Methodological heterogeneity, as well as limited reproducibility data and the relative scarcity of studies available suggest the need for standardized acquisition protocols and larger, well-designed studies to determine its clinical usefulness.
Abstract
The evaluation of fetal cardiac function is moving towards the angle-independent myocardial deformation techniques, including the atrial strain obtained with speckle-tracking echocardiography. Angle-independent myocardial deformation techniques are gaining increasing traction and interest, where speckle-tracking-derived atrial strain (AS) has emerged as a potentially sensitive marker of subclinical myocardial dysfunction.
This scoping review aims to give an overview of the existing evidence regarding fetal atrial mechanics, which covers physiology, methodological aspects, reported reference values, and potential clinical use. Fetal atrial strain assessment is technically challenging. The traditional triphasic atrial cycle tends to be shortened with high fetal heart rate, creating a pattern of predominant reservoir domination. Furthermore, there are no standard acquisition protocols, gating strategies, and software implementations which may restrict the ability to replicate and compare studies conducted by different researchers.
The inclusion criteria were met by only six heterogeneous studies because there is still a limited number of studies in this field. Therefore, the current results should be considered as tentative and exploratory. There is emerging evidence indicating fetal atrial strain varies with clinical circumstances. Lower atrial strain values have been reported in maternal diabetes, which may reflect a change in myocardial function. Placental insufficiency in contrast, however, seems to be accompanied by a relatively preserved atrial strain which may be due to adaptive cardiovascular responses to hypoxic stress. But the observations are based on small sample sizes and need to be validated further.
Fetal atrial strain is a promising quantitative measure of fetal cardiac function overall. Methodological heterogeneity, however, as well as limited reproducibility data and the relative scarcity of studies available suggest the need for standardized acquisition protocols and larger, well-designed studies to determine its clinical usefulness.
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
Two-dimensional ultrasound is optimal for screening; RT-3DE shows highest consistency with cardiovascular magnetic resonance for precise diagnosis, and 3DE-LACI has demonstrated independent prognostic value in cardiac amyloidosis.
He-Yang Liu, Quan Li, Wenjie Han et al.· Frontiers in Cardiovascular...· 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
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.
Parminder Sharma, Arghadip Bose, Basant Kumar· Indian Journal of Clinical C...· 0 citations
Fetal speckle tracking echocardiography is an ultrasound-based technique used to assess myocardial velocity and deformation of the fetal heart. Despite its potential, the method has not yet been integrated into routine pregnancy care, partly due to concerns about inconsistent reproducibility. This study aimed to evaluate the intra- and inter-observer reproducibility of global longitudinal strain measurements derived from a fixed fetal cardiac cycle, using speckle tracking echocardiography. Healthy women with singleton pregnancies were enrolled during the second trimester. From enrolment until delivery, four-chamber view clips of the fetal heart were acquired every four weeks. For intra-observer reproducibility, a single observer analyzed the same heart cycle in one DICOM clip twice for global longitudinal strain in the left and right ventricles, with a minimum interval of two weeks between assessments in a blinded manner. For inter-observer reproducibility, two independent observers analyzed the same cardiac cycle within one DICOM clip. A total of 124 women were included, yielding 632 ultrasound clips. Intra-observer reproducibility was poor to moderate for global longitudinal strain for the right and left ventricles. Inter-observer reproducibility demonstrated moderate to good reproducibility for global longitudinal strain in both ventricles. The reproducibility was generally higher in the left ventricle than in the right, and the highest reproducibility was observed before 32 weeks of gestation. In conclusion, speckle tracking echocardiography during pregnancy showed variable reproducibility of strain analysis when performed on a fixed cardiac cycle, with more consistent results in the left ventricle. These findings support the potential utility of fetal speckle tracking echocardiography, while highlighting the need for further refinement of reproducibility before clinical implementation.
Eline Meireson, C. D. de Vet, J. van Laar et al.· PLoS ONE· 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
