Practical guidance in echocardiographic assessment of global longitudinal strain.

THERE HAS BEEN INCREASING INTEREST IN THE MEASUREMENT OF GLOBAL MYOCARDIAL STRAIN because it is a sensitive and robust index to detect subclinical myocardial dysfunction, with a defined normal range (1). Numerous commercially-available versions of speckle tracking software are available for strain analysis, and measurement involves 6 steps that are common to different methods (Figure 1). Surprisingly, however, there are no standard instructions for measuring it adequately. This could be one of the causes of interobserver variation, especially in different echocardiography laboratories (2). The authors developed a set of 9 cases as a step to establishing reader uniformity in an international multicenter trial of the incremental value of myocardial strain for the detection of cardiotoxicity (SUCCOUR