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of strain. In some commercial applications, the acoustic markers are tracked more individually, calculating the velocity from the motion and the sampling interval (inverse of frame rate) generating a velocity field. Unlike tissue
Doppler, this velocity field in not limited to the beam direction. Strain rate and strain are then calculated from the velocities. Speckle tracking has been shown to be comparable to tissue Doppler derived strain, and has been validated against MR.
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141:. Speckle tracking can thus track in two dimensions. However, as the axial (in the direction of the beam) resolution of the ultrasound is far better than the transverse, the tracking ability is less in the transverse direction. Also, the transverse resolution (and hence, tracking ability) decreases with depth, in a sector scan where ultrasound beams diverge.
178:, left ventricular deformation is defined by the three normal strains (longitudinal, circumferential, and radial) and three shear strains (circumferential-longitudinal, circumferential-radial, and longitudinal-radial). The principal benefit of LV shear strains is amplification of the 15% shortening of
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Roes SD, Mollema SA, Lamb HJ, van derWall EE, de Roos A, Bax JJ. Validation of echocardiographic two-dimensional speckle tracking longitudinal strain imaging for viability assessment in patients with chronic ischemic left ventricular dysfunction and comparison with contrastenhanced magnetic resonance
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using available information from the strongest echoes, very oft the mitral annulus, so the regional measurements are not pure regional, but rather to a degree, spline functions of the global average. AS the method uses B-mode, frame rate of speckle tracking is limited to the relatively low frame rate
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Different commercial and non commercial operators then use different approaches to derive motion and deformation parameters. The motion of a single kernel can be resolved into displacement curves, and the distance between two kernels into strain (deformation). Strain rate will then be time derivative
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Increasing frame rate in B-mode is done by reducing line density, i.e. lateral resolution, and thus making the method more angle dependent. Finally, the method on some applications is dependent on the ROI (Region Of
Interest) size and shape. In principle Speckle tracking is available for deformation
186:. Left ventricular shearing increases towards the subendocardium, resulting in a subepicardial to subendocardial thickening strain gradient. Similar to MRI, STE utilizes "Lagrangian strain" which defines motion around a particular point in tissue as it revolves through time and space. Throughout the
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substantial, especially when compared to an external reference. Thus, measurements, normal limits and cut off values are only vendor specific. Due to industrial secrecy, the details of the different algorithms may also be largely unavailable, so a detailed investigation in modelling is difficult.
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The main problem with speckle tracking, however, is increasingly recognised: The lack of standardisation. Each vendor of ultrasound equipment, or analysis software, has different algorithms, that will perform differently during analysis. In head to head comparisons, biases between analysis may be
128:
As the speckle pattern is random, any region of the myocardium has a unique speckle pattern: Within the picture, a defined area "kernel" can be defined, and as this speckle pattern is relatively stable, the kernel can be recognised in the next frame, within a larger search area, by a "best match"
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Twist or torsional deformation define the base-to-apex gradient and is the result of myocardial shearing in the circumferential-longitudinal planes such that, when viewed from the apex, the base rotates in a counterclockwise direction. Likewise the LV apex concomitantly rotates in a clockwise
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Amundsen BH, Crosby J, Steen PA, Torp H, Slørdahl SA, Støylen A. Regional myocardial long-axis strain and strain rate measured by different tissue
Doppler and speckle tracking echocardiography methods: a comparison with tagged magnetic resonance imaging. Eur J Echocardiogr. 2009
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Modesto KM, Cauduro S, Dispenzieri A, Khandheria B, Belohlavek M, Lysyansky P, Friedman Z, Gertz M, Abraham TP.Two-dimensional acoustic pattern derived strain parameters closely correlate with one-dimensional tissue
Doppler derived strain measurements. Eur J Echocardiogr. 2006
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Edvardsen T, Gerber BL, Garot J, Bluemke DA, Lima JA, Smiseth OA.Quantitative assessment of intrinsic regional myocardial deformation by
Doppler strain rate echocardiography in humans: validation against three-dimensional tagged magnetic resonance imaging. Circulation
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of B-mode. If the frame rate is too low, the tracking quality becomes reduced, due to frame-to-frame decorrelation. This may also be a problem if the heart rate is high, (which in fact is a relative decrease in frame rate - fewer frames per heart cycle).
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Costa SP, Beaver TA, Rollor JL, Vanichakarn P, Magnus PC, Palac RT.Quantification of the variability associated with repeat measurements of left ventricular two-dimensional global longitudinal strain in a real-world setting. J Am Soc
Echocardiogr. 2014
112:) that allows the region to be tracked. The speckle pattern is relatively stable, at least from one frame to the next. In post processing this can be tracked consecutively frame to frame and ultimately resolved into angle-independent two-dimensional (
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Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E,et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll
Cardiol
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Helle-Valle T, Crosby J, Edvardsen T, Lyseggen E, Amundsen BH, Smith HJ, Rosen BD, Lima JA, Torp H, Ihlen H, Smiseth OA. New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation. 2005 Nov
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measurement in all directions, however, due to the limitation of lateral resolution in apical images, measuring circumferential and transmural deformation needs parasternal cross sectional views. On the other hand, compared to
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beam. Its use has remained limited due to angle dependency, substantial intraobserver and interobserver variability and noise interference. Speckle tracking technology has to a certain degree overcome these limitations.
