Doppler Strain Imaging Closely Reflects Myocardial Energetic Status in Acute Progressive Ischemia and Indicates Energetic Recovery After Reperfusion

Kořínek, Josef; Sengupta, Partho P.; Wang, Jianwen; Romero‐Corral, Abel; Boukatina, Anna; Vítek, J; Krishnamoorthy, Vijay; Stephen, S.; Dzeja, Petras P.; Terzic, André; Khandheria, Bijoy K.; Bělohlávek, Marek

doi:10.1016/j.echo.2008.01.010

Cited by 9 publications

(2 citation statements)

References 31 publications

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“…radial thinning) was first noted followed by delayed radial thickening (figures 4(b) and 5(b)). This delayed deformation phenomenon has previously been reported by several groups (Korinek et al 2008, Skulstad et al 2002, Takayama et al 1988) under acute ischemia and termed ‘post-systolic shortening / thickening’, a potential indicator of myocardial viability.…”

Section: Discussionsupporting

confidence: 61%

In vivostudy of myocardial elastography under graded ischemia conditions

et al. 2011

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The capability of currently available echocardiography-based strain estimation techniques to fully map myocardial abnormality at early stages of myocardial ischemia is yet to be investigated. In this study, myocardial elastography (ME), a radio-frequency (RF)-based strain imaging technique that maps the full 2D transmural angle-independent strain tensor in standard echocardiographic views at both high spatial and temporal resolution is presented. The objectives were to (1) evaluate the performance of ME on mapping the onset, extent and progression of myocardial ischemia at graded coronary constriction levels (from partial to complete coronary flow reduction), and (2) validate the accuracy of the strain estimates against sonomicrometry (SM) measurements. A non-survival canine ischemic model (n = 5) was performed by gradually constricting the left anterior descending (LAD) coronary blood flow from 0% (baseline blood flow) to 100% (zero blood flow) at 20% increments. An open-architecture ultrasound system was used to acquire RF echocardiograms in a standard full short-axis view at the frame rate of 211 fps, at least twice higher than what is typically used in conventional echocardiographic systems, using a previously developed, fully automated composite technique. Myocardial deformation was estimated by ME and validated against sonomicrometry. ME estimates and maps transmural (1) 2D displacements using RF cross-correlation and recorrelation; and (2) 2D polar (radial and circumferential) strains, derived from 2D (i.e. both lateral and axial) displacement components, at high accuracy. Full-view strain images were shown and found to reliably depict decreased myocardial function in the region at risk at increased levels of coronary flow reduction. The ME radial strain was deemed to be a more sensitive, quantitative, regional measure of myocardial ischemia as a result of coronary flow reduction when compared to the conventional wall motion score index and ejection fraction. Good agreement (0.22% strain bias, 95% limits of agreement) using Bland–Altman analysis and good correlation (r = 0.84) were found between the ME and SM measurements. These findings demonstrate for the first time that ME could map angle-independent strains to non-invasively detect, localize and characterize the early onset of myocardial ischemia, i.e. at 40%, and possibly as low as 20%, LAD flow reduction, which could be further associated with the severity of coronary stenosis.

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Section: Discussionsupporting

confidence: 61%

In vivostudy of myocardial elastography under graded ischemia conditions

et al. 2011

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“…There is growing evidence in the literature that regional myocardial strain may aid in the early detection of subtle changes in myocardial function caused by ischemia, when wall motion abnormality cannot be visually detected. 18,20,48–50 This ability stems from the fact that longitudinal strain mostly reflects contractile function of the subendocardial fibers, which are predominantly affected by ischemia. 51 …”

Section: Discussionmentioning

confidence: 99%

Fusion of Three-Dimensional Echocardiographic Regional Myocardial Strain with Cardiac Computed Tomography for Noninvasive Evaluation of the Hemodynamic Impact of Coronary Stenosis in Patients with Chest Pain

Mor‐Avi

Patel

Maffessanti

et al. 2018

Journal of the American Society of Echocardiography

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Background Combined evaluation of coronary stenosis and the extent of ischemia is essential in patients with chest pain. Intermediate-grade stenosis on computed tomographic coronary angiography (CTCA) frequently triggers downstream nuclear stress testing. Alternative approaches without stress and/or radiation may have important implications. Myocardial strain measured from echocardiographic images can be used to detect subclinical dysfunction. The authors recently tested the feasibility of fusion of three-dimensional (3D) echocardiography–derived regional resting longitudinal strain with coronary arteries from CTCA to determine the hemodynamic significance of stenosis. The aim of the present study was to validate this approach against accepted reference techniques. Methods Seventy-eight patients with chest pain referred for CTCA who also underwent 3D echocardiography and regadenoson stress computed tomography were prospectively studied. Left ventricular longitudinal strain data (TomTec) were used to generate fused 3D displays and detect resting strain abnormalities (RSAs) in each coronary territory. Computed tomographic coronary angiographic images were interpreted for the presence and severity of stenosis. Fused 3D displays of subendocardial x-ray attenuation were created to detect stress perfusion defects (SPDs). In patients with stenosis >25% in at least one artery, fractional flow reserve was quantified (HeartFlow). RSA as a marker of significant stenosis was validated against two different combined references: stenosis >50% on CTCA and SPDs seen in the same territory (reference standard A) and fractional flow reserve < 0.80 and SPDs in the same territory (reference standard B). Results Of the 99 arteries with no stenosis >50% and no SPDs, considered as normal, 19 (19%) had RSAs. Conversely, with stenosis >50% and SPDs, RSAs were considerably more frequent (17 of 24 [71%]). The sensitivity, specificity, and accuracy of RSA were 0.71, 0.81, and 0.79, respectively, against reference standard A and 0.83, 0.81, and 0.82 against reference standard B. Conclusions Fusion of CTCA and 3D echocardiography–derived resting myocardial strain provides combined displays, which may be useful in determination of the hemodynamic or functional impact of coronary abnormalities, without additional ionizing radiation or stress testing.

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Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Hyler

Pischke

Halvorsen

et al. 2015

Journal of the American Society of Echocardiography

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The epicardially attached miniaturized ultrasound transducer allowed the precise detection of different levels of coronary flow reduction. The results also showed a quantitative and linear relationship among coronary flow, ischemia, and myocardial function. Thus, the ultrasound transducer has the potential to improve the monitoring of myocardial ischemia and to detect graft failure during and after heart surgery.

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Doppler Strain Imaging Closely Reflects Myocardial Energetic Status in Acute Progressive Ischemia and Indicates Energetic Recovery After Reperfusion

Abstract: Background-Capitalizing on mechanoenergetic coupling, we investigated whether strain echocardiography can noninvasively estimate the ratio of adenosine triphosphate (ATP) to adenosine diphosphate (ADP), a marker of energetic status during acute myocardial ischemia and reperfusion.

Cited by 9 publications

References 31 publications

In vivostudy of myocardial elastography under graded ischemia conditions

In vivostudy of myocardial elastography under graded ischemia conditions

Fusion of Three-Dimensional Echocardiographic Regional Myocardial Strain with Cardiac Computed Tomography for Noninvasive Evaluation of the Hemodynamic Impact of Coronary Stenosis in Patients with Chest Pain

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

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