Brief introduction about speckle tracking and strain and its role in RCMP

1. Speckle tracking and strain
Dr Siva Subramaniyan
PGIMER &Dr.RML Hospital
New Delhi

2. RCM
• CMP characterized by a “restrictive filling” and by a reduced diastolic
volume of one or both ventricles, with preserved systolic function and
in absence of significant hypertrophy.
• Myocardial interstitial fibrosis: typical pathological finding

3. DIAGNOSIS BY ECHO
• No pathognomonic signs (exclusion of other pathologies)

4. 2D ECHO
Left ventricle
- LV non dilated,
- non hypertrophic,
- with preserved systolic function
in secondary RCM –mostly there is increased thickness
• in advanced disease – biventricular function may decrease

5. • ATRIUM
- significant dilatation of both atrium is common finding

6. DOPPLER
• Mitral valve inflow velocity on pulsed wave Doppler will show grade 3
diastolic dysfunction.
• Short deceleration time (160ms)
• Mitral valve inflow velocity on pulsed wave Doppler showing < 25%
variation.

9. Tissue Doppler
• Tissue Doppler imaging at medial mitral annulus showing early
systolic velocity E’< 7cm/sec.

10. VALVE FUNCTION
• > 2/3 will have TR with PAH
• Around 2/3 will have mitral regurgitation
• TR> MR

11. STRAIN
• Strain rate Imaging is a method in Echocardiography for measuring
regional or global deformation of the myocardium .
• The term "deformation" refers to the myocardium changing shape
and dimensions during the cardiac muscle

13. Displacement, Velocity
• Displacement is the measure defining how far a myocardial segment moves from
an initial point.
• Velocity is used to describe how fast the myocardium moves in a particular
direction. During systole myocardium travels towards apex and velocities are
positive in nature. During diastole heart muscle moves to its initial position and
diastolic velocities are negative.

14. STRAIN
• Strain - is defined as the fractional or percentage change in an objects
dimension in comparison to the object’s original dimension.
• Deformation in basic sense may denote lengthening, shortening, or
thickening.

17. STRAIN RATE
• strain rate can be defined as the speed at which deformation occurs.

19. V,D VS S, SR

20. STRAIN
• Strain
• Velocity
• Strain rate

21. TYPES OF STRAINS
• Myocardial deformation occurs in the longitudinal direction, circumferential as
well as in radial direction. Using end diastole as a fixed reference point, the
myocardium, during systole, shortens longitudinally, reduces circumferentially
and thickens radially
• 1. Longitudinal strain (LS)
• 2. Circumferential strain (CS)
• 3. Radial strain (RS).

23. • The myocardial deformation is negative longitudinally and
circumferentially (negative LS and CS)
• positive radially (positive RS)

24. • LS varies between = −20% and −22%,
• CS =−20% and −25%
• RS = + 30% and 40%