Speckle Tracking Echocardiography: Is it Ready for Routine Clinical Use?

Speckle tracking echocardiography, is now well into the second decade since the original publications describing the technique. The initial attempts had been toward delineating the normal range of the velocities, and in particular LV strain analysis, which enables quantitative assessment of LV deformation. Furthermore, the technique was shown to permit measurement of strain from the longitudinal, radial and circumferential aspects. After establishing the normal range of strain in the normal myocardium, efforts were made to differentiate these from infarcted regions, which was achieved successfully by us and others. This was followed by the real challenge of accurate assessment of both ischemic myocardium and the attempt to achieve a quantitative measure for viability. These efforts are still under extensive investigation worldwide and will be reviewed.

Apart from these efforts in patients with ischemic heart disease, speckle tracking echocardiography was shown most promising to assess patients with asymptomatic severe aortic stenosis and to help in selecting those in whom earlier surgery is recommended. Furthermore, the technique enables accurate assessment of LA function, and may have important clinical application in differentiating between patients who would develop atrial fibrillation as opposed to those who will not.

The main challenge before introducing this technique into routine clinical use is reducing significantly inter-observer measurements and in particular, inter-vendor variability. Several international efforts are currently underway toward this important goal.

Speckle tracking echocardiography has come a long way and has a great potential to become the most important quantitative measure to assess LV myocardial function.