Echocardiographic strain imaging, also known as deformation imaging, has been developed as a means to objectively quantify regional myocardial function. First introduced as post-processing of tissue Doppler imaging velocity converted to strain and strain rate, strain imaging has more recently also been derived from digital speckle tracking analysis. Strain imaging has been used to gain greater understanding into the pathophysiology of cardiac ischemia and infarction, primary diseases of the myocardium, and the effects of valvular disease on myocardial function, and to advance our understanding of diastolic function. Strain imaging has also been used to quantify abnormalities in the timing of mechanical activation for heart failure patients undergoing cardiac resynchronization pacing therapy. Further advances, such as 3-dimensional speckle tracking strain imaging, have emerged to provide even greater insight. Strain imaging has become established as a robust research tool and has great potential to play many roles in routine clinical practice to advance the care of the cardiovascular patient. This perspective reviews the physiology of myocardial strain, the technical features of strain imaging using tissue Doppler imaging and speckle tracking, their strengths and weaknesses, and the state-of-the-art present and potential future clinical applications.
Key Words
deformation
echocardiography
myocardial
Abbreviations and Acronyms
CMR
cardiac magnetic resonance
CRT
cardiac resynchronization therapy
DSE
dobutamine stress echocardiography
EF
ejection fraction
LBBB
left bundle branch block
LV
left ventricular
TDI
tissue Doppler imaging
2D
2-dimensional
3D
3-dimensional
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Dr. Gorcsan has received research grant support from GE and Toshiba. Dr. Tanaka has reported that he has no relationships relevant to the contents of this paper to disclose.