HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.05.054v1 46/5/864    most recent 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 ISI Web of Science 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 ISI Web of Science (25) Citing Articles via Google Scholar Google Scholar Articles by Zhang, Y. Articles by Sanderson, J. E. Search for Related Content PubMed PubMed Citation Articles by Zhang, Y. Articles by Sanderson, J. E.

CLINICAL RESEARCH: CARDIAC ULTRASOUND

Strain Rate Imaging Differentiates Transmural From Non-Transmural Myocardial Infarction

A Validation Study Using Delayed-Enhancement Magnetic Resonance Imaging

Yan Zhang, MB, PhD^_*, Anna K.Y. Chan, MRCP^_*, Cheuk-Man Yu, MD, FRCP^_*, Gabriel W.K. Yip, MD^_*, Jeffrey W.H. Fung, FRCP^_*, Wynnie W.M. Lam, FRCR, Nina M.C. So, FRCR, Mei Wang, MB, PhD^_*, Eugene B. Wu, MD, MRCP^_*, John T. Wong, MRCP^_* and John E. Sanderson, MD, FACC^_*,_*

^_* Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR

Manuscript received August 24, 2004; revised manuscript received May 3, 2005, accepted May 10, 2005.

^_* Reprint requests and correspondence: Dr. John E. Sanderson, Keele University Medical School, University Hospital of North Staffordshire NHS Trust, Department of Cardiology, City General Hospital, Stoke-on-Trent ST4 6QG, United Kingdom. (Email: John.Sanderson{at}uhns.nhs.uk).

OBJECTIVES: The aim of this study was to determine if strain rate imaging (SRI) correlates with the transmural extent of myocardial infarction (MI) measured by contrast-enhanced magnetic resonance imaging (Ce-MRI).

BACKGROUND: Identification of the transmural extent of myocardial necrosis and degree of non-viability after acute MI is clinically important.

METHODS: Tissue Doppler echocardiography with SRI and Ce-MRI were performed in 47 consecutive patients with a first acute MI between days 2 and 6 and compared to 60 age-matched healthy volunteers. Peak myocardial velocities and peak myocardial deformation strain rates were measured. Location and size of the infarct zone was confirmed by Ce-MRI using the delayed enhancement technique with a 16-segment model.

RESULTS: Contrast-enhanced MRI identified transmural infarction in 21 patients, non-transmural infarction in 15 (mean transmurality of infarct 72.3 ± 10.6%), and another 11 patients with subendocardial infarction (<50% transmural extent of the left ventricular wall). Peak systolic strain rate (SRs) of the transmural infarction segments was significantly lower compared to normal myocardium or with non-transmural infarction segments (both p < 0.0005). A cutoff value of SRs >–0.59 s^–1 detected a transmural infarction with high sensitivity (90.9%) and high specificity (96.4%), and –0.98 s^–1 >SRs >–1.26 s^–1 distinguished subendocardial infarction from normal myocardium with a sensitivity of 81.3% and a specificity of 83.3%.

CONCLUSIONS: Peak myocardial deformation by SRI can differentiate transmural from non-transmural MI, and it allows noninvasive determination of transmurality of the scar after MI and thereby the extent of non-viable myocardium.

Abbreviations and Acronyms   Am = atrial contraction velocity   Ce-MRI = contrast-enhanced magnetic resonance imaging   Em = early diastolic velocity   FDG-PET = [18F]fluorodeoxyglucose positron emission tomography   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   MI = myocardial infarction   ROC = receiver-operating characteristic curve   Sm = peak systolic velocity   SRa = atrial strain rate   SRe = early diastolic strain rate   SRI = strain rate imaging   SRs = peak systolic strain rate   TDI = tissue Doppler imaging   WMSI = wall motion score index

This article has been cited by other articles:

				O. Gjesdal, T. Helle-Valle, E. Hopp, K. Lunde, T. Vartdal, S. Aakhus, H.-J. Smith, H. Ihlen, and T. Edvardsen Noninvasive Separation of Large, Medium, and Small Myocardial Infarcts in Survivors of Reperfused ST-Elevation Myocardial Infarction: A Comprehensive Tissue Doppler and Speckle-Tracking Echocardiography Study Circ Cardiovasc Imaging, November 1, 2008; 1(3): 189 - 196. [Abstract] [Full Text] [PDF]

