Available online 22 April 2023

In our opinion, this study as well as others on this topic are important if we are to develop a widely used index of systolic dysfunction that reliably precedes a reduction in EF. We speculate that its principal use might be in the population of patients with pressure-overload hypertrophy, in whom concentric remodeling appears to mask LV dysfunction and may even correlate with cardiac magnetic resonance evidence of fibrosis. Our work with midwall shortening has taught us that concentric

Dr. Aurigemma owes an unpayable debt of gratitude to the late Dr. William H. Gaasch, who understood and taught the principles of LV systolic function, including the principal strains, long before the technology was available to measure these parameters noninvasively.

2023 by the American Society of Echocardiography.