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362 Cardio Diabetes Medicine 2017

Strain and Strain Rate Imaging in Early De-

tection of Ventricular Systolic Dysfunction -

is This The Best Investigation?

Dr. R. Balamurugan., MD DM(cardio)
Asst.. Prof Dept. Of Cardiology, TKMCH

Abstract tion. Apart from 2D the various other modalities used
Echocardiographic assessment of LV function plays over the last three decades are 3D echo,cardiac MRI
a crucial role in day to day clinical practice.Apart from and multislice CT which were limited by expensive-
the traditional methods ,newer echocardiographic ness , loading conditions and geometric assumptions
techniques and deformation imaging utilizing strain .Later it was recognised that non invasive evaluation
and strain rate measurements by Tissue Doppler and of myocardial tissue deformation(Strain) analysis by
speckle tracking methods gives better understand- tissue Doppler study and speckle tracking methods
ing for evaluation of the complex cardiac mechan- has potential advantage of more reproducible and
ics.The various types of strain imaging longitudinal, independent of load and geometric assumptions.
circumferential and radial strain measurements is
useful and got a lot of clinical applications in early Standard Methods For Evaluation of LV
detection of myocardial and pericardial diseases.This Systolic Function
innovative technique should be part of other tradi- Traditional echocardiograhic measures of LV systolic
tional echocardiographic parameters to have a better function are M-mode, two dimensional (2D) exam-
understanding of cardiac function in different clinical inations for dimensions and Doppler derived ejection
settings. This review describes about the fundamen- indices for ventricular performance. 2D Echocar-
tal concepts of speckle tracking in obtaining strain diograhic measures of LV systolic function includes
measurements,their clinical applications and useful- ejection phase indices like fractional shortening (FS)
ness in early detection of LV dysfunction. , ejection fraction (EF) and Doppler derived echocar-
diograhic measures of LV systolic function includes
Key words: changes in peak and mean pressure over time (Δp/Δt)
S-Strain,SR-Strain rate,LS-Longitudinal strain,CS-Cir- and systolic time intervals.
cumferential strain,RS-radial strain,STE-Speckle EF calculation by modified Simpson’s rule with bi-
tracking echo,TDI-Tissue Doppler imaging plane planimetry of LV is currently recommended [1]

Introduction Important Limitations of Ejection Fraction
Assessment of LV systolic function plays an im- Global LV systolic function by EF carries an important
portant role in prognostic and therapeutic aspects limitations due to its dependence on instantaneous
of most other acquired diseases. Echocardiogram a loading conditions, reproducibility, and low sensitivity
simple clinical tool used since long back in estimat- in detecting subtle LV systolic impairment [1].
ing the LV systolic function.Initial attempts used only
linear measurements,later 2D methods used area The EF was primarily introduced in order to charac-
and volume calculations to asses LV function.These terize the reduced myocardial function in dilated LV,
methods however had lot of drawbacks as linear but becomes inaccurate in the cases of reduced end
measurements(M Mode) provide information regard- diastolic volume (EDV), as well as severe myocardial
ing dimention and contractility along a single line only hypertrophy as in cases of “Heart failure with pre-
in a heart with regional variation in shape and func- served EF (HFPEF)” [1-3]

GCDC 2017