My Approach to 3-Dimensional Left Ventricular Strain

Abstract

The role of strain analysis using 2-dimensional speckle tracking (2DST) has been well documented, and it represents an important complementary tool in the assessment of cardiac mechanics, adding value in the identification of incipient and subclinical myocardial injury in different clinical scenarios. A significant advance related to echocardiography was the development of 3-dimensional speckle tracking (3DST), which has the potential to overcome many limitations intrinsic to 2-dimensional technology, offering additional parameters of myocardial deformation (such as area strain) and a more comprehensive quantification of the geometry and function of the left ventricular myocardium, based on a single image acquisition. Among its main limitations, the low temporal and spatial resolution stands out, in addition to the dependence on high-quality images and a well-trained operator. Although it is a relatively recent technique that is still under development, several experimental studies and some clinical investigations have already demonstrated the reproducibility and potential applicability of 3DST. The objective of this article is to add information about adequate analysis of 3-dimensional left ventricular strain and explore its main points of vulnerability, discussing important variables to increase the accuracy and reproducibility of this technology.