This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hoffmann, R. Articles by Hanrath, P. Search for Related Content PubMed PubMed Citation Articles by Hoffmann, R. Articles by Hanrath, P.

CLINICAL STUDY: MYOCARDIAL ISCHEMIA

Strain rate measurement by doppler echocardiography allows improvedassessment of myocardial viability inpatients with depressed left ventricular function

Rainer Hoffmann, MD^*,*, Ertunc Altiok^*, Bernd Nowak, MD, Nicole Heussen, Harald Kühl, MD, Hans-J.ürgen Kaiser, MD, Udalrich Büll, MD and Peter Hanrath, MD, FACC^*

^* Medical Clinic I, University RWTH, Aachen, Germany
Department of Nuclear Medicine, University RWTH, Aachen, Germany
Department of Biomedical Statistics, University Rheinisch Westfälische Technische Hochschule, Aachen, Germany

Manuscript received February 22, 2001; revised manuscript received October 15, 2001, accepted November 1, 2001.

^* Reprint requests and correspondence: Dr. Rainer Hoffmann, Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
Rhof{at}pcserver.mk1.rwth-aachen.de

OBJECTIVES: This study sought to evaluate whether objective assessment of the myocardial functional reserve, using strain rate imaging (SRI), allows accurate detection of viable myocardium.

BACKGROUND: Strain rate imaging is a new echocardiographic modality that allows quantitative assessment of segmental myocardial contractility.

METHODS: In 37 patients (age 58 ± 9 years) with ischemic left ventricular dysfunction, myocardial viability was assessed using low-dose (10 µg/kg body weight per min) two-dimensional dobutamine stress echocardiography (DSE), tissue Doppler imaging, SRI and ¹⁸F-fluorodeoxyglucose (¹⁸FDG) positron emission tomography (PET). The peak systolic tissue Doppler velocity and peak systolic myocardial strain rate were determined at baseline and during low-dose dobutamine stress from the apical views.

RESULTS: A total of 192 segments with dyssynergy at rest were classified by ¹⁸FDG PET as viable in 94 and nonviable in 98. An increase of peak systolic strain rate from rest to dobutamine stimulation by more than –0.23 1/s allowed accurate discrimination of viable from nonviable myocardium, as determined by ¹⁸FDG PET with a sensitivity of 83% and a specificity of 84%. Receiver operating characteristic (ROC) curve analysis showed an area under the curve for prediction of nonviable myocardium, as determined by ¹⁸FDG PET using SRI, of 0.89 (95% confidence interval [CI] 0.88 to 0.90), whereas the area under the ROC curve using tissue Doppler imaging was 0.63 (95% CI 0.61 to 0.65).

CONCLUSIONS: The increase in the peak systolic strain rate during low-dose dobutamine stimulation allows accurate discrimination between different myocardial viability states. Strain rate imaging is superior to two-dimensional DSE and tissue Doppler imaging for the assessment of myocardial viability.

Abbreviations and Acronyms   1FDG   CI   confidence interval   DSE   dobutamine stress echocardiography   18FDG   18F-fluorodeoxyglucose   LV   left ventricle or ventricular   PET   positron emission tomography   ROC   receiver operating characteristic   SR   strain rate   SRI   strain rate imaging   99mTc   technetium-99m   TDI   tissue Doppler imaging

This article has been cited by other articles:

				R.A. Argyle and S.G. Ray Stress and strain: double trouble or useful tool? Eur J Echocardiogr, August 1, 2009; 10(6): 716 - 722. [Abstract] [Full Text] [PDF]

				T. H. Marwick The future of echocardiography Eur J Echocardiogr, July 1, 2009; 10(5): 594 - 601. [Abstract] [Full Text] [PDF]

				S.-M. Park, A. Prasad, C. Rihal, M. R. Bell, and J. K. Oh Left Ventricular Systolic and Diastolic Function in Patients With Apical Ballooning Syndrome Compared With Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction: A Functional Paradox Mayo Clin. Proc., June 1, 2009; 84(6): 514 - 521. [Abstract] [Full Text] [PDF]

