Myocardial strain imaging: how useful is it in clinical decision making?

Abstract

Myocardial strain is a principle for quantification of left ventricular (LV) function which is now feasible with speckle-tracking echocardiography. The best evaluated strain parameter is global longitudinal strain (GLS) which is more sensitive than left ventricular ejection fraction (LVEF) as a measure of systolic function, and may be used to identify sub-clinical LV dysfunction in cardiomyopathies. Furthermore, GLS is recommended as routine measurement in patients undergoing chemotherapy to detect reduction in LV function prior to fall in LVEF. Intersegmental variability in timing of peak myocardial strain has been proposed as predictor of risk of ventricular arrhythmias. Strain imaging may be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. Strain may also be used to diagnose myocardial ischaemia, but the technology is not sufficiently standardized to be recommended as a general tool for this purpose. Peak systolic left atrial strain is a promising supplementary index of LV filling pressure. The strain imaging methodology is still undergoing development, and further clinical trials are needed to determine if clinical decisions based on strain imaging result in better outcome. With this important limitation in mind, strain may be applied clinically as a supplementary diagnostic method.

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

“…Ventricular contractile performance was assessed using LV strain, with longitudinal strain being the most sensitive measure, as the sub-endocardial distribution of longitudinal fibres renders them particularly prone to hypoperfusion [22]. We observed reductions in both longitudinal and circumferential global strain during dialysis, although longitudinal changes were most notable.…”

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

“…Although LVEF is the most commonly used measure of cardiac function, it is load dependent, influenced by heart rate, and may not accurately reflect cardiac contractility as long as ventricular–vascular coupling is maintained22 or in the presence of hypertrophy 23, 24. GLS, however, has been shown to be a more sensitive measure of cardiac dysfunction 25.…”

Modern Possibilities of Speckle Tracking Echocardiography in Clinical Practice

“…1). К преимуществам STE следует отнести то, что наличие акустических маркеров позволяет более точ-но по сравнению с тканевой допплерографией оце-нивать механику отдельных участков миокарда [11].…”