2D and 3D Speckle Tracking Echocardiography

Function by 2D and 3D Echocardiography using STE

This section of the website is dedicated to the use of 3D echocardiography for functional assessment of the Right and Left Ventricle (RV and LV). We are using, in the NeoCardioLab, the Philips Epiq-7 machine with the X6-1 and X5-1 transducers (Pediatric and Adult xMatrix Array Transducers). We are also using the TomTec arena software in order to obtain LV and RV volumes. This website will not be discussing the use of 3D echocardiography for anatomical evaluation, valvular structural assessment or trans-esophageal evaluations.

Speckle Tracking Echocardiography in the NICU - Background concepts

How to use TomTEC-Arena to measure myocardial deformation by Speckle Tracking

How to use TomTEC-Arena to measure 3D Right and Left Ventricular volumes by Speckle Tracking

Cardiac Function - Right and Left Ventricles

Represents the continuous process from filling of the ventricle(s) to ejection in the respective outflow tract(s)

All this results in “2 classical phases” of cardiac cycle that we divide (traditionally) between systole (which results eventually in ejection) and diastole (which results in ventricular filling). There is a phase of isovolumetric relaxation and isovolumetric contraction. 

Left Ventricle

LV contracts mostly circumferentially and with torsion (wringing movement) with minor longitudinal contribution. The relaxation has been described to have the base rotate counterclockwise and apical clockwise (endocardial layer). The rate at which untwisting happens gives insight on diastolic function. 

(Important references: Bansal M, Kasliwal RR. Indian heart journal 65 (2013) 117e123; Lai, W. W., Mertens, L. L., Cohen, M. S., & Geva, T. (2015). Echocardiography in pediatric and congenital heart disease: from fetus to adult. John Wiley & Sons.; Crean A et al. Journal of Cardiovascular Magnetic Resonance, 2011; J Am Soc Echocardiogr 2012;25:543-52.)

Below is a great depiction of the left ventricle in 3D by computational reconstruction. One can see the circumferential contraction, the radial thickening of the myocardium during the contraction, as well as the wringing effect (rotational properties) of the various layers of the LV. This is a YouTube video and the profile of Dr Rossi on ResearchGate can be accessed here.

Speckle-Tracking Principles

2D Longitudinal STE on the LV in A4C

2D Longitudinal STE on the LV in A5C

2D Longitudinal STE on the LV at apical level in the parasternal short axis view

By convention

Rotation analysis from a 3D Echocardiography by TomTec - Apex (blue), Base (Red), Torsion (Orange) from NeoCardioLab.

Rotation analysis from 2D Echocardiography by TomTec (NeoCardioLab participant). When doing rotation analysis by 2D, one needs to ensure that the images are sequentially obtained to avoid variation in loading conditions, as well as heart rate. The base and apex need to be acquired by facing the structure and not sweeping with an angle. 

Important terminology 

Bull's eye of the LV for Strain assessment. ©Neocardiolab


The LV contracts in a wringing (in french, we say: "essorage") motion (the apex and the base will rotate in different directions; with a gradient from the endocardium to the epicardium) and with a contraction towards the inside of the cavity (circumferential). The longitudinal aspect of contraction is not as pronounced as the longitudinal contraction of the RV. 

The RV, which has fibrous discontinuity between the AV valve (usually a tricuspid) and the Outflow tract (usually a pulmonary valve), will contract in a bellow motion with the inflow going towards the outflow, the free wall going towards the septum and the septum going towards the free wall (assuming there is no increase RV afterload, there is adequate spread of electrical activation and the conformation is as expected - ie: no VSD, etc). 

When we look at the LV, we can look at the global circumferential strain (% deformation towards the inside of the cavity) and torsion (gradience of difference of degrees of rotation from Apex to base of LV). 

For the RV, we can look at the RV free wall and septal longitudinal strain. 

Global just means we take free wall and septal together. 

Knowing that the LV is bullet shape, we often talk about "peak global longitudinal strain" (pGLS) when assessing the deformation in the longitudinal planes of all the standard views in 2D (A2C, A3C, A4C) or in full 3D volume. 

