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

Region of Interest (ROI)

  • Includes the entire myocardium (90% or more)

  • Blood should not be included

  • Trabecula should not be included

  • Papillary muscles should not be included

  • Pericardium should not be included

Too broad ROI

Too broad ROI

Too narrow ROI

Too narrow ROI

Optimal measurement in a focused 4-ChV

Optimal measurement in a focused 4-ChV

Less angle-dependent than Doppler measurements,
but also Strain has angle dependency

Less angle-dependent than Doppler measurements,
but also Strain has angle dependency

Angle vs Foreshortening

Optimal measurement in the focused 4-ChV vs foreshortening

Optimal measurement in the focused 4-ChV vs foreshortening

Subcostal limitation in strain measurement
due to subopitmal angle and foreshortening

Subcostal limitation in strain measurement
due to subopitmal angle and foreshortening

Foreshortening should be avoided
as it changes the strain measurement (overestimation)

Foreshortening should be avoided
as it changes the strain measurement (overestimation)

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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