Abstract
Strain imaging provides an accessible, feasible and non-invasive technique to assess cardiac mechanics. Speckle tracking echocardiography (STE) is the primary modality with the utility for detection of subclinical ventricular dysfunction. Investigation and adoption of this technique has increased significantly in both the research and clinical environment. It is therefore important to provide information to guide the sonographer on the production of valid and reproducible data. The focus of this review is to (1) describe cardiac physiology and mechanics relevant to strain imaging, (2) discuss the concepts of strain imaging and STE and (3) provide a practical guide for the investigation and interpretation of cardiac mechanics using STE.
Highlights
The assessment of myocardial function provides a core component of the echocardiographic examination. This has been underpinned by the assessment of left ventricular ejection fraction (LVEF), but increasingly speckle tracking echocardiography (STE) is being used in both research and clinical environments to directly assess myocardial wall deformation
All images used for left ventricle (LV) and right ventricle (RV) strain analysis are acquired as part of the minimum dataset for a standard adult transthoracic echocardiography (TTE) (15)
STE analysis to produce LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and rotation, twist and torsion curves relies on the acquisition of specific views (Fig. 5)
Summary
The assessment of myocardial function provides a core component of the echocardiographic examination. The sub-endocardium (innermost), the mid-myocardium and the sub-epicardium (outermost) The interaction of these layers plays a key role in ensuring stroke volume and overall cardiac output. There is shortening of the muscle fibres in all three layers of the LV myocardium subsequently leading to reductions in both LV length and circumference. As a result of the myocardium being an incompressible structure, there is resultant thickening of the LV myocardial walls (the thickening of the LV myocardium as seen on 2D echocardiography) This myocardial deformation can be termed longitudinal, circumferential and radial. The key overall deformation is shortening of the longitudinal fibres during ventricular systole (8). Circumferential and radial RV deformation is currently not routinely measured due partially to less influence on RV function, and the limitations of commercially available technology that can accurately track the thinner walls of the RV
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