Jul 2026· Indian Journal of Clinical Cardiology· Vol 7, pp. 230 - 244· 0 citations· 69 references
TL;DR
This review will provide methodology, normal reference values, and clinical applications of right ventricular global longitudinal strain, specifically for the Indian context, incorporating recent Indian studies across acute myocardial infarction, valvular heart disease, cardiac surgery, heart failure with preserved ejection fraction, and diabetes mellitus.
Abstract
Right ventricular function has historically received less attention than left ventricular function. Yet, emerging evidence highlights its crucial prognostic role in various cardiovascular diseases, including acute myocardial infarction, pulmonary hypertension, pulmonary embolism, and congenital heart disease. Advances in echocardiography, particularly two-dimensional speckle-tracking echocardiography, have enabled quantitative assessment of right ventricular global longitudinal strain and right ventricular free-wall longitudinal strain, providing greater sensitivity for detecting subclinical right ventricular dysfunction than conventional indices, such as tricuspid annular plane systolic excursion or fractional area change. This review will provide methodology, normal reference values, and clinical applications of right ventricular global longitudinal strain, specifically for the Indian context. It incorporates recent Indian studies across acute myocardial infarction, valvular heart disease, cardiac surgery, heart failure with preserved ejection fraction, and diabetes mellitus. International data provide a comparative context, revealing significant gaps in population-specific normative data for India. Technical challenges, including vendor variability, load dependency, and imaging quality limitations, are discussed alongside emerging technologies such as 3D speckle-tracking, artificial intelligence integration, and telemedicine applications. The review concludes with recommendations for establishing India-specific reference ranges, developing comprehensive training programs, and conducting large-scale prospective outcome studies to facilitate routine clinical integration of right ventricular strain imaging across India’s diverse healthcare landscape.
The combined assessment of left ventricular global longitudinal strain and left atrial reservoir strain has recently demonstrated significant incremental prognostic value in patients with heart failure with reduced ejection fraction, reinforcing the concept that ventricular and atrial mechanics provide complementary information beyond conventional echocardiographic parameters. However, the implications of these findings extend beyond risk stratification in established heart failure. Growing evidence indicates that myocardial deformation abnormalities frequently involve all four cardiac chambers and develop during the preclinical stages of cardiovascular disease, when left ventricular ejection fraction and conventional echocardiographic indices remain preserved. Across diverse clinical settings—including metabolic disorders, inflammatory diseases, cardio‐oncology, pregnancy‐related cardiovascular conditions, and chronic pulmonary diseases—comprehensive multichambered speckle‐tracking echocardiography has consistently identified early mechanical remodeling before overt structural or functional abnormalities become evident. This evolving evidence supports a paradigm shift from isolated chamber‐specific strain analysis toward integrated whole‐heart mechanical phenotyping. At the same time, the remarkable sensitivity of strain imaging requires careful interpretation, as myocardial deformation is influenced not only by intrinsic myocardial function but also by loading conditions, technical factors, and extrinsic mechanical determinants such as thoracic anatomy. Future research should therefore focus on comprehensive four‐chamber mechanical assessment as a physiological and clinically meaningful approach for the early identification, characterization, and risk stratification of cardiovascular disease.
A. Sonaglioni, G. L. Nicolosi· Echocardiography· 0 citations
A practical framework for the perioperative use of myocardial strain is provided by summarizing the current evidence, clarifying its methodological limitations, simplifying its acquisition and interpretation for non-expert users, distinguishing established clinical applications from future research directions, and identifying the key evidence gaps that must be addressed.
C. Beyls, F. Gonzalez, E. Donal et al.· Journal of Clinical Medicine· 0 citations
Nonischemic cardiomyopathy (NICM) carries significant morbidity and mortality. While left ventricular ejection fraction (LVEF) remains central to risk stratification, it may not fully capture the extent of myocardial impairment, and strain imaging can provide independent prognostic information beyond LVEF alone. Myocardial strain imaging may provide additional prognostic value, but its role in NICM remains incompletely defined. This scoping review, conducted per PRISMA-ScR guidelines, searched PubMed, Embase, and Cochrane Library from inception through October 25, 2025, to identify studies evaluating myocardial strain parameters, specifically left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain, left ventricular global radial strain, and right ventricular global longitudinal strain, in adult NICM populations using speckle-tracking echocardiography or cardiac magnetic resonance feature tracking. Data were extracted by 2 independent reviewers and synthesized descriptively. From 1356 records, 36 studies (7903 patients) were included, with follow-up ranging from 9 months to 7.8 years. LVGLS was the most frequently assessed parameter. Across 21 studies evaluating major adverse cardiovascular events, worse baseline strain values were consistently associated with increased risk (hazard ratios 1.06-2.70 per unit decrease in strain magnitude). Two studies reported significant associations with ventricular arrhythmias, and 4 showed that more favorable baseline strain predicted a higher likelihood of left ventricular reverse remodeling. Strain parameters, particularly LVGLS, remained independently associated with outcomes in 34 of 36 studies after multivariable adjustment, often providing incremental value beyond LVEF and late gadolinium enhancement. These findings support strain imaging, especially LVGLS, as an adjunct to conventional risk stratification in diverse NICM populations. Standardized, multicenter prospective studies are needed to establish its role in clinical decision-making.