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Hanekom L, Cho GY, Leano R, Jeffriess L, Marwick TH. Comparison of two-dimensional speckle and tissue
Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation. Eur Heart J. 2007
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D’Hooge J, Heimdal A, Jamal F, Kukulski T, Bijnens B, Rademakers F, et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 2000;1:
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Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaum M, et al.Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. JAm Soc
Echocardiogr
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showed significantly higher AUC for speckle tracking for detecting dysfunctional segments. However, this study only included patients with coronary disease. The lower frame rate has been seen to be a problem in
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Cho GY, Chan J, Leano R, Strudwick M, Marwick TH. Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging. Am J Cardiol 2006;
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Insana MF, Wagner RF, Garra BS, Momenan R, Shawker TH. Pattern recognition methods for optimizing multivariate tissue signatures in diagnostic ultrasound. Ultrason
Imaging. 1986 Jul;8(3):165-80
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Geyer, Holly; Caracciolo, Giuseppe; Abe, Haruhiko; Wilansky, Susan (2010), "Assessment of Myocardial Mechanics Using Speckle Tracking Echocardiography: Fundamentals and Clinical Applications",
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Kaluzynski K, Chen X, Emelianov SY, Skovoroda AR, O'Donnell M. Strain rate imaging using two-dimensional speckle tracking. IEEE Trans Ultrason Ferroelectr Freq Control. 2001 Jul;48(4):1111-23.
210:. This stored energy is released with the onset of relaxation similar to a spring uncoiling and results in suction forces. These forces are then used for rapid early diastolic restoration.
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This method of documentation of myocardial motion is a noninvasive method of definition for both vectors and velocity. When compared to other technologies seeking noninvasive definition of
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Ingul CB, Torp H, Aase SA, Berg S, Stoylen A, Slordahl SA. Automated analysis of strain rate and strain: feasibility and clinical implications. J Am Soc Echocardiogr. 2005 May;18(5):411-8.
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is defined as the fractional or percentage change in an objects dimension in comparison to the object’s original dimension. Similarly, strain rate can be defined as the speed at which
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Bohs LN, Friemel BH, Trahey GE. Experimental velocity profiles and volumetric flow via two-dimensional speckle tracking. Ultrasound Med Biol. 1995;21(7):885-98
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Bohs LN, Trahey GE. A novel method for angle independent ultrasonic imaging of blood flow and tissue motion. IEEE Trans Biomed Eng. 1991 Mar;38(3):280-6.
137:, which is an alternative. The movement of the kernel across the image can thus be tracked, in principle independent of the beam angle, as opposed to
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In the study by Cho et al, both TVI derived and speckle tracking derived longitudinal strain showed modest correlation with MRI derived strain. The
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Abraham TP, Dimaano VL, Liang HY. Role of tissue Doppler and strain echocardiography in current clinical practice. Circulation 2007;116: 2597-609.
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In order to achieve sufficient tracking quality when single markers are used, however commercial algorithms very often resort to varieties of
190:, the end-diastolic tissue dimension represents the unstressed initial material length. Speckle tracking is one of two methods for
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to speckle tracking technology, requires achieving sufficient parallel orientation between the direction of motion and the
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120:). These sequences provide both quantitative and qualitative information regarding tissue deformation and motion.
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technique. It analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the
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The utilities of STE are increasingly recognized. Strain results derived from STE have been validated using
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Marwick; Yu; Sun (2007) Myocardial Imaging: Tissue Doppler and Speckle Tracking. Wiley-Blackwell.
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Asbjorn Stoylen: Website; Strain rate Imaging. Myocardial deformation imaging by ultrasound.
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Sutherland; Hatle; Claus; D'hooge;Bijnens (2006) Doppler Myocardial Imaging. BSWK, Belgium.
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into 40% radial LV wall thickening, which ultimately translates into a >60% change in LV
259:, that method is mainly only available for longitudinal measures from the apical position.
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direction. During ejection, LV torsion results in the storage of
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Postoperative circumferential LV strain rate 2-D speckle tracking
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Reisner, SA; Lysyansky, P; Agmon, Y; Mutlak, D (2004),
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Clinical Applications of Speckle Tracking Technology:
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317:Hypertensive Heart Disease
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343:Diastolic Heart Disease
297:Stress Echocardiography
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292:Myocardial Infarctions
332:Stress Cardiomyopathy
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336:Pericardial Disease/
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375:Strain rate imaging
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52:cardiology
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