A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography

Strain-based imaging techniques (and specifically speckle-tracking echocardiography) have been shown to have clinical utility in a variety of settings. This technique is being embraced and increasingly adopted in many echocardiography laboratories worldwide. This review appraised speckle-tracking echocardiography in a clinical context by providing a critical evaluation of the prognostic and diagnostic insights that this technology can provide. In particular, we discuss the use of speckle-tracking strain in selected areas, such as undifferentiated left ventricular hypertrophy, cardio-oncology, aortic stenosis, and ischemic heart disease. The potential utility of regional and chamber strains (namely segmental left ventricular strain, left atrial strain, and right ventricular strain) are also discussed. Future directions for this technology are explored. Before its clinical application, it is particularly important that physicians be cognizant of the technical challenges and inherent limitations of strain data, which are also addressed here.