Original Article Speckle- Tracking Echocardiography for the Staging of Diastolic Dysfunction: The Correlation Between Strain-Based Indices and the Severity of Left Ventricular Diastolic Dysfunction Farzad Ebrahimi, MD * ,y ,1 , Mohammad Hadi Gharedaghi, MD, MPH z , Muhammad Zubair, MD y , David Kohanchi, MD y , Katayoun Aghajani, MD * ,y , Kenneth Candido, MD * ,y * Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL y Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL z Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA Objectives: Left ventricular diastolic function can be assessed by various methods. Tissue Doppler imaging is among the most commonly used techniques. However, this imaging is angle- dependent, affected by loading conditions, and susceptible to myocardial tethering. Speckle- track- ing echocardiography also can measure strain-based indices to assess diastolic function, and it has fewer limitations than tissue Doppler imaging. Using speckle- tracking echocardiography, the authors evaluated the correlation between the stage of diastolic dysfunction and strain-based indi- ces in patients undergoing cardiac surgery to determine whether strain-based indices can be used intraoperatively to identify the extent of left ventricular diastolic dysfunction. Design: Retrospective clinical study. Setting: Single university hospital. Participants: Fifty-eight patients undergoing cardiac surgery (December 2017 to December 2019). Interventions: None. Measurement and Main Result: Preoperative echocardiographic reports and intraoperative echocardiographic images of the participants were studied. The correlation between the stage of left ventricular diastolic dysfunction and strain-based indices (including early diastolic peak longi- tudinal strain and tissue deceleration time) were evaluated. Early diastolic peak longitudinal strain rate significantly correlated with the stage of diastolic dysfunction (r = 0.7 and p < 0.0001). Tissue deceleration time significantly correlated with the stage of diastolic dysfunction in patients with diastolic abnormality (r = 0.4 and p = 0.02). When patients with normal diastolic function were included, this correlation was not significant (r= 0.25 and p = 0.05). Conclusions: Intraoperatively measured early diastolic peak longitudinal strain rate and tissue deceleration time correlated with the severity of diastolic dysfunction in patients undergoing cardiac surgery. Ó 2020 Elsevier Inc. All rights reserved. Key Words: Anesthesia; diastolic dysfunction; strain-based indices; intraoperative; speckle- tracking echocardiography; deceleration time; strain rate INTRAOPERATIVE ASSESSMENT of diastolic function by conventional echocardiography, including tissue Doppler imaging (TDI), is often influenced by general anesthesia, sur- gically- induced hemodynamic changes, positive- pressure ventilation, and alterations in the patient’s position. 1 However, This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors. 1 Address reprint requests to Farzad Ebrahimi, MD, Department of Anesthe- siology, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave. Suite 4815, Chicago, IL 60657. E-mail address: ebrahimi@uic.edu (F. Ebrahimi). https://doi.org/10.1053/j.jvca.2020.06.081 1053-0770/Ó 2020 Elsevier Inc. All rights reserved. ARTICLE IN PRESS Journal of Cardiothoracic and Vascular Anesthesia 000 (2020) 16 Contents lists available at ScienceDirect Journal of Cardiothoracic and Vascular Anesthesia journal homepage: www.jcvaonline.com