Use of strain analysis in dobutamine stress echocardiography. Longitudinal strain curves at baseline (left) and at peak stress (right). (A) Stress-induced ischaemia during a dobutamine stress echocardiogram results in a reduced regional systolic strain and the development of post-systolic shortening (PSS). The total strain may remain constant. (B) In normally perfused regions, the longitudinal strain profile hardly changes during a stress test. (C) ECG. AVC, aortic valve closure; MVO, mitral valve opening. Modified and reproduced with permission from Voigt JU, Exner B, Schmiedehausen K, et al. Strain rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 2003; 107: 2120–6.