Review article
Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function

https://doi.org/10.1016/j.echo.2004.03.027Get rights and content

Abstract

On the basis of color Doppler myocardial motion data, 1-dimensional regional natural strain rate and strain curves can now be calculated by comparing local myocardial velocity profiles. Such deformation data sets may be an important, new, and more sensitive approach to quantifying both regional radial and long-axis function of the left or right ventricle in both acquired and congenital heart disease. The normal ranges of regional velocity, strain rate, and strain values have already been determined in both adults and children. This review will focus both on the potential clinical applications of these new ultrasound-based deformation parameters and the current limitations inherent in implementing the technique in everyday practice.

Section snippets

Technical aspects of ϵ/SR imaging

A prior review has comprehensively covered the technical aspects of ϵ/SR imaging.3 Thus, further explanation in this article would be superfluous.

Data acquisition

Although integration of a regional velocity curve measures regional displacement, the integration of a regional SR curve will derive the regional ϵ curve (Figure 1). Although regional systolic strain rates (SRs) measure the rate of local deformation, regional systolic strain (ϵ) express the percentage of deformation (note that regional ϵ estimation provides no information on absolute wall thickness but only measures relative changes). Each regional ϵ curve can be subdivided into component

Changes in preload, afterload, and contractility: how do they affect SR/ϵ measurement?

Myocardial deformation is the result of the complex interaction of intrinsic contractile force and extrinsic loading conditions applied to a tissue with variable elastic properties. Therefore, changes in preload and afterload, and the changes in myocardial stiffness, are important determinants of the pattern and the magnitude of myocardial deformation. Thus, SR and ϵ indices are not direct measures of contractility.

Mathematic modelling studies6 would predict that peak systolic ϵ values will

Ischemic heart disease

Despite several attempts to implement new cardiac ultrasound methods to quantify ischemia, the routine clinical evaluation of regional function in ischemic heart disease has remained firmly on the basis of visual assessment of wall motion and wall thickening. However, the eye has been shown to have limitations in assessing the timing of the complex changes in regional myocardial deformation that occur in differing ischemic substrates. Kvitting et al7 showed that healthy individuals can neither

RV disease

Despite the numerous diseases that alter RV function, the evaluation of RV regional function remains a challenge. Recent reports have demonstrated that using SR/ϵ is not only feasible for quantification of regional RV function but is usually applicable even where the acoustic window is poor, as is often the case in patients with chronic pulmonary hypertension. Peak SR has been shown to correlate with peak systolic pulmonary artery pressure. The same study also showed that an increase in

Conclusions

Ultrasonic deformation imaging can now be applied in the clinical setting. Data can be acquired at the bedside in real time and postprocessed either by the ultrasound machine or by an offline computer. Postprocessing tools have been developed that can reduce postprocessing time to minutes. Initial clinical studies have shown the technique to add significant new data on abnormalities of regional myocardial deformation in an important number of disease entities. These studies have also added to

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