Chapter 1. Basic of Strain Imaging & the normal Strain

Chapter 1. Basic of Strain Imaging & the normal Strain

LV, LA, RV, RA

LV, LA, RV, RA

Myocardial mechanics — the left ventricle

LV systole / diastole

Ejection fraction — How, Why, Biplane (Simpson) / 2D Strain (longitudinal)

Indications for Strain Imaging

Quality criteria Strain Imaging / Speckle Tracking Echocardiography

Normal values of Strain Imaging — LV Strain

17-Segment Model for Bulls-eye

How to measure LV Strain

Normal LV Strain — Bulls-eye

Region of Interest (ROI)

Angle & Foreshortening

PSI & Dispersion

Normal values – RV strain

Normal values – LA strain

Normal values – RA strain

Limitations of Strain Imaging

Normal values Strain Imaging — RA Strain

  • Don’t cut off the RA roof

  • RA Strain is measured in the 4-ChV

  • A focus (optimal image) should be on the RA

RASr: Right atrial stain reservoir

(normal value around 42,7%)

RASct: Right atrial strain contraction

(normal value around -16,1%)

PV/AVO: Pulmonic/aortic valve opening

PV/AVC: Pulmonic/aortic valve closure

TV/MVO: Tricuspid/mitral valve opening

TV/MVC: Tricuspid/mitral valve closure

Normal RA Strain

Frame rate 54/sec







ROI with color codes




Frame rate 54/sec





ROI with color codes






RASr 46%

RAScd -27%

RASct -19%


Atrial contraction


  • EKG — R is easier identified than the P-wave

  • Pre-a has to be adapted sometimes



RASr 46%
RAScd -27%

RASct -19%

Atrial contraction

  • EKG — R is easier identified than the P-wave

  • Pre-a has to be adapted sometimes

Focused RA

Focused RA

Frame rate 54/sec
ROI with color codes
RASr 46%
RAScd -27%

RASct -19%

Atrial contraction

  • EKG — R is easier identified than the P-wave

  • Pre-a has to be adapted sometimes

The contents of the website, including the videos, were created without influence from third parties.

The contents of the website, including the videos, were created without influence from third parties.

The Strain Book

Represented by Dr. Martin Altersberger

Contact: heart.lungs.ultrasound@gmail.com

The Strain Book

Represented by Dr. Martin Altersberger

Contact: heart.lungs.ultrasound@gmail.com

© 2026 The Strain Book by Dr. Martin Altersberger. All rights reserved.

© 2026 The Strain Book by Dr. Martin Altersberger. All rights reserved.

© 2026 The Strain Book by Dr. Martin Altersberger. All rights reserved.

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