Thread by @IlliasulK

🧵 Can we have cardiac dysfunction despite a normal ejection fraction?

Even with a normal LV ejection fraction (LVEF), early myocardial damage can exist — especially in conditions like systemic sclerosis, lupus, or diabetes.

Let’s explore how we can detect it early — before symptoms appear.

Lets explore about Speckle Tracking Echocardiography (STE) 👇

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The science behind it:

The LV myocardium has spiral architecture — fibers run longitudinally, circumferentially, and radially.
Each fiber layer contributes to a different “strain” during contraction.

When the myocardium weakens, strain changes before EF drops.

Image source-ecgwave

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It tracks natural “speckles” in the myocardium on 2D echo frames — measuring how much each segment deforms during systole and diastole.

📊 Strain = (D₂ − D₁) / D₁
Values are negative (shortening from the original length).

Meet the hero: Global Longitudinal Strain (GLS)
GLS captures the average longitudinal shortening of the LV.

✅ Normal ≈ −18% to −22%

⚠️ Less negative values (e.g., −16%, −14%) suggest subtle systolic dysfunction — even when EF is 60%.

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So simply 👇

How do we calculate Global Longitudinal Strain (GLS)?

👉 GLS = % change in myocardial length between diastole & systole
📏 Formula: (Ldiastole − Lsystole) / Ldiastole × 100
🫀 Since the LV shortens, values are negative (normal ≈ −18% to −22%)

➡️ Less negative = early systolic dysfunction, even when EF looks “normal.”

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Why it matters in systemic sclerosis (SSc):

A large study (n=234, J Rheumatol 2019) followed patients with SSc using speckle tracking:

•LVEF remained stable
•But 19% had significant GLS decline (≥15%) over ~2.3 years
•These patients developed muscle weakness, lung fibrosis, and renal dysfunction

What this tells us:

🫀 LV dysfunction in SSc can progress silently.

GLS picks it up before EF falls — giving us a window for early intervention.

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Clinical takeaway:

•Use GLS for early detection of subclinical LV dysfunction
•Enables better risk stratification
•Allows timely treatment & closer follow-up

💡 Moral of the story:

Normal EF doesn’t always mean a normal heart

Sometimes, only a strain reveals the struggle.

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