Role of Quantitative Wall Motion Analysis in Patients with Acute Chest Pain at Emergency Department

Abstract

BackgroundEvaluation of acute chest pain in emergency department (ED), using limited resource and time, is still very difficult despite recent development of many diagnostic tools. In this study, we tried to determine the applicability of new semi-automated cardiac function analysis tool, velocity vector imaging (VVI), in the evaluation of the patients with acute chest pain in ED.MethodsWe prospectively enrolled 48 patients, who visited ED with acute chest pain, and store images to analyze VVI from July 2005 to July 2007.ResultsIn 677 of 768 segments (88%), the analysis by VVI was feasible among 48 patients. Peak systolic radial velocity (Vpeak) and strain significantly decreased according to visual regional wall motion abnormality (Vpeak, 3.50 ± 1.34 cm/s for normal vs. 3.46 ± 1.52 cm/s for hypokinesia, 2.51 ± 1.26 for akinesia, p < 0.01; peak systolic radial strain -31.74 ± 9.15% fornormal, -24.33 ± 6.28% for hypokinesia, -20.30 ± 7.78% for akinesia, p < 0.01). However, the velocity vectors at the time of mitral valve opening (MVO) were directed outward in the visually normal myocardium, inward velocity vectors were revealed in the visually akinetic area (VMVO, -0.85 ± 1.65 cm/s for normal vs. 0.10 ± 1.46 cm/s for akinesia, p < 0.001). At coronary angiography, VMVO clearly increased in the ischemic area (VMVO, -0.88+1.56 cm/s for normal vs. 0.70 + 2.04 cm/s for ischemic area, p < 0.01).ConclusionRegional wall motion assessment using VVI showed could be used to detect significant ischemia in the patient with acute chest pain at ED.

Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field

“…In patients with acute myocardial infarction (AMI), LVGLS correlates positively with the extent of infarction size and the peak concentration of cardiac troponin T level 33)34). Regional wall motion assessment with VVI was used to detect significant ischemia in patients with acute chest pain who visited an emergency room 35). Kim et al35) showed different peak radial strain values among normal motion, hypokinesia, and akinesia (31.74±9.15% for normal, 24.33±6.28% for hypokinesia, 20.30±7.78% for akinesia, p<0.01).…”

“…Regional wall motion assessment with VVI was used to detect significant ischemia in patients with acute chest pain who visited an emergency room 35). Kim et al35) showed different peak radial strain values among normal motion, hypokinesia, and akinesia (31.74±9.15% for normal, 24.33±6.28% for hypokinesia, 20.30±7.78% for akinesia, p<0.01).…”

Velocity Vector Imaging technology and standard echocardiography in evaluation of left ventricular function in patients with coronary artery disease before and after coronary bypass surgery

“…Технология Velocity Vector Imaging у пациентов с ишемической болезнью сердца (ИБС) обсуждается в литературе, однако основным предметом изучения являются глобальные деформационные свойства про дольных волокон [7][8][9]. Изменению функции цирку лярных и радиальных волокон уделяется меньшее внимание [10].…”

Ergonovine Provocation Echocardiography for Detection and Prognostication in Patients with Vasospastic Angina

“…Echocardiographic examinations can detect coronary artery disease through the presence of regional wall motion abnormalities and are facilitated by newer strain analysis methods. 5) Since ergonovine provocation echocardiography was first introduced in 1994 by Song et al, 6) it has been validated and regarded as a useful noninvasive method to diagnose VSA. Compared to invasive coronary angiography with provocation tests, ergonovine provocation echocardiography is both reliable for the diagnosis of VSA and offers advantages such as safety and feasibility.…”