Clinical Applications of Strain Echocardiography (Article In Press)

The purpose of this document is multifold. First, it is meant to guide clinical echocardiographers in the applications of strain with clear supporting evidence for its use. Second, updated clinical advice should encourage the hardware and software industries to develop improved algorithms. Third, it provides guidance to payers as to which applications of strain are most worthy of reimbursement. Finally, gaps inthe technology and evidence base are identified in hopes of inspiring new developments and applications in the field. The clinical advice is based on expert opinion, as extensive randomized controlled trials using strain-based measures do not exist within this space. The document itself is organized into modules facilitating updates in specific advice as new evidence is published. The initial section covers technical developments since 2011 with emphasis on the EACVI-ASE Strain Standardization Task Force. The next section addresses the critical issue of establishing normal ranges in strain, particularly left ventricular global longitudinal strain (LVGLS). The bulk of the document discusses clinical applications for strain, including HF, cardio-oncology, ischemia, valvular heart disease, the right ventricle, the left atrium, exercise and dobutamine stress applications, and CHD.