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Strain Echocardiography
Posted by NBeener
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Strain Echocardiography September 29, 2024 10:06PM |
Registered: 2 years ago Posts: 80 |
Somebody PM'd me with a few interesting questions about strain echocardiography. I figured I'd just create a post on the subject in the hopes that something here can be of help to others:
Ejection Fraction (EF) can be extremely useful when it's reduced. The problem is that a normal EF doesn't always mean a heart that is functioning normally. At a minimum, cardiology now speaks quite a bit about HFpEF -- Heart Failure with Preserved Ejection Fraction -- thought to represent roughly half of heart failure cases in the US with roughly equally bad outcomes.
Too many cardiologists still believe "No reduction in Ejection Fraction ... no problem." Don't ask me how I know this ;-)
And -- really -- any number of pathologies from mild to serious can be associated with a normal EF.
Strain echocardiography adds a key parameter to the normal echo: the strain rate. If you think about a pair of blue jeans ... when they fit well and you've worn them quite a bit ... you can generally move in them rather easily. Now give them a good hosing down with spray starch. Much harder to move in them now because they're stiff.
Strain echocardiography detects and quantifies this stiffness, most often caused by fibrosis, which -- as many of us know -- tends to underlie some arrhythmias, including AF. Degree of fibrosis also tends to predict the worsening of AF and its recurrence after catheter ablation.
To use an analogy, systolic heart failure (a/k/a Heart Failure with Reduced Ejection Fraction (or HFrEF)) is like not being able to exhale well, while diastolic heart failure (a/k/a HFpEF) is not being able to inhale well. Filling a stiff heart with blood is like trying to blow up a beer bottle instead of a supple balloon. While cardiac MRI is an excellent way to detect and quantify myocardial fibrosis, it's not very commonly ordered and is pretty expensive. Strain echocardiography captures much of the benefit at much lower cost.
People who get significantly short of breath on exertion but who are basically fine at rest may have undiagnosed heart failure. Cardiopulmonary Exercise Testing (a/k/a CPET or iCPET (for invasive)) can often tease this out, but this is also expensive and probably underutilized. Strain echocardiography can sometimes pick up subtle cardiac issues that may either solve the puzzle or point the way to the best next step.
The cardiotoxicity from radiation therapy for some cancers comes -- among other things -- as fibrosis. Strain imaging is used to detect that fibrosis early -- before it starts to lower EF -- allowing course correction to minimize harm.
I would imagine that tertiary care facilities and teaching hospitals are probably the best place to get a strain echo these days, but -- since they have strain echocardiography near me -- I haven't had to look. I'd probably just ask my cardiologist who can perform them nearby.
Other relevant links:
[www.heartfailurematters.org]
[www.sciencedirect.com]
[jnm.snmjournals.org]
[www.ncbi.nlm.nih.gov]
[www.ncbi.nlm.nih.gov]
[www.ncbi.nlm.nih.gov]
[stanfordhealthcare.org]
[academic.oup.com]
Edited 1 time(s). Last edit at 09/29/2024 11:51PM by NBeener.
Ejection Fraction (EF) can be extremely useful when it's reduced. The problem is that a normal EF doesn't always mean a heart that is functioning normally. At a minimum, cardiology now speaks quite a bit about HFpEF -- Heart Failure with Preserved Ejection Fraction -- thought to represent roughly half of heart failure cases in the US with roughly equally bad outcomes.
Too many cardiologists still believe "No reduction in Ejection Fraction ... no problem." Don't ask me how I know this ;-)
And -- really -- any number of pathologies from mild to serious can be associated with a normal EF.
Strain echocardiography adds a key parameter to the normal echo: the strain rate. If you think about a pair of blue jeans ... when they fit well and you've worn them quite a bit ... you can generally move in them rather easily. Now give them a good hosing down with spray starch. Much harder to move in them now because they're stiff.
Strain echocardiography detects and quantifies this stiffness, most often caused by fibrosis, which -- as many of us know -- tends to underlie some arrhythmias, including AF. Degree of fibrosis also tends to predict the worsening of AF and its recurrence after catheter ablation.
To use an analogy, systolic heart failure (a/k/a Heart Failure with Reduced Ejection Fraction (or HFrEF)) is like not being able to exhale well, while diastolic heart failure (a/k/a HFpEF) is not being able to inhale well. Filling a stiff heart with blood is like trying to blow up a beer bottle instead of a supple balloon. While cardiac MRI is an excellent way to detect and quantify myocardial fibrosis, it's not very commonly ordered and is pretty expensive. Strain echocardiography captures much of the benefit at much lower cost.
People who get significantly short of breath on exertion but who are basically fine at rest may have undiagnosed heart failure. Cardiopulmonary Exercise Testing (a/k/a CPET or iCPET (for invasive)) can often tease this out, but this is also expensive and probably underutilized. Strain echocardiography can sometimes pick up subtle cardiac issues that may either solve the puzzle or point the way to the best next step.
The cardiotoxicity from radiation therapy for some cancers comes -- among other things -- as fibrosis. Strain imaging is used to detect that fibrosis early -- before it starts to lower EF -- allowing course correction to minimize harm.
I would imagine that tertiary care facilities and teaching hospitals are probably the best place to get a strain echo these days, but -- since they have strain echocardiography near me -- I haven't had to look. I'd probably just ask my cardiologist who can perform them nearby.
Other relevant links:
[www.heartfailurematters.org]
[www.sciencedirect.com]
[jnm.snmjournals.org]
[www.ncbi.nlm.nih.gov]
[www.ncbi.nlm.nih.gov]
[www.ncbi.nlm.nih.gov]
[stanfordhealthcare.org]
[academic.oup.com]
Edited 1 time(s). Last edit at 09/29/2024 11:51PM by NBeener.
