Two-dimensional strain imaging: a new echocardiographic advance with research and clinical applications

Over the past two decades the quest for quantitative evaluation of left ventricular function and regional wall motion has escalated, allowing several aspects of myocardial contractile patterns to be quantified, both during stress echocardiography and in the assessment of dyssynchrony. Most of the literature to date has used Tissue Doppler Imaging (TDI) techniques to assess essentially long-axis function due to the angle dependency of Doppler based techniques. This brief review introduces the early development, validation and potential clinical applications of a new technique of quantifying two-dimensional (radial and circumferential) strains and strain rates through tracking myocardial "speckles". In-vivo and in-vitro validation of this 2D-strain imaging technique has been undertaken and reached a point where it is considered ready for more widespread investigations into clinical utility. One important advantage over TDI techniques is that it is not limited by dependency on the angle of insonation. Several recent studies looking at ventricular function in specific groups of patients have reported practical ability to distinguish the abnormally from the normally contracting regions of ventricular walls. It provides new and complementary quantitative information about ventricular dyssynchrony and regional wall motion abnormalities. More research studies are needed to determine the sensitivity and specificity of the measurements obtained using this technique and define its strengths and limitations. In particular, whether the measured values correlate well with clinical outcomes will need to be established in longitudinal interventional studies. The clinical utilities of this technique over the coming years are likely to expand rapidly.