Current and Evolving Echocardiographic Techniques for the Quantitative Evaluation of Cardiac Mechanics: ASE/EAE Consensus Statement on Methodology and Indications Endorsed by the Japanese Society of Echocardiography

Abstract

Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment. Several such techniques have emerged over the past decades to address the issue of reader's experience and inter-measurement variability in interpretation. Some were widely embraced by echocardiographers around the world and became part of the clinical routine, whereas others remained limited to research and exploration of new clinical applications. Two such techniques have dominated the research arena of echocardiography: (1) Doppler-based tissue velocity measurements, frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements. Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated back- scatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses, briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.

Definitions for a Common Standard for 2D Speckle Tracking Echocardiography: Consensus Document of the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging

“…Clinical literature reports that acquisition frame rates ranging from 40 to 80 Hz have been widely used to measure motion and deformation at normal heart rates. 1 As mechanical events become shorter with an increasing heart rate, the frame rate needed to resolve a particular physiological event becomes higher. Therefore, the frame rate should be increased with the increase in heart rate especially for paediatric studies, exercise, and pharmacological stress exams with agents (e.g.…”

“…1 Deformation imaging has been shown to provide unique information on regional and global ventricular function with some studies showing reduced inter-and intraobserver variability in assessing regional left ventricular (LV) function. 2 The main areas of application of these techniques have been assessment of myocardial mechanics, ischaemic heart disease, cardiomyopathies, LV diastolic dysfunction, and in detecting subclinical myocardial dysfunction in patients † J.-U.V., G.P., and P.L.…”

Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

“…Echocardiographic speckle tracking analysis offers a detailed characterization of LV deformation in systole—including the extent to which the LV length shortens in the long axis (longitudinal strain), the extent to which the LV cavity circumference decreases in the short axis (circumferential strain), and the extent to which the LV walls thicken (transverse and radial strains) 14, 15. The different LV strain components (eg, longitudinal vs. circumferential) reflect myofiber function in distinct orientations and at different layers of the ventricle (eg, subendocardium vs. mesomyocardium).…”

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

“…LVEF, as well as LV and atrial volumes should be measured with bi-planar or three-dimensional echocardiography. 169 Assessments of valve function and diastolic function (such as E/e' ratio) are likewise of major importance, 170 as is evaluation of inferior vena cava diameter for the determination of volume status and right atrial pressure. Deformation imaging with strain analysis may reveal dysfunction that is not apparent using traditional methods.…”

“…Deformation imaging with strain analysis may reveal dysfunction that is not apparent using traditional methods. 170 The information on cardiac structure and function obtained by TTE provides important prognostic information before non-cardiac surgery. 59,171 Thus, routine pre-operative echocardiography should be considered in high-risk surgical populations; however, routine echocardiography is not indicated in every cardiac patient.…”