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The Diagnostic and Prognostic Value of Echocardiographic Strain

Educational Objective
To describe clinical uses of speckle-tracking echocardiography strain imaging of the left ventricle for diagnosis and management of cardiac disease.
1 Credit CME
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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: February 28, 2019.

Corresponding Author: Nausheen Akhter, MD, Department of Medicine, Northwestern University, 675 N St Clair St, Ste 19-100, Chicago, IL 60611 (

Published Online: May 1, 2019. doi:10.1001/jamacardio.2019.1152

Author Contributions: Dr Akhter had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Singh, Voss, Lentz, Akhter.

Critical revision of the manuscript for important intellectual content: Singh, Lentz, Thomas, Akhter.

Obtained funding: Thomas.

Administrative, technical, or material support: Lentz, Thomas, Akhter.

Supervision: Thomas, Akhter.

Conflict of Interest Disclosures: Dr Thomas has received honoraria from General Electric, Edwards, Abbott, and Bay Labs and reports spouse employment with Bay Labs. No other disclosures were reported.

Funding/Support: This work was supported by a grant from the Irene D. Pritzker Foundation.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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