Strain Imaging in Cardio-Oncology

Abstract

Echocardiographic imaging is crucial for patient management during cardiotoxic cancer therapy. Left ventricular ejection fraction is the most commonly used parameter for identifying left ventricular dysfunction. However, it lacks sensitivity to detect subclinical changes in cardiac function due to cardiotoxic treatment. Global longitudinal strain (GLS) is the best studied strain parameter with established diagnostic and prognostic value. Multiple studies have demonstrated changes in GLS as an early marker of cardiotoxicity. This document serves as a primer to help clinicians in the acquisition and interpretation of strain in cardio-oncology. Cases with embedded videos illustrate a step-by-step approach to obtaining GLS measurements and common pitfalls to avoid. The document includes a concise summary of the indications of GLS in cardio-oncology and its role in guiding oncological therapy. Practical approaches on how to implement strain in the echo laboratory with guidance on training and quality assurance are also discussed.

Central Illustration

Highlights

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  Compared with LVEF, GLS is a more sensitive and reproducible measure of LV systolic function and has emerged as an early marker of cardiotoxicity.

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  Despite evidence supporting the clinical utility of GLS imaging, familiarity with the practical process of strain imaging among clinicians is lacking.

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  Although each vendor has its own proprietary software for strain imaging, the basic steps of measuring GLS are similar.

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  Education is needed to enhance the performance, analysis, and interpretation of GLS for the management of cardio-oncology patients.