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Strain and Strain Rate Imaging in Early Detection of Ventricular 365
Systolic Dysfunction - is This The Best Investigation?

4.Coronary Artery Disease for evaluating right ventricular function or function of
hearts with single-ventricle physiology.
Reduced LS values in asymptomatic patients even
without wall motion abnormalities is a strong pre- In contrast to only EF analysis,new speckle tracking
dictor of stable ischemic cardiomyopathy.LS after echocardiogram utilizing strain ,strain rate parame-
reperfusion therapy is an excellent predictor of LV ters have shown to reliably detect preclinical abnor-
remodelling and adverse events.LS also correlates malities in both regional and global myocardial func-
well with regional extent of scar tissue as evaluated tion at an early stage .[9]
by contrast MRI.[12]
A cuttoff value of -4.5 % for regional LS discriminates Limitations of Strain,Strain rate imaging
between viable myocardium and scar tissue.[3] Stain measurements are not possible in non sinus
rhythms.
The postsystolic motion or index measured after aor-
tic valve closure is an important quantitative marker STE requires good image acquisition to delineate
for analysis of ischemic myocardium. endocardial border
In transmural pathologies like myocardial infarction The STE technique results depend critically on the
where epi,mid and subendocardial functions are uni- machine with which the analysis are made and they
formly affected and all LS,CS,RS show significant im- are not interchangeable among different manufac-
pairement.[3] tures.
The tissue Doppler derived strain and strain rate has
5.Heart Failure And Dyssynchrony
a limitation of angle dependency,noise interference ,
STE plays a vital role in understanding mechanics inter intra observer variability and strict dependence
of heart failure.Decreased LS but preserved apical on frame rate[7]
rotation mechanics and variable CS and RS are the
hallmark Heart failure with preserved EF.When the These parameters are technically more challenging
HF syndrome progress from diastolic to systolic dys- and require further standardizations.Further stud-
function the LV torsion and peak untwisting rate are ies are required to assess the incremental value of
valso reduced.[12,4] strains acquired from 2D /3D datasets Prospective
clinical trials for validation of this technique in large
populations are still lacking.
6.Dilated Cardiomyopathy
DCM has shown impairement of all three strains(LS Conclusion
,CS and RS) and also decrease in apical twist and
untwisting velocity. Strain imaging is an innovative technique for objec-
tively quantifying myocardial mechanics. Quantifica-
7.Stress Cardiomyopathy tion of LS,RS,CS allows an accurate and reproducible
assessment of segmental and global LV/RV function.
It is a form of reversible LV systolic dysfunction with LS has been found to be the most useful and easy
transient apical ballooning.Here STE shows reduction parameter obtained from apical views.
in various strains extendind beyond any single arteri-
al territory,also with reduced peak systolic strain and STE is more comprehensive, feasible and reproduc-
strain rate in apical and basal regions differentiating ible.
Stress Cardiomyopathy from ACS. Echocardiography is currently the most widely used
method in the assessment of ventricular function.
Advantages of Strain,Strain rate imaging Besides the traditional methods, , newer techniques

Deformation imaging techniques (SR and S) have should be introduced in clinical routine .Strain ,Strain
some important advantages over the standard ECHO rate imaging is thus one amoung the best investiga-
techniques. The main benefit of regional S and SR tion in early detection of LV dysfunction There is no
lies in the rapid and objective detection of regions single ideal technique or parameter for this purpose,
with delayed or decreased deformation, while for tra- so the combination of several of the other parame-
ditional echocardiographic methods, one has to de- ters is also necessary in order to have more compre-
pend on subjective assessment for this information. hensive information about different aspects of heart
function in different clinical settings
Another advantage of this technique is its indepen-
dence of ventricular geometry,therefore, it is suitable

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