**4. Summary and conclusions**

The assessment of LV and RV myocardial deformation during exercise is feasible and has contributed unique insight into cardiac physiology in health and disease. Inherent methodological challenges require appropriate training and a careful approach to image acquisition, analysis and interpretation. However, ongoing technological advancements and an increasing knowledge suggest that the echocardiographic assessment of myocardial deformation during exercise will play an ever-increasing role in future research and the clinical examination of the cardiac patient.
