Detection Of Regional Myocardial Dysfunction Research Articles

CCTA-derived strain analysis in detection of regional myocardial dysfunction in coronary artery disease patients with preserved left ventricular ejection fraction: A feasibility study.

To evaluate the feasibility of using coronary computed tomography angiography (CCTA)-derived strain to detect regional myocardial dysfunction in coronary artery disease (CAD) patients with normal left ventricular ejection fraction (LVEF). A total of 1,580 segments from 101 patients who underwent stressed CT myocardial perfusion imaging (CT-MPI) and CCTA were retrospectively enrolled in this study. The CT-derived global and segmental strain values were evaluated using the feature tracking technique. Segments with myocardial blood flow (MBF) < 125 ml/min/100 ml and 95 ml/min/100 ml were categorized as ischemic and infarcted, respectively. Segmental radial strain (SRS) and segmental circumferential strain (SCS) in the abnormal segments (including all segments with MBF < 125 ml/min/100 ml) were significantly lower than those in the normal segments (14.81±8.65% vs 17.17±9.13%, p < 0.001; -10.21±5.79% vs -11.86±4.52%, p < 0.001, respectively). SRS and SCS values in infarcted segments were significantly impaired compared with the ischemic segments (12.43±8.03% vs. 15.32±8.71%, p = 0.038; -7.72±5.91% vs. -10.67±5.66%, p = 0.010, respectively). The AUCs for SRS and SCS in detecting infarcted segments were 0.622 and 0.698, respectively (p < 0.05). It is feasible for using CCTA-derived strain parameters to detect regional myocardial dysfunction in CAD patients with preserved LVEF. Segmental radial and circumferential strain have the potential ability to distinguish myocardial ischemia from infarction, and normal from ischemic myocardium.

Role of speckle tracking in detection of regional myocardial dysfunction in patients with inferior STEMI with no RSWMAs

Role of speckle tracking in detection of regional myocardial dysfunction in patients with inferior STEMI with no RSWMAs

Real time 3 D Echocardiography for Evaluation of Left Ventricle in Children With Thalassemia Major

Background: Cardiovascular events and complications are the leading causes of mortality and morbidity in patients with Thalassemia Major (TM). Early identification of ventricular dysfunction, before the appearance of symptoms, can alter the prognosis by optimizing therapy. The aim of this study was to clarify the value of Real Time 3D Echocardiography (RT3DE) or 4-D echo in early detection of regional myocardial dysfunction in those patients before the development of overt cardiomyopathy. Methods: This study was carried out on 60 children divided into 2 groups; Group I included 30 children with TM, Group II : 30children matched for age and sex as a control group. All the children were subjected to through clinical evaluation for any signs of heart failure, Echocardiography studies included M mode , Tissue Doppler imaging (TDI) and Real Time 3D Echocardiography (RT3DE) for assessment of left ventricle. Results: TDI showed that S velocity as well as E/ A ratio were significantly decreased in TM compared with the control. There was significant LV enlargement through LV LSS and DSI in TM. There was no significant relation between hemoglobin level, serum ferritin and different echo parameters in our cohort. Conclusion : RT3DE with tissue Doppler technique(TDI) are promising tools for early detection of regional systolic or diastolic dysfunction of left ventricle in children with TM.

Real Time 3-D Echocardiography for Evaluation of Left Ventricle in Children

Background: Cardiovascular events and complications are the leading causes of mortality and morbidity in patients with sickle cell anemia (SCA) . Early identification of ventricular dysfunction, before the appearance of symptoms, can alter the prognosis by optimizing therapy. This study aimed at clarifying the value of Real Time 3D Echocardiography (RT3DE ) in early detection of regional myocardial dysfunction in those patients before the development of overt cardiomyopathy. Methods: This is an observational cross sectional study that was carried out on 60 children divided into 2 groups; Group 1 included 30 children with SCA, Group 2: 30 children matched for age and sex as a control group. For all children: ethically committee approval and informed consent from the parents or their guardians was obtained. All Children with SCA under the age of 15 who do not show any signs or symptoms of heart failure were included in this study . Any child with present or past history of heart failure or any child with associated congenital or acquired heart diseases was excluded from the study. All children with systemic diseases that may affect cardiac structure and function have been also excluded. All the children were subjected to through clinical evaluation for any signs of heart failure, Echocardiography studies , included M mode , Tissue Doppler and 4D echo for assessment of left ventricle. Statistical analysis : IBM SPSS statistics was used for data analysis. Data were expressed as Mean ±SD. t test was used for differences in the variables between patients and control . Pearson correlation test was used for possible association between each two variables. Statistical significance was defined as a p value < 0.05. Results: TDI showed left ventricular systolic and diastolic dysfunction in SCA compared with the control. RT3DE was a sensitive tool to detect an increase in LVEF . There was no significant LV enlargement through LV LSS and DSI in our cohort. There was no significant relation between hemoglobin level and different echo parameters in the studied groups. Conclusion : RT3DE with tissue Doppler technique are promising tools for early detection of regional systolic or diastolic dysfunction of left ventricle in children with SCA.

