The paradox of reduced myocardial shortening in the
presence of preserved EF is explained mathematically
through geometric factors, where EF can be constant
for a large variation in shortening if other geometric
factors are altered to compensate. Increased wall
thickness and/or reduced ED volume augment EF,
and therefore can maintain a normal EF despite
reduced shortening. EF is quadratically dependent
on circumferential shortening and only linearly
dependent on longitudinal shortening; hence, EF is
less sensitive to a reduction in longitudinal shortening.
Our findings suggest that strain measurements reflect
systolic function better than EF in patients with
preserved EF.
Comparison Between Ejection Fraction and Strain
Editorial Comment V. Fuster MP4
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