Clinical applications and prognostic implications of strain and strain rate imaging

Strain and strain rate imaging (also known as deformation imaging) are techniques used to measure myocardial deformation. These newer echocardiographic modalities overcome the limitations of conventional echocardiography and provide a sensitive means of objectively quantifying regional and global myocardial function. It has enabled us to better understand regional myocardial function and risk stratify patients with coronary artery disease, cardiomyopathies and valvular heart disease. Also, they have been used to assess left ventricular dyssynchrony, predict responders and optimize cardiac resynchronization therapy. However, the lack of standardization and inter-vendor variability in measurements are major roadblocks to using deformation imaging in routine clinical practice. This article discusses the fundamental concept of deformation, in particular relating to strain and strain rate imaging using speckle tracking imaging and tissue Doppler imaging, the clinical applications and its prognostic implications.