🧵 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) 👇
#Cardiology #Rheumatology #Echo #Rheumatology #Immunology
#Sullysrounds #MedX #Medtwitter #Mnemonics #Medicine #History
@DrAkhilX @IhabFathiSulima @Janetbirdope #MedTwitter #RheumTwitter @CelestinoGutirr
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) 👇
#Cardiology #Rheumatology #Echo #Rheumatology #Immunology
#Sullysrounds #MedX #Medtwitter #Mnemonics #Medicine #History
@DrAkhilX @IhabFathiSulima @Janetbirdope #MedTwitter #RheumTwitter @CelestinoGutirr
Tweet 2/6
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
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
Tweet 3/6
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%.
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%.
Tweet 4/6
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.”
#Echo #Cardiology #MedTwitter
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.”
#Echo #Cardiology #MedTwitter
Tweet 5/6
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.
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.
#Echo #Cardiology #Rheumatology #SSc #Medtwitter
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.
#Echo #Cardiology #Rheumatology #SSc #Medtwitter
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