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CLINICAL STUDY: NEW METHODS

Time to onset of regional relaxation: feasibility, variability and utility of a novel index of regional myocardial function by strain rate imaging

Theodore P. Abraham, MD^*, Marek Belohlavek, MD, PhD, FACC^*, Helen L. Thomson, MBBS^*, Cristina Pislaru, MD, Bijoy Khandheria, MD, FACC^*, James B. Seward, MD, FACC^* and Patricia A. Pellikka, MD, FACC^*,*

^* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
Department of Physiology and Biophysics, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received February 23, 2001; revised manuscript received January 17, 2002, accepted February 5, 2002.

^* Reprint requests and correspondence: Dr. Theodore P. Abraham, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA.
abraham.theodore{at}mayo.edu

OBJECTIVES: Time to onset of regional relaxation (T_R) has been proposed as a novel index of regional myocardial function. This study sought to prospectively establish the feasibility and variability of T_R in healthy volunteers (CONTROL) and to examine its utility in patients with inducible ischemia (PATIENT).

BACKGROUND: Strain rate imaging (SRI) depicts myocardial deformation and enables quantitation of regional myocardial function with high temporal and spatial resolution. Thus, regional mechanical events can be accurately timed with SRI. The time point of regional transition from contraction to relaxation is altered in pathologic states.

METHODS: Resting mean segmental T_R was determined in 60 subjects: 20 in the CONTROL group and 40 in the PATIENT group. T_R was also measured at peak dobutamine stress in the PATIENT group. An automated image analysis program determined the time point of transition from regional contraction to relaxation activity, and calculated T_R, defined as the time, in milliseconds, from the electrocardiogram R-wave to this transition point.

RESULTS: Automated T_R measurements were feasible in more than 90% of the segments in CONTROL and PATIENT groups. Mean T_R was 353 ± 24 ms and was shorter in the mid segments compared to apical and basal segments. Intra- and interobserver variability were low (6% and 9%, respectively). In the PATIENT group, the percent decrease in T_R during dobutamine stress was significantly higher in normal compared to ischemic segments (30% vs. 19%, respectively, p = 0.01). A percent change >20% in T_R identified patients with an ischemic response during dobutamine infusion (sensitivity 92%, specificity 75%).

CONCLUSIONS: T_R, a novel quantitative index of regional myocardial function, can be determined with low variability and satisfactory feasibility in routine clinical settings. Percent change in T_R identifies ischemic segments during dobutamine stress echocardiography (DSE) and may allow quantitative assessment of DSE.

Abbreviations and Acronyms   ATP   adenosine triphosphate   CAD   coronary artery disease   DSE   dobutamine stress echocardiography   SRI   strain rate imaging   TDI   tissue Doppler imaging   TR   time to onset of regional relaxation

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