1.9 Speckle Tracking / Deformation Imaging - Basics
Spring, deform, bend shorten
Analogy: Spring, deform, bend shorten
Speckle tracking is a new technology which provides important additional information related to systolic and diastolic function of the ventricles, It analyses speckle artifacts in the echo image to obtain information of myocardial contractility and also on relaxation. Speckles are small areas of higher echogenicity which are caused by reflections, refraction, and scattering of echo beams. By tracking such speckles in the wall of the left ventricle throughout the cardiac cycle it is possible to obtain information on the direction and velocity of motion. Comparing the motion of individual speckles to each other allows us to analyze the „deformation“ of the myocardium. In other words the magnitude that myocardial „fibers“ expand (diastole) or contract (systole).
Speckle Tracking
Speckle tracking: Speckles are tracked through out the cardiac cycle the direction and velocity of displacement is recorded and used to calculate „deformation“ parameters
The term that is used to describe the degree of deformation is „strain“, while strain rate is the rate of change in strain over time. Negative strain (shortening) means contraction, while positive strain is relaxation (lengthening).
Advantages of Speckle Tracking over Tissue Doppler
Angle independant
Only reflects active contraction (no tethering effects)
More robust
Less influenced by frame rate
Easy to perform
All compontents of deformation can be assessed
Strain is the degree of myocardial shortening in percent. Positive strain denotes relaxation and negative strain contraction.
We now know that the contractile function of the heart has several components (see section 3.2.3.2.2 Myocardial Mechanics). Speckle tracking is able to analyze each of these components separately. In short axis views you will be able to look at radial and circumferential deformation, while the apical views are used to assess longitudinal function. Subendocardial function is driven mostly by longitudinal contraction, and is often impaired before the circumferential or radial component deteriorates. Thus, longitudinal function serves as an early marker of left ventricular dysfunction. There are numerous disease entities in which strain derived deformation parameters are reduced before the ejection fraction drops. Specific patterns will be discussed in the corresponding chapters.
Longitudinal strain allows detection of subclinical left ventricular dysfunction.
Strain can be computed during every point and time of the cardiac cycle. The best parameter for systolic function however is the peak systolic strain. Peak systolic strain is defined as the maximal shortening (at any region of the myocardium) during systole (after the onset of the QRS complex and before aortic valve closure occurs). It is possible to measure strain in individual segments by averaging all segments of the entire ventricle. This value is called global peak systolic strain (GPSS). Usually this is done for longitudinal strain from all apical views. Therefore it is also called global longitudinal peak systolic strain (GLPSS). There is some heterogeneity for different segments and there is also some degree of variation in absolute strain values between different vendor, especially for radial and circumferential strain. Normal values for strain are depicted the following table.