Simultaneous 4-Chamber Strain

Analysis of myocardial deformation, or strain imaging, is becoming part of routine echocardiography.1 The most widely accepted parameter to date has been global longitudinal strain as a measure of global left ventricular (LV) function. Global longitudinal strain (LS) of the LV, in (negative) percent, is the average of the maximal shortening (in percent) in the apico-basal direction of each of 18 LV segments visualized in the 3 standard apical views. The strain curves are computed using speckle tracking to determine myocardial velocity in a region of interest from which local strain is derived. LS is defined as deformation (shortening or lengthening) along the midline of LV walls, that is, in an apico-basal direction, but following the curvature of the LV walls.2 Similarly, global left or right atrial or right ventricular LS can be obtained as average of segmental peak LS. Strain data are highly dependent on image quality and frame rate, as well as physiological parameters as blood pressure.See Article by Addetia et al The article of Addetia et al3 in this issue of Circulation: Cardiovascular Imaging explores LS values from all 4 chambers obtained simultaneously from the 4-chamber view of the same cardiac cycle using a software (Epsilon Imaging, Ann Arbor MI) that can accommodate data acquired with echo machines from different echo manufacturers, although for this article, only echos acquired with one brand of echo machines were used. LS analysis was based on speckle tracking in 21 segments per patient (6 for the LV, 3 for the right ventricle, and 6 each for left and right atrium, …