Automated Versus Visual Segmental Scoring

Echocardiography is the most widely used noninvasive test for assessing the structure and function of the heart, accounting for 14% of overall Medicare expenditures for imaging in 2007.1 Despite the availability of a variety of validated quantitative methods for assessing chamber size and cardiac function, many elements of echocardiographic interpretation remain qualitative rather than quantitative. This is particularly true of the assessment of regional wall motion. Notwithstanding progress in the field of myocardial perfusion echocardiography2 and earlier efforts to quantitate regional function with acoustic quantitation3 and Doppler tissue imaging-based methods,4 echocardiographic assessment of regional wall motion remains the principal method by which echocardiographers make the diagnosis of coronary disease. Moreover, the ability to visually identify stress-induced regional wall motion abnormalities is the foundation for stress echocardiography. Article see p 47 The ability to reproducibly and reliably detect regional wall motion abnormalities is an essential skill for any physician interpreting echocardiograms and conceded to be one of the most difficult skills to acquire.5 Consequently, an automated quantitative approach to assessing regional function would be invaluable as a tool for the interpretation of echocardiograms for teaching and research and could prove useful in training echocardiographers. The study of Liel Cohen6 in this issue of Circulation: Cardiovascular Imaging proposes just such a tool. In their article, the authors report their evaluation of a semiautomated method of measuring regional longitudinal strain to develop segmental scores, classifying segments as normal, hypokinetic, or akinetic/dyskinetic/aneurysmal. As the authors note, strain analysis based on speckle tracking as opposed to angle-dependent Doppler tissue imaging methods is appealing because it avoids translation artifact and angle dependence. Twelve expert echocardiographers of the Israeli Echocardiography Research Group at 9 major Israeli cardiology centers used this approach as well as qualitative visual segmental scoring in 15 patients …

Feasibility and Accuracy of Different Techniques of Two-Dimensional Speckle Based Strain and Validation With Harmonic Phase Magnetic Resonance Imaging

Different 2-dimensional speckle-based strain techniques have been developed to overcome the problem of angle dependency with Doppler-based strain. However, their relative accuracy has not been assessed. The aim of this study was to determine the feasibility and accuracy of 2 such techniques (velocity vector imaging [VVI] and automated function imaging [AFI]), using tagged harmonic phase (HARP) magnetic resonance imaging (MRI) as a reference standard. Thirty patients with known or suspected ischemic heart disease underwent measurement of peak systolic longitudinal, radial, and circumferential Lagrangian strain with all 3 techniques using a 16-segment model. The extent of scar tissue in each segment was determined using contrast-enhanced MRI. The measurement of myocardial strain in all 3 directions was highly feasible with both VVI and AFI. Longitudinal strain was underestimated by both VVI (-11 +/- 8%; P < .01) and AFI (-12 +/- 6%; P < .01) in comparison with HARP MRI (-14 +/- 5%), and radial strain was underestimated by VVI (14 +/- 18% vs 23 +/- 7%; P < .01). All strain measurements with AFI showed better correlation and agreement with HARP MRI compared with VVI. Circumferential strain with AFI had the greatest accuracy (area under the receiver operating characteristic curve = 0.74, P < .001) for the prediction of scar tissue on MRI. Two-dimensional strain measured with AFI has significantly better accuracy than VVI. Circumferential strain with AFI has the best discriminative ability for the detection of regional myocardial dysfunction.

Detection of Regional Myocardial Dysfunction in Patients with Acute Myocardial Infarction Using Velocity Vector Imaging

