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CLINICAL STUDY: MYOCARDIAL ISCHEMIA

Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography

^a Department of Cardiology, National Hospital, University of Oslo, Norway

Manuscript received March 9, 2000; revised manuscript received September 22, 2000, accepted November 3, 2000.

Reprint requests and correspondence: Dr. Thor Edvardsen, Dept. of Cardiology, The National Hospital, 0027 Oslo, Norway
thor.edvardsen{at}klinmed.uio.no

OBJECTIVES

We sought to evaluate if echocardiographic strain measurements could detect acute myocardial ischemia, and to compare this new method with myocardial velocity measurements and wall motion score index.

BACKGROUND

Tissue Doppler echocardiography (TDE) is a promising method for assessing regional myocardial function. However, myocardial velocities measured by tissue Doppler echocardiography (TDE) vary throughout the left ventricle (LV) because of tethering effects from adjacent tissue. Strain Doppler echocardiography (SDE) is a new tool for measuring regional myocardial deformation excluding the effect of adjacent myocardial tissue.

METHODS

Seventeen patients undergoing angioplasty of the left anterior descending coronary artery (LAD) were studied. Left ventricular longitudinal wall motion was assessed by TDE and SDE from the apical four-chamber view before, during and after angioplasty from multiple myocardial segments simultaneously.

RESULTS

Systolic strain values were uniformly distributed in the different nonischemic LV segments, whereas systolic velocities decreased from basis to apex. During LAD occlusion, strain measurement showed expansion in the apical septal segment in 16 of 17 patients (7.5 ± 6.5% vs. –17.7 ± 7.2%, p < 0.001) and reduced compression in the mid-septal segment (p < 0.05) compared with baseline. Segments not supplied by LAD remained unchanged. Tissue Doppler echocardiography showed reduced velocities in all septal segments (p < 0.05) during angioplasty even though LAD does not supply the basal septal segment. Negative systolic velocities were present in 11 of 17 patients. Wall motion score index increased during ischemia (1.3 ± 0.4, p < 0.05).

CONCLUSIONS

The new SDE approach might be a more accurate marker than TDE for detecting systolic regional myocardial dysfunction induced by LAD occlusion.

Abbreviations and Acronyms   2-D = two-dimensional   CX = circumflex artery   LAD = left anterior descending coronary artery   LV = left ventricle   MRI = magnetic resonance imaging   SD = standard deviation   SDE = strain Doppler echocardiography   TDE = tissue Doppler echocardiography   WMSI = wall motion score index

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