Left Ventricular Myocardial Deformation Assessment by 4Dimensional XStrain Speckle Tracking Echocardiography: An Innovative Technology

Strain based imaging techniques, particularly speckle tracking echocardiography (STE) have been shown to have clinical utility in a variety of clinical settings. Currently, STE is being embraced and increasingly adopted in numerous echocardiographic laboratories worldwide. In context with contemporary non invasive cardiovascular procedures, 2Dimensional STE is most sought-after method to evaluate LV strain, rotation, twist and torsion. Two dimensional (2D), three dimensional (3D) and 4Dimensional (4D) deformation assessment by STE is inherently associated with certain limitations. For better appraisal of LV contractile properties recently introduced updated version of 4D XStrain STE has been employed to analyse the various complex multidimensional LV mechanics. This novel technology is a reliable, affordable and a simple tool for estimation of regional and global myocardial function. Furthermore, 4D XStrain STE can accurately quantify the 4D LV ejection-fraction, end-diastolic and end-systolic volumes and sphericity index (SI). However, this distinctive technology has not been widely adopted and its assessment is still limited to research applications. Hence we aimed to familiarize this innovative technology by comprehensively addressing its technique, advantages and limitations, with the intent that it may serve a more meaningful purpose in the current volatile scenario of cardio-vascular disease. Keywords: 4Dimensional XStrain Echocardiography, LV strain, LV rotation, LVtwist, LV untwist, LV torsion.