Velocity vector imaging (VVI) is a new echocardiographic technique of measuring regional myocardial velocities and deformation. Our aim was to evaluate the feasibility and accuracy of VVI in defining regional functional abnormalities in patients with an acute myocardial infarction. Standard echocardiography and delayed enhancement (DE) magnetic resonance imaging were performed in 32 patients (29 men, mean age 61.2 +/- 8.1 years) within 36 hours of primary angioplasty. Twenty healthy volunteers (16 men, mean age 34.6 +/- 6.3 years) served as control subjects. Using VVI for offline analysis, segmental longitudinal deformation indices were measured. Infarcted, adjacent, and remote left ventricular segments were defined according to DE magnetic resonance imaging and coronary angiography. Infarct transmurality was also graded based on the DE extent within each segment on DE magnetic resonance imaging (0%-25%, 26%-50%, 51%-75%, and >76% of wall thickness). As compared with remote segments, myocardial infarction segments had significantly lower longitudinal systolic strain (S) (-9.6% vs -14.6%, P < .0001), lower S rate (-0.75 vs -1.08 s(-1), P < .0001), and a higher postsystolic S index (21% vs 8.3%, P < .001). By receiver operating characteristic curve analysis, a myocardial peak systolic longitudinal S lower than -6.5% in at least one ventricular segment showed best predictive value (94%) for detecting an infarcted left ventricle. Peak systolic S and S rate were useful predictors of the presence of regional dysfunction, and for the localization and transmural extent of the infarct. VVI is a promising new tool for studying myocardial motion and deformation with good feasibility in the clinical setting. The assessment of myocardial longitudinal systolic S and S rate with VVI can be used to identify the presence, location, and the transmural extent of myocardial infarction.

276 Arterial stiffness and diastolic dysfunction in patients with systemic sclerosis

s S33 Eur J Echocardiography Abstracts Supplement, December 2006 276 Arterial stiffness and diastolic dysfunction in patients with systemic sclerosis J. Bozo 1 ; R. Faludi 1 ; G. Kumanovics 1 ; L. Czirjak 1 ; A. Cziraki 1 ; T. Simor 1 ; L. Papp 1 1Univ. Pecs, Heart Institute, Faculty of Med., Pecs, Hungary Objectives: Vascular abnormalities are hallmarks of almost all systemic sclerosis patients. Impaired relaxation of the left ventricle is also characteristic for scleroderma heart disease. The aim of our study was to determine whether parameters of arterial stiffness correlate with echocardiographic indices of left ventricular relaxation impairment. Material: 21 patients with limited and diffuse scleroderma (18 women, mean age: 55±9 years) were studied. Methods: Parameters of local and systemic arterial stiffness (pulse wave velocity: PWV; augmentation index: Aix) were determined by automatic brachial pulse wave analysis (Arteriograph®). The same parameters and elastic modulus (Ep), stiffness index (s), arterial compliance (AC) were measured on left brachial and common carotid arteries by echo-tracking (Aloka ProSound 5500). Indices of diastolic function were also determined with the same ultrasound system: in addition to the conventional Doppler parameters of the transmitral flow early (E) and late (A) diastolic velocities, deceleration time (DT), isovolumic relaxation time (IVRT) myocardial early (Ea) and late (Aa) diastolic velocities were measured at the lateral border of the mitral annulus using tissue Doppler imaging. E/A and E/Ea ratios were calculated. Simple associations between the variables were estimated by Pearson’s method. Results: Carotid Ep showed significant correlations with both A (r=0.537, p<0.05) and E/A (r=-0.500, p<0.05) values, and correlated with IVRT also significantly (r=0.489, p<0.05). Carotid s correlated with A (r=0.479, p<0.05), E/A (r=-0.548, p<0.05) and IVRT (r=0.564, p<0.01). Carotid AC correlated with A (r=-0.512, p<0.05), E/A (r=0.551, p<0.05) and IVRT values (r=-0.436, p<0.05). Carotid PWV and Aix showed similarly significant correlations with A, E/A, IVRT and with A and E/A values, respectively. Ep, s and PWV determined by pulse-wave analysis and brachial artery echo-tracking did not correlate with the echocardiographic parameters of the left ventricular diastolic function. Brachial AC showed a significant correlation with A (r=-0.478, p<0.05) and DT (r=0.469, p<0.05). Significant correlation was found between Aix measured by pulse-wave analysis and Aa (r=0.560, p<0.05). Conclusion: Distensibility of elastic arteries correlates well with the echocardiographic indices of the left ventricular diastolic function, but stiffness of muscular type arteries is less useful to predict the degree of diastolic impairment. Selected parameters of arterial stiffness are good predictors of diastolic dysfunction in scleroderma patients ±. 277 Tissue Doppler analysis of regional myocardial dysfunction in patients with systemic sclerosis M. Hirata 1 ; A. Takagi 2 ; K. Shimamoto 3 ; S. Ihara 1 ; H. Watanabe 1 ; K. Mizuochi 1 ; M. Endou 1 ; M. Kawana 3 1Institute of Geriatrics, TWMU, Cardiology Dept., Tokyo, Japan; 2Tokyo Women’s Medical University Hospital, Cardiology Dept., Tokyo, Japan; 3TWMU Aoyama Hospital, Cardiology Dept., Tokyo, Japan Purpose: Systemic sclerosis (SSc) is a multi-system disorder characterized by connective tissue fibrosis resulting in poor cardiac prognosis. Tissue Doppler imaging (TDI) might be useful in early detection of regional myocardial dysfunction. The aim of this study is to estimate the early myocardial dysfunction in SSc patients by using TDI. Methods: Twenty patients with SSc without obvious wall motion abnormalities were compared to 25 age-matched control subjects. E/A ratio and deceleration time (DCT) of trnasmitral inflow were recorded. Peak systolic strain (A) and diastolic strain at the first 30% of diastolic duration (B) were measured on strain curve at midventricular septum. Strain diastolic index was calculated as (A-B)/A×100(%). Results: There was no difference between the two groups in E/A, DCT and peak systolic strain. In contrast, strain diastolic index in SSc was significantly lower than those of control (p<0.01) (Table 1). Conclusion: TDI derived strain diastolic index appeared to be useful in early detection of diastolic dysfunction in patients with SSc.

