Kersten Johannes, Jerg Achim, Kirsten Johannes, Persch Hasema, Krieg Sarah, Liu Yuefei, Letnes Jon Magne, Schellenberg Jana
University Hospital of Ulm, Ulm, Germany.
Herzplus Ulm, Ulm, Germany.
Echocardiography. 2025 Aug;42(8):e70251. doi: 10.1111/echo.70251.
This review evaluates the applications of speckle-tracking echocardiography (STE) in stress echocardiography, focusing on feasibility, physiological adaptations, and its diagnostic and prognostic utility in cardiovascular conditions.
A systematic search of PubMed identified studies published up to December 28, 2024, using terms related to STE, stress echocardiography, and myocardial strain. Grey literature was excluded. Eligible studies assessed myocardial strain under stress conditions and reported on feasibility, diagnostic accuracy, or prognostic outcomes.
Sixty-four studies were included, covering healthy individuals, athletes, at-risk populations, and patients with cardiovascular conditions. Feasibility studies demonstrated high interobserver reliability, with strain parameters measurable in > 80% of cases (intraclass correlation coefficient [ICC] 0.80 to 0.92). In healthy individuals and athletes, STE revealed myocardial adaptations and exercise-induced changes. In at-risk populations, such as those with diabetes or after cardiotoxic therapies, STE identified subclinical myocardial dysfunction, facilitating early intervention. For coronary artery disease (CAD) and heart failure (HF), stress-induced changes in global and segmental strain improved diagnostic accuracy and risk stratification, with thresholds such as a > 15% reduction in global longitudinal strain under stress aiding therapeutic decision-making.
STE enhances the diagnostic and prognostic utility of stress echocardiography by providing reproducible strain parameters and facilitating early detection of dysfunction in high-risk populations. Future research should focus on standardizing strain analysis and integrating artificial intelligence (AI) to optimize clinical applications.
本综述评估斑点追踪超声心动图（STE）在负荷超声心动图中的应用，重点关注其可行性、生理适应性以及在心血管疾病中的诊断和预后效用。
通过对PubMed进行系统检索，确定截至2024年12月28日发表的研究，使用与STE、负荷超声心动图和心肌应变相关的术语。排除灰色文献。符合条件的研究评估了应激状态下的心肌应变，并报告了可行性、诊断准确性或预后结果。
纳入64项研究，涵盖健康个体、运动员、高危人群和心血管疾病患者。可行性研究表明，观察者间可靠性高，应变参数在>80%的病例中可测量（组内相关系数[ICC]为0.80至0.92）。在健康个体和运动员中，STE揭示了心肌适应性和运动诱导的变化。在高危人群中，如糖尿病患者或接受心脏毒性治疗后的人群，STE识别出亚临床心肌功能障碍，有助于早期干预。对于冠状动脉疾病（CAD）和心力衰竭（HF），负荷诱导的整体和节段应变变化提高了诊断准确性和风险分层，例如负荷下整体纵向应变降低>15%等阈值有助于治疗决策。
STE通过提供可重复的应变参数并促进高危人群中功能障碍的早期检测，增强了负荷超声心动图的诊断和预后效用。未来的研究应专注于标准化应变分析并整合人工智能（AI）以优化临床应用。
