Incremental Value of Strain Rate Analysis as an Adjunct to Wall-Motion Scoring for Assessment of Myocardial Viability by Dobutamine Echocardiography

Hanekom, L.; Jenkins, Carly; Jeffries, Leanne; Case, Colin; Mundy, Julie; Hawley, Carmel M.; Marwick, Thomas H.

doi:10.1161/circulationaha.104.489310

Cited by 161 publications

(106 citation statements)

References 38 publications

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“…20,21 In our study, the akinetic but viable myocardium of patients with ABS showed more prominent postsystolic shortening. 5,[20][21][22][23][24][25][26] in our study, the systolic and postsystolic shortening parameters were not different between patients with recovered akinetic myocardium and those without recovered akinetic myocardium, and they were not able to predict recovery in patients with AMI with revascularization. Most other studies included not only akinetic but also hypokinetic myocardium.…”

Section: Discussioncontrasting

confidence: 58%

Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox

Park

Prasad

Rihal

et al. 2009

Mayo Clinic Proceedings

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OBJECTIVE:To compare left ventricular (LV) systolic and diastolic function in patients with apical ballooning syndrome (ABS) and those with acute myocardial infarction (AMI) using 2-dimensional Doppler echocardiography and strain rate imaging (SRI). PATIENTS AND METHODS:We prospectively enrolled patients with newly diagnosed AMI and ABS who had akinetic apical walls. Both 2-dimensional Doppler echocardiography and SRI were performed on hospital day 1 or within 24 hours of primary percutaneous coronary intervention. RESULTS:Twenty-four patients with AMI and 13 patients with ABS (mean ± SD age, 63±15 vs 73±12 years; P=.03) were prospectively enrolled in the study from October 3, 2005 through July 12, 2006.The mean ± SD LV end-diastolic volume was larger (58.1±9.1 vs 45.2±10.6 mL/m 2 ; P<.001) and the mean ± SD LV ejection fraction was lower (35%±6% vs 43%±9%; P=.006) in patients with ABS compared with patients with AMI. The early diastolic mitral annular velocity was similar (0.06±0.02 vs 0.06±0.02 m/s; P=.85) in both groups, but the ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was higher in patients with AMI than in patients with ABS (16.3±6.9 vs 12.2±3.2; P=.05). The systolic strain rate was decreased at the apex in both groups (P=.98). Both the early diastolic strain rate of the apex (0.64±0.24 vs 0.48±0.30 s -1 ; P=.04) and the postsystolic shortening index of the apex (61%±15% vs 45%±23%; P=.006) were higher in the patients with ABS than in those with AMI. However, early diastolic SR was higher in the akinetic apical walls of patients with AMI with recovery than those with no recovery (0.64±0.35 vs 0.43±0.25 s -1 ; P=.04) and was similar between akinetic apical walls of patients with AMI with recovery and the akinetic apical walls of ABS.CONCLUSION: Compared with patients with AMI, those with ABS showed the functional paradox of worse initial LV systolic function with larger LV size but better LV diastolic function. The early systolic strain rate and postsystolic shortening were greater in patients with ABS than in those with AMI; hence, these measurements can be helpful in distinguishing ABS from AMI and in detecting myocardial viability.Mayo Clin Proc. 2009;84(6):514-521 ABS = apical ballooning syndrome; AMI = acute myocardial infarction; CAG = coronary angiography; E = early diastolic mitral valve inflow velocity; Ea = early diastolic mitral annulus velocity; E/Ea = ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity; ECG = electrocardiography; LV = left ventricular; LVEF = LV ejection fraction; PCI = percutaneous coronary intervention; SR = strain rate; SRI = SR imaging; STEMI = ST-segment elevation myocardial infarction; WMSI = wall motion score index © 2009 Mayo Foundation for Medical Education and ResearchT he clinical presentation of apical ballooning syndrome (ABS) mimics that of acute myocardial infarction (AMI). Both conditions are characterized by acute onset of chest pain, electrocardiographic (ECG) ...

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Section: Discussioncontrasting

confidence: 58%

Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox

Park

Prasad

Rihal

et al. 2009

Mayo Clinic Proceedings

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“…Strain is a measure of myocardial deformation, which is an intrinsic mechanical property. Myocardial strain derived by tagged magnetic resonance imaging (MRI) (Garot, Lima 2004), by Doppler echocardiography (Hanekom, Jenkins 2005) and by 2DSE (Reisner, Lysyansky 2004) have incremental value to conventional measures of regional myocardial function in ischemic heart disease. Our group recently demonstrated that 2DSE is a sensitive and specific means of detecting myocardial viability and stunning in a rat ischemiareperfusion model, and was superior to regional thickening by 2D and M-mode echocardiography (Migrino, Zhu 2007).…”

Section: Discussion and Summarymentioning

confidence: 99%

Early Detection of Doxorubicin Cardiomyopathy Using Two-Dimensional Strain Echocardiography

