Introduction: The use of tissue velocity and strain rate imaging is proposed for the quantification of non-viable myocardium. This study is aimed at investigating the differences in tissue velocity and strain rate imaging indices between non-viable left ventricular apical segments and the normal segments using segment-by-segment comparison.
Materials and Method: Thirty-two patients with akinetic left ventricular apical segments and without viability were selected using two-dimensional echocardiography and dobutamine stress echocardiography; 32 individuals with normal echocardiography and coronary angiography formed the normal group. Peak systolic velocity, peak systolic strain, and strain rate were measured in the four left ventricular apical segments and the apex 17th segment.
Results: The patient group had a significantly lower ejection fraction (26.88±6.06% vs. 56.56±2.36%; p<0.001). Overall, the patient group had significantly lower resting peak systolic velocity, systolic strain, and strain rate. In the segment-by-segment comparison, only systolic strain showed a remarkable reduction in the patient group, while reduction in Sm and strain rate were not significant in all the segments. After dobutamine stress echocardiography, only systolic strain showed an insignificant increase compared to the resting values. In the apex 17th segment, Sm showed significant reduction in the patient group.
Conclusion: The ST in apical segments may be used as a quantitative index for detecting akinesia both at rest and after dobutamine infusion. Reduction in Sm can be used as a marker of akinesia in the apical cap at rest.
Stoylen A, Heimdal A, Bjornstad K, Torp HG, Dr Techn, Skjmrpe T. Strain Rate Imaging by Ultrasound in the Diagnosis of Regional Dysfunction of the Left Ventricle. Echocardiography 1999; 16: 321-329.
Smiseth OA, Stoylen A, Ihlen H. Tissue Doppler imaging for the diagnosis of coronary artery disease. Current Opinion in Cardiology: 2004; 19: 421-9.
Citro R, Galderisi M. Myocardial Postsystolic Motion in Ischemic and Not Ischemic Myocardium: The Clinical Value of Tissue Doppler. Echocardiography 2005; 22 (6): 525-532.
Bach DS, Armstrong WF, Donovan CL, Muller DWM. Quantitative Doppler tissue imaging for assessment of regional myocardial velocities during transient ischemia and reperfusion. Am Heart J 1996; 132: 721–5.
Edvardsen T, Skulstad H, Aakhus S, Urheim S, Ihlen H. Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography. Journal of American College of Cardiology 2001; 37(3): 726–30.
Derumeaux G, Ovize M, Loufoua J, Lofoua J, Andre-Fouet X, Minaire Y, et al. Doppler tissue imaging quantities regional wall motion during myocardial ischemia and reperfusion. Circulation 1998; 97: 1970–7.
Kukulski T, Jamal F, D’Hooge J, Bijnens B, De Scheerder I, Sutherland GR. Acute changes in systolic and diastolic events during clinical coronary angioplasty: a comparison of regional velocity, strain rate, and strain measurement. J Am Soc Echocardiography 2002;15:1–12.
Jamal F, Kukulski T, D’hooge J, De Scheerder I, Sutherland G. Abnormal postysystolic thickening in acutely ischemic myocardium during coronary angioplasty: a velocity, strain, and strain rate Doppler myocardial imaging study. J Am Soc Echocardiography 1999; 12:994–6.
Sadeghian H, Majidi S, Lotfi-Tokaldany M, Nikdoust F, Sheikhfathollahi M, Abbasi SH. Evaluation of longitudinal tissue velocity and deformation imaging in akinetic nonviable inferobasal segments of left ventricular myocardium by dobutamine stress echocardiography. Echocardiography 2009; 26:801-6.
Sadeghian H, Ahmadi F, Lotfi-Tokaldany M, Salehi R, Zavar R, Fathollahi MS, et al. Longitudinal tissue velocity and deformation imaging in inferobasal left ventricular aneurysm. Echocardiography 2010; 27: 803-8.
Sadeghian H, Lotfi Tokaldany M, Fallah N, Abbasi SH, Ahmadi SH, karimi AA, et al. Accuracy of Dobutamine Stress Echocardiography in Detecting Recovery of Contractile Reserve after Revascularization of Ischemic Myocardium. Journal of Tehran University Heart Center. 2007; 4: 223-228.
Sadeghian H, Majd-Ardakani J, Lotfi-Tokaldany M, Jahangiri C, Fathollahi MS. Comparison between dobutamine stress echocardiography and myocardial perfusion scan to detect viable myocardium in patients with coronary artery disease and low ejection fraction. Hellenic Journal of Cardiology 2009;50:45-51.
Sadeghian H, Majd-Ardakani J, Lotfi-Tokaldany M. Assessment of Myocardial Viability: Selection of Patients for Viability Study and Revascularization. Journal of Tehran University Heart Center 2009; 4:5-15.
Sun JP, Popović ZB, Greenberg NL, Xu XF, Asher CR, Stewart WJ, et al. Noninvasive quantification of regional myocardial function using Doppler-derived velocity, displacement, strain rate, and strain in healthy volunteers: effects of aging. J Am Soc Echocardiography 2004; 17:132-8.
Palmes PP, Masuyama T, Yamamoto K, Kondo H, SakataY, Takiuchi S, et al. Myocardial longitudinal motion by tissue velocity imaging in the evaluation of patients with myocardial infarction. J Am Soc Echocardiography 2000;13: 818–26.
Dagianti A, Vitarelli A, Conde Y, Penco M, Fedele F, Dagianti A. Assessment of regional left ventricular function during exercise test with pulsed tissue Doppler imaging. Am J Cardiology 2000; 86(suppl): 30G-32G.
Naqvi TZ, Nevman G, Broyde A, and siegel RJ. Myocardial Doppler tissue imaging: findings in inferior myocardial infarction and left ventricular hypertrophy-wall motion assessment. J Am Soc Echocardiography. 2001; 14:864-73.
Weidemann F, Dommke C, Bijnens B, Claus P, D’hooge J, Mertens P, et al. Defining the transmurality of a chronic myocardial infarction by ultrasonic strain-rate imaging: implications for identifying intramural viability: an experimental study. Circulation 2003;107: 883-8
Hoffmann R, Altiok E, Nowak B, Heussen N, Ku¨hl H, Kaiser HJ, et al. Strain Rate Measurement by Doppler Echocardiography Allows Improved Assessment of Myocardial Viability in Patients With Depressed Left Ventricular Function. J Am Coll Cardiology 2002; 39:443–9.
Cain P, Khoury V, Short L, Marwick TH. Usefulness of quantitative echocardiographic techniques to predict recovery of regional and global left ventricular function after acute myocardial infarction. American Journal of Cardiology. 2003;91:391-6.
Marwick TH. Measurement of strain and strain rate by echocardiography: ready for prime time? J Am Coll CArdiol 2006; 47: 1313-27.
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