Figure 2).

Effect of myocardial shortening (peak systolic strain) and left ventricular end-diastolic wall thickness on ejection fraction. The ejection fraction increases with increasing left ventricular end-diastolic wall thickness. Worsening longitudinal strain leads to a reduction in ejection fraction. Reducing circumferential strain results in a relatively greater fall in ejection fraction compared with longitudinal strain. A Effect of peak systolic longitudinal strain on ejection fraction (midwall circumferential strain normal). B Effect of peak systolic midwall circumferential strain on ejection fraction (longitudinal strain normal)