Migrino

Aggarwal

Konorev

et al. 2008

Ultrasound in Medicine & Biology

112

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Doxorubicin is one of the most effective chemotherapeutic agents; however, it causes dose-dependent cardiomyopathy that may lead to heart failure. Conventional measures of ventricular function, such as fractional shortening, are insensitive in detecting early doxorubicin cardiomyopathy. We tested whether novel 2-dimensional radial strain echocardiography (2DSE) can detect early doxorubicin injury following chronic administration in a rat model. 14 male Sprague Dawley rats (240−260 g) received doxorubicin 2.5 mg/k IV per week for 10 (n=4) or 12 weeks (n=10); 17 controls received saline (10 weeks, n=7 and 12 weeks, n=10). Serial 2DSE from 0−12 weeks was done at the mid left ventricle using Vivid 7 echo (General Electric, Waukesha, WI, USA). With Q analysis software, radial strain was obtained. From the 2D image, anatomical M-mode through the anterior/inferior walls was used to measure fractional shortening. Fibrosis (Masson's trichrome) and caspase-3 activity were measured from excised hearts. Radial strain was lower in the doxorubicin group (12 week: 26.7 ±3 vs. 38.3±2.6%, p=0.006), with significant difference by 8 weeks whereas fractional shortening was lower with doxorubicin only after 12 weeks (30.2±1.7 vs. 37.6±1.4%, p=0.02). Doxorubicin group had lower cardiac mass (0.85±0.09 vs. 1.14±0.04 g, p=0.001), higher caspase-3 activity (1.95 ±0.2 fold increase over control, p<0.0001) and fibrosis (3.9±0.7 vs. 0.7±0.1%, p=0.005). Radial strain was related directly to cardiac mass (R=0.61, p=0.0007) and inversely to caspase-3 activity (R=−0.5, p=0.005). 2-dimensional radial strain echocardiography is useful in the early detection of doxorubicin cardiac injury and the reduction in radial strain is associated with histologic markers of doxorubicin cardiomyopathy.

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“…The determination of PEVL by strain rate imaging may be a solution to overcoming the tethering effect and the variability of its value depending on the segments assessed, unlike its parent methodology, TDI. However, although strain rate imaging technique is theoretically a promising and interesting tool, especially thanks to its independence of tethering or translational effect, it is highly susceptible to signal noise and, as such, inter-observer correlation is not satisfactory, [25][26][27] which is an important pragmatic limitation that compromises the clinical acceptance of strain rate imaging technique. Third, the apical segments were omitted from the analyses, which could not be avoided because of the inherent limitation of TDI; that is, angle-dependency.…”

Section: Discussionmentioning

confidence: 99%

Clinical Validity of Longitudinal Pre-Ejectional Myocardial Velocity for Identifying the Transmural Extent of Viable Myocardium Early After Reperfusion of an Infarct-Related Coronary Artery

Kim

Chang

Kim

et al. 2007

Circ J

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Background Positive longitudinal pre-ejectional velocity (+PEVL) was recently reported to be a reliable index of myocardial recovery early after successful revascularization in myocardial infarction (MI); that is, it recognizes the transmural extent of viable myocardium. The applicability of PEVL in the real-world clinical setting for identifying the transmural extent of viable myocardium in reperfused recent MI was assessed. Methods and ResultsUsing tissue Doppler imaging, the resting basal and mid myocardial PEVLs were determined within 3 days after revascularization in 41 consecutive patients with recent MI. Infarct thickness was semiquantified using delayed gadolinium-enhanced magnetic resonance imaging (MRI) at baseline and at 6-month follow up to differentiate transmural from nontransmural MI. The proportion of segments showing the presence of +PEVL was not significantly changed as infarct thickness increased (p=0.2), with 66.2% having +PEVL even in segments involving >75% transmural infarction. Moreover, +PEVL was found in a large fraction of segments with akinesia (70.4%). Specificity and negative predictive value of +PEVL for assessing infarct nontransmurality were disappointingly low (32.0% and 26.9%, respectively). All of these results were not altered when the 6-month follow-up MRI was done. Conclusions +PEVL cannot be regarded as a reliable marker for predicting the transmural extent of viable myocardium in recent MI. (Circ J 2007; 71: 1904 -1911

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Incremental Value of Strain Rate Analysis as an Adjunct to Wall-Motion Scoring for Assessment of Myocardial Viability by Dobutamine Echocardiography

Abstract: Background-Assessment of myocardial viability based on wall-motion scoring (WMS) during dobutamine echocardiography (DbE) is difficult and subjective.

Cited by 161 publications

References 38 publications

Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox

Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox

Early Detection of Doxorubicin Cardiomyopathy Using Two-Dimensional Strain Echocardiography

Clinical Validity of Longitudinal Pre-Ejectional Myocardial Velocity for Identifying the Transmural Extent of Viable Myocardium Early After Reperfusion of an Infarct-Related Coronary Artery

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