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Review
. 2025 Mar;18(3):340-381.
doi: 10.1016/j.jcmg.2024.07.011. Epub 2024 Sep 11.

Myocardial Strain Imaging: Theory, Current Practice, and the Future

Otto A Smiseth  1 , Oliver Rider  2 , Marta Cvijic  3 , Ladislav Valkovič  4 , Espen W Remme  5 , Jens-Uwe Voigt  6
Affiliations
Free article
Review

Myocardial Strain Imaging: Theory, Current Practice, and the Future

Otto A Smiseth et al. JACC Cardiovasc Imaging. 2025 Mar.
Free article

Abstract

Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.

Keywords: cardiac magnetic resonance; cardiomyopathy; myocardial function; myocardial work; speckle-tracking echocardiography; strain imaging.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Rider is supported by a British Heart Foundation Senior Clinical Research Fellowship (FS/SCRF/22/32014). Dr Valkovič is supported by a Sir Henry Dale Fellowship from The Wellcome Trust and Royal Society (221805/Z/20/Z). Both authors acknowledge the support of the British Heart Foundation Center of Research Excellence Oxford. Dr Smiseth is a coinventor of “Method for Myocardial Segment Work Analysis” and holds a patent on “Estimation of Blood Pressure in the Heart;” and has received a speaker honorarium from GE Healthcare. Dr Voigt has received speaker honoraria and/or consultancy fees from GE Healthcare, Philips Healthcare, and TomTec Imaging Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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