{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:58:45Z","timestamp":1785329925395,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Myocardial strain imaging, derived from speckle-tracking echocardiography (STE), has evolved from a research tool into a reproducible technique for detecting subclinical myocardial dysfunction. Recent advances in automated contouring and artificial intelligence have improved feasibility, reproducibility, and analysis speed, making multichamber strain assessment increasingly accessible in perioperative practice. Perioperative cardiovascular complications, including myocardial injury after non-cardiac surgery (MINS), postoperative atrial fibrillation (POAF), and heart failure, are associated with substantial postoperative morbidity and mortality. Conventional echocardiographic parameters, particularly left ventricular ejection fraction (LVEF), lack sensitivity for detecting early myocardial dysfunction. By quantifying myocardial deformation, strain imaging identifies subtle abnormalities in ventricular and atrial mechanics before conventional echocardiographic abnormalities become evident. Among available parameters, left ventricular global longitudinal strain (LV-GLS) and left atrial reservoir strain (LASr) provide the strongest evidence for perioperative risk stratification, with impaired values independently associated with MINS and POAF, respectively. Right ventricular strain (RV-GLS, RV-FWLS) and right atrial reservoir strain (RASr) remain promising but less standardized parameters supported mainly by observational data. Despite these advances, several barriers continue to limit widespread implementation, including vendor variability, the lack of standardized thresholds, and the absence of validated transesophageal echocardiography (TEE)-specific reference values. Importantly, current evidence supports myocardial strain primarily as a tool for risk stratification rather than for guiding therapy. No randomized trial has demonstrated that strain-guided perioperative management improves clinical outcomes, and its incremental value beyond established perioperative tools, including clinical risk scores, biomarkers, and conventional echocardiography, remains to be established. This review aims to provide a practical framework for the perioperative use of myocardial strain by summarizing the current evidence, clarifying its methodological limitations, simplifying its acquisition and interpretation for non-expert users, distinguishing established clinical applications from future research directions, and identifying the key evidence gaps that must be addressed before strain-guided strategies can be incorporated into routine perioperative care.<\/jats:p>","DOI":"10.3390\/jcm15155927","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:45:14Z","timestamp":1785325514000},"page":"5927","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myocardial Strain in Perioperative Medicine: A Practical Review for Anesthesiologists"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8949-7348","authenticated-orcid":false,"given":"Christophe","family":"Beyls","sequence":"first","affiliation":[{"name":"Anesthesia and Critical Care Department, Amiens Hospital University, F-80054 Amiens, France"},{"name":"UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80000 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8539-1092","authenticated-orcid":false,"given":"Filipe Andr\u00e9","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Centro Cardiovascular da Universidade de Lisboa, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Intensive Care Unit of Hospital CUF Tejo, Av. Jos\u00e9 Manuel de Mello 171, 1350-352 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2677-3389","authenticated-orcid":false,"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Laboratoire Traitement du Signal et de l\u2019Image (LTSI), UMR 1099, University of Rennes and Inserm, F-35000 Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazine","family":"Mahjoub","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care Department, Amiens Hospital University, F-80054 Amiens, France"},{"name":"UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80000 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.bjae.2021.05.008","article-title":"Perioperative care in cardiac surgery","volume":"21","author":"Pokhrel","year":"2021","journal-title":"BJA Educ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e351","DOI":"10.1161\/CIR.0000000000001285","article-title":"AHA\/ACC\/ACS\/ASNC\/HRS\/SCA\/SCCT\/SCMR\/SVM guideline for perioperative cardiovascular management for noncardiac surgery: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"150","author":"Thompson","year":"2024","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e287","DOI":"10.1161\/CIR.0000000000001024","article-title":"Diagnosis and management of patients with myocardial injury after noncardiac surgery: A scientific statement from the American Heart Association","volume":"144","author":"Ruetzler","year":"2021","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1093\/eurheartj\/ehad019","article-title":"Postoperative atrial fibrillation: From mechanisms to treatment","volume":"44","author":"Gaudino","year":"2023","journal-title":"Eur. 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