Myocardial strain to detect subtle left ventricular systolic dysfunction

In daily clinical practice, LV systolic function is routinely assessed with the use of two-dimensional echocardiography. Using biplane LV end-diastolic and end-systolic volumes, LVEF is calculated. The introduction of real-time three-dimensional echocardiography has improved the accuracy of echocardiographic assessment of LVEF. However, calculated LVEF may not truly represent LV systolic function in specific cardiac diseases or when subtle LV dysfunction is present. Two-dimensional speckle tracking echocardiography enables assessment of myocardial strain, thereby providing detailed information on global and regional LV deformation. This is of particular interest when subtle LV systolic dysfunction is present despite preserved LVEF. In this review, the potential use of LV global longitudinal strain to detect subtle LV systolic dysfunction is illustrated in various clinical scenarios.