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CLINICAL STUDY: CARDIAC ULTRASOUND

Identification of acutely ischemic myocardium using ultrasonic strain measurements

A clinical study in patients undergoing coronary angioplasty

^* Department of Cardiology, Gasthuisberg Hospital, Leuven, Belgium

Manuscript received December 30, 2001; revised manuscript received May 9, 2002, accepted August 20, 2002.

^* Reprint requests and correspondence: Dr. George R. Sutherland, University Hospital Gasthuisberg, Department of Cardiology, Herestraat 49, B-3000 Leuven, Belgium.
George.Sutherland{at}uz.kuleuven.ac.be

OBJECTIVES: The goal of this study was to investigate whether the changes in myocardial deformation measured with ultrasonic strain could accurately identify acutely ischemic myocardium during coronary angioplasty.

BACKGROUND: Early identification of acute myocardial ischemia has important clinical implications. The accuracy of ultrasonic strain for the detection of acute myocardial ischemia has been validated in animal experiments but has not been investigated in the clinical setting.

METHODS: In 73 patients (64 ± 12 years), either radial or longitudinal strain values were monitored in the "at-risk" segments before, during, and early after right, circumflex, and left anterior descending coronary angioplasty. Based on the visual wall motion assessed before the angioplasty, segments were divided into normokinetic (group I) and hypo/akinetic (group II). Strain data in the "at-risk " segments were compared with values derived from the adjacent nonischemic segments and normal values in 20 controls.

RESULTS: Coronary occlusion induced a marked reduction in the systolic strain both in the radial (from 49 ± 6.9% to 23 ± 4.6% in group I and from 21.9 ± 11% to 11.3 ± 8.4% in group II, p < 0.001) and longitudinal directions. Concomitantly, postsystolic strain increased (from 3.8 ± 3.1% to 14.6 ± 9.5% in group I, and from 4.4 ± 3.7% to 11.3 ± 7.8% in group II in radial direction, p < 0.001). Upon reperfusion, all deformation parameters returned to near preocclusion values. In comparison with control, baseline, and reperfusion data, the systolic and postsystolic strain parameters measured during total coronary occlusion identified acutely ischemic myocardium with a sensitivity of 86% to 95% and a specificity of 83% to 89%.

CONCLUSIONS: In this model of acute ischemia, ultrasonic strain indexes differentiate acutely ischemic segments from both normal and dysfunctional myocardium. This should be a promising new approach to the bedside monitoring of acute ischemic changes in regional myocardial function.

Abbreviations and Acronyms   AVC   aortic valve closure   CDMI   color Doppler myocardial imaging   ECG   electrocardiogram/electrocardiographic   PEAK   peak strain   PS   postsystolic strain   SYS   end-systolic strain   PSI   postsystolic strain index   PTCA   percutaneous transluminal coronary angioplasty   ROC   receiver operating characteristic   T   time delay from aortic valve closure to peak strain   WMS   wall motion score

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