Three-Dimensional Speckle Tracking Echocardiography in Cardiac Mechanics

Three-dimensional speckle tracking echocardiography (3DSTE) is a non-invasive imaging modality that employs full-volume datasets and automated tracking of natural acoustic markers to quantify myocardial deformation in all spatial directions. By analysing longitudinal, circumferential and radial components simultaneously, 3DSTE generates comprehensive parameters such as global longitudinal strain, global circumferential strain, global radial strain, area strain and principal strain. Rotational mechanics, including left ventricular twist and torsion, are also derived to assess the helical architecture and synchrony of contraction. Compared with two-dimensional techniques, 3DSTE overcomes through-plane motion artefacts and provides true volumetric quantification. Its high reproducibility and angle independence have led to reference ranges in healthy populations and demonstration of feasibility across diverse patient groups. Clinically, 3DSTE has proven sensitive in detecting subclinical dysfunction in heart failure with preserved ejection fraction, monitoring myocardial performance in overt heart failure, evaluating valvular and congenital disease and studying physiological adaptation in athletes. Ongoing technical advances aim to refine spatial and temporal resolution, reduce inter-vendor variability and integrate artificial intelligence for automated border detection. The global significance of 3DSTE lies in its potential to standardise cardiac mechanics assessment, support early diagnosis, guide therapy and improve risk stratification without radiation exposure or substantial workflow disruption.

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Three-Dimensional Speckle Tracking Echocardiography in Cardiac Mechanics publication trend

The graph below shows the total number of articles in three-dimensional speckle tracking echocardiography in cardiac mechanics across all publications each year (not limited to Nature Index journals).

Technical terms

Three-dimensional speckle tracking echocardiography (3DSTE): An ultrasound technique that tracks natural acoustic markers in three dimensions to quantify myocardial deformation.

Global longitudinal strain (GLS): The percentage change in myocardial length from base to apex during systole, reflecting longitudinal fibre function.

Global circumferential strain (GCS): The proportionate reduction in myocardial circumference at mid-ventricular level during contraction.

Global radial strain (GRS): The percentage thickening of the myocardium in the radial direction during systole.

Area strain: A composite parameter integrating longitudinal and circumferential deformation, representing change in myocardial surface area.

Principal strain: The maximal and minimal directional strains derived from three-dimensional deformation tensors, independent of pre-defined axes.

Twist and torsion: The wringing motion of the left ventricle, calculated as the net difference in rotation between apex and base, indicative of myocardial fibre architecture and synchrony.

References

1. Clinical Usefulness of Speckle-Tracking Echocardiography in Patients with Heart Failure with Preserved Ejection Fraction. Diagnostics (2023).
2. A review of current trends in three-dimensional analysis of left ventricular myocardial strain. Cardiovascular Ultrasound (2020).
3. Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure. Journal of Clinical Medicine (2022).
4. 3D Strain helps relating LV function to LV and structure in athletes. Cardiovascular Ultrasound (2014).
5. Dependence of Left Ventricular Rotational Mechanics on Left Atrial Volumes in Non-Smoker Healthy Adults: Analysis Based on the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study. Journal of Clinical Medicine (2023).