				M. M. Kylmala, M. K. Antila, S. M. Kivisto, K. Lauerma, P. H. Vesterinen, H. A. Hanninen, L. Toivonen, and M. K. Laine Tissue Doppler strain-mapping in the assessment of the extent of chronic myocardial infarction: validation using magnetic resonance imaging Eur J Echocardiogr, September 1, 2008; 9(5): 678 - 684. [Abstract] [Full Text] [PDF]

				W. Streb, M. Marciniak, P. Claus, A. Marciniak, M. McLaughlin, J. D'hooge, F. E. Rademakers, B. Bijnens, and G. R. Sutherland Full or pressure limited reperfusion of an acute myocardial infarct results in a different wall thickness and deformation of the distal myocardium - implications for clinical reperfusion strategies Eur J Echocardiogr, July 1, 2008; 9(4): 458 - 465. [Abstract] [Full Text] [PDF]

				M. Becker, A. Lenzen, C. Ocklenburg, K. Stempel, H. Kuhl, M. Neizel, M. Katoh, R. Kramann, J. Wildberger, M. Kelm, et al. Myocardial Deformation Imaging Based on Ultrasonic Pixel Tracking to Identify Reversible Myocardial Dysfunction J. Am. Coll. Cardiol., April 15, 2008; 51(15): 1473 - 1481. [Abstract] [Full Text] [PDF]

				D. S. Owens and J. F. Plehn Recognizing Unrecognized Risk: The Evolving Role of Ventricular Functional Assessment in Population-Based Studies Circulation, July 10, 2007; 116(2): 126 - 130. [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]

				Z. B. Popovic, C. Benejam, J. Bian, N. Mal, J. Drinko, K. Lee, F. Forudi, R. Reeg, N. L. Greenberg, J. D. Thomas, et al. Speckle-tracking echocardiography correctly identifies segmental left ventricular dysfunction induced by scarring in a rat model of myocardial infarction Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2809 - H2816. [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]

				R. Hoffmann Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction: reply Eur. Heart J., May 1, 2007; 28(9): 1174 - 1174. [Full Text] [PDF]

				Z.-Z. Song and J. Ma Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction Eur. Heart J., May 1, 2007; 28(9): 1173 - 1174. [Full Text] [PDF]

				T. Vartdal, H. Brunvand, E. Pettersen, H.-J. Smith, E. Lyseggen, T. Helle-Valle, H. Skulstad, H. Ihlen, and T. Edvardsen Early Prediction of Infarct Size by Strain Doppler Echocardiography After Coronary Reperfusion J. Am. Coll. Cardiol., April 24, 2007; 49(16): 1715 - 1721. [Abstract] [Full Text] [PDF]

				R. Hoffmann and M. Becker Myocardial deformation to determine transmurality of myocardial infarction?: Reply Eur. Heart J., January 2, 2007; 28(2): 269 - 270. [Full Text] [PDF]

				Y. Zhang and J. E. Sanderson Myocardial deformation to determine transmurality of myocardial infarction Eur. Heart J., January 2, 2007; 28(2): 269 - 269. [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]

				J. A. White, R. Yee, X. Yuan, A. Krahn, A. Skanes, M. Parker, G. Klein, and M. Drangova Delayed Enhancement Magnetic Resonance Imaging Predicts Response to Cardiac Resynchronization Therapy in Patients With Intraventricular Dyssynchrony J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1953 - 1960. [Abstract] [Full Text] [PDF]

				J. Chan, L. Hanekom, C. Wong, R. Leano, G.-Y. Cho, and T. H. Marwick Differentiation of Subendocardial and Transmural Infarction Using Two-Dimensional Strain Rate Imaging to Assess Short-Axis and Long-Axis Myocardial Function J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2026 - 2033. [Abstract] [Full Text] [PDF]

				M. Becker, R. Hoffmann, H. P. Kuhl, H. Grawe, M. Katoh, R. Kramann, A. Bucker, P. Hanrath, and N. Heussen Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction Eur. Heart J., November 1, 2006; 27(21): 2560 - 2566. [Abstract] [Full Text] [PDF]

				J. E. Sanderson Letter by Sanderson Regarding Article "Contractile Behavior of the Left Ventricle in Diastolic Heart Failure: With Emphasis on Regional Systolic Function" Circulation, July 4, 2006; 114(1): e13 - e13. [Full Text] [PDF]

				A. E. Weyman The Year in Echocardiography J. Am. Coll. Cardiol., February 21, 2006; 47(4): 856 - 863. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas Highlights of the Year in JACC 2005 J. Am. Coll. Cardiol., January 3, 2006; 47(1): 184 - 202. [Full Text] [PDF]