Cardiac Shear Wave Elastography: Principles, Clinical Applications, and Practical Considerations for Interpretation.

Authors

Fan Wu, Qiyao Xu

Published in

Echocardiography (Mount Kisco, N.Y.). Volume 43. Issue 7. Pages e70551.

Abstract

Cardiac shear wave elastography (SWE) is an emerging ultrasound-based technique that enables noninvasive assessment of myocardial mechanical properties beyond conventional motion- and deformation-based indices. By tracking the propagation of shear waves within the myocardium using ultrafast imaging, SWE provides stiffness-related information that may complement standard echocardiographic parameters in selected clinical settings. In this narrative review, we summarize the methodological principles of cardiac SWE, including acoustic radiation force-induced techniques, natural shear wave imaging approaches, and emerging three-dimensional SWE. We discuss current clinical evidence in key disease states characterized by altered myocardial stiffness, such as hypertrophic cardiomyopathy, cardiac amyloidosis, heart failure with preserved ejection fraction, and post-transplant or diffuse myocardial injury. Importantly, SWE measurements are highly context-dependent and influenced by cardiac phase, loading conditions, myocardial anisotropy, imaging plane, and acquisition methodology. Therefore, reported values should be interpreted as reflecting stiffness-related myocardial behavior rather than direct measures of fibrosis or specific histopathologic substrates. At present, cardiac SWE remains primarily a research-stage technique, with potential roles in phenotypic characterization, disease burden assessment in selected populations, longitudinal monitoring, and future integration into multiparametric echocardiographic and artificial intelligence-assisted workflows. Further standardization, definition of normal reference ranges, technical validation, and multicenter clinical studies are required before broader clinical adoption. In conclusion, cardiac SWE represents a promising extension of echocardiographic assessment of myocardial mechanics, but its clinical interpretation requires careful consideration of methodological, physiological, and disease-specific determinants.

PMID:
42440181
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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