Myocardial Strain Assessment in Echocardiography

Myocardial strain assessment by echocardiography has revolutionised the evaluation of ventricular function by quantifying the deformation of cardiac muscle during the cardiac cycle. Unlike traditional measures of systolic performance, such as ejection fraction, strain imaging detects subtle alterations in myocardial contractility and provides both global and regional indices of myocardial health. Two-dimensional speckle-tracking echocardiography traces natural acoustic markers within the myocardium, yielding quantitative measures of longitudinal, circumferential and radial deformation. Advances in software algorithms now allow layer-specific analysis of the endocardium, mid-myocardium and epicardium, while polar “bull’s-eye” plots facilitate rapid visualisation of segmental mechanics. This technique has proven valuable in the early detection of cardiotoxicity, assessment of ischaemic injury, stratification of heart failure phenotypes and evaluation of valvular heart disease. Age, sex and loading conditions influence normal strain values, prompting the establishment of robust reference ranges. The global longitudinal strain (GLS) parameter in particular has attained broad clinical acceptance as a sensitive marker of subclinical left ventricular dysfunction and a predictor of outcomes across diverse cardiovascular disorders.

Research from Nature Portfolio

Multilayer assessment of myocardial deformation by feature-tracking cardiac magnetic resonance has underscored the physiological gradient in strain from the subendocardium to the subepicardium and its progressive attenuation across the spectrum of heart failure. In a cohort spanning preserved, mid-range and reduced ejection fraction phenotypes, endocardial global longitudinal strain showed the greatest absolute values and the earliest decline with worsening systolic function. Circumferential strain exhibited a similar transmural pattern but was less sensitive at normal ejection fraction. These findings highlight the predominance of subendocardial dysfunction in early disease and support the translation of layer-specific deformation analysis into echocardiographic practice.

Myocardial Strain Assessment in Echocardiography publication trend

The graph below shows the total number of articles in myocardial strain assessment in echocardiography across all publications each year (not limited to Nature Index journals).

Technical terms

Global Longitudinal Strain (GLS): Quantitative measure of myocardial shortening along the long axis, expressed as a negative percentage.

Speckle-Tracking Echocardiography (STE): Ultrasound technique that tracks natural acoustic “speckles” within the myocardium to calculate deformation parameters.

Global Circumferential Strain (GCS): Quantitative measure of myocardial shortening around the ventricular circumference during systole.

Strain Rate: Speed of myocardial deformation over time, expressed in s⁻¹, reflecting contractile velocity.

Subendocardial layer: Inner myocardial region adjacent to the ventricular cavity, often the earliest site of ischaemic or loading-induced injury.

References

1. Ten Years of 2D Longitudinal Strain for Early Myocardial Dysfunction Detection: A Clinical Overview. BioMed Research International (2018).
2. Normal range of myocardial layer-specific strain using two-dimensional speckle tracking echocardiography. PLOS ONE (2017).
3. Echocardiographic Reference Ranges of Global Longitudinal Strain for All Cardiac Chambers Using Guideline-Directed Dedicated Views. JACC Cardiovascular Imaging (2023).
4. Myocardial dysfunction assessed by speckle-tracking in good-grade subarachnoid hemorrhage patients (WFNS 1–2): a prospective observational study. Critical Care (2023).
5. Effect of Experience and Training on the Concordance and Precision of Strain Measurements. JACC Cardiovascular Imaging (2016).
6. Range Variability in CMR Feature Tracking Multilayer Strain across Different Stages of Heart Failure. Scientific Reports (2019).