4Dimensinal XStrain Echocardiographic Assessment of Left Ventricular Strain and Rotational Mechanics: Technology, Clinical Application, Advantages and Limitations

Currently, because of its phenomenal ability to non-invasively assess the left ventricular (LV) systolic function, 2Dimensional speckle tracking echocardiography (STE) is being increasingly embraced in numerous echocardiographic laboratories, multinationally. 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 estimation by STE is intrinsically accompanied 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 trustworthy, economical and a simplistic tool for estimation of regional and global myocardial function. Furthermore, 4D XStrain STE can accurately quantify the 4D LV ejection-fraction, LV volumes and sphericity index (SI). However, this noteworthy technology has not been extensively implemented and its assessment is still limited to research applications dominantly. Hence, we aimed to familiarize this innovative technology by comprehensively addressing its technique, advantages and limitations, with intent that it may serve a more meaningful purpose in the current volatile scenario of cardio-vascular disease.