Top Things to Know: Speckle-Tracking Strain Echocardiography for the Assessment of Left Ventricular Structure and Function
Published: August 06, 2025
Prepared by Barbara Entl, MD, Science and Medicine Advisor American Heart Association
- Accurate assessment of left ventricular (LV) systolic function is essential for evaluating, managing, and prognosticating cardiac disease. Several imaging modalities are available, each with its strengths and limitations.
- Left ventricular global longitudinal strain (GLS) has emerged as a more sensitive and reproducible diagnostic and prognostic tool than traditional ejection fraction (EF). It offers lower inter- and intra-observer variability and detects early subendocardial dysfunction, even when EF remains normal.
- This scientific statement reviews the principles and technical considerations of speckle tracking echocardiography (STE)—the technique used to derive GLS—its application in various cardiac conditions, and the role of STE in cardiac resynchronization and implantable cardioverter defibrillator therapy.
- Two-dimensional STE quantifies myocardial strain by tracking tissue deformation in the longitudinal, circumferential, and radial planes, expressed as the percentage change in myocardial length over the cardiac cycle.
- Midwall GLS predominates in clinical practice because the transmural variation in longitudinal strain is small and not clinically meaningful to isolate, especially given that echocardiographic resolution does not reliably distinguish layer-specific strain. In contrast, radial and circumferential strain show greater variation across the myocardial wall.
- Although longitudinal strain is relatively uniform, GLS values can differ based on whether endocardial or full-wall tracking is used. It is, therefore, essential to note the tracking method and vendor-specific algorithm when interpreting results.
- GLS is particularly valuable in heart failure: it detects subclinical myocardial dysfunction—especially in patients with preserved or mildly reduced EF—and, in overt heart failure with reduced ejection fraction (HFrEF), has stronger associations with mortality and hospitalization than LVEF.
- Detection of subclinical LV dysfunction using GLS in valvular heart disease—particularly in aortic stenosis and mitral or aortic regurgitation—supports timely intervention and correlates with better patient outcomes.
- Radial strain by STE reflects systolic LV wall thickening due to myofiber shortening and myocardial compressibility. Radial strain curves quantify LV mechanical dyssynchrony and identify the latest activated segment in patients with HFrEF (EF < 35%) undergoing cardiac resynchronization therapy, potentially guiding optimal lead placement.
- Advances in artificial intelligence and three-dimensional STE hold promise for expanding the capabilities of strain imaging. Unlike 2D STE, 3D STE can simultaneously capture longitudinal, circumferential, and radial strain in a single acquisition. However, its lower spatial and temporal resolution may reduce tracking accuracy and lead to underestimating global strain.
- Despite these limitations, strain imaging remains a valuable tool for detecting early left ventricular dysfunction, supporting personalized treatment, timely interventions, and more precise risk assessment.
Citation
Mihos CG, Liu JE, Anderson KM, Pernetz MA, O’Driscoll JM, Aurigemma GP, Ujueta F, Wessly P; on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Speckle-tracking strain echocardiography for the assessment of left ventricular structure and function: a scientific statement from the American Heart Association. Circulation. Published online August 6, 2025. doi: 10.1161/ CIR.0000000000001354