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.
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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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|
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|
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|
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|
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|
 |
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|
 |

|
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|
 |
|

|
 |

|
 |
 
L. Banks, Z. Sasson, M. Busato, and J. M. Goodman
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108(1):
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[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. P. Anstadt, S. Budharaju, R. J. Darner, B. A. Schmitt, L. J. Prochaska, A. J. Pothoulakis, and P. M. Portner
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88(6):
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[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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Eur Heart J Cardiovasc Imaging,
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10(8):
iii9 - iii14.
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[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. E. Sharman, J. E. Davies, C. Jenkins, and T. H. Marwick
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November 1, 2009;
54(5):
1099 - 1105.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. E. Sharman, J. Brown, D. J. Holland, G. Macdonald, K. Kostner, and T. H. Marwick
Influence of Altered Blood Rheology on Ventricular-Vascular Response to Exercise
Hypertension,
November 1, 2009;
54(5):
1092 - 1098.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. Oxborough, A. M. Batterham, R. Shave, N. Artis, K. M. Birch, G. Whyte, P. N. Ainslie, and K. P. George
Interpretation of two-dimensional and tissue Doppler-derived strain ({varepsilon}) and strain rate data: is there a need to normalize for individual variability in left ventricular morphology?
Eur Heart J Cardiovasc Imaging,
July 1, 2009;
10(5):
677 - 682.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. H. Marwick
The future of echocardiography
Eur Heart J Cardiovasc Imaging,
July 1, 2009;
10(5):
594 - 601.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. H. Marwick and J. Narula
The Growth and Growth of Cardiac Ultrasound for the Evaluation of Myocardial Function
J. Am. Coll. Cardiol. Img.,
June 1, 2009;
2(6):
790 - 792.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. M. Hawkins, M. C. Petrie, M. I. Burgess, and J. J.V. McMurray
Selecting Patients for Cardiac Resynchronization Therapy: The Fallacy of Echocardiographic Dyssynchrony
J. Am. Coll. Cardiol.,
May 26, 2009;
53(21):
1944 - 1959.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. Hassan, M. Salem, and M. Sayed
Doping and effects of anabolic androgenic steroids on the heart: histological, ultrastructural, and echocardiographic assessment in strength athletes
Human and Experimental Toxicology,
May 1, 2009;
28(5):
273 - 283.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
T. Abraham, D. Kass, G. Tonti, G. F. Tomassoni, W. T. Abraham, J. J. Bax, and T. H. Marwick
Imaging Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol. Img.,
April 1, 2009;
2(4):
486 - 497.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. Wang and S. F. Nagueh
Current Perspectives on Cardiac Function in Patients With Diastolic Heart Failure
Circulation,
March 3, 2009;
119(8):
1146 - 1157.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. H. Amundsen, J. Crosby, P. A. Steen, H. Torp, S. A. Slordahl, and A. Stoylen
Regional myocardial long-axis strain and strain rate measured by different tissue Doppler and speckle tracking echocardiography methods: a comparison with tagged magnetic resonance imaging
Eur Heart J Cardiovasc Imaging,
March 1, 2009;
10(2):
229 - 237.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. George, R. Shave, D. Oxborough, T. Cable, E. Dawson, N. Artis, D. Gaze, T. Hew-Butler, K. Sharwood, and T. Noakes
Left ventricular wall segment motion after ultra-endurance exercise in humans assessed by myocardial speckle tracking
Eur Heart J Cardiovasc Imaging,
March 1, 2009;
10(2):
238 - 243.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
I. Kronzon
