Mihos Christos G, Liu Jennifer E, Anderson Kelley M, Pernetz Maria Alexandra, O'Driscoll Jamie M, Aurigemma Gerard P, Ujueta Francisco, Wessly Priscilla
Circulation. 2025 Sep 9;152(10):e96-e109. doi: 10.1161/CIR.0000000000001354. Epub 2025 Aug 6.
Assessment of left ventricular systolic function is essential for diagnosing and managing cardiac diseases and provides important prognostic information to the treating clinician. However, traditional methods for assessing left ventricular systolic function such as ejection fraction are limited by their reliance on geometric assumptions, subjective reader interpretation, sensitivity to loading conditions and volume, and reflection of a single plane of motion. In addition to interobserver and intraobserver variability and technical confounders, this evaluation is complicated by the complex 3-dimensional organization of the myocardial fibers, which are oriented longitudinally in the subendocardium, transversely in the midmyocardium, and obliquely in the subepicardium. Conversely, 2-dimensional speckle-tracking echocardiography measures left ventricular deformation as myocardial strain in the 3 planes of chamber motion: longitudinal, circumferential, and radial. From a clinical perspective, left ventricular global longitudinal strain offers superior diagnostic and prognostic value across the spectrum of cardiovascular disorders compared with ejection fraction, is highly reproducible, and detects subclinical dysfunction before the ejection fraction declines. Given the expanding clinical utility of speckle-tracking echocardiography and the incremental prognostic and therapeutic value of integrating global longitudinal strain into clinical practice as a potential biomarker, the objectives of this scientific statement are (1) to review the principles and technical aspects of speckle-tracking echocardiography strain imaging; (2) to provide a practical, evidence-based review of the application of speckle-tracking echocardiography in heart failure, cardiomyopathies, ischemic heart disease, valvular disease, and cardio-oncology; (3) to explore the potential utility of speckle-tracking echocardiography in cardiac resynchronization and implantable cardioverter defibrillator therapy; and (4) to outline the future directions of speckle-tracking echocardiography.
评估左心室收缩功能对于心脏病的诊断和管理至关重要，并为治疗临床医生提供重要的预后信息。然而，传统的评估左心室收缩功能的方法，如射血分数，受到其对几何假设的依赖、读者主观解读、对负荷条件和容量的敏感性以及单一运动平面反映的限制。除了观察者间和观察者内的变异性以及技术混杂因素外，这种评估还因心肌纤维复杂的三维结构而变得复杂，心肌纤维在内皮下层纵向排列，在心肌中层横向排列，在心外膜下层倾斜排列。相反，二维斑点追踪超声心动图通过测量心室运动三个平面（纵向、圆周和径向）的心肌应变来评估左心室变形。从临床角度来看，与射血分数相比，左心室整体纵向应变在心血管疾病谱中具有更高的诊断和预后价值，具有高度可重复性，并且在射血分数下降之前就能检测到亚临床功能障碍。鉴于斑点追踪超声心动图的临床应用不断扩大，以及将整体纵向应变作为一种潜在生物标志物纳入临床实践所具有的递增预后和治疗价值，本科学声明的目标是：（1）回顾斑点追踪超声心动图应变成像的原理和技术方面；（2）基于证据对斑点追踪超声心动图在心力衰竭、心肌病、缺血性心脏病、瓣膜病和心脏肿瘤学中的应用进行实用综述；（3）探讨斑点追踪超声心动图在心脏再同步化治疗和植入式心脏复律除颤器治疗中的潜在应用；（4）概述斑点追踪超声心动图的未来发展方向。
