lot of attention over the last few years. Global longitudinal strain (GLS), a robust parameter of 2D strain is used to measure LV function. Circumferential and radial strain have proved to be less reliable and not recommended for routine use. GLS provides incremental information over and above LVEF. It has been widely studied in AS, MR and AR (especially AS) and also in transcatheter interventions like TAVI and Mitraclip procedures.

2D strain as an application and GLS as a measurement tool have shown to be useful in patients having valvular heart disease for studying cardiac mechanics, assessment of risk, predicting adverse events, for prognosis and in selecting patients for valve surgery or percutaneous valve procedures. 2D strain has also been studied in a limited way for RV and LA function in valvular heart disease, but not advocated for routine use though it shows potential to be a useful tool in the future. These are some limitations: Inter-vendor variability, dependence on image quality, affected by age, gender and load, and some technical challenges. 2D strain has shown value, it is robust and is a proven parameter, but due to certain limitations in its methodology and also lack of data in certain areas, it needs to be used with certain care and thought. Guidelines do make a mention, but suggest caution while using it in clinical scenarios. 2D strain in valvular heart is ready for prime time, can be used in routine clinical practice, but should be used in an integrated way and not to be used as the sole or primary parameter to make important decisions in valvular heart disease.