Wall Motion Tracking and Activation Imaging – Latest Developments and Applications for Patients with Heart Failure

Wall motion tracking is a relatively new tool to define regional and global wall motion, ventricular volumes and ejection fraction. Speckle-tracking echocardiography (STE) allows the calculation of a variety of myocardial function indices – including longitudinal, radial, transverse and circumferential strain, strain rate, displacement, velocity and rotation (twist and torsion) – not only as a 2D application, but also in 3D. In patients with heart failure and cardiac dyssynchrony, there remains a lack of optimal management regarding decisions to implant a cardiac resynchronisation therapy device. Many decisions are made based on data from electrocardiography. Whereas conventional echocardiographic techniques are of limited value in defining mechanical dyssynchrony, newer developments, such as 2D and 3D speckle tracking, have been shown to have significant potential to define the latest site of mechanical activation. Recent 3D STE innovations, including activation imaging, 3D strain and area tracking, open new doors to the definition of segmental delay of mechanical deformation related to time. There is considerable optimism that 3D techniques will improve the present understanding and treatment of patients with cardiac dyssynchrony.