				C. Marcucci, R. Lauer, and A. Mahajan New Echocardiographic Techniques for Evaluating Left Ventricular Myocardial Function Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2008; 12(4): 228 - 247. [Abstract] [PDF]

				N R Van de Veire, J De Sutter, J J Bax, and J R T C Roelandt Technological advances in tissue Doppler imaging echocardiography Heart, August 1, 2008; 94(8): 1065 - 1074. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola, V. Dilsizian, C. M. Kramer, T. H. Marwick, and J.-L. J. Vanoverschelde Chronic ischemic left ventricular dysfunction from pathophysiology to imaging and its integration into clinical practice. J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 536 - 555. [Abstract] [Full Text] [PDF]

				R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC) Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437. [Abstract] [Full Text] [PDF]

				T. P. Abraham, V. L. Dimaano, and H.-Y. Liang Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice Circulation, November 27, 2007; 116(22): 2597 - 2609. [Full Text] [PDF]

				H. Thibault, L. Gomez, E. Donal, G. Pontier, M. Scherrer-Crosbie, M. Ovize, and G. Derumeaux Acute myocardial infarction in mice: assessment of transmurality by strain rate imaging Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H496 - H502. [Abstract] [Full Text] [PDF]

				M. Penicka, P. Tousek, B. De Bruyne, W. Wijns, O. Lang, J. Madaric, M. Vanderheyden, J. Tintera, M. Maly, P. Widimsky, et al. Myocardial positive pre-ejection velocity accurately detects presence of viable myocardium, predicts recovery of left ventricular function and bears a prognostic value after surgical revascularization Eur. Heart J., June 1, 2007; 28(11): 1366 - 1373. [Abstract] [Full Text] [PDF]

				C.-M. Yu, J. E. Sanderson, T. H. Marwick, and J. K. Oh Tissue Doppler Imaging: A New Prognosticator for Cardiovascular Diseases J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1903 - 1914. [Abstract] [Full Text] [PDF]

				C. B. Ingul, E. Rozis, S. A. Slordahl, and T. H. Marwick Incremental Value of Strain Rate Imaging to Wall Motion Analysis for Prediction of Outcome in Patients Undergoing Dobutamine Stress Echocardiography Circulation, March 13, 2007; 115(10): 1252 - 1259. [Abstract] [Full Text] [PDF]

				C. Schneider, K. Jaquet, R. Malisius, S. Geidel, E. Bahlmann, S. Boczor, T. Rau, M. Antz, K.-H. Kuck, and K. Krause Attenuation of cardiac remodelling by endocardial injection of erythropoietin: ultrasonic strain-rate imaging in a model of hibernating myocardium Eur. Heart J., February 2, 2007; 28(4): 499 - 509. [Abstract] [Full Text] [PDF]

				J. D. Thomas and Z. B. Popovic Assessment of Left Ventricular Function by Cardiac Ultrasound J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2012 - 2025. [Abstract] [Full Text] [PDF]

				M Becker, E Bilke, H Kuhl, M Katoh, R Kramann, A Franke, A Bucker, P Hanrath, and R Hoffmann Analysis of myocardial deformation based on pixel tracking in two dimensional echocardiographic images enables quantitative assessment of regional left ventricular function Heart, August 1, 2006; 92(8): 1102 - 1108. [Abstract] [Full Text] [PDF]

				T. H. Marwick Measurement of Strain and Strain Rate by Echocardiography: Ready for Prime Time? J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1313 - 1327. [Abstract] [Full Text] [PDF]

				T.-H. Park, S. F. Nagueh, D. S. Khoury, H. A. Kopelen, S. Akrivakis, K. Nasser, G. Ren, and N. G. Frangogiannis Impact of myocardial structure and function postinfarction on diastolic strain measurements: implications for assessment of myocardial viability Am J Physiol Heart Circ Physiol, February 1, 2006; 290(2): H724 - H731. [Abstract] [Full Text] [PDF]

