This review is aimed at understanding the clinical connect betweenischemia and tissue changes by firstly, describing the historical and clinicopathophysiologicalperspective of deformation imaging and secondly clinical advances of tissue imaging; nextthe body of evidence currently available for this methodology; and finally, the feasibility andbarriers to clinical translation. There will also be a brief review of the feasibility and currentuse of contrast for perfusion with flash imaging Myocardial contrast echocardiography (MCE) for the detection of ischemia.

Myocardial ischemia detection has come a long way since the clinicalsymptom was scientifically described several centuries ago and matched withpathophysiological correlation. The majority of cases are atherosclerotic macro-vesselobstruction or thrombosis and lesser degree various other forms of obstruction includingdynamic changes in both small and large vascular beds. On a statistical level most lifethreatening cases are atherosclerotic and correlated physiologically with an ischemiccascade. With the identification of non-linearity of ischemic cascade and hence concepts ofischemic constellation, it is increasingly clear that circumstances can determine which aspectof the cascade is noted and altering the probability of significant ischemi a.

Myocardial deformation and perfusion imaging adds a novel perspective of myocardial performance under stress.