Left ventricular global longitudinal strain calculated from manually traced endocardial border lengths utilizing the images for routine ejection fraction measurement by biplane method of disks

  • Kazunori OkadaEmail author
  • Sanae Kaga
  • Minami Araki
  • Kosuke Tsujita
  • Ayaka Yoshikawa
  • Mizuki Hara
  • Yoichi Sakamoto
  • Nobuo Masauzi
  • Taisei Mikami
Original Article—Cardiology



The purpose of this study was to test whether the fractional change in the endocardial border length between end-diastole and end-systole as manually traced in left ventricular ejection fraction (LVEF) measurement using the biplane method of disks (MOD) was consistent with the global longitudinal strain derived from speckle-tracking echocardiography.


For 105 patients who underwent echocardiography, two- and four-chamber images with manually traced endocardial lines for LVEF measurement by MOD were stored. LV endocardial lengths at end-diastole and at end-systole were measured on both images to calculate the fractional length changes, which were averaged (GLSMOD). Speckle-tracking analysis was performed to measure global longitudinal strains in the apical two- and four-chamber and long-axis images, and the three values were averaged (GLSSTE) according to the ASE and EACVI guidelines.


There was no significant difference between GLSMOD and GLSSTE. GLSMOD correlated well with GLSSTE (r = 0.81, p < 0.001), and there was no fixed bias in the Bland–Altman analysis. The intraclass correlations for the intra- and inter-observer comparisons for GLSSTE were excellent, and those for GLSMOD were adequate.


The fractional LV endocardial border length change, GLSMOD, showed sufficient agreement with GLSSTE to justify its use as a substitute for the STE-derived global longitudinal strain.


Global longitudinal strain Speckle-tracking echocardiography Biplane method of disks Ejection fraction Left ventricular systolic function 


Compliance with ethical standards

Conflict of interest

This study was financially supported by a grant-in-aid for scientific research from the Japanese Society of Sonographers (No. 2017-1). The authors declare no other conflicts of interest.

Ethical approval

This study was approved as a retrospective observational study by the Research Ethics Committee of the Faculty of Health Sciences at Hokkaido University. Instead of obtaining informed consent, the objectives and methods of the present study were shared with the public through our institution’s website and a physical bulletin board; patients who did not wish to participate could request their data to be deleted from the study.


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Copyright information

© The Japan Society of Ultrasonics in Medicine 2019

Authors and Affiliations

  1. 1.Faculty of Health SciencesHokkaido UniversitySapporoJapan
  2. 2.Department of Health Sciences, School of MedicineHokkaido UniversitySapporoJapan
  3. 3.Kitanodai ClinicMedical Corporation Hokuseki GroupKitahiroshimaJapan

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