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01.12.2009 | Research | Ausgabe 1/2009 Open Access

Cardiovascular Ultrasound 1/2009

A new 2D-based method for myocardial velocity strain and strain rate quantification in a normal adult and paediatric population: assessment of reference values

Cardiovascular Ultrasound > Ausgabe 1/2009
C Bussadori, A Moreo, M Di Donato, B De Chiara, D Negura, E Dall'Aglio, E Lobiati, M Chessa, C Arcidiacono, JS Dua, F Mauri, M Carminati
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7120-7-8) contains supplementary material, which is available to authorized users.

Competing interests

CB acted as consultant to ESAOTE in the development of the clinical software.

Authors' contributions

CB: Conceptualized and designed the study, executed all the echocardiographic exams, analyzed and interpreted the data, overviewed at the file processing and wrote the manuscript. AM: Reviewed the manuscript and made substantial contribution to the conception and design of the study. MDD: Reviewed the manuscript, made substantial contribution of data interpretation, contributed to the statistical analysis. BdeC: Contributed to drafting of the manuscript and statistical analysis. DN: Examined clinically all the subjects and participated in the post processing of echocardiographic files. EDA: Participated in the post processing of echocardiographic files and overviewed all data processing and collection. EL: Reviewed the manuscript for relevant intellectual content. MCH: Made substantial contribution to study conception and design. JSD: Reviewed the manuscript for relevant intellectual content. CA: Participated in the post processing of echocardiographic files and overviewed all data processing and collection. FM: Made substantial contribution to study conception and design. MC: Made substantial contribution to study conception and design.



Recent advances in technology have provided the opportunity for off-line analysis of digital video-clips of two-dimensional (2-D) echocardiographic images.
Commercially available software that follows the motion of cardiac structures during cardiac cycle computes both regional and global velocity, strain, and strain rate (SR).
The present study aims to evaluate the clinical applicability of the software based on the tracking algorithm feature (studied for cardiology purposes) and to derive the reference values for longitudinal and circumferential strain and SR of the left ventricle in a normal population of children and young adults.


45 healthy volunteers (30 adults: 19 male, 11 female, mean age 37 ± 6 years; 15 children: 8 male, 7 female, mean age 8 ± 2 years) underwent transthoracic echocardiographic examination; 2D cine-loops recordings of apical 4-four 4-chamber (4C) and 2-chamber (2C) views and short axis views were stored for off-line analysis.
Computer analyses were performed using specific software relying on the algorithm of optical flow analysis, specifically designed to track the endocardial border, installed on a Windows™ based computer workstation. Inter and intra-observer variability was assessed.


The feasibility of measurements obtained with tissue tracking system was higher in apical view (100% for systolic events; 64% for diastolic events) than in short axis view (70% for systolic events; 52% for diastolic events). Longitudinal systolic velocity decreased from base to apex in all subjects (5.22 ± 1.01 vs. 1.20 ± 0.88; p < 0.0001). Longitudinal strain and SR significantly increased from base to apex in all subjects (-12.95 ± 6.79 vs. -14.87 ± 6.78; p = 0.002; -0.72 ± 0.39 vs. -0.94 ± 0.48, p = 0.0001, respectively). Similarly, circumferential strain and SR increased from base to apex (-21.32 ± 5.15 vs. -27.02 ± 5.88, p = 0.002; -1.51 ± 0.37 vs. -1.95 ± 0.57, p = 0.003, respectively).
Values of global systolic SR, both longitudinal and circumferential, were significantly higher in children than in adults (-1.3 ± 0.2, vs. -1.11 ± 0.2, p = 0.006; -1.9 ± 0.6 vs. -1.6 ± 0.5, p = 0.0265, respectively). No significant differences in longitudinal and circumferential systolic velocities were identified for any segment when comparing adults with children.


This 2D based tissue tracking system used for computation is reliable and applicable in adults and children particularly for systolic events. Measured with this technology, we have established reference values for myocardial velocity, Strain and SR for both young adults and children.
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