Fully Automated Multi-Chamber Strain Profiling in Consecutive Patients Undergoing Transthoracic Echocardiography: Feasibility, Functional Clustering, and Prognostic Implications
- 1Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital
Abstract
AimsMyocardial strain enables sensitive assessment of cardiac function, but its clinical application has largely focused on individual chambers or selected patient populations. We evaluated the feasibility and clinical relevance of fully automated multi-chamber strain assessment in consecutive patients undergoing routine transthoracic echocardiography (TTE).
Methods and resultsThis retrospective study included 8,350 consecutive adults undergoing TTE. A hospital-wide artificial intelligence (AI)-based system automatically measured left ventricular (LV) global longitudinal strain (LVGLS), left atrial (LA) reservoir strain (LASr), and right ventricular (RV) free-wall strain (RVFWS). AI-derived LVGLS was available from at least one apical view in 97.1% of patients and from all three views in 94.8%; LASr and RVFWS were available in 94.1% and 94.5%, respectively, resulting in complete multi-chamber strain assessment in 90.3%. Strain measures showed modest correlations with conventional chamber-specific echocardiographic parameters and differential associations with clinical outcomes. Gaussian mixture modeling identified three distinct clusters characterized by preserved multi-chamber function, RV-dominant dysfunction, and pan-chamber dysfunction. Compared with the preserved cluster, pan-chamber dysfunction was associated with the highest risk of all-cause death or heart failure hospitalization (adjusted hazard ratio, 3.44; 95% CI, 2.43-4.88; P<0.001). Prognostic associations remained evident in patients with LV ejection fraction (LVEF) [≥]50%, and cluster assignment provided incremental prognostic information beyond clinical factors, LVEF, and RV fractional area change.
ConclusionsFully automated multi-chamber strain assessment was feasible in a large consecutive TTE cohort. Integrating strain across cardiac chambers may provide complementary functional characterization and identify clinically relevant clusters with prognostic information beyond conventional assessment.
Graphical Abstract
O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=126 SRC="FIGDIR/small/26365880v1_ufig1.gif" ALT="Figure 1"> View larger version (39K): [email protected]@1229fdforg.highwire.dtl.DTLVardef@2e1730org.highwire.dtl.DTLVardef@1f489d9_HPS_FORMAT_FIGEXP M_FIG C_FIG
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BibTeX
@misc{noh2026fully,
title = {{Fully Automated Multi-Chamber Strain Profiling in Consecutive Patients Undergoing Transthoracic Echocardiography: Feasibility, Functional Clustering, and Prognostic Implications}},
author = {S. A. Noh and J. Park and Y. E. Yoon and J. Jeon and Y. Jang and S.-A. Lee and M. Bak and H.-M. Choi and I.-C. Hwang and G.-Y. Cho},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.20.26365880},
url = {https://www.medrxiv.org/content/10.64898/2026.10.20.26365880v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Fully Automated Multi-Chamber Strain Profiling in Consecutive Patients Undergoing Transthoracic Echocardiography: Feasibility, Functional Clustering, and Prognostic Implications
AU - S. A. Noh
AU - J. Park
AU - Y. E. Yoon
AU - J. Jeon
AU - Y. Jang
AU - S.-A. Lee
AU - M. Bak
AU - H.-M. Choi
AU - I.-C. Hwang
AU - G.-Y. Cho
PY - 2026
DA - 2026/10/20
PB - medRxiv
DO - 10.64898/2026.10.20.26365880
UR - https://www.medrxiv.org/content/10.64898/2026.10.20.26365880v1
AB - AimsMyocardial strain enables sensitive assessment of cardiac function, but its clinical application has largely focused on individual chambers or selected patient populations. We evaluated the feasibility and clinical relevance of fully automated multi-chamber strain assessment in consecutive patients undergoing routine transthoracic echocardiography (TTE). Methods and resultsThis retrospective study included 8,350 consecutive adults undergoing TTE. A hospital-wide artificial intelligence (AI)-based system automatically measured left ventricular (LV) global longitudinal strain (LVGLS), left atrial (LA) reservoir strain (LASr), and right ventricular (RV) free-wall strain (RVFWS). AI-derived LVGLS was available from at least one apical view in 97.1% of patients and from all three views in 94.8%; LASr and RVFWS were available in 94.1% and 94.5%, respectively, resulting in complete multi-chamber strain assessment in 90.3%. Strain measures showed modest correlations with conventional chamber-specific echocardiographic parameters and differential associations with clinical outcomes. Gaussian mixture modeling identified three distinct clusters characterized by preserved multi-chamber function, RV-dominant dysfunction, and pan-chamber dysfunction. Compared with the preserved cluster, pan-chamber dysfunction was associated with the highest risk of all-cause death or heart failure hospitalization (adjusted hazard ratio, 3.44; 95% CI, 2.43-4.88; P<0.001). Prognostic associations remained evident in patients with LV ejection fraction (LVEF) [≥]50%, and cluster assignment provided incremental prognostic information beyond clinical factors, LVEF, and RV fractional area change. ConclusionsFully automated multi-chamber strain assessment was feasible in a large consecutive TTE cohort. Integrating strain across cardiac chambers may provide complementary functional characterization and identify clinically relevant clusters with prognostic information beyond conventional assessment. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=126 SRC="FIGDIR/small/26365880v1_ufig1.gif" ALT="Figure 1"> View larger version (39K): [email protected]@1229fdforg.highwire.dtl.DTLVardef@2e1730org.highwire.dtl.DTLVardef@1f489d9_HPS_FORMAT_FIGEXP M_FIG C_FIG
ER -