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Non Invasive Assessment of Myocardial Deformation Using Speckle Tracking Echocardiography (STE)

Clinical Need

The assessment of LV deformation by STE has been shown to provide incremental information in many clinical settings. The fact that this technology offers the possibility of analyzing the different components of LV deformation means that it can provide important information about the transmural heterogeneity of myocardial contractile function that is extremely useful for detecting subclinical states that are likely to progress into either systolic or diastolic heart failure. According to the current clinical literature, the non-invasive assessment of myocardial deformation can be effectively used in many common cardiovascular diseases affecting LV function and provide important additional clinical information to the physicians.

Among them we can mention:

  • MYOCARDIAL INFARCTION: In patients with myocardial infarctions, longitudinal strains are significantly reduced proportionately within the area of infarction. For instance, according to Gejdal et al, the infarcted segments can be detected with high sensitivity and specificity using a longitudinal strain cutoff value of 15 %.
  • CORONARY ARTERY DISEASE: LV longitudinal mechanics at rest can be attenuated in patients with coronary artery disease, as the sub endocardium is the area of the left ventricle most vulnerable to the effects of hypoperfusion and ischemia.
  • VALVULAR DISEASE: STE can improve the results of a standard 2D echocardiography examination in valvular heart diseases, as it can provide insights into the pattern of adaptive remodeling and detect the presence of subclinical cardiac dysfunction. In fact, due to the LV adaptive remodeling, such patients can remain asymptomatic or minimally symptomatic for a long period of time even in the presence of severe valvular disease.
  • LEFT VENTRICULAR HYPERTROPHY: STE has been reported to be used for detecting subclinical myocardial changes in LV hypertrophy, as well as for distinguishing the different causes of LV hypertrophy.
  • DILATED CARDIOMYOPATHY: This pathology is associated with the reduction of strains in all 3 directions and STE can therefore be widely used to detect and stage it
  • SUBCLINICAL CARDIAC INVOLVEMENT IN SYSTEMIC DISEASES: this technology proved to be extremely useful in the preclinical detection of cardiac involvement in systemic diseases such as diabetes mellitus, systemic sclerosis, etc.


Alongside its state-of-the-art 2DSTE solution XStrain, Esaote has introduced XStrain4D, a new method of quantifying regional deformation. XStrain4D provides an additional, easy-to-use solution that the physician can use to quickly and intuitively correlate and quantify the multidirectional components of heart mechanics related to longitudinal and transverse contractility in a 3D environment. This approach simplifies the overall data interpretation by not adding further overheads to examination data acquisition and processing.


XStrain4D represents a further step forward in the interpretation of LV deformation mechanics.

Utilizing LV border tracking obtained with XStrain 2D on standard apical 4CH, 2CH, and apical LAX views, XStrain4D delivers a more complete and intuitive picture of cardiac deformation behavior, providing temporal compensation for heart rate variations, spatial alignment of the 3 views in 3D space, and adaptation of a dynamic LV surface model.

This tool, relying on high spatial and temporal resolution 2D imaging acquisitions, addresses and resolves the major limitations and criticalities currently related to use of full-volume 3D STE solutions. These limitations are related to image quality (random noise), and low temporal (volume rate) and spatial resolution (voxel size) that affect the frame-to-frame correlation on local image features, thus contributing to suboptimal myocardial tracking.


Esaote XStrain and XStrain4D Advanced Technology - Video


View Video on YouTube Esaote Channel


<small>Technology and features are system/configuration dependent. Specifications subject to change without notice. Information might refer to products or modalities not yet approved in all countries. Product images are for illustrative purposes only. For further details, please contact your Esaote sales representative. </small>

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