Left ventricular myocardial strain in neonates is influenced by the definition of the basal region of interest

Previous studies have examined the effects of various acquisition- and post-processing parameters such as frame rate/heart rate ratio, probe frequency, smoothing, drift compensation, and region of interest width on strain in the perinatal age group. The aim of this study was to examine how measurement of left ventricular strain is influenced by different definitions of the basal region of interest. Transthoracic echocardiography was performed on 41 healthy neonates within ten days after birth. Left ventricle longitudinal strain was assessed in four-, three-, and two-chamber views, with global longitudinal strain calculated as a mean of these. Segmental and layer-specific strains were measured in the four-chamber view. During image processing, the basal region of interest was placed at four different levels in early diastole, ranging from the mitral valve annulus (level 1) to the leaflet tips (level 4). Displacement of the basal region of interest from level 1 to level 4 resulted in a significant change in longitudinal strain values between : from − 19.0% to -20.6% for global longitudinal strain, and from − 18.5% to -20.7%, -19.4% to -20.1%, and − 19.2% to -21.0% for four-chamber, three-chamber and two-chamber strain, respectively (p < 0.001 for all measures). Similar changes were observed for segmental and layer-specific longitudinal strain analyses. The placement of the basal region of interest significantly impacted left ventricular strain measurements in neonates. These findings highlight the importance of precise and consistent region of interest positioning to ensure reproducible myocardial function assessments.