Assessment of Myocardial Viability at Dobutamine Echocardiography by Deformation Analysis Using Tissue Velocity and Speckle-Tracking

Bansal, Manish; Jeffriess, Leanne; Leano, Rodel; Mundy, Julie; Marwick, Thomas H.

doi:10.1016/j.jcmg.2009.09.025

Cited by 94 publications

(76 citation statements)

References 22 publications

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“…There is evidence to suggest that strain may assist in assessing viability either at rest or with stress. 4 Most importantly, strain represents an independent supplement to wall motion for evaluating LV mechanics.…”

Section: Speckle Tracking 2d Strainmentioning

confidence: 99%

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A Practical Approach to Using Strain Echocardiography to Evaluate the Left Ventricle

Feigenbaum

Mastouri

Sawada

2012

Circ J

101

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp valuation of left ventricular (LV) systolic function is a critical component of the practice of cardiology and a fundamental function of the echocardiographic examination. Although LV systolic function is commonly defined by ejection fraction (EF), there are numerous technical and hemodynamic limitations to EF. A qualitative "eyeball" estimate has high variability, and quantitative measurements are subject to endocardial border definition and formulas that make assumptions in geometry of the LV. The EF denotes global LV function and does not convey any regional differences in function that may exist in patients with various cardiomyopathies. Hyperkinetic segments can distort a global measurement, leading to an underestimation of the significance of regional abnormalities. There are several alternative techniques that can either supplement or replace EF, including tissue Doppler recordings of the mitral annulus and measurements such as the TEI or myocardial performance index. Doppler-Derived Strain RateThe newest technique for evaluating the LV uses the concept of strain or strain rate. This technique assesses myocardial mechanics by measuring the relationship between 2 points within the myocardium as if they were connected by a rubber band. When the 2 points move away from each other (myocardial lengthening during diastole), strain values are positive. When the 2 points move toward each other (myocardial shortening during systole), strain is decreased, generating negative strain. Strain and strain rate can be derived from either tissue Doppler or speckle tracking 2-or 3-dimensional (D) echocardiography. Using tissue Doppler, which is a form of pulsed Doppler, specific points within the myocardium can be identified. 1 Tracking these Doppler points enables measurement of strain rate. Because Doppler is velocity or distance divided by time, the initial measurement is strain rate. Integrating the strain rate gives strain.There are limitations to the Doppler-based strain rate. As with all Doppler applications, the Doppler-derived strain rate is angledependent. The Doppler strain rate sample volume is also fixed while the myocardium is moving. Thus the sample volume may not stay within the myocardium throughout the cardiac cycle. Strain rate is a derivative of strain and tends to be noisy. Figure 1 shows one way of recording strain rate using "curved M-mode". A resting normal 4-chamber view shows yellowishbrown strain rate during ventricular systole. The strain rate recording of the apex is not reliable, because the apex is perpendicular to the ultrasonic beam, so there is no Doppler signal. With exercise the systolic strain rate turns reddish brown, indicating a higher degree of negativity or contraction in the basal segments. This patient has a blockage in the left anterior descending coronary artery. With exercise, there is a delay in the onset of contraction of the apical half of the septal and lateral walls, a failur...

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Section: Speckle Tracking 2d Strainmentioning

confidence: 99%

“…The extremely low strain values suggest the non-viability of those segments. 4 Non-ischemic cardiomyopathy shows a diffuse pattern of abnormal strain segments (Figure 6). 19 The main strain feature is that the pattern of abnormal strain segments does not match any coronary artery perfusion.…”

Section: Examples Of Abnormal Sementioning

confidence: 99%

A Practical Approach to Using Strain Echocardiography to Evaluate the Left Ventricle

Feigenbaum

Mastouri

Sawada

2012

Circ J

101

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“…Longitudinal and circumferential strain rate during low dose dobutamine stress test determined by speckle tracking echocardiography can be used as a measure of myocardial viability and is able to predict functional recovery of the myocardial segment after revascularization [18].…”

Section: Discussionmentioning

confidence: 99%

Regional myocardial contractile reserve assessed by strain echocardiography and the response to cardiac resynchronization therapy

et al. 2014

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non-responders (2.14 ± 2.9 vs. -0.94 ± 1.74, p = 0.042). Patients with increased deformation in the LV lead area during dobutamine stimulation were more likely to be responders to CRT compared to patients without increased deformation in this area (81% vs. 20%, p = 0.0002). They exhibited significant increase in LVEF (8.8% ± 10.3% vs. 0.3% ± 6.4%, p = 0.01). LV electrode localization in viable myocardium was a good predictor of response to CRT (AUC 0.852, p < 0.0001). Conclusions: Regional contractile reserve assessed by strain rate echocardiography during dobutamine infusion predicts the response to CRT. (Cardiol J 2014; 21, 5: 524-531)

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“…Table 3 illustrates clinical studies evaluating deformation parameters during DSE for the assessment of viability. [15][16][17][18][19] Longitudinal strain and strain rate imaging evaluated at low dose have shown particular promise in the identification of viability, as defined by the gold standard of functional recovery after revascularisation. Hanekom et al 15 investigated TDI derived strain and strain rate in 55 patients with previous myocardial infarction and LV dysfunction undergoing DSE for viability assessment (figure 5).…”

Section: Detection Of Viabilitymentioning

confidence: 99%

Advanced techniques in dobutamine stress echocardiography: focus on myocardial deformation analysis

Joyce

Delgado

Bax

et al. 2014

Heart

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Assessment of Myocardial Viability at Dobutamine Echocardiography by Deformation Analysis Using Tissue Velocity and Speckle-Tracking

Abstract: Combination of TVI or STE methods with DbE can predict viability, with TVI strain and SR at LDD being the most accurate. TVI measures can predict viability in both anterior and posterior circulations, but STE measurements predict viability only in the anterior circulation.

Cited by 94 publications

References 22 publications

A Practical Approach to Using Strain Echocardiography to Evaluate the Left Ventricle

A Practical Approach to Using Strain Echocardiography to Evaluate the Left Ventricle

Regional myocardial contractile reserve assessed by strain echocardiography and the response to cardiac resynchronization therapy

Advanced techniques in dobutamine stress echocardiography: focus on myocardial deformation analysis

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