				J. Gorcsan III Echocardiographic Strain Imaging for Myocardial Viability: An Improvement Over Visual Assessment? Circulation, December 20, 2005; 112(25): 3820 - 3822. [Full Text] [PDF]

				L. Hanekom, C. Jenkins, L. Jeffries, C. Case, J. Mundy, C. Hawley, and T. H. Marwick Incremental Value of Strain Rate Analysis as an Adjunct to Wall-Motion Scoring for Assessment of Myocardial Viability by Dobutamine Echocardiography: A Follow-Up Study After Revascularization Circulation, December 20, 2005; 112(25): 3892 - 3900. [Abstract] [Full Text] [PDF]

				P. Schuster, K. Matre, and S. Faerestrand Assessment of regional timing of left ventricular systolic longitudinal movement by Doppler tissue synchronization imaging in structurally normal hearts Eur J Echocardiogr, October 1, 2005; 6(5): 336 - 343. [Abstract] [Full Text] [PDF]

				R I Williams, N Payne, T Phillips, J D'hooge, and A G Fraser Strain rate imaging after dynamic stress provides objective evidence of persistent regional myocardial dysfunction in ischaemic myocardium: regional stunning identified? Heart, February 1, 2005; 91(2): 152 - 160. [Abstract] [Full Text] [PDF]

				J.-U. Voigt, U. Nixdorff, R. Bogdan, B. Exner, K. Schmiedehausen, G. Platsch, T. Kuwert, W. G. Daniel, and F. A. Flachskampf Comparison of deformation imaging and velocity imaging for detecting regional inducible ischaemia during dobutamine stress echocardiography Eur. Heart J., September 1, 2004; 25(17): 1517 - 1525. [Abstract] [Full Text] [PDF]

				O. A. Breithardt, L. Herbots, J. D'Hooge, P. Claus, B. Bijnens, C. Stellbrink, A. Franke, and G. R. Sutherland Strain rate imaging in CRT candidates Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D16 - D24. [Abstract] [Full Text] [PDF]

				M. Penicka, J. Bartunek, W. Wijns, I. De Wolf, G. R. Heyndrickx, H. De Raedt, E. Barbato, and B. De Bruyne Tissue doppler imaging predicts recovery of left ventricular function after recanalization of an occluded coronary artery J. Am. Coll. Cardiol., January 7, 2004; 43(1): 85 - 91. [Abstract] [Full Text] [PDF]

				K. C. Wu and J. A.C. Lima Noninvasive Imaging of Myocardial Viability: Current Techniques and Future Developments Circ. Res., December 12, 2003; 93(12): 1146 - 1158. [Abstract] [Full Text] [PDF]

				F. Jamal, C. Bergerot, L. Argaud, J. Loufouat, and M. Ovize Longitudinal strain quantitates regional right ventricular contractile function Am J Physiol Heart Circ Physiol, December 1, 2003; 285(6): H2842 - H2847. [Abstract] [Full Text] [PDF]

				D Pellerin, R Sharma, P Elliott, and C Veyrat Tissue Doppler, strain, and strain rate echocardiography for the assessment of left and right systolic ventricular function Heart, November 1, 2003; 89(90003): iii9 - 17. [Abstract] [Full Text] [PDF]

				C. G. Fonseca, H. C. Oxenham, B. R. Cowan, C. J. Occleshaw, and A. A. Young Aging alters patterns of regional nonuniformity in LV strain relaxation: a 3-D MR tissue tagging study Am J Physiol Heart Circ Physiol, July 11, 2003; 285(2): H621 - H630. [Abstract] [Full Text] [PDF]

				J.-U. Voigt, B. Exner, K. Schmiedehausen, C. Huchzermeyer, U. Reulbach, U. Nixdorff, G. Platsch, T. Kuwert, W. G. Daniel, and F. A. Flachskampf Strain-Rate Imaging During Dobutamine Stress Echocardiography Provides Objective Evidence of Inducible Ischemia Circulation, April 29, 2003; 107(16): 2120 - 2126. [Abstract] [Full Text] [PDF]