Use of strain and tissue velocity imaging for early detection of regional myocardial dysfunction in patients with beta thalassemia

Iron overload contributes to cardiac dysfunction in patients with beta thalassemia (Th). Tissue velocity and strain imaging (TVI and SI) might prove useful in early detection of regional myocardial dysfunction in these patients. The aim of this study is to clarify the value of TVI and SI in early detection of regional myocardial dysfunction in thalassemia patients. This study included two age-matched groups; G1: 27 Th patients and G2: 14 normal subjects. Conventional echo-Doppler measures of LV and RV dimensions and function were obtained. TVI measures included systolic and diastolic myocardial velocities (Sm, Em, Am and Em/Am) of the basal segments of septal wall, lateral LV and RV free walls. Systolic strain values were measured in the same basal segments and included S-septal, S-LV and S-RV. Strain and TVI data were compared in the two groups. Sm and strain values were compared in the different walls (LV, RV and septum) in each group separately. S-LV was lower in G1 than G2 (20.9 +/- 6.8 vs 27.2 +/- 4.3, p < 0.001), while S-septal was higher in G1 than G2 (31.1 +/- 8.3 vs 25.1 +/- 3.8, p < 0.01). TVI measures of diastolic performance of the septal and RV walls were different in G1 compared to G2. Septal-Em was lower, septal-Am was higher and septal-Em/Am was lower in G1 compared to G2. RV-Am was higher and RV-Em/Am was lower in G1 compared to G2. Other SI and TVI measures were not significantly different in G1 from G2. Sm and strain values were lower in the lateral LV wall compared to septal wall in G1 but not in G2, while the corresponding values of the RV wall were higher than those of the septal and LV walls in both groups (G1 and G2). Thalassemia patients have regional systolic dysfunction in the lateral LV wall and regional diastolic dysfunction in the septal and RV wall. TVI and the newer modality SI are promising tools for quantitative assessment of regional myocardial function. SI seems more capable of early detection of regional myocardial dysfunction.

Early detection of regional myocardial dysfunction by strain doppler echocardiography in patients with primary amyloidosis

Early detection of regional myocardial dysfunction by strain doppler echocardiography in patients with primary amyloidosis

1982 Memorial Award Paper. Detection of regional myocardial dysfunction during ischemia with computerized tomography: documentation and physiologic basis.

Cross-sectional imaging techniques have the potential for measuring left ventricular (LV) wall thickness (WTh) dynamics. This proposition was assessed in a canine experimental model, using prospectively gated computed tomography (CT) scans before and after occlusion of a coronary artery. Gated CT scans detected loss of wall thickening in the LV anterior segment immediately after occlusion of the left anterior descending coronary artery in two dogs. After demonstrating the feasibility of using gated CT scans to demonstrate ischemic functional abnormalities by monitoring wall thickness changes, we assessed the relationship between regional wall thickening dynamics and coronary blood flow in eight anesthetized dogs. Graded circumflex (Cx) coronary artery stenosis (CAS) was produced while sonomicrometer crystals continuously recorded LV WTh and extent of wall thickening (EWTh) in the anterior descending and the Cx distributions. The first significant change in EWTh in the ischemic segment occurred at 33% decrease in CBF (P less than .05) which corresponded to an 80% CAS. At 33% decrease in CBF, there was a concomitant increase in EWTh in the normal segment. In conclusion, we have demonstrated the feasibility of using gated CT to detect myocardial ischemia by monitoring WTh dynamics. Physiologic studies document a close relationship between regional wall thickening dynamics and coronary blood flow and should provide a basis for interpretation of dynamic cross-sectional images of the left ventricle in ischemic heart disease.