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

Abstract

Speckle tracking echocardiography (STE) is a reliable imaging technique of recognized clinical value in several settings. This method uses the motion of ultrasound backscatter speckles within echocardiographic images to derive myocardial velocities and deformation parameters, providing crucial insights on several cardiac pathological and physiological processes. Its feasibility, reproducibility, and accuracy have been widely demonstrated, being myocardial strain of the various chambers inserted in diagnostic algorithms and guidelines for various pathologies. The most important parameters are Global longitudinal strain (GLS), Left atrium (LA) reservoir strain, and Global Work Index (GWI): based on large studies the average of the lower limit of normality are −16%, 23%, and 1442 mmHg%, respectively. For GWI, it should be pointed out that myocardial work relies primarily on non‐invasive measurements of blood pressure and segmental strain, both of which exhibit high variability, and thus, this variability constitutes a significant limitation of this parameter. In this review, we describe the principal aspects of the theory behind the use of myocardial strain, from cardiac mechanics to image acquisition techniques, outlining its limitation, and its principal clinical applications: in particular, GLS have a role in determine subclinical myocardial dysfunction (in cardiomyopathies, cardiotoxicity, target organ damage in ambulatory patients with arterial hypertension) and LA strain in determine the risk of AF, specifically in ambulatory patients with arterial hypertension.

Does coronary artery calcium score influence myocardial contraction?

“…In conclusion, Frimodt-Møller et al 3 observed for the first time a correlation at rest between CACS and multilayer GLS without significant coronary stenosis. Since all previous studies were able to detect GLS impairment only in patients with obstructive coronary disease, 13 these results have to be confirm by a multicenter trial. Further studies are needed to better understand the potential role of multilayer GLS assessment to detect subclinical atherosclerosis.…”

Electrocardiography versus Echocardiography in Severe Aortic Stenosis with the Consideration of Coexistent Coronary Artery Disease

“…New indices, such as global longitudinal strain and mechanical dispersion, were shown to increase the accuracy of obstructive CAD detection [38,39]. Moreover, the assessment of myocardial strain has a well-validated prognostic value [40].…”

Targeting subclinical ventricular dysfunction in atrial fibrillation: What can myocardial work add?

“…Reduced work efficiency is observed in cardiomyopathies, accompanied by declines in GLS and LVEF. 2 MW assessment is based on the acquisition of transthoracic views for GLS analysis followed by non-invasive systolic BP measurement. This BP measurement, obtained using a sphygmomanometer, is crucial for estimating peak systolic pressure within the left ventricle and is input into the echocardiography system for subsequent MW analysis.…”