Normal Values for Left Ventricular Strain
The normal value for left ventricular global longitudinal strain (LV GLS) ranges from -16% to -22%, with a mean of -20%. 1
Understanding LV Strain Measurement
Left ventricular strain is a measure of myocardial deformation that provides valuable information about cardiac function beyond traditional parameters like ejection fraction. It is measured using speckle tracking echocardiography (STE), which tracks the movement of natural acoustic markers in the myocardium throughout the cardiac cycle.
Key Normal Values:
- LV global longitudinal strain (GLS): -16% to -22%, mean -20% 1
- Abnormal LV GLS is considered to be ≥-16% (less negative) 2
- Borderline LV GLS: -16% to -18% 2
- Normal LV GLS: -18% and lower (more negative) 2
Clinical Significance
LV strain measurements are particularly valuable in:
- Subclinical LV dysfunction detection: GLS can identify myocardial dysfunction before changes in ejection fraction become apparent
- Heart failure with preserved ejection fraction (HFpEF): Impaired LV GLS is common in HFpEF patients despite normal ejection fraction 3
- Monitoring cardiotoxicity: Sequential follow-up of patients receiving cardiotoxic medications
- Valvular heart disease: Assessing myocardial function in conditions like aortic stenosis and mitral regurgitation
Important Considerations
Vendor Variability
While global strain measurements have become more standardized across vendors, some variability still exists. The European Association of Cardiovascular Imaging (EACVI) recommends reporting:
- The type of echo machine (vendor and model) used for measurement 1
- Normal reference values to differentiate normal from pathological conditions 1
Age and Gender Considerations
- LV strain values may be slightly higher (more negative) in women than men 1
- Strain values tend to decrease with age 1
Measurement Technique
For accurate LV strain measurement:
- Proper image quality is essential
- The region of interest should be limited to the myocardium, excluding the pericardium 1
- Measurements should be taken in the LV-focused views
Clinical Applications
In clinical practice, LV GLS should be considered when:
- Assessing subclinical LV dysfunction
- Evaluating patients with preserved ejection fraction but symptoms of heart failure
- Monitoring patients receiving cardiotoxic therapies
- Risk stratification in various cardiac conditions
LV GLS provides incremental prognostic information beyond traditional echocardiographic parameters and should be considered as part of a comprehensive cardiac assessment when available.