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We determined whether the LS reflects contraction process in patients with asynchronous LV activation. We studied 144 patients with an ejection fraction\u2009\u2264\u200935%, who had left bundle branch block (LBBB, n\u2009=\u200942), right ventricular apical (RVA) pacing (n\u2009=\u200934), LV basal- or mid-lateral pacing (n\u2009=\u200923), and no conduction block (Narrow-QRS, n\u2009=\u200945). LS distribution maps were constructed using 3 standard apical views. The times from the QRS onset-to-early systolic positive peak (Q-EPpeak) and late systolic negative peak (Q-LNpeak) were measured to determine the beginning and end of contractions in each segment. Negative strain in LBBB initially appeared in the septum and basal-lateral contracted late. In RVA and LV pacing, the contracted area enlarged centrifugally from the pacing site. Narrow-QRS showed few regional differences in strain during the systolic period. The Q-EPpeak and Q-LNpeak exhibited similar sequences characterized by septum to basal-lateral via the apical regions in LBBB, apical to basal regions in RVA pacing, and lateral to a relatively large delayed contracted area between the apical- and basal-septum in LV pacing. Differences in Q-LNpeaks between the apical and basal segments in delayed contracted wall were 107\u2009\u00b1\u200930\u00a0ms in LBBB, 133\u2009\u00b1\u200946\u00a0ms in RVA pacing, and 37\u2009\u00b1\u200920\u00a0ms in LV pacing (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05, between QRS groups). Specific LV contraction processes were demonstrated by evaluating the LS distribution and time-to-peak strain. These evaluations may have potential to estimate the activation sequence in patients with asynchronous LV activation.<\/jats:p>","DOI":"10.1007\/s10554-023-02834-w","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T05:02:47Z","timestamp":1679893367000},"page":"1251-1262","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Estimation of left ventricular activation sequence in patients with heart failure using two-dimensional speckle tracking echocardiography"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0629-2927","authenticated-orcid":false,"given":"Hideyuki","family":"Hara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tazuru","family":"Igarashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toyoji","family":"Kaida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masami","family":"Murakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Ito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichi","family":"Niwano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junya","family":"Ako","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,3,27]]},"reference":[{"issue":"10","key":"2834_CR1","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1093\/eurheartj\/ehw506","volume":"38","author":"JJ Bax","year":"2017","unstructured":"Bax JJ, Delgado V, Sogaard P, Singh JP, Abraham WT, Borer JS, Dickstein K, Gras D, Brugada J, Robertson M, Ford I, Krum H, Holzmeister J, Ruschitzka F, Gorcsan J (2017) Prognostic implications of left ventricular global longitudinal strain in heart failure patients with narrow QRS complex treated with cardiac resynchronization therapy: a subanalysis of the randomized EchoCRT trial. 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