Beginner’s Guide to Strain:
What should be in your lab in 2018
Bonita Anderson
DMU (Cardiac), MApplSc (Med Ultrasound), ACS, AMS, FASE
Disclosures
None
Calculation of Strain
Strain can be Positive
Strain can be Negative
Caveat #1: Variability
“
Because of intervendor and intersoftware
variability …… serial assessment of GLS in
individual patients should be performed
using the same vendor’s equipment and the
same software
Lang RM, et al. J Am Soc Echocardiogr 2015;28:1-39
Caveat #2: Normal Values
GLS
Lang RM, et al. J Am Soc Echocardiogr 2015;28:1-39
Caveat #2: Normal Values
“
….. peak GLS in the range of -20% can be expected
in a healthy person, and the lower the absolute
value of strain is below this value, the more likely
it is to be abnormal
Lang RM, et al. J Am Soc Echocardiogr 2015;28:1-39
Caveat #3: Image Quality
Caveat #3: Image Quality
“
When regional tracking is suboptimal in
more than two myocardial segments in a
single view, the calculation of GLS should
be avoided
Lang RM, et al. J Am Soc Echocardiogr 2015;28:1-39
Caveat #4: Learning Curve
Chan J, et al. J Am Soc Echocardiogr 2017; 11:1081-1090
Caveat #4: Learning Curve
“
There is a significant learning curve
associated with LV strain analysis.
We recommend a minimum of 50 studies for
training to achieve competency in GLS
analysis
Chan J, et al. J Am Soc Echocardiogr 2017; 11:1081-1090
GLS Differentiates LVH Aetiology
Athlete’s Heart Hypertensive Heart Hypertrophic CM
GLS normal or increased GLS mildly decreased GLS severely decreased
Afonso L, ….. Abraham TP. BMJ Open 2012;2:e001390
References & Further Reading
Anderson B. Chapter 14: Doppler Assessment of Ventricular Systolic Function. Pages: 287‐294. In Echocardiography: The
Normal Examination and Echocardiographic Measurements. 3rd edition. Echotext, Australia. 2017.
Blessberger H, Binder T. NON-invasive imaging: Two dimensional speckle tracking echocardiography: basic principles.
Heart. 2010 May;96(9):716-22
Blessberger H, Binder T. Two dimensional speckle tracking echocardiography: clinical applications. Heart. 2010
Dec;96(24):2032‐40.
Chan J, et al. Left Ventricular Global Strain Analysis by Two-Dimensional Speckle-Tracking Echocardiography: The Learning
Curve. J Am Soc Echocardiogr. 2017 Nov;30(11):1081-1090.
Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography. J Am Coll
Cardiol. 2017 Feb 28;69(8):1043-1056.
Farsalinos KE, Daraban AM, Ünlü S, Thomas JD, Badano LP, Voigt JU. Head‐to‐Head Comparison of Global Longitudinal
Strain Measurements among Nine Different Vendors: The EACVI/ASE Inter‐Vendor Comparison Study. J Am Soc
Echocardiogr. 2015 Oct;28(10):1171‐1181, e2
Lang RM, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the
American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr
2015;28:1-39
References & Further Reading
Mirea O, Duchenne J, Voigt JU. Recent advances in echocardiography: strain and strain rate imaging. F1000Res. 2016 Apr
29;5. pii: F1000 Faculty Rev-787.
Mor‐Avi V, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics:
ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am
Soc Echocardiogr. 2011 Mar;24(3):277‐313
Negishi K, et al. Practical guidance in echocardiographic assessment of global longitudinal strain. JACC Cardiovasc Imaging.
2015 Apr;8(4):489-492
Plana JC, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a
report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc
Echocardiogr. 2014 Sep;27(9):911‐39
Voigt JU, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the
EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015 Jan;16(1):1‐11
Yamada A, et al. Reproducibility of regional and global longitudinal strains derived from two‐dimensional speckle‐tracking
and doppler tissue imaging between expert and novice readers during quantitative dobutamine stress echocardiography. J
Am Soc Echocardiogr. 2014 Aug;27(8):880‐7.
EACVI free webinar: How and why to measure LV myocardial strain:
https://www.youtube.com/watch?v=ipmZXGF9HT4&feature=youtu.be
