Echocardiographic strain imaging: what do paediatric cardiologists need to know?

: Assessment of systolic and diastolic function of both the left and right ventricles is an integral part of the assessment and management of children with heart disease. Despite corrective or palliative repair of congenital heart disease, dysfunction of the systemic ventricle, which may a morphologic left or a right ventricle, subpulmonary right ventricle, and the functional single ventricle may occur in the long term. Conventional echocardiographic indices of cardiac function can be regarded as parameters of indirect changes consequential to the shortening and lengthening of the myocardium in the cardiac cycle. Direct interrogation of myocardial deformation, on the other hand, may shed important lights on the understanding, diagnosis and prognosis of cardiac dysfunction in the paediatric cardiac population. In the past decade, technological advances in echocardiographic strain imaging have enabled direct interrogation of global and regional deformation of the myocardium. In this review, the concept of strain imaging, the evolution of echocardiographic strain imaging, the methods of ventricular and atrial strain quantification, and clinical applications of strain imaging in children and young adults with congenital heart disease are discussed. The gaps and challenges in the clinical translational use of echocardiographic strain imaging are also highlighted. Given the emerging data on potential prognostic values of strain measures in the prediction of occurrence of adverse cardiovascular outcomes in the congenital heart population, it is timely for paediatric cardiologists to consider the incorporation of strain imaging into the clinical management algorithm.