Myocardial strain imaging: how useful is it in clinical decision making?
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.
Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Heart Failure Research, Center for Cardiological Innovation and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway otto.smiseth@ous-hf.no.
Otto A
OA
Smiseth
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7489 Trondheim, Norway.
Hans
H
Torp
Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Heart Failure Research, Center for Cardiological Innovation and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway.
Anders
A
Opdahl
Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Heart Failure Research, Center for Cardiological Innovation and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway.
Kristina H
KH
Haugaa
Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Heart Failure Research, Center for Cardiological Innovation and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway.
Stig
S
Urheim
D000970:Antineoplastic Agents / Q000009:adverse effects; D057791:Cardiac Imaging Techniques / Q000379:methods*; D058406:Cardiac Resynchronization Therapy; D009202:Cardiomyopathies / Q000000981:diagnostic imaging; D000066491:Clinical Decision-Making / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000000981:diagnostic imaging; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D015588:Observer Variation; D018579:Patient Selection; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
D000970:Antineoplastic Agents
Cardiomyopathy; Chemotherapy; Heart failure; Hypertrophic cardiomyopathy; Left atrial strain; Left ventricular function; Strain imaging; Ventricular arrhythmia