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Identification of acutely ischemic myocardium using ultrasonic strain measurements

A clinical study in patients undergoing coronary angioplasty

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

View larger version (45K): [in a new window]   Figure 1 Strain data processing. Strain rate B-mode data (top) was postprocessed from myocardial velocities. Strain rate profiles were obtained from a user-defined region of interest (white circle) and averaged over three consecutive cardiac cycles to derive mean strain rate profiles (middle). Mean strain profiles (bottom) were obtained by time-integrating of the mean strain rate profiles with end-diastole (electrocardiogram [ECG] R-top) as a reference time-point. Note the marked difference between the radial and longitudinal deformation magnitude. The timing of aortic valve closure (AVC) was used as a marker of end-systole (vertical dashed lines). SAX = short-axis parasternal view.

View larger version (22K): [in a new window]   Figure 2 Parameters derived from strain profiles. A schematic representation of radial and longitudinal ischemic strain profiles. Systolic (SYS) and peak strains (PEAK) were measured at end-systole and peak deformation, respectively. T is the time from aortic valve closure (AVC) to peak strain. Postsystolic strain was calculated as the difference between PEAK and SYS (absolute change). PSI = postsystolic index.

View larger version (37K): [in a new window]   Figure 3 A typical example of acute ischemic changes in regional deformation. Radial deformation: strain profiles obtained before occlusion (baseline), 30 to 60 s after occlusion (occlusion) of the right coronary artery, and 2 min after balloon deflation (reperfusion) from the "at-risk" posterior basal segment with visually normal preocclusion wall motion (a) or abnormal wall motion (b). Longitudinal deformation: strain profiles obtained before occlusion, 30 to 60 s after occlusion of the left anterior descending coronary artery, and 2 min after balloon deflation from the "at-risk" septal apical segment with visually normal preocclusion wall motion (a) or abnormal visual wall motion (b). The timing of aortic valve closure (AVC) is represented by vertical dashed lines. The augmentation in postsystolic shortening during occlusion is indicated with black arrows.

View larger version (30K): [in a new window]   Figure 4 Individual response of collateralized segments (group A, n = 7, closed circles) and noncollateralized segments (group C, n = 29, open circles) during occlusion of the right coronary artery/circumflex artery. The measurements are performed for postsystolic strain in radial direction.

View larger version (33K): [in a new window]   Figure 5 Receiver operating characteristic (ROC) curves testing the diagnostic value of end-systolic, peak strain, and post-systolic strain index in the identification of acutely ischemic segments during coronary occlusion. Optimal cutoff values are represented by closed and open circles.

View larger version (39K): [in a new window]   Figure 6 Groups 1, 2, and 3. Individual segmental response during acute occlusion (OCCL), reperfusion (REC), and 12 months after the right coronary artery/circumflex artery angioplasty (A). Corresponding wall motion score analysis is shown in B. BAS = baseline. *p < 0.05, baseline vs. 1 year follow-up, p = NS, baseline vs. 12 months follow-up.