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Non-invasive imaging
Two dimensional speckle tracking echocardiography: clinical applications
  1. Hermann Blessberger1,
  2. Thomas Binder2
  1. 1AKH Linz, Department of Internal Medicine I – Cardiology, Linz, Austria
  2. 2Department of Cardiology, Medical University of Vienna, Internal Medicine II, AKH, Vienna, Austria
  1. Correspondence to Professor Thomas Binder, Department of Cardiology, Medical University of Vienna, Internal Medicine II, AKH, Waehringerguertel 18-20, Vienna 1090, Austria; thomas.binder{at}meduniwien.ac.at

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This review is the second of two articles that focus on two dimensional speckle tracking echocardiography (STE). While the first article described the principles of STE, this review deals with its potential clinical applications. The technology of speckle tracking based strain analysis is rather new.w1 w2 However, there is considerable experience with parameters of deformation measured with tissue Doppler imaging (TDI). Since measurements of strain and strain rate (SR) correlate well with those of TDI, much of what has been shown with TDI can probably be applied to STE. Because STE has numerous advantages compared to TDI (reproducibility, complete analysis of radial and circumferential strain, twist, torsion, and rotation), it adds important information to what is already known from TDI. The number of publications which investigate STE in clinical and subclinical conditions is rapidly growing and confirms the potential of this technology. This review summarises the current experience of STE, points to potential clinical applications and future developments of STE, and describes its limitations.

STE and coronary artery disease

The echocardiographic assessment of coronary artery disease (CAD) is mainly based on the detection of regional wall motion abnormalities, lack of myocardial thickening, and visualisation of scar tissue. However, this approach is highly subjective, requires considerable operator experience, and strongly depends on image quality. Even though several different methods to quantify regional wall motion abnormalities have been proposed, none of these are robust enough to be used in clinical practice. The experience with TDI has shown that the analysis of regional tissue deformation provides important additional information and even allows quantification of ischaemic abnormalities.

Ischaemic and scarred tissue shows a reduction and delay of peak segmental strain and SR.w3 w4 This is true for longitudinal, circumferential, and radial strain/SR components.w3 w4 An important additional phenomenon—which occurs early after the onset of ischaemia and …

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