New Insights in Strain Mechanics (LA, RA, and RV)

Purpose of Review The purpose of this paper is to review the current status and literature surrounding left atrial, right atrial, and right ventricular strain. Recent Findings Advancements in chamber-specific strain software and taskforce consensus statements have helped overcome the previous limitations of reproducibility and inter-vendor variability. Strain has increasing utility due to its superior diagnostic sensitivity and independent prognostic value over traditional imaging assessments in a range of clinical conditions. Summary The use of strain as a reliable and reproducible marker of cardiac function is most widely accepted in the assessment of left ventricular global longitudinal strain (GLS). However, strain can also be assessed in other cardiac chambers (left atrium (LA), right ventricle (RV), and right atrium (RA)). Consolidation and refinement of strain assessments in these other chambers have been achieved by chamber-specific software and uniform approaches to measurements. Strain accounts for the complex anatomy and physiology of these chambers and therefore holds sensitive diagnostic capacity. Current clinical applications are mainly in prognostication however utility is expanding specifically in LA strain, to identify and manage occult atrial fibrillation and in estimation of LV filling pressures. Further research is required to determine a universal approach in RV strain measurements and to improve technical capabilities in RA strain assessment.