Order Echo Strain for the Boards Discussion
Order Echo Strain for the Boards Discussion
1. Each of the following statements regarding strain imaging
are true except
A. Strain refers to the lengthening, shortening, or
thickening of a region of the myocardium.
B. Strain rate (ε˙) describes the distance over which
C. With tissue Doppler imaging (TDI), the direction of the
myocardial velocity denotes contraction or elongation.
D. Tissue Doppler imaging (TDI) parameters of velocity
are used to calculate strain rate.
E. Strain is calculated by integrating strain rate values over
2. Which of the following is true of strain imaging?
A. Strain imaging provides a method to objectively
quantify regional myocardial function independently of
B. Strain imaging can only be performed using tissue
Doppler imaging (TDI).
C. Strain is measured in units of cm/s.
D. TDI-based longitudinal, radial, circumferential, and
rotational strains are best measured from the apical
E. Longitudinal strain should be the same at all points
along the septum in a normal heart.
3. A patient with a history of a remote myocardial infarction is
being evaluated for angina and potential revascularization.
You are trying to determine if the myocardium is ischemic
and/or viable. Which of the following is true regarding
strain analysis for myocardial ischemia and viability?
A. Strain imaging can improve the sensitivity and
specicity of detecting ischemia in response to
dobutamine when compared to conventional stress echo.
B. Speckle-tracking echocardiography can reliably predict
the transmural extent of myocardial infarction.
C. TDI strain rate analysis can provide incremental value
over wall motion scoring alone to determine the viability
of the myocardial segments in dobutamine stress echo.
D. Speckle-tracking echocardiography strain analysis can
accurately predict viable myocardium from transmural
E. All of the options are true.
4. Which of the following is false regarding strain imaging?
A. Strain imaging can help distinguish hypertrophic
cardiomyopathy (HCM) from the “athlete’s
B. Strain imaging can help distinguish HCM from
left ventricular hypertrophy (LVH) related to
C. Strain imaging can help distinguish the cardiac
hypertrophy of Friedreich ataxia (FA) from HCM.
D. Strain imaging can help determine the cardiac
involvement in light chain amyloidosis before the onset
of clinical symptoms.
E. Strain rate imaging can provide additional data to
predict prognosis in light chain amyloidosis beyond
established 2D echo and TDI modalities.
5. Which of the following statements is false regarding strain
imaging in subclinical cardiac disease?
A. In Fabry disease, detection of subclinical cardiac
involvement, prior to myocardial brosis, is possible
using strain imaging.
B. Strain imaging can provide adjunctive clinical
information to the standard echocardiographic study
in patients receiving chemotherapy known to be
C. Strain imaging can provide evidence of subclinical
myocardial involvement in asymptomatic patients with
D. Strain imaging has no additional clinical utility
in patients with diabetes and normal ejection
E. All of the options.
Echo Strain for the Boards
Alison L. Bailey
(c) 2015 Wolters Kluwer. All Rights Reserved.
420 Section XII Newer Applications
6. For valvular heart disease, which of the following is true
regarding strain imaging?
A. Strain imaging does not offer additional clinical utility
in patients with severe aortic stenosis (AS) and normal
ejection fraction (EF) when compared to age-matched
patients with LVH.
B. In patients with asymptomatic moderate to severe AS,
strain imaging during exercise testing can identify a
group of patients with a “normal” exercise test but with
evidence of subclinical systolic dysfunction.
C. The addition of STE strain imaging to standard echo
evaluation did not change the ability to predict the
development of symptoms or worsening LV function
in patients with moderate to severe aortic regurgitation
(AR) managed conservatively.
D. In patients with chronic, severe mitral regurgitation, the
addition of strain imaging does not improve the ability
to predict postoperative declines in EF.
E. Strain analysis did not improve risk prediction for
postoperative mortality in patients referred for cardiac
surgery when compared to standard surgical risk
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