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Time to onset of regional relaxation: feasibility, variability and utility of a novel index of regional myocardial function by strain rate imaging

Theodore P. Abraham, MD^*, Marek Belohlavek, MD, PhD, FACC^*, Helen L. Thomson, MBBS^*, Cristina Pislaru, MD, Bijoy Khandheria, MD, FACC^*, James B. Seward, MD, FACC^* and Patricia A. Pellikka, MD, FACC^*,*

^* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
Department of Physiology and Biophysics, Mayo Clinic, Rochester, Minnesota, USA

View larger version (112K): [in a new window]   Figure 1 Top panelillustrates the color M-mode image, with yellowindicating systolic shortening (s) and blue-white indicating diastolic lengthening (d) in strain rate imaging. The time point of transition from shortening to lengthening (contraction to relaxation) is indicated by the solid black line. The middle panelshows the strain rate tracing, * = systolic wave; solid arrow = late diastolic wave; open arrow = early diastolic wave. The lower panelis the electrocardiogram trace. An example of the time to onset of relaxation (electrocardiogram R-wave to the transition point) is illustrated at the bottom of the strain rate tracing (TR). The dotted linesseparate the septum into apical (top), mid and basal segments.

View larger version (81K): [in a new window]   Figure 2 Strain rate color M-mode image illustrating a decrease in TR from baseline (a) to peak stress (b) in the nonischemic basal segment (black arrow), and minimal TR change in the ischemic apical segment (white arrow). TR = time to onset of regional relaxation.

View larger version (21K): [in a new window]   Figure 3 Plot demonstrating no difference in baseline TR between normal (white bars) and ischemic (black bars) segments, a longer TR at peak stress and a smaller difference between peak and baseline TR in ischemic segments compared with normal segments (left). The percent change in TR (peak vs. baseline) normalized to baseline TR was significantly higher in normal (30%) compared to ischemic (19%) segments (right). *p < 0.05. TR = time to onset of regional relaxation.