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J Am Coll Cardiol, 2006; 47:1313-1327, doi:10.1016/j.jacc.2005.11.063 (Published online 14 March 2006).
© 2006 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Measurement of Strain and Strain Rate by Echocardiography

Ready for Prime Time?

Thomas H. Marwick, MD, PhD*

University of Queensland Department of Medicine, Princess Alexandra Hospital, Brisbane, Australia.

Manuscript received August 8, 2005; revised manuscript received November 21, 2005, accepted November 22, 2005.

* Reprint requests and correspondence: Dr. Thomas H. Marwick, University of Queensland Department of Medicine, Princess Alexandra Hospital, Brisbane, Qld 4102, Australia. (Email: tmarwick{at}soms.uq.edu.au).

Strain and strain rate (SR) are measures of deformation that are basic descriptors of both the nature and the function of cardiac tissue. These properties may now be measured using either Doppler or two-dimensional ultrasound techniques. Although these measurements are feasible in routine clinical echocardiography, their acquisition and analysis nonetheless presents a number of technical challenges and complexities. Echocardiographic strain and SR imaging has been applied to the assessment of resting ventricular function, the assessment of myocardial viability using low-dose dobutamine infusion, and stress testing for ischemia. Resting function assessment has been applied in both the left and the right ventricles, and may prove particularly valuable for identifying myocardial diseases and following up the treatment response. Although the evidence base is limited, SR imaging seems to be feasible and effective for the assessment of myocardial viability. The use of the technique for the detection of ischemia during stress echocardiography is technically challenging and likely to evolve further. The clinical availability of strain and SR measurement may offer a solution to the ongoing need for quantification of regional and global cardiac function. Nonetheless, these techniques are susceptible to artifact, and further technical development is necessary.

Abbreviations and Acronyms
  2D = two-dimensional
  LV = left ventricle/ventricular
  RV = right ventricle/ventricular
  SR = strain rate
  SRI = strain rate image/imaging




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