Myocardial strain imaging: how useful is it in clinical decision making?

Eur Heart J. 2016 Apr 14;37(15):1196-207. doi: 10.1093/eurheartj/ehv529. Epub 2015 Oct 27.


Myocardial strain is a principle for quantification of left ventricular (LV) function which is now feasible with speckle-tracking echocardiography. The best evaluated strain parameter is global longitudinal strain (GLS) which is more sensitive than left ventricular ejection fraction (LVEF) as a measure of systolic function, and may be used to identify sub-clinical LV dysfunction in cardiomyopathies. Furthermore, GLS is recommended as routine measurement in patients undergoing chemotherapy to detect reduction in LV function prior to fall in LVEF. Intersegmental variability in timing of peak myocardial strain has been proposed as predictor of risk of ventricular arrhythmias. Strain imaging may be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. Strain may also be used to diagnose myocardial ischaemia, but the technology is not sufficiently standardized to be recommended as a general tool for this purpose. Peak systolic left atrial strain is a promising supplementary index of LV filling pressure. The strain imaging methodology is still undergoing development, and further clinical trials are needed to determine if clinical decisions based on strain imaging result in better outcome. With this important limitation in mind, strain may be applied clinically as a supplementary diagnostic method.

Keywords: Cardiomyopathy; Chemotherapy; Heart failure; Hypertrophic cardiomyopathy; Left atrial strain; Left ventricular function; Strain imaging; Ventricular arrhythmia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antineoplastic Agents / adverse effects
  • Cardiac Imaging Techniques / methods*
  • Cardiac Resynchronization Therapy
  • Cardiomyopathies / diagnostic imaging
  • Clinical Decision-Making / methods*
  • Coronary Artery Disease / diagnostic imaging
  • Heart Failure / diagnostic imaging
  • Heart Valve Diseases / diagnostic imaging
  • Humans
  • Myocardial Ischemia / diagnostic imaging
  • Observer Variation
  • Patient Selection
  • Prognosis
  • Risk Assessment / methods
  • Stroke Volume / physiology
  • Ventricular Dysfunction, Left / diagnostic imaging


  • Antineoplastic Agents