We talk about "peak longitudinal strain"  (pLS) when we have only one plane (example: A4C). 

We talk about "peak" (pGLS, pGCS - circumferential, pGRS - radial, pEDSR - peak early diastolic strain rate, pGLSR - peak GLS rate) - when we assess the peak at the contraction or relaxation. 

We talk about "pGLSs" (systolic) when we match the curves with the aortic valve opening and closure. 

"Deformation analysis" encompasses the assessment of % (strain), speed (strain rate), displacement (distance of movement), degrees (torsional properties) of the deformational properties of the ventricles. These properties can be assessed for segments, for global ventricle, in systole and in diastole. 

Although theoretically STE is less influenced by preload status compared to other standard measure of functions using 2D ECHO, TDI, M-Mode, etc... all these measures are realistically influenced by preload for the RV or the LV.

This article is key at explaining the Twisting mechanics of the LV

Here is the screenshot of a deformation analysis done by TomTec for the LV in parasternal short axis view at the mid-papillary muscle area. Here are selected the Strain-Rate curves. The LV is divided in segments and each segment is represented by a curve. There is a systolic and diastolic phase to the contraction. One may see the radial and circumferential curves, as well as summary table of the peak of strain rate for each segment, as well as the average. The radial strain rate is positive during contraction. The circumferential strain rate is negative during contraction. The curves can also outline the strain rage in diastole (positive for the circumferential strain rate, and negative for the radial one). The time to peak gives a sense of the dysynchrony of activation.  ©Neocardiolab

This is the summary panel that TomTEC provides for 2D analysis of the longitudinal deformation of the LV when inputing the apical 2,3 and 3 chamber views. There is a Bull's eye depicting the strain values for each segments. There is also a 3D remodelling from the 2D acquisition, with estimated end diastolic and systolic volumes. ©Neocardiolab

These are the curves for each segment in the A4C related to the longitudinal strain in %. The peak appears for each segment in the summary table, as well as the average % of each peak. The measurements are done for the endocardium. One may also ask from the software to do the same measurements of the epicardium and myocardium. Typically, in the literature, values are reported for measurements taken at the endocardial layer. ©Neocardiolab

Longitudinal strain rate in Apical 4 Chamber view for the LV. One may also obtain values from the average curve on the early diastolic strain rate peak. ©Neocardiolab

3D volume obtained from the apex in a premature newborn (1 kg). ©Neocardiolab

LV 3D - STE. Here the software tracks the endocardial layer. One may also obtain the LV mass by STE when applying the epicardial layer tracking algorithm. ©Neocardiolab

From the 3D analysis, one may obtain end diastolic and systolic volumes, ejection fraction, stroke volume, peak circumferential/longitudinal strain, twist and torsion. ©Neocardiolab

Time to peak of contraction analysis to detect dys-synchrony of segments. ©Neocardiolab

Longitudinal strain by segment. ©Neocardiolab

3D STE for the RV in a premature newborn. © NeoCardioLab 

From the 3D RV volume, one may obtain the estimated end-diastolic and systolic volumes, ejection fraction and stoke volume. The algorithm also provides the longitudinal strain of the RV free wall and septum. ©Neocardiolab

This is an exceptional publication available from the American Society of Echocardiography website and from the European Association of Echocardiography. This article is available on the web, by clicking here. The online PDF is linked here:


These are 2 presentations in PDF that are publicly available on the website of the ASE. You can access them by clicking here and here. The presentations are from Dr Wendy Tsang, from the University of Toronto at Toronto General Hospital. They are among the best presentations available on the web teaching on the use of 3D echocardiography. Please make sure to visit the UofT website on Virtual TEE. You can find the ResearchGate profile of Dr Tsang here. I have put the linked PDF from the ASE website available here:


Segmentation of the left ventricle


Speckle Tracking Echocardiography in French 

Echocardiographie par suvie de pixel en français

Presentation (PDF) on STE principles


Created by Gabriel Altit - Neonatologist / Créé par Gabriel Altit (néonatalogiste) - © NeoCardioLab - 2020-2024 - Contact us / Contactez-nous