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Updated: Jun 12, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Optimization of myocardial strain imaging and speckle tracking for resynchronization after congenital heart surgery
Erin Madriago1, David J Sahn, Seshadri Balaji
1Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health and Science University, Portland, OR 97239, USA.
Insights
Speckle tracking strain analysis offers a promising method for optimizing cardiac resynchronization therapy in pediatric heart failure patients. This technique allows for live, on-site adjustments, improving cardiac function effectively.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Echocardiography
Background:
- Cardiac resynchronization therapy (CRT) improves cardiac function in pediatric heart failure.
- Optimal methods for assessing dyssynchrony in children are not well-established.
- Tissue Doppler imaging, including strain and speckle tracking, shows potential for CRT optimization.
Purpose of the Study:
- To evaluate the efficacy of speckle tracking strain analysis for optimizing CRT in pediatric patients.
- To determine if live, on-site optimization of CRT is feasible in children.
Main Methods:
- Case study of two pediatric patients with complex congenital heart disease and heart block post-surgery.
- Conventional epicardial pacing led to heart failure; CRT was initiated.
- Speckle tracking strain analysis was used to adjust ventriculo-ventricular delay for optimal synchrony.
Main Results:
- CRT optimization using speckle tracking strain analysis led to normalization of cardiac function in both patients.
- Patient 1 achieved optimal synchrony with LV preceding RV by 30 ms.
- Patient 2 achieved optimal synchrony with RV preceding LV by 20 ms.
- Optimization was successfully performed live, without the need for offline analysis.
Conclusions:
- Speckle tracking strain analysis is a successful tool for live, on-site optimization of CRT in children.
- This technique can effectively improve cardiac function in pediatric patients requiring CRT.
- Further research is warranted to refine this optimization process.
Abstract:
Cardiac resynchronization therapy can improve cardiac function in children with heart failure. The optimal method of assessing dyssynchrony has not been established. Newer tissue Doppler techniques such as strain assessment and speckle tracking appear to be promising for optimization of resynchronization. Two children aged 7 weeks and 4 months, with transposition of the great arteries and ventricular septal defect, and double outlet right ventricle with pulmonary stenosis, developed heart block after surgery. Conventional epicardial pacing resulted in heart failure in both. Upgrade to cardiac resynchronization therapy was not associated with normalization of function by echo, necessitating optimization. Baseline ventriculo-ventricular delay was 4 ms. Speckle tracking strain assessment was performed while adjusting ventriculo-ventricular delay. In Patient 1, synchrony was best with left ventricular (LV) activation preceding right ventricular (RV) by 30 ms. In Patient 2, it was best with RV preceding LV by 20 ms. At follow-up, both patients had normalization of function. In each case, optimization and reprogramming could be done live with no need for offline analysis. Speckle tracking strain analysis appears to be successful in the live, on-site optimization of cardiac resynchronization therapy in children. Further studies may help refine this process further.
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