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J Am Coll Cardiol, 2002; 39:443-449 © 2002 by the American College of Cardiology Foundation |
* 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.
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