Global Longitudinal Strain (GLS) and Speckle Tracking: Measurement Methodology, Norms, and Clinical Application
GLS Measurement Methodology
The average global longitudinal strain (GLS) is calculated using standard apical views: apical long-axis (A3C), four-chamber (A4C), and two-chamber (A2C). The image is obtained from the apical view using the 2D mode; the units of measurement are negative percentages (−%).
Key conditions for quality registration: high image quality with stable heart rate and frame rate of 40–90 frames/s. Clear visualization of the endocardial and epicardial borders throughout the cardiac cycle is required for adequate segmental tracking in systole and diastole. Markers are placed in the basal and apical parts of the corresponding segments using automatic tracking to maintain high reproducibility.
GLS Norms
In a study on metabolic syndrome, a normal GLS was considered to be in the range of −18% to −25%. Even with a normal average GLS, a decrease in regional longitudinal strain (in the inferolateral and inferoseptal segments) can be observed. Universal GLS thresholds for specific nosologies (particularly for MetS) have not been established [to be clarified].
Clinical Application
The speckle tracking method (STE) allows for the assessment of myocardial deformation and provides additional information to traditional geometric parameters (shortening fraction, ejection fraction).
HFpEF and Diastolic Dysfunction. Although GLS is not an index of LV diastolic function, reduced GLS is among the criteria for assessing HFpEF and is associated with worse outcomes in many cardiovascular diseases accompanied by diastolic dysfunction, including cardiomyopathies and left-sided valvular heart diseases (ASE, 2025).
Aortic Regurgitation. GLS can indicate early LV dysfunction; as AR progresses, the GLS value decreases (BSE, 2025).
Cardiac Amyloidosis. GLS is part of the echocardiographic protocol for assessing transthyretin amyloidosis with calculations through A4C, A2C, A3C views.
Cardio-Oncology. In children undergoing chemotherapy, LV GLS detects subclinical LV dysfunction earlier than traditional indicators.
Metabolic Syndrome. MetS reduces the average GLS; STE can be used as a reliable method for early detection of LV myocardial damage.
Features and Limitations
Peak GLS is already part of the routine clinical process in adult patients. In children with CHD and altered ventricular geometry, STE provides reliable quantitative assessment of myocardial function as a complement to traditional parameters. Inter-vendor differences in 2D-STE GLS values should be considered, which is the subject of ongoing standardization efforts (ASE/EACVI, 2024).
Frequently asked questions
Through which views is GLS calculated?
Through three standard apical views: apical long-axis (A3C), four-chamber (A4C), and two-chamber (A2C).
What frame rate is needed for accurate measurement?
40–90 frames/s with a stable heart rate, with clear visualization of the endocardium and epicardium throughout the cardiac cycle.
What GLS values are considered normal?
In a study on metabolic syndrome, a normal GLS range was considered to be from −18% to −25%. Universal nosological thresholds in fragments have not been established.
What is the advantage of GLS over ejection fraction?
GLS/STE detects subclinical LV dysfunction earlier than traditional indicators — for example, in children after chemotherapy and in patients with MetS.
Is reduced GLS included in the criteria for HFpEF?
Yes, reduced LV GLS is one of the criteria for assessing HFpEF and is associated with worse outcomes in diseases with diastolic dysfunction (ASE, 2025).