Striving towards the ideal cardiac functional assessment strategy: the contribution of tissue Doppler, strain and strain rate imaging

In cardiac research, a major goal of prevention of catastrophic events by risk-factor management and earlier detection has, in recent years, led to a proliferation of imaging modalities, moving us from old-fashioned chest X-ray through increasingly sophisticated approaches such as magnetic resonance imaging (MRI) and multi-slice fast computer-aided tomography (CT) scanning. Today, we have the option of using a vast array of invasive and non-invasive approaches, with diverse technical underpinnings, to assess various, and often overlapping aspects of cardiac function. Tissue Doppler imaging (TDI) and the related applications of strain and strain rate imaging are new technologies that are now being evaluated in the realm of practical patient care, and the underlying principles remind us that cardiac contractility is a reflection of the integration of muscle fibre architecture, mechanics and metabolism. TDI is the first technology that allowed imaging of motion within the myocardial wall rather than that of the blood pool, and permits analysis of velocities and accelerations from ultrasonic scatterers in muscle. Since its inception, it has been used to evaluate both new cardiac functional parameters as well as conventional function; for some of these, TDI has proven the superior imaging modality, while for others it offers only incremental information over conventional approaches.