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Re: Strain Echocardiography September 30, 2024 01:06AM |
Registered: 3 years ago Posts: 399 |
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Re: Strain Echocardiography September 30, 2024 11:26AM |
Registered: 2 years ago Posts: 80 |
Nope.
Google's AI answer looks good enough:
Google's AI answer looks good enough:
Quote
AI Overview
A strain echo and a stress echo are both echocardiogram techniques that use ultrasound imaging to evaluate the heart, but they have different purposes and uses:
Strain echo
A newer technique that can help diagnose heart conditions early by showing how the heart muscle moves.
Stress echo
A test that shows how well the heart pumps blood while the patient exercises. It's often used to detect coronary artery disease and other heart conditions. A doctor may order a stress echo if a patient has chest pain, angina, or has had a recent heart attack.
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Re: Strain Echocardiography September 30, 2024 11:34AM |
Registered: 2 years ago Posts: 80 |
Asking Google the question in a different way yielded a different answer with, perhaps, more/better info:
Quote
Strain and stress echocardiograms are both cardiac imaging techniques that can help assess heart function, but they differ in several ways:
Purpose
A strain echo is used to assess regional myocardial function, while a stress echo is used to detect myocardial ischemia.
How they work
A strain echo measures the deformation of the heart muscle, while a stress echo compares the heart's activity at rest to when it's working hard.
What they show
A strain echo can show regional thickening and thinning, as well as shortening and lengthening of the heart muscle. A stress echo can show areas of the heart muscle that aren't receiving enough blood.
How they're used
A strain echo can help screen for cardiomyopathy, and might also help cardiologists decide on treatment plans. A stress echo is often used to detect myocardial ischemia, which can be caused by a narrowed or blocked artery.
Other considerations
Strain and strain rate measurements are dependent on ventricular wall thickness and shape, as well as pre- and after-load. Stress echocardiograms can involve physical, pharmacological, or electrical stress, and can cause side effects like chest pain, high blood pressure, and irregular heartbeats.
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Re: Strain Echocardiography June 12, 2025 02:01PM |
Registered: 2 years ago Posts: 80 |
Not sure if I can 'bump' this thread, but I wanted to add a ChatGPT answer on the subject:
Quote
ChatGPT
Global longitudinal strain (GLS) by speckle-tracking echocardiography is **increasingly recognized as a valuable noninvasive marker** of myocardial fibrosis and left ventricular (LV) function, and it has growing relevance in the context of **atrial fibrillation (AF)**—particularly regarding **predicting outcomes of catheter ablation**.
Here’s a breakdown of what the literature and clinical consensus suggest:
---
### ✅ **GLS as a Surrogate for Myocardial Fibrosis**
* **Reduced GLS** correlates well with **diffuse myocardial fibrosis** as confirmed by cardiac MRI (T1 mapping or late gadolinium enhancement).
* Even when LVEF is preserved, a **subclinical decrease in GLS** can indicate early myocardial disease or fibrosis.
* Particularly in AF, fibrosis affects **both atrial and ventricular tissue**, influencing both arrhythmogenic substrate and procedural outcomes.
---
### 📉 **GLS and AF Ablation Outcomes**
1. **Reduced GLS is associated with higher AF recurrence rates post-ablation.**
* Studies show that **lower (less negative) GLS values** (e.g., > –16%) are linked to **poorer outcomes** after pulmonary vein isolation or other AF ablation techniques.
* This suggests that patients with more diffuse ventricular fibrosis have a less favorable atrial remodeling environment and worse electrical substrate.
2. **GLS may outperform LVEF** in risk stratification.
* In patients with preserved EF, a **normal EF but impaired GLS** suggests hidden systolic dysfunction, which may correlate with atrial structural remodeling.
* Therefore, GLS can **add prognostic information beyond standard measures**.
3. **GLS is also connected to left atrial function.**
* Although it’s primarily a measure of **left ventricular deformation**, impaired LV strain is **strongly linked with impaired LA reservoir function**, which predicts **AF persistence and recurrence**.
* Some echocardiography protocols also assess **LA strain**, which can be an even more **direct measure of atrial fibrosis**.
---
### 📚 **Representative Studies**
* **Sanchis et al. (2016)** – Found GLS independently predicted late recurrence of AF post-ablation even in patients with preserved EF.
* **Park et al. (2014)** – Showed that impaired GLS (worse than –16%) was associated with a **two-fold higher risk of recurrence** after AF ablation.
* **Kuppahally et al. (2010)** – Correlated **late gadolinium enhancement (MRI)** with decreased GLS and worse ablation outcomes.
---
### 🧠 **Interpretation**
* **High Sensitivity?** Moderately high. GLS captures subtle fibrosis and dysfunction that predispose to arrhythmia recurrence.
* **Specificity?** Lower—reduced GLS can result from other conditions (e.g., hypertension, diabetes, cardiomyopathies).
* **Usefulness?** Strong as part of a **multimodal risk stratification** approach alongside LA volume, LA strain, BNP, and MRI (if available).
---
### 🧪 **Typical GLS Cutoffs (LV)**
| Category | GLS Value (Approximate) |
| ---------- | ----------------------- |
| Normal | –18% to –22% |
| Borderline | –16% to –18% |
| Abnormal | > –16% |
---
### 🔍 Bottom Line
**GLS is a moderately sensitive and clinically meaningful surrogate for myocardial fibrosis** that can help predict AF ablation outcomes, especially recurrence risk. While not a direct measurement of atrial fibrosis, its ability to detect global myocardial impairment and its link with LA dysfunction make it a **valuable noninvasive tool in pre-ablation evaluation**.
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