltoUSA

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