This document discusses speckle tracking and strain analysis in echocardiography for diagnosing restrictive cardiomyopathy (RCM). It defines key terms like strain, strain rate, displacement and velocity. It describes the different types of strain - longitudinal, circumferential, and radial. Normal strain values are provided. RCM is characterized by restrictive filling and reduced diastolic volume. Echocardiography can detect features like left ventricular hypertrophy, dilated atria, and diastolic dysfunction by Doppler. Strain imaging further aids in the diagnosis by detecting reduced longitudinal and circumferential strain.

1. Speckle tracking and strain
Dr Siva Subramaniyan
PGIMER &Dr.RML Hospital
New Delhi

2. RCM
• CMP characterized by a “restrictive filling” and by a reduced diastolic
volume of one or both ventricles, with preserved systolic function and
in absence of significant hypertrophy.
• Myocardial interstitial fibrosis: typical pathological finding

3. DIAGNOSIS BY ECHO
• No pathognomonic signs (exclusion of other pathologies)

4. 2D ECHO
Left ventricle
- LV non dilated,
- non hypertrophic,
- with preserved systolic function
in secondary RCM –mostly there is increased thickness
• in advanced disease – biventricular function may decrease

5. • ATRIUM
- significant dilatation of both atrium is common finding

6. DOPPLER
• Mitral valve inflow velocity on pulsed wave Doppler will show grade 3
diastolic dysfunction.
• Short deceleration time (160ms)
• Mitral valve inflow velocity on pulsed wave Doppler showing < 25%
variation.

9. Tissue Doppler
• Tissue Doppler imaging at medial mitral annulus showing early
systolic velocity E’< 7cm/sec.

10. VALVE FUNCTION
• > 2/3 will have TR with PAH
• Around 2/3 will have mitral regurgitation
• TR> MR

11. STRAIN
• Strain rate Imaging is a method in Echocardiography for measuring
regional or global deformation of the myocardium .
• The term "deformation" refers to the myocardium changing shape
and dimensions during the cardiac muscle

13. Displacement, Velocity
• Displacement is the measure defining how far a myocardial segment moves from
an initial point.
• Velocity is used to describe how fast the myocardium moves in a particular
direction. During systole myocardium travels towards apex and velocities are
positive in nature. During diastole heart muscle moves to its initial position and
diastolic velocities are negative.

14. STRAIN
• Strain - is defined as the fractional or percentage change in an objects
dimension in comparison to the object’s original dimension.
• Deformation in basic sense may denote lengthening, shortening, or
thickening.

17. STRAIN RATE
• strain rate can be defined as the speed at which deformation occurs.

19. V,D VS S, SR

20. STRAIN
• Strain
• Velocity
• Strain rate

21. TYPES OF STRAINS
• Myocardial deformation occurs in the longitudinal direction, circumferential as
well as in radial direction. Using end diastole as a fixed reference point, the
myocardium, during systole, shortens longitudinally, reduces circumferentially
and thickens radially
• 1. Longitudinal strain (LS)
• 2. Circumferential strain (CS)
• 3. Radial strain (RS).

23. • The myocardial deformation is negative longitudinally and
circumferentially (negative LS and CS)
• positive radially (positive RS)

24. • LS varies between = −20% and −22%,
• CS =−20% and −25%
• RS = + 30% and 40%