Beginner s Guide to Strain: What should be in your lab in Disclosures
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1 Beginner s Guide to Strain: What should be in your lab in 2018 Bonita Anderson DMU (Cardiac), MApplSc (Med Ultrasound), ACS, AMS, FASE None Disclosures
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3 Calculation of Strain Strain can be Positive
4 Strain can be Negative
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8 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
9 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
10 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:
11 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:
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13 GLS Differentiates LVH Aetiology Athlete s Heart GLS normal or increased Hypertensive Heart GLS mildly decreased Afonso L,.. Abraham TP. BMJ Open 2012;2:e Hypertrophic CM GLS severely decreased
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18 References & Further Reading Anderson B. Chapter 14: Doppler Assessment of Ventricular Systolic Function. Pages: In Echocardiography: The Normal Examination and Echocardiographic Measurements. 3rd edition. Echotext, Australia Blessberger H, Binder T. NON-invasive imaging: Two dimensional speckle tracking echocardiography: basic principles. Heart May;96(9): Blessberger H, Binder T. Two dimensional speckle tracking echocardiography: clinical applications. Heart Dec;96(24): Chan J, et al. Left Ventricular Global Strain Analysis by Two-Dimensional Speckle-Tracking Echocardiography: The Learning Curve. J Am Soc Echocardiogr Nov;30(11): Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography. J Am Coll Cardiol Feb 28;69(8): 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 Oct;28(10): , 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 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 Mar;24(3): Negishi K, et al. Practical guidance in echocardiographic assessment of global longitudinal strain. JACC Cardiovasc Imaging Apr;8(4): 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 Sep;27(9): 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 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 Aug;27(8): EACVI free webinar: How and why to measure LV myocardial strain:
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