Diastolic wall strain: A simple marker of abnormal cardiac mechanics

Senthil Selvaraj, Frank G. Aguilar, Eva E. Martinez, Lauren Beussink, Kwang Youn A. Kim, Jie Peng, Daniel C. Lee, Ateet Patel, Jin Sha, Marguerite R. Irvin, Donna K. Arnett, Sanjiv J. Shah

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: Diastolic wall strain (DWS), defined using posterior wall thickness (PWT) measurements from standard echocardiographic images (DWS = [PWT(systole)-PWT(diastole)]/PWT(systole)), has been proposed as a marker of left ventricular (LV) diastolic stiffness. However, the equation for DWS is closely related to systolic radial strain, and whether DWS is associated with abnormal cardiac mechanics (reduced systolic strains and diastolic tissue velocities) is unknown. We sought to determine the relationship between DWS and systolic and diastolic cardiac mechanics.

Methods. We calculated DWS and performed speckle-tracking analysis in a large population- and family-based study (Hypertension Genetic Epidemiology Network [HyperGEN]; N = 1907 after excluding patients with ejection fraction [EF] < 50% or posterior wall motion abnormalities). We measured global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS, respectively) and early diastolic (e') tissue velocities, and we determined the independent association of DWS with cardiac mechanics using linear mixed effects models to account for relatedness among study participants. We also prospectively performed receiver-operating characteristic (ROC) analysis of DWS for the detection of abnormal cardiac mechanics in a separate, prospective validation study (N = 35).

Results: In HyperGEN (age 51 ± 14 years, 59% female, 45% African-American, 57% hypertensive), mean DWS was 0.38 ± 0.05. DWS decreased with increasing comorbidity burden (β-coefficient -0.013 [95% CI -0.015, -0.011]; P < 0.0001). DWS was independently associated with GLS, GCS, GRS, and e' velocity (adjusted P < 0.05) but not LV chamber compliance (EDV20, P = 0.97). On prospective speckle-tracking analysis, DWS correlated well with GLS, GCS, and GRS (R = 0.61, 0.57, and 0.73, respectively; P < 0.001 for all comparisons). C-statistics for DWS as a diagnostic test for abnormal GLS, GCS, and GRS were: 0.78, 0.79, and 0.84, respectively.

Conclusions: DWS, a simple parameter than can be calculated from routine 2D echocardiography, is closely associated with systolic strain parameters and early diastolic (e') tissue velocities but not LV chamber compliance.

Original languageEnglish
Article number40
JournalCardiovascular Ultrasound
Issue number1
StatePublished - Oct 3 2014

Bibliographical note

Funding Information:
The HyperGEN cardiac mechanics ancillary study was funded by the National Institutes of Health (R01 HL 107577 to S.J.S.). The HyperGEN parent study was funded by cooperative agreements (U10) with the National Heart, Lung, and Blood Institute: HL54471, HL54472, HL54473, HL54495, HL54496, HL54497, HL54509, HL54515.

Publisher Copyright:
© 2014 Selvaraj et al.; licensee BioMed Central Ltd.


  • Cardiac mechanics
  • Diastolic dysfunction
  • Echocardiography
  • Speckle-tracking
  • Strain
  • Systolic dysfunction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Diastolic wall strain: A simple marker of abnormal cardiac mechanics'. Together they form a unique fingerprint.

Cite this