The International Journal of Cardiovascular Imaging

, Volume 35, Issue 12, pp 2177–2188 | Cite as

Novel mesh-derived right ventricular free wall longitudinal strain analysis by intraoperative three-dimensional transoesophageal speckle-tracking echocardiography: a comparison with conventional parameters

  • Marius KellerEmail author
  • Tobias Lang
  • Andreas Schilling
  • Martina Nowak-Machen
  • Peter Rosenberger
  • Harry Magunia
Original Paper


Longitudinal right ventricular (RV) function is substantial and might be reflected by free wall longitudinal strain (FWLS). Software solutions for FWLS analysis by two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) are available, but data on validation are sparse. In this study, a novel method for FWLS analysis on 3D meshes (“mesh surface”, MS-FWLS,) was tested for feasibility and compared to available parameters. 80 patients undergoing left-sided cardiac valve surgery with intraoperative TEE were included retrospectively. 2D-FWLS, 3D-derived (3Dd)-FWLS (assessed in optimized four-chamber views after volume analysis) and MS-FWLS were measured and compared to conventional parameters (3Dd-TAPSE, FAC and RVEF). The mean FWLS values did not differ significantly between methods (− 19.0 ± 6.1%, − 20.0 ± 7.3%, − 19.5 ± 7.3% for 2D-, 3Dd- and MS-FWLS, respectively). No significant differences in the mean FWLS between patients with normal or increased pulmonary artery pressures as well as normal or reduced left ventricular ejection fraction were observed. Agreement was best between 3Dd- and MS-FWLS (r = 0.89, bias = − 1.0%, LOA ± 6.9%). Conventional echocardiographic parameters yielded poorer intermodality agreement. In patients with discrepant results between 2D- and 3Dd-FWLS, 3Dd-FWLS and MS-FWLS yielded similar results (r = 0.82, bias = − 0.3%, LOA ± 8.6%), while 2D-FWLS and MS-FWLS did not. Intra- and interobserver variabilities of strain analyses were low. MS-FWLS might represent a promising method to overcome artefacts associated with 2D analysis. Its prognostic relevance needs to be investigated in prospective studies.


Right ventricle Free wall strain Transesopheageal echocardiography Speckle-tracking Three-dimensional 



2D free wall longitudinal strain


3D-derived free wall longitudinal strain


3D-derived tricuspid annular plane systolic excursion


FOUR-chamber view






End-tidal carbon dioxide


Fractional area change


Fraction of inspired oxygen


End-diastolic right ventricular free wall thickness


Free wall longitudinal strain


Intraclass correlation coefficient


Left ventricle/left ventricular


Left ventricular ejection fraction


Mean arterial pressure


Millimetre of mercury


Mesh surface free wall longitudinal strain


Not (statistically) significant


New York Heart Association


Systolic pulmonary artery pressure


Region of interest


Right ventricle/right ventricular


Right ventricular end-diastolic volume


Right ventricular ejection fraction


Right ventricular end-systolic volume


Speckle-tracking echocardiography


Strengthening the Reporting of Observational Studies in Epidemiology


Tricuspid annular plane systolic excursion


Transoesophageal echocardiography


Transthoracic echocardiography



The authors thank all employees of the cardiothoracic and cardiac anaesthesia units at University Hospital Tuebingen for supporting image acquisition.


This work was supported by a grant from the Deutsche Forschungsgemeinschaft (DFG): Grant DFG-INST 2388/71-1 FUGG.

Compliance with ethical standards

Conflict of interest

All authors (Marius Keller, Tobias Lang, Andreas Schilling, Martina Nowak-Machen, Peter Rosenberger and Harry Magunia) declare that they have no conflicts of interest.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Anaesthesiology and Intensive Care Medicine, University Hospital TuebingenEberhard-Karls-UniversityTuebingenGermany
  2. 2.Chair of Visual Computing, Department of Computer ScienceEberhard-Karls-UniversityTuebingenGermany
  3. 3.Institute of Anaesthesiology and Intensive Care MedicineKlinikum IngolstadtIngolstadtGermany

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