Today, I review, link to, and excerpt from Speckle-Tracking Strain Echocardiography for the Assessment of Left Ventricular Structure and Function: A Scientific Statement From the American Heart Association [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Circulation. 2025 Sep 9;152(10):e96-e109. doi: 10.1161/CIR.0000000000001354. Epub 2025 Aug 6.
All that follows is from the above resource.
Abstract
Assessment of left ventricular systolic function is essential for diagnosing and managing cardiac diseases and provides important prognostic information to the treating clinician. However, traditional methods for assessing left ventricular systolic function such as ejection fraction are limited by their reliance on geometric assumptions, subjective reader interpretation, sensitivity to loading conditions and volume, and reflection of a single plane of motion. In addition to interobserver and intraobserver variability and technical confounders, this evaluation is complicated by the complex 3-dimensional organization of the myocardial fibers, which are oriented longitudinally in the subendocardium, transversely in the midmyocardium, and obliquely in the subepicardium. Conversely, 2-dimensional speckle-tracking echocardiography measures left ventricular deformation as myocardial strain in the 3 planes of chamber motion: longitudinal, circumferential, and radial. From a clinical perspective, left ventricular global longitudinal strain offers superior diagnostic and prognostic value across the spectrum of cardiovascular disorders compared with ejection fraction, is highly reproducible, and detects subclinical dysfunction before the ejection fraction declines. Given the expanding clinical utility of speckle-tracking echocardiography and the incremental prognostic and therapeutic value of integrating global longitudinal strain into clinical practice as a potential biomarker, the objectives of this scientific statement are (1) to review the principles and technical aspects of speckle-tracking echocardiography strain imaging; (2) to provide a practical, evidence-based review of the application of speckle-tracking echocardiography in heart failure, cardiomyopathies, ischemic heart disease, valvular disease, and cardio-oncology; (3) to explore the potential utility of speckle-tracking echocardiography in cardiac resynchronization and implantable cardioverter defibrillator therapy; and (4) to outline the future directions of speckle-tracking echocardiography.
Assessing left ventricular (LV) systolic function is essential for diagnosing and managing cardiac diseases. The complex 3-dimensional organization of the myocardial fibers of the heart, which are arranged in a helical and perpendicular orientation, enables efficient “wringing-like” ejection, complicating traditional assessment. Fiber orientation varies throughout the myocardial wall, being longitudinal in the subendocardium, transverse in the midmyocardium, and oblique in the subepicardium.1 Traditional methods for assessing LV systolic function such as LV ejection fraction (LVEF) are limited by their reliance on LV geometric assumptions, subjective reader interpretation, sensitivity to loading conditions and volume, and the fact that they primarily reflect a single plane of LV motion.1In contrast, 2-dimensional speckle-tracking echocardiography (STE) measures myocardial strain, which assesses myocardial deformation during contraction and relaxation in the aforementioned longitudinal, circumferential, and radial planes and is expressed as a percentage change in myocardial length during the cardiac cycle. More specifically, LV global longitudinal strain (GLS) offers superior diagnostic and prognostic value across the spectrum of cardiovascular disorders compared with LVEF and is used in clinical practice for its sensitivity in detecting subclinical LV dysfunction often before LVEF declines.2 The strengths of GLS by STE include its angle independence, sampling of all LV wall segments in a given view, high feasibility and reproducibility, and excellent spatial resolution.1,3Joint statements were issued to standardize strain imaging with STE, aiming to reduce variability and to improve its clinical application.3,4 In addition, recommendations for cardiac chamber quantification outlined best practices for measurement and reporting of strain.5 Given the expanding clinical utility of STE and the incremental prognostic and therapeutic value of integrating GLS into clinical practice as a potential biomarker, the objectives of this scientific statement are (1) to review the principles and technical aspects of STE strain imaging; (2) to provide a practical, evidence-based review of the application of STE in heart failure (HF), cardiomyopathies, ischemic heart disease, valvular disease, and cardio-oncology; (3) to explore the potential utility of STE in cardiac resynchronization and implantable cardioverter defibrillator therapy; and (4) to outline the future directions of STE.Principles and Technical Considerations
Overview of LV Anatomy, Deformation, and Mechanics
