Background The accurate measurement of left ventricular (LV) ejection fraction (EF) is highly dependent on professional experience and adequate visualization. The tissue motion of mitral annular displacement (TMAD) can be easily and quickly assessed using speckle tracking echocardiography (STE) for evaluating the LV systolic function, even in patients with poor acoustic windows. Therefore, this study aimed to validate whether LVEF can be estimated using the STE-derived TMAD when LVEF is not available. Methods Four-hundred fifty-six outpatients were consecutively enrolled in this study. An optimized regression model for LVEF-TMAD was developed in the derivation set (n=287), and its reliability was verified in the validation set (n=123) and regional wall motion abnormalities (RWMA) set (n=46). Results In the derivation set, the power models had the highest F-value, and the power equations were chosen to estimate LVEF according to TMAD in the validation set. Near-zero bias and a narrow range of differences were observed between the observed and estimated LVEF. The highest intra-class correlation coefficient was observed between the observed LVEF and estimated LVEF according to the normalized TMAD at the midpoint of mitral annular (nTMADmid). Moreover, there were no significant differences between the observed and estimated LVEF in the RWMA set. Conclusion The LVEF can be estimated with the STE-derived TMAD using a power equation, even for patients with RWMA, and the nTMADmid may be the optimal parameter. The proposed method may provide a clinically acceptable alternative for evaluating LV systolic function when the direct measurement of LVEF is not available.

Arrhythmogenic cardiomyopathy (AC) is a rare inherited myocardial disorder, a cause of sudden death in young people and atheletes; biventricular involvement is often involved. We report on a case of AC diagnosed with multimodality imaging, including transthoracic echocardiography (TTE), two-dimensional strain echocardiography (2DSE), real-time three-dimensional echocardiography (RT-3DE) and cardiac magnetic resonance (CMR) imaging. Especially, combination of 2DSE and RT-3DE was utilized in the diagnosis of AC. In a word, we review the cardiac anomalies associated with AC by multiple imaging techniques and highlight the supplementary role of new echocardiography techniques diagnosing AC when CMR contraindications exist for AC patients.