Current clinical use of speckle-tracking strain imaging: insights from a worldwide survey from the European Association of Cardiovascular Imaging (EACVI)

Abstract

Background Echocardiographic speckle-tracking strain imaging (STE) has been a major advance in myocardial function quantification. We aimed to explore current world-wide clinical application of STE. Methods Access, feasibility, access, and clinical implementation of STE were investigated with a worldwide open-access online survey of the European Association of Cardiovascular Imaging (EACVI). Results Participants (429 respondents, 77 countries) from tertiary centers (46%), private clinics or public hospitals (54%) using different vendors for data acquisition and analysis were represented. Despite almost universal access (98%) to STE, only 39% of the participants performed and reported STE results frequently (>50%). Incomplete training and time constraints were the main reasons for not using STE more regularly. STE was mainly used to assess the left ventricular (99%) and less frequently the right ventricular (57%) and the left atrial (46%) function. Cardiotoxicity (88%) and cardiac amyloidosis (87%) were the most frequent reasons for the clinical use of left ventricular STE. Left atrial STE was used most frequently for the diagnosis of diastolic dysfunction and right ventricular STE for the assessment of RV function in pulmonary hypertension (51%). Frequency of STE use, adherence to optimal techniques and clinical appropriateness of STE differed according to training experience and across vendors. Key suggestions outlined by respondents to increase the clinical use of STE included improved reproducibility (48%) and standardization of strain values across vendors (42%). Conclusions Although STE is now readily available, it is underutilized in the majority of centers. Structured training, improved reproducibility and inter-vendor standardization may increase its uptake.

Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice

“…According to a recent worldwide survey, the most commonly used software includes (Table 3, Figure 5) 57 : ‐ Echopac (GE Healthcare, Horten, Norway): Vendor‐specific; the software “Automated Function Imaging” (AFI) requires the user to identify and place two basal markers and one apical marker which allows the software to generate a semi‐automated region of interest (ROI) around the myocardium, allowing for manual adjustments; it tracks the unique speckle patterns within the myocardium across frames in a set of three longitudinal 2D‐image planes (apical 3ch, 2ch, and 4ch) and displays the results for each plane. It combines the results into a bull's‐eye summary, displaying segmental and global peak systolic values, representing average mid‐myocardial strain. ‐ QLab (Philips Healthcare, Andover, Massachusetts, USA): Vendor‐specific; the software “Automated Cardiac Motion Quantification” (aCMQ) acts similar to the precedent, incorporating a ROI after basal and apical markers were placed.…”

Challenges in Echocardiography for the Diagnosis and Prognosis of Non-Ischemic Hypertensive Heart Disease

“…Under this scope, RV speckle tracking could be an alternative to obtain a better assessment of RV deformation and dysfunction in HHD with good correlation with CMR findings. Nevertheless, its clinical use remains limited, since the acquisition of images is challenging, and the prognostic value remains to be proved in large-scale studies [111].…”

Four-Dimensional Flow Echocardiography: Blood Speckle Tracking in Congenital Heart Disease: How to Apply, How to Interpret, What Is Feasible, and What Is Missing Still

“…The limited data currently available do not allow for a meta-analysis [29][30][31]. The routine use of BST will be feasible only when the technique is available on most of the echocardiographic machines and when basic (2D) and advanced (e.g., energy loss, vorticity, inter-ventricular pressure difference) measures are feasible in a semi-automatic fashion and consistent among different vendors [32]. The evolution of 3D strain echocardiography [33] is crucial also for BST echocardiography for a better understanding of vortex dimensions and their relationship with cardiac structures and great vessels.…”