Original ArticleEmerging Clinical Role of Strain Imaging in Echocardiography
Section snippets
Background
Strain, represented by the symbol ɛ, is a dimensionless index that refers to the amount of tissue deformation normalised to its original shape. It represents the fractional change in one dimension, typically length, in response to a stress, and can be mathematically written aswhere L is the length of the myocardium after deformation and L0 is its original length. By convention, strain is defined as positive when the distance between the points of measurement is increasing (i.e.
Echocardiographic Imaging Modalities
To quantify myocardial strain and strain rate, there are two different types of echocardiographic imaging modalities: tissue doppler imaging (TDI) and two-dimensional (2D) speckle tracking. These imaging modalities derive information on myocardial strain and strain rate from two fundamentally different ways.
Normal Values
Application of strain and strain rate imaging in clinical practice depends on, amongst other things, establishment of a range of normal values through a wide age range and an acceptably low inter-observer and intra-observer and test–retest variability.
Similar to the age-dependency of tradition pulsed-wave Doppler velocities at the LV inflow, colour tissue Doppler velocities have been shown to be age-dependent with an age-related decrease in the S′ and E′ velocities and an increase in the A′
LV Systolic and Diastolic Function
Strain and strain rate imaging have been used most extensively in the evaluation of LV systolic function. Both the peak and mean strain rate have been shown to show high correlations (r about 0.9) to the maximum elastance in animal models with tissue Doppler S′ velocities showing inferior correlations [9].
Strain and strain rate imaging have been used to assess ventricular function in a wide range of congenital and acquired heart disease as well as in the post-operative setting [8]. They have
Technical Considerations
Although strain and strain rate imaging are exciting developments in echocardiography and show promise in improving our understanding of myocardial mechanics and in enhancing our ability to evaluate function and risk stratify, attention to technical details is essential in order to obtain reliable and reproducible information. This is particularly important as strain and strain rate data are very susceptible to noise while technical factors play a pivotal role in affecting the signal to noise
Conclusions
Strain and strain rate imaging are emerging techniques in echocardiography. They have provided valuable tools in the understanding and assessment of the basics of myocardial properties and mechanics. Despite intense research interest, strain and strain rate imaging have not been successfully incorporated into everyday clinical practice and still remain primarily a research tool. There is considerable evidence to suggest strain and strain rate imaging further add to the information we can obtain
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