CLINICAL RESEARCH
Myocardial strain rate is a superior method for evaluation of left ventricular subendocardial function compared with tissue Doppler imaging
Ikuo Hashimoto, MD*,
Xiaokui Li, MD*,
Aarti Hejmadi Bhat, MD*,
Michael Jones, MD ,
Arthur D. Zetts and
David J. Sahn, MD, FACC*,*
* Clinical Care Center for Congenital Heart Disease, Oregon Health and Sciences University, Portland, Oregon, USA
National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
* Reprint requests and correspondence: Dr. David J. Sahn, L608, Pediatric Cardiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239-3098, USA.
sahnd{at}ohsu.edu
OBJECTIVES: This study was performed to evaluate subendocardial function using strain rate imaging (SRI).
BACKGROUND: The subendocardium and mid-wall of the left ventricle (LV) play important roles in ventricular function. Previous methods used for evaluating this function are either invasive or cumbersome. Strain rate imaging by ultrasound is a newly developed echocardiographic modality based on tissue Doppler imaging (TDI) that allows quantitative assessment of regional myocardial wall motion.
METHODS: We examined eight sheep using TDI in apical four-chamber views to evaluate the LV free wall. Peak strain rates (SRs) during isovolumic relaxation (IR), isovolumic contraction (IC), and myocardial strain were measured in the endocardial (End), mid-myocardial (Mid), and epicardial (Epi) layers. For four hemodynamic conditions (created after baseline by blood, dobutamine, and metoprolol infusion), we compared differences in SR of End, Mid, and Epi layers to peak positive and negative first derivative of LV pressure (dP/dt).
RESULTS: Strain rate during IC showed a good correlation with +dP/dt (r = 0.74, p < 0.001) and during IR with –dP/dt (r = 0.67, p = 0.0003). There was a significant difference in SR between the myocardial layers during both IC and IR (End: –3.4 ± 2.2 s–1, Mid: –1.8 ± 1.5 s–1, Epi: –0.63 ± 1.0 s–1, p < 0.0001 during IC; End: 2.2 ± 1.5 s–1, Mid: 1.0 ± 0.8 s–1, Epi: 0.47 ± 0.64 s–1, p < 0.0001 during IR). Also, SRs of the End and Mid layers during IC were significantly altered by different hemodynamic conditions (End at baseline: 1.7 ± 0.7 s–1; blood: 2.0 ± 1.1 s–1; dobutamine: 3.4 ± 2.3 s–1; metoprolol: 1.0 ± 0.4 s–1; p < 0.05). Myocardial strain showed differences in each layer (End: –34.3 ± 12.6%; Mid: –22.6 ± 12.1%; Epi: –11.4 ± 7.9%; p < 0.0001) and changed significantly in different hemodynamic conditions (p < 0.0001).
CONCLUSIONS: Strain and SR appear useful and sensitive for evaluating myocardial function, especially for the subendocardial region.
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Abbreviations and Acronyms
| | dP/dt | = first derivative of LV pressure | | End | = endocardial layer | | Epi | = epicardial layer | | IC | = isovolumic contraction | | IR | = isovolumic relaxation | | LV | = left ventricle/ventricular | | Mid | = mid-myocardial layer | | SR | = strain rate | | SRI | = strain rate imaging | | TDI | = tissue Doppler imaging |
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