Strain Imaging in Cardio-Oncology

JACC CardioOncol. 2020 Dec 15;2(5):677-689. doi: 10.1016/j.jaccao.2020.10.011. eCollection 2020 Dec.


Echocardiographic imaging is crucial for patient management during cardiotoxic cancer therapy. Left ventricular ejection fraction is the most commonly used parameter for identifying left ventricular dysfunction. However, it lacks sensitivity to detect subclinical changes in cardiac function due to cardiotoxic treatment. Global longitudinal strain (GLS) is the best studied strain parameter with established diagnostic and prognostic value. Multiple studies have demonstrated changes in GLS as an early marker of cardiotoxicity. This document serves as a primer to help clinicians in the acquisition and interpretation of strain in cardio-oncology. Cases with embedded videos illustrate a step-by-step approach to obtaining GLS measurements and common pitfalls to avoid. The document includes a concise summary of the indications of GLS in cardio-oncology and its role in guiding oncological therapy. Practical approaches on how to implement strain in the echo laboratory with guidance on training and quality assurance are also discussed.

Keywords: 2D, 2-dimensional; 3D, 3-dimensional; ACC, American College of Cardiology; AL, amyloid light chains; ASE, American Society of Echocardiography; CMRI, cardiac magnetic resonance imaging; CTRCD, cancer treatment–related cardiac dysfunction; DICOM, Digital Imaging and Communications in Medicine; EACVI, European Association of Cardiovascular Imaging; GLS, global longitudinal strain; LV, left ventricle; LVEF, left ventricular ejection fraction; ROI, region of interest; STE, speckle tracking echocardiography; VEGF, vascular endothelium growth factor; cancer; cardiotoxicity; echocardiography; global longitudinal strain; left ventricular function.

Publication types

  • Review