Dina Mohammed, Humza Saeed, Abdallah Rayyan et al.· Cardiology in Review· 0 citations
Introduction Left ventricular diastolic dysfunction is associated with left atrial remodeling and alterations of the pulmonary circulation. However, whether these interconnected changes across the cardiopulmonary axis can be simultaneously characterized using a non-dedicated whole-body MRI examination in individuals free of overt cardiovascular disease remains unclear. Methods 339 subjects (mean age 56.4 years; 43.4% female) without overt cardiovascular disease were included. Linear regression models, adjusted for age, sex, and cardiovascular risk factors, explored the association of Left ventricle (LV) filling rates with left atrium (LA) size and function, and mean pulmonary artery (MPA). Results Average maximal LA was 19.6 cm2, minimal LA 11.8 cm2, area-based LA function 39.8%, non-electrocardiogram-synchronized LA size 16.8 cm2, LV early filling rate 227.1 mL/s, late filling rate 238.4 mL/s, and MPA diameter 2.67 cm. Higher early and late LV filling rates were associated with larger maximal LA size across all models (β = 2.30; β = 1.00), minimal LA size (β = 1.41; β = 0.77), and non-electrocardiogram-synchronized LA size (β = 1.86; β = 0.90, all p < 0.001, fully adjusted model). Higher early LV filling rates, but not higher late LV filling rates, were associated with larger MPA diameter across all models (β = 0.06, p = 0.03, fully adjusted model). Conclusion In individuals free of overt cardiovascular disease, MRI-derived LV filling dynamics were associated with structural alterations of the left atrium and pulmonary vasculature, suggesting that changes across the cardiopulmonary axis may already be detectable by whole-body MRI before clinical disease becomes apparent.
C. Wintergerst, R. Lorbeer, Susanne Rospleszcz et al.· Frontiers in Cardiovascular...· 0 citations
Heart failure with preserved ejection fraction (HFpEF) represents an increasingly prevalent clinical syndrome, driven by population ageing and the growing burden of cardiometabolic comorbidities, and is associated with significant morbidity and mortality. Due to its heterogeneous pathophysiology and the frequent absence of overt structural abnormalities, early diagnosis and accurate risk stratification remain challenging. In the current era of emerging disease-modifying therapies, the identification of sensitive imaging markers able to detect early myocardial dysfunction and refine patient characterization has become increasingly important. Speckle-tracking echocardiography has emerged as a valuable tool for the comprehensive evaluation of HFpEF, allowing the assessment of subclinical myocardial impairment beyond conventional parameters. Left ventricular global longitudinal strain (LV-GLS) identifies subtle systolic dysfunction despite preserved left ventricular ejection fraction (LVEF) and provides incremental diagnostic and prognostic information. Accordingly, LV-GLS has been incorporated into contemporary diagnostic algorithms and may represent a promising marker for monitoring disease progression and therapeutic response. Beyond the left ventricle (LV), left atrial (LA) strain has gained increasing relevance as a marker of atrial myopathy and elevated filling pressures. Left atrial reservoir strain (LARS) detects early atrial dysfunction before overt structural remodelling, improves the identification of HFpEF in patients with unexplained dyspnoea, and provides additional prognostic information, including prediction of atrial fibrillation and thromboembolic risk. Moreover, right ventricular free-wall longitudinal strain (RV-FWLS) allows early recognition of right ventricular involvement and has shown important prognostic implications, particularly in relation to pulmonary vascular dysfunction and exercise intolerance. Overall, a multi-chamber strain-based approach may improve HFpEF diagnosis, phenotyping, and risk stratification, supporting a transition toward a more personalized management strategy. Further prospective studies are needed to define the role of strain imaging in guiding therapeutic decisions and monitoring treatment response.
M. C. Pastore, Clarissa Carmona De Azevedo Bellagamba, A. Stefanini et al.· Journal of Clinical Medicine· 0 citations
ABSTRACT Background and Aim: Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease in cats, and early detection of myocardial dysfunction remains challenging using conventional echocardiography alone. This study evaluated myocardial function using two-dimensional speckle-tracking echocardiography and investigated the diagnostic value of left ventricular global longitudinal strain (LVGLS), right ventricular longitudinal strain (RVLS), left atrial reservoir strain (LARS), and strain–volume curve analysis for differentiating HCM phenotypes in cats. Materials and Methods: A retrospective observational study was conducted on 40 client-owned cats categorized into three groups: Healthy controls (n = 15), cats with a hypertrophic phenotype and normal left atrial size (n = 13), and cats with a hypertrophic phenotype accompanied by left atrial enlargement (n = 12). Comprehensive echocardiographic examinations included conventional measurements together with LVGLS, RVLS, LARS, circumferential strain, and strain–volume curve analysis. Group comparisons and correlations between strain-derived and conventional echocardiographic parameters were analyzed using appropriate statistical methods, with significance set at p < 0.05. Results: Cats with HCM and left atrial enlargement exhibited significantly lower LVGLS and LARS than healthy cats, indicating impaired ventricular systolic deformation and reduced atrial reservoir function. RVLS did not differ significantly among groups, suggesting relative preservation of right ventricular systolic function during the early stages of disease. Strain–volume curve analysis demonstrated progressive flattening and rightward displacement in affected cats, reflecting impaired myocardial deformation despite preserved conventional systolic indices such as fractional shortening. Moderate correlations were observed between LVGLS and radial strain, whereas LARS showed inverse correlations with indices of left ventricular hypertrophy. These findings indicate that strain-derived parameters provide complementary functional information beyond conventional echocardiographic measurements. Conclusion: Multi-chamber strain echocardiography integrating LVGLS, RVLS, LARS, and strain–volume curve analysis provides a comprehensive assessment of myocardial mechanics in cats with HCM. This approach improves characterization of hypertrophic phenotypes, facilitates earlier recognition of myocardial dysfunction, and may enhance disease staging and clinical decision-making in feline cardiology.
Xu Ying, Chattida Panprom, S. Petchdee· Veterinary World· 0 citations
