A heart attack or conditions such as cardiomyopathy can damage the myocardium (heart muscle) and lead to heart failure. Devices such as pacemakers and left ventricular assist devices (LVAD) can help to support the heart during heart failure. Ultrasound strain imaging allows measurement of deformation in the myocardium and can therefore improve understanding of heart function. The research in this thesis was performed to improve diagnostic measurements, by use of ultrasound strain imaging, to help inform pre- and post-device implantation decision making. This was first performed in experimental studies, investigating new methods for estimating remaining left ventricular function in the LVAD supported heart. Furthermore, clinical studies were undertaken to investigate the reliability of strain measurements in dyssynchronous heart failure patients, these could potentially be used to predict response to pacemaker implantation. Surrounding studies investigated new strain measurement techniques and tools for validating them, and the effect of exercise on the failing heart.

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