Strain rate measurement by doppler echocardiography allows improvedassessment of myocardial viability inpatients with depressed left ventricular function

Hoffmann, Rainer; Altiok, Ertunc; Heussen, Nicole; Hanrath, Peter; Nowak, Bernd; Kaiser, H.; Büll, Ü.; Kühl, Harald P.

doi:10.1016/s0735-1097(01)01763-6

Cited by 201 publications

(58 citation statements)

References 19 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: 62%

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: 62%

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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“…SR correlates with myocardial perfusion during dobutamine stress 59 and is superior to TDI in detecting CAD 60 . S and SR are reduced in ischaemia/infarction with augmentation in viable segments 61 .…”

Section: Newer Parameters and Applicationmentioning

confidence: 90%

Echocardiographic evaluation of systolic heart failure

Thomas

2009

Australas J Ultrason Med

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Echocardiography is the most commonly used modality for evaluating left ventricular size and function in the context of systolic heart failure. Traditional techniques, though extensively used, have their limitations and more recently several newer technologies have emerged that are more reproducible, provide prognostic information, guide therapies and have an important role in monitoring progress. This review will evaluate the traditional and more novel techniques used and briefly provide an overview of the role of echocardiography in guiding and monitoring therapies in patients with systolic heart failure.

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“…They applied strain and strain rate imaging to the standard apical 4-chamber, apical 2-chamber, and apical long-axis views and combined these measures with routine visual wall-motion scoring. 17,18 The investigators then reassessed patients 9 months after percutaneous revascularization or coronary bypass surgery and defined a positive viability response as improvements in wall motion Ն4 segments or an overall increase Ն5% in ejection fraction units. Of the 42% of patients with improvements in ventricular function after…”

Section: Articles Pp 3892 and 3901mentioning

confidence: 99%

“…10 This supports the incremental value of strain imaging in this particular scenario. 17,18 Another practical clinical scenario in which strain imaging adds incremental value is in the assessment of radial dyssynchrony in patients evaluated for cardiac resynchronization therapy. 20 Dyssynchrony analysis of the timing of regional contraction is usually limited to similar types of patients with depressed ejection fraction, lowamplitude wall excursion, and varying degrees of passive tethering motion, particularly in the septum.…”

Section: Articles Pp 3892 and 3901mentioning

confidence: 99%

Echocardiographic Strain Imaging for Myocardial Viability

Gorcsan

2005

Circulation

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Strain rate measurement by doppler echocardiography allows improvedassessment of myocardial viability inpatients with depressed left ventricular function

Abstract: The increase in the peak systolic strain rate during low-dose dobutamine stimulation allows accurate discrimination between different myocardial viability states. Strain rate imaging is superior to two-dimensional DSE and tissue Doppler imaging for the assessment of myocardial viability.

Cited by 201 publications

References 19 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

Echocardiographic evaluation of systolic heart failure

Echocardiographic Strain Imaging for Myocardial Viability

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