Cardiac Shear Wave Elastography: Principles, Clinical Applications, and Practical Considerations for Interpretation.

Area of Science:

• Cardiovascular Imaging
• Ultrasound Technology
• Myocardial Mechanics

Background:

• Cardiac shear wave elastography (SWE) is an emerging ultrasound technique.
• It assesses myocardial mechanical properties beyond traditional methods.
• SWE tracks shear wave propagation for stiffness information.

Purpose of the Study:

• To review the principles and clinical evidence of cardiac SWE.
• To discuss its applications in various cardiac conditions.
• To highlight limitations and future directions for clinical adoption.

Main Methods:

• Narrative review of methodological principles.
• Discussion of acoustic radiation force-induced and natural shear wave imaging.
• Inclusion of emerging 3D SWE techniques.

Main Results:

• Cardiac SWE shows potential in hypertrophic cardiomyopathy, amyloidosis, heart failure with preserved ejection fraction, and myocardial injury.
• Measurements are context-dependent (phase, loading, anisotropy).
• SWE reflects stiffness-related behavior, not direct fibrosis measures.

Conclusions:

• Cardiac SWE is a promising research-stage tool for myocardial mechanics assessment.
• Further standardization, validation, and multicenter studies are essential.
• Clinical interpretation requires careful consideration of influencing factors.