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Noninvasive Myocardial Strain Measurement by Speckle Tracking Echocardiography

Validation Against Sonomicrometry and Tagged Magnetic Resonance Imaging

Brage H. Amundsen, MD^_*,_*, Thomas Helle-Valle, MD, Thor Edvardsen, PhD, MD, Hans Torp, DrTechn^_*, Jonas Crosby, MSc^_*, Erik Lyseggen, MD, Asbjørn Støylen, MD, PhD^_*,, Halfdan Ihlen, MD, PhD, João A.C. Lima, MD, FACC, Otto A. Smiseth, MD, PhD, FACC and Stig A. Slørdahl, MD, PhD^_*,

^_* Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Institute for Surgical Research/Department of Cardiology, Rikshospitalet University Hospital, Oslo, Norway
Department of Cardiology, St. Olavs Hospital/Trondheim University Hospital, Trondheim, Norway
Department of Cardiology, Johns Hopkins University, Baltimore, Maryland

View larger version (12K): [in a new window]   Figure 1 (A) Figure from the experimental study showing an apical four-chamber view with crystal positions (circles) and directions for strain and shortening measurements (arrows). (B) Figure from the clinical study showing an apical four-chamber view with the positions of the seven regions of interest (circles) and arrows to indicate where strain was measured.

View larger version (24K): [in a new window]   Figure 2 Speckle tracking: the motion of the region of interest (ROI) from one frame (t0) to the next (t1) can be quantified in two dimensions, allowing angle-independent measurements. t = time.

View larger version (24K): [in a new window]   Figure 3 (A) Plot showing the relation between left ventricular short-axis (SX) shortening by sonomicrometry (SM) and speckle tracking echocardiography (STE). (B) Bland-Altman plot showing the mean difference (dotted middle line) and 95% limits of agreement (dashed lines).

View larger version (14K): [in a new window]   Figure 4 (A) Plot showing the relation between long-axis (LX) strain by sonomicrometry (SM) and speckle tracking echocardiography (STE). (B) Bland-Altman plot showing the mean difference (dotted middle line) and 95% limits of agreement (dashed lines).

View larger version (12K): [in a new window]   Figure 5 Recordings from a single experiment during left anterior descending artery occlusion. (Upper