PRO: Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists' Armamentarium
Anesth. Analg.,
January 1, 2009;
108(1):
37 - 40.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. Skubas
Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists' Armamentarium: A Core Review
Anesth. Analg.,
January 1, 2009;
108(1):
48 - 66.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. Donal, C. De Place, G. Kervio, F. Bauer, R. Gervais, C. Leclercq, P. Mabo, and J.-C. Daubert
Mitral regurgitation in dilated cardiomyopathy: value of both regional left ventricular contractility and dyssynchrony
Eur Heart J Cardiovasc Imaging,
January 1, 2009;
10(1):
133 - 138.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. C. Afonso, J. Bernal, J. J. Bax, and T. P. Abraham
Echocardiography in hypertrophic cardiomyopathy: the role of conventional and emerging technologies.
J. Am. Coll. Cardiol. Img.,
November 1, 2008;
1(6):
787 - 800.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. Kosmala, T. M. O'Moore-Sullivan, R. Plaksej, J. Kuliczkowska-Plaksej, M. Przewlocka-Kosmala, and T. H. Marwick
Subclinical Impairment of Left Ventricular Function in Young Obese Women: Contributions of Polycystic Ovary Disease and Insulin Resistance
J. Clin. Endocrinol. Metab.,
October 1, 2008;
93(10):
3748 - 3754.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. H. Marwick and M. Schwaiger
The Future of Cardiovascular Imaging in the Diagnosis and Management of Heart Failure, Part 2: Clinical Applications
Circ Cardiovasc Imaging,
September 1, 2008;
1(2):
162 - 170.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. Kuznetsova, L. Herbots, T. Richart, J. D'hooge, L. Thijs, R. H. Fagard, M.-C. Herregods, and J. A. Staessen
Left ventricular strain and strain rate in a general population
Eur. Heart J.,
August 2, 2008;
29(16):
2014 - 2023.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N R Van de Veire, J De Sutter, J J Bax, and J R T C Roelandt
Technological advances in tissue Doppler imaging echocardiography
Heart,
August 1, 2008;
94(8):
1065 - 1074.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R S Gabriel, A J Kerr, V Sharma, I S L Zeng, and R A H Stewart
B-type natriuretic peptide and left ventricular dysfunction on exercise echocardiography in patients with chronic aortic regurgitation
Heart,
July 1, 2008;
94(7):
897 - 902.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Batterham, R. Shave, D. Oxborough, G. Whyte, and K. George
Longitudinal plane colour tissue-Doppler myocardial velocities and their association with left ventricular length, volume, and mass in humans
Eur Heart J Cardiovasc Imaging,
July 1, 2008;
9(4):
542 - 546.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. P. Abraham, V. L. Dimaano, and H.-Y. Liang
Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice
Circulation,
November 27, 2007;
116(22):
2597 - 2609.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. F Tops, E. E van der Wall, M. J Schalij, and J. J Bax
Multi-modality imaging to assess left atrial size, anatomy and function
Heart,
November 1, 2007;
93(11):
1461 - 1470.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. J. Kelly, Y. Zhang, K. Connelly, A. J. Cox, J. Martin, H. Krum, and R. E. Gilbert
Tranilast attenuates diastolic dysfunction and structural injury in experimental diabetic cardiomyopathy
Am J Physiol Heart Circ Physiol,
November 1, 2007;
293(5):
H2860 - H2869.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. Hanekom, G.-Y. Cho, R. Leano, L. Jeffriess, and T. H. Marwick
Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation
Eur. Heart J.,
July 2, 2007;
28(14):
1765 - 1772.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C.-M. Yu, J. E. Sanderson, T. H. Marwick, and J. K. Oh
Tissue Doppler Imaging: A New Prognosticator for Cardiovascular Diseases
J. Am. Coll. Cardiol.,
May 15, 2007;
49(19):
1903 - 1914.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. E. Sanderson
Systolic and Diastolic Ventricular Dyssynchrony in Systolic and Diastolic Heart Failure
J. Am. Coll. Cardiol.,
January 2, 2007;
49(1):
106 - 108.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Galderisi
Can Technical Limitations of Strain Rate Imaging Be Overtaken by Particular Arrangements?
J. Am. Coll. Cardiol.,
October 17, 2006;
48(8):
1729 - 1729.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. H. Marwick
Reply
J. Am. Coll. Cardiol.,
October 17, 2006;
48(8):
1729 - 1730.
[Full Text]
[PDF]
|
 |
|
|