Speckle tracking echocardiography derived systolic longitudinal strain is better than rest single photon emission tomography perfusion imaging for nonviable myocardium identification

Abstract

Background. The aim was to compare the speckle tracking echocardiography (STE) derived systolic longitudinal strain (SL Smax ) with rest single photon emission computed tomography (SPECT) perfusion imaging (Q REST ), and to define the optimal cut-offs for SL Smax to discriminate transmural scar on contrast-enhanced magnetic resonance imaging (ceCMR). Methods and Results. In 100 patients with chronic ischemic left ventricular (LV) dysfunction, myocardial viability was assessed using STE and rest SPECT to predict LV segmental relative extent of delayed enhancement (DE) >75% on ceCMR. Correlation was found between regional SL Smax (r=-0.59, P<0.0001) and DE on ceCMR. The SL Smax optimal cutoff -5.3% identified segments with DE>75% on ceCMR (sensitivity 83.1%, specificity 84.6%). Optimal cut-offs SL Smax for segments corresponding to individual perfusion territories (-3.6%, -5.3% and -4.7% for LAD, LCx resp. RCA perfusion territories) were identified. There was a significant difference (AUC 0.866 vs. 0.822 for SL Smax resp. Q REST , p=0.036) in the accuracy of predicting non-viable segment due to the greater accuracy of SL Smax than Q REST in the RCA perfusion territory (AUC 0.893 vs. 0.75 for SL Smax resp. Q REST , P=0.001). Conclusions. STE enabled identification of LV non-viable segments. Cut-off values derived for perfusion territories of individual coronary arteries improve the accuracy of predicting a transmural scar presence. In comparison with rest myocardial SPECT perfusion imaging, STE is more accurate in predicting non-viable myocardium.

The detection of viable myocardium by low‐dose dobutamine stress speckle tracking echocardiography in patients with old myocardial infarction

“…The analysis of the deformation parameters was performed off‐line with the aid of a commercially available speckle‐tracking system in a Philips workstation equipped with QLAB software 8.1 (Advanced Quantification software; Philips Ultrasound, Bothell, WA). The left ventricle was analyzed using a standard 17‐segment model according to the standards of the American Heart Association . After manual tracing of the endocardial borders at the end‐systolic frame from the three apical views and three parasternal short‐axis views, an automated tracking algorithm outlined the myocardium in successive frames throughout the cardiac cycle.…”

“…The left ventricle was analyzed using a standard 17segment model according to the standards of the American Heart Association. 10 After manual tracing of the endocardial borders at the end-systolic frame from the three apical views and three parasternal short-axis views, an automated tracking algorithm outlined the myocardium in successive frames throughout the cardiac cycle. A region of interest was manually adjusted to include the entire myocardial thickness.…”

Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography

“…4a-c and 5a-b). We independently set sub-classification of abnormal perfusion segments and severely infarcted segments in SPECT and CMR group for the study [9,22,24,25]. However, interestingly, their cut-off values of SPECT and CMR were comparable for detecting abnormal perfusion segments (1.23 mL/g/min for SPECT and 1.25 mL/g/min for CMR) and severe myocardial infarction (0.92 mL/g/min for SPECT and 0.98 mL/g/min for CMR), respectively.…”

“…A segment with a score ≥1 in stress image was defined as abnormal perfusion segment. A segment with a score of ≥3 in stress and rest images was defined as severe myocardial infarction [22].…”

Role of 2-dimensional speckle tracking echocardiography in diagnosis of coronary artery stenosis instable angina pectoris patients

“…No previous published study compared longitudinal systolic strain by speckle tracking with ischemic segments by SPECT MPI but most studies directed towards detection of viability, as the study conducted by Roes et al shows that the longitudinal peak systolic strain parameter achieved a higher diagnostic accuracy in predicting non-viable myocardium [26]. Martin et al who studied 100 patients with chronic ischemic left ventricular (LV) dysfunction for assessment of myocardial viability using STE and rest SPECT and found that STE is more accurate in predicting non-viable myocardium [27]. Ola et al reported that Global strain measured by 2D-STE is an excellent predictor of myocardial infarct size in chronic ischemic heart disease.…”