John Gorcsan, MD, Washington University cardiologist discusses how echocardiographic strain imaging has emerged as an important noninvasive tool to assist in monitoring for chemotherapy cardiotoxicity. Global longitudinal strain (GLS) can be incorporated into the routine cardiac ultrasound examination and reported as an adjunct measure of left ventricular (LV) function. Data continues to build the GLS is additive to LV ejection fraction, and can provide additional prognostic information to patients being treated with cardiotoxic agents. Strain imaging is also useful to detect cardiac amyloidosis. A characteristic apical sparing pattern is observed where strain is more reduced at mid LV and basal LV levels. Strain imaging can be added to routine echo Doppler data, such as reduced early diastolic mitral annular velocities seen with cardiac amyloidosis. Because amyloidosis may be difficult to diagnose clinically, the addition of strain imaging may result in an increased diagnostic yield of patients with cardiac amyloidosis.