Identification of acutely ischemic myocardium using ultrasonic strain measurements

Kukulski, Tomasz; Jamal, F; Herbots, Lieven; D’hooge, Jan; Bijnens, Bart; Hatle, Liv; Scheerder, Ivan De; Sutherland, George R.

doi:10.1016/s0735-1097(02)02934-0

Cited by 181 publications

(106 citation statements)

References 31 publications

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“…Several studies showed that a significant delay occurred in the timing of maximal segmental thickening during acute ischemia, that is, post-systolic shortening [24]. Therefore, in such condition, postsystolic strain is larger in magnitude than end-systolic strain.…”

Section: Assessment By Strain Measurementmentioning

confidence: 99%

Quantitative Assessment of Wall Motion Using Myocardial Strain

et al. 2003

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Background: Since regional tissue velocities are affected by motion of the adjacent regions as well as the whole heart translational motion, the quantification of wall motion using conventional tissue Doppler method may be questionable.Recently, a new echocardiographic system which enables the calculation of myocardial strain based on tissue Doppler information has been developed. Methods:We investigated whether myocardial strain could quantify regional myocardial contraction in 13 patients with normal wall motion and in 18 patients with wall motion abnormalities. Left ventricular segmental wall motion was assessed with conventional 2-dimensional echocardiography at the apical 2-, 3-, and 4-chamber views. The same views were imaged also with tissue Doppler method to determine regional systolic myocardial strain.Results: By 2-dimensional echocardiography, 230 segments were judged normokinesis, 83 segments hypokinesis and 23 segments showed akinesis. No segments showed dyskinesis. Peak systolic strain values of normokinetic, hypokinetic and akinetic wall segments were significantly different from each other (-20.1±5.5% for normokinesis, -11.9±5.0% for hypokinesis, p<0.0001 vs. normokinesis, and -6.3±3.4% for akinesis, p<0.0001 vs. normokinesis and p<0.0001 vs. hypokinesis) without significant overlap. Peak systolic strain values in normal subjects were similar among all segments, suggesting insignificant regional variations (p=ns). Conclusion:Systolic myocardial strain agreed well with assessed wall motion. Myocardial strain imaging may be a new powerful tool to quantify regional wall contraction. (J Echocardiogr 2003; 1: 23-28)

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Section: Assessment By Strain Measurementmentioning

confidence: 99%

Quantitative Assessment of Wall Motion Using Myocardial Strain

et al. 2003

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“…Therefore, parameters of diastolic function can provide incremental information in identifying the extent of myocardial necrosis compared with indexes of systolic function in patients with coronary artery disease. In this regard, it is possible to assess regional function objectively using strain Doppler imaging (9,13,19). We therefore underwent this experimental study in dogs to test the hypothesis that compared with systolic function measurements, the assessment of diastolic function by strain Doppler echocardiography will provide the more accurate estimate of the extent of viable myocardium.…”

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confidence: 99%

Impact of myocardial structure and function postinfarction on diastolic strain measurements: implications for assessment of myocardial viability

Park

Nagueh

Khoury

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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. Impact of myocardial structure and function postinfarction on diastolic strain measurements: implications for assessment of myocardial viability. Am J Physiol Heart Circ Physiol 290: H724 -H731, 2006. First published September 23, 2005 doi:10.1152/ajpheart.00714.2005.-We sought to assess the role of regional diastolic function by Doppler echocardiography in predicting myocardial viability. Sixteen dogs underwent left anterior descending coronary artery (n ϭ 8) or circumflex (n ϭ 8) occlusion. All animals were imaged at baseline and 1-8 wk postinfarction (post-MI). In 10 dogs, invasive hemodynamic monitoring with a conductance catheter placed in the left ventricle (LV) was performed at the above time points. Dobutamine was infused at 1-8 wk post-MI to determine LV contractile reserve. Histomorphological analysis was performed to determine the presence of viable myocardium and changes in interstitial matrix. Post-MI, diastolic strain rate measurements (in radial and longitudinal planes) decreased significantly in the distribution of the diseased artery (P Ͻ 0.01) and on multiple regression analysis were determined by time constant of LV relaxation, end-diastolic pressure, regional stiffness, and the ratio of cellular infiltration to collagen deposition in the interstitial matrix. Among several indexes, diastolic strain rate during dobutamine infusion readily identified segments with Ͼ20% transmural infarction and related best to the extent of interstitial fibrosis (r ϭ Ϫ0.86, P Ͻ 0.01). In an animal model of healing canine infarcts, diastolic strain rate by Doppler echocardiography appears to be a promising novel index of myocardial viability. diastole; infarction; coronary THE PROGNOSIS OF PATIENTS with coronary artery disease is largely dependent on the presence and extent of myocardial viability (14). Accordingly, the accurate assessment of viable myocardium is needed for proper patient management. Echocardiographic techniques, in particular dobutamine echocardiography (14), have emerged as important diagnostic modalities that can identify residual viable myocardium in patients with coronary artery disease. There is, however, a paucity of data on the utility of assessment of regional diastolic function in these patients. This approach is important given the recent reports on diastolic function assessment during stress echocardiography (1,12,20).Depending on the extent of ischemia, regional expansion may be delayed at a time when systolic function is normal (1, 21). Alternatively, it is possible for regional stiffness to be relatively unchanged despite the presence of systolic dysfunction as in myocardial stunning (16). Therefore, parameters of diastolic function can provide incremental information in identifying the extent of myocardial necrosis compared with indexes of systolic function in patients with coronary artery disease. In this regard, it is possible to assess regional function objectively using strain Doppler imaging (9, 13, 19). We therefore underwent this experimental study in dogs to test the hy...

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“…[3][4][5][6][7][8][9][10] It is frequently observed in patients with CAD presenting with LV asynergy. [23][24][25] Earlier studies have demonstrated the presence of abnormal diastolic function in patients with CAD without evidence of systolic wall motion abnormalities by radionuclide angiography or digitized cineangiography.…”

Section: Discussionmentioning

confidence: 99%

“…Both clinical [3][4][5] and animal studies [6][7][8][9][10] have demonstrated that PSS is related to myocardial ischemia.…”

Section: Editorial P 37mentioning

confidence: 99%

Detection of Diastolic Abnormality by Dyssynchrony Imaging Correlation With Coronary Artery Disease in Patients Presenting With Visibly Normal Wall Motion

Onishi

Uematsu

Nanto

et al. 2009

Circ J

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Background Post-systolic shortening (PSS) is a sensitive indicator of myocardial ischemia. Methods and ResultsWe have developed a tissue Doppler imaging technique that portrays PSS, and whether PSS correlates with coronary artery disease (CAD) was investigated in 186 patients presenting with chest pain and normal echocardiograms. Delays of the displacement peaks from end-systole were calculated in the apical views and displayed from green (0 ms) to red (≥100 ms): detection of diastolic abnormality by dyssynchrony imaging (DADI). CAD was judged positive by DADI when the left ventricular segments were color-coded red. Patients subsequently underwent thallium-201 myocardial perfusion single-photon emission computed tomography (n=150), coronary angiography (CAG, n=74), or both (n=37). CAD(-) was defined as negative scintigraphy test and/or no significant coronary artery stenosis by CAG. In 43 patients (23%), CAD(+) was confirmed by CAG as >75% diameter stenosis. DADI predicted CAD with sensitivity of 60%, specificity of 75%, predictive accuracy of 72%, positive predictive value of 42%, and negative predictive value of 86%. Among 74 patients who underwent CAG, sensitivity was best for the left anterior descending artery. Conclusions DADI detected the regional diastolic abnormality, which correlated with the presence of CAD in patients presenting with visibly normal wall motion. (Circ J 2009; 73: 125 -131)

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Identification of acutely ischemic myocardium using ultrasonic strain measurements

Abstract: In this model of acute ischemia, ultrasonic strain indexes differentiate acutely ischemic segments from both normal and dysfunctional myocardium. This should be a promising new approach to the bedside monitoring of acute ischemic changes in regional myocardial function.

Cited by 181 publications

References 31 publications

Quantitative Assessment of Wall Motion Using Myocardial Strain

Quantitative Assessment of Wall Motion Using Myocardial Strain

Impact of myocardial structure and function postinfarction on diastolic strain measurements: implications for assessment of myocardial viability

Detection of Diastolic Abnormality by Dyssynchrony Imaging Correlation With Coronary Artery Disease in Patients Presenting With Visibly Normal Wall Motion

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