Still a Long Way to Go
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
In this issue of Circulation: Cardiovascular Imaging, Amzulescu et al1 provide an extensive comparison of global and segmental echocardiographic speckle-tracking (ST) systolic strains and cardiac magnetic resonance imaging (CMR) tagging strain, generally regarded as the gold standard for strain imaging. Evaluation of systolic strains and strain rates has emerged as an important focus in assessment of conditions that impair myocardial function including ischemic heart disease, hypertensive heart disease, dilated cardiomyopathy, hypertrophic cardiomyopathy, myocarditis, and infiltrative cardiomyopathies.2,3 Strain abnormalities develop in most settings before overt clinical disease or even mild subclinical abnormalities of ventricular ejection fraction and have prognostic significance, as do severity and progression of strain abnormalities in advanced or treated disease. Although these prognostic relationships are useful, development of focused clinical roles for strain imaging has been very slow, with assessment and management of myocardial asynergy in heart failure with reduced ejection fraction and more sensitive detection of myocardial ischemia during stress testing being closest to realization.
See Article by Amzulescu et al
Given the relative availability and utilization of echocardiography and CMR, particularly in the United States, and the challenges of performing CMR-guided procedures, it is hardly surprising that echocardiographic strain methods have dominated clinical research and efforts at routine clinical applications, with a publication ratio in the literature of roughly 10:1. But there have been recurrent concerns about the reliability of echocardiographic strain values despite the fact that the axial spatial resolution and temporal resolution are far superior to those used with CMR. The present study clarifies the issue to a considerable degree. The authors’ overall findings will be generally familiar to those using both echocardiographic and CMR strain methods but may not be as familiar in the broader cardiovascular community. Both methods perform well in phantom studies. However, in patients, ST …