A Practical Approach to Using Strain Echocardiography to Evaluate the Left Ventricle

Left ventricular (LV) evaluation is the most important use of echocardiography. Speckle tracking strain echocardiography (SE) provides a quantitative regional and global LV assessment, is an independent supplement to wall motion analysis and has been validated over the past 10 years. Despite these facts, SE is not being used routinely, especially in the United States. SE can generate longitudinal, radial, and circumferential strain measurements and LV twist. Although intriguing and potentially useful, these measurements also are confusing, complicated, time consuming, and frequently displayed as difficult-to-interpret wave forms. A pragmatic approach to SE simplifies the suggested method for strain calculation to reduce the time required and enhance reproducibility. With this modification the strain calculations take only 2-4 min. The yield is >80% in all patients. Reproducibility is at least as good as ejection fraction. Longitudinal strain is the most sensitive and reproducible of the various strain measurements, so it is the only strain we record. For simplicity, systolic strain is displayed as a positive number. Lastly, we primarily use a bullseye presentation for peak systolic strain. Many clinical examples are illustrated. However, as with all tests, SE is not perfect; there are limitations and potential false positives, but a practical approach to SE eventually should help make it a part of all echocardiographic examinations.