Strain imaging – from Scandinavian research to global deployment

Figures & data

Figure 1. Speckle tracking strain analysis from day 1 after STEMI with culprit lesion in the left anterior descending coronary artery, displaying (A) peak systolic longitudinal strain in the apical long-axis view of −8.7%, (B) peak systolic longitudinal strain in the four-chamber view of −10.0%, (C) peak systolic longitudinal strain in the two-chamber view of −11.8%, and (D) the corresponding strain map with systolic strain values provided in each myocardial segment and with a parametric code, with strong red colors representing systolic shortening and blue colors depicting systolic lengthening of a segment. GLS was 10.2% in this patient. With permission from: Munk et al.[18]

Figure 2. Example of strain curves from the apical long-axis view, from a patient with an occluded left circumflex artery at baseline. Substantial post-systolic shortening is observed in the basal- and mid-inferolateral segments (yellow and cyan traces). After successful revascularization, normal systolic function is observed in the same segments at follow-up. With permission from: Eek et al.[23]

Figure 3. Strain curves from a patient with significant coronary artery stenosis (A). Strain curves from an individual without coronary artery disease (B). With permission from: Smedsrud et al.[24]

Figure 4. Left panel shows time to peak strain in an HCM patient without ventricular arrhythmias. Mechanical dispersion is 50 ms. Right panel shows time to peak strain in an HCM patient with ventricular arrhythmias. Mechanical dispersion is pronounced with 90 ms. With permission from: Haland et al.[30]

Figure 5. Mechanical dispersion in a healthy individual (left panel), an asymptomatic mutation carrier (mid panel) and an arrhythmogenic right ventricular cardiomyopathy patient with recurrent arrhythmias (right panel). Horizontal white arrow indicates contraction duration defined as the time from onset R to maximum myocardial shortening. Vertical arrows indicate the timing of maximum myocardial shortening in each segment. Right panel shows more pronounced mechanical dispersion. Modified from Sarvari et al.[16]

Figure 6. Kaplan–Meier analyses showing unfavorable outcome in CRT patients with dyssynchrony after CRT implantation. With permission from: Haugaa et al.[39]

Figure 7. The automatic strain analysis in a patient with non-ST-segment elevation acute coronary syndrome with occluded circumflex (CX) artery in apical four-chamber view shows reduced color-coded endocardial strain values in the segments supplied by the CX artery on the left. The red line and the red arrowheads depict the border of the epicardium. Color-coding from yellow to green indicates strain from +30% to –30%. Yellow indicates preserved strain. Brown indicates areas with reduced strain. Strain curves for the six endocardial segments are displayed on the right. The curves representing the segments supplied by the CX artery show reduced strain values of –15% to –17% (white arrow). Endocardial global longitudinal strain was reduced in this patient to –15%. With permission from: Sarvari et al.[42].

Munk K, Andersen NH, Terkelsen CJ, et al. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention. J Am Soc Echocardiogr. 2012;25:644–651.

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Eek C, Grenne B, Brunvand H, et al. Postsystolic shortening is a strong predictor of recovery of systolic function in patients with non-ST-elevation myocardial infarction. Eur J Echocardiogr. 2011;12:483–489.

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Smedsrud MK, Sarvari S, Haugaa KH, et al. Duration of myocardial early systolic lengthening predicts the presence of significant coronary artery disease. J Am Coll Cardiol. 2012;60:1086–1093.

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Haland TF, Almaas VM, Hasselberg NE, et al. Strain echocardiography is related to fibrosis and ventricular arrhythmias in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imag. 2016;17:613–621.

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Sarvari SI, Haugaa KH, Anfinsen OG, et al. Right ventricular mechanical dispersion is related to malignant arrhythmias: a study of patients with arrhythmogenic right ventricular cardiomyopathy and subclinical right ventricular dysfunction. Eur Heart J. 2011;32:1089–1096.

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Haugaa KH, Marek JJ, Ahmed M, et al. Mechanical dyssynchrony after cardiac resynchronization therapy for severely symptomatic heart failure is associated with risk for ventricular arrhythmias. J Am Soc Echocardiogr. 2014;27:872–879.

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Sarvari SI, Haugaa KH, Zahid W, et al. Layer-specific quantification of myocardial deformation by strain echocardiography may reveal significant CAD in patients with non-ST-segment elevation acute coronary syndrome. JACC Cardiovasc Imag. 2013;6:535–544.

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