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May 1, 2019

The Diagnostic and Prognostic Value of Echocardiographic Strain

Author Affiliations
  • 1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2North Shore Hospital, Auckland, New Zealand
  • 3Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Cardiol. 2019;4(6):580-588. doi:10.1001/jamacardio.2019.1152
Key Points

Question  What is the clinical utility of echocardiographic strain in the diagnosis and prognosis of cardiac disease?

Findings  Echocardiographic strain is used to evaluate cardiac dysfunction in patients with coronary artery disease, valvulopathies, cardiomyopathies, and cancer treatment–associated cardiac dysfunction. This review presents an array of speckle-tracking echocardiographic images of characteristic bull’s-eye plots that can be used to inform the differential diagnosis and prognosis for these common cardiac conditions.

Meaning  The pattern of the bull’s-eye plot can be used by clinicians as a diagnostic and prognostic tool in contemporary patient care for a variety of cardiovascular conditions.


Importance  Myocardial deformation or strain by speckle-tracking echocardiography (STE) has become an established echocardiographic modality for the diagnostic and prognostic evaluation of cardiac dysfunction. Current literature supports the incremental value of strain in diagnosis, risk stratification, and prognostication of a multitude of cardiac disease states.

Observations  Strain has been studied across the clinical spectrum from common to obscure pathologic conditions. This review presents the current literature evaluating characteristic strain patterns across this clinical spectrum, discusses prognostic implications, and provides a case series of classic strain polar maps, which are also known as bull’s-eye plots.

Conclusions and Relevance  Characteristic bull’s-eye patterns can be used to guide patient evaluation and management.

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