Abstract
PURPOSE: This review evaluates the applications of speckle-tracking echocardiography (STE) in stress echocardiography, focusing on feasibility, physiological adaptations, and its diagnostic and prognostic utility in cardiovascular conditions. METHODS: A systematic search of PubMed identified studies published up to December 28, 2024, using terms related to STE, stress echocardiography, and myocardial strain. Grey literature was excluded. Eligible studies assessed myocardial strain under stress conditions and reported on feasibility, diagnostic accuracy, or prognostic outcomes. RESULTS: Sixty-four studies were included, covering healthy individuals, athletes, at-risk populations, and patients with cardiovascular conditions. Feasibility studies demonstrated high interobserver reliability, with strain parameters measurable in > 80% of cases (intraclass correlation coefficient [ICC] 0.80 to 0.92). In healthy individuals and athletes, STE revealed myocardial adaptations and exercise-induced changes. In at-risk populations, such as those with diabetes or after cardiotoxic therapies, STE identified subclinical myocardial dysfunction, facilitating early intervention. For coronary artery disease (CAD) and heart failure (HF), stress-induced changes in global and segmental strain improved diagnostic accuracy and risk stratification, with thresholds such as a > 15% reduction in global longitudinal strain under stress aiding therapeutic decision-making. CONCLUSIONS: STE enhances the diagnostic and prognostic utility of stress echocardiography by providing reproducible strain parameters and facilitating early detection of dysfunction in high-risk populations. Future research should focus on standardizing strain analysis and integrating artificial intelligence (AI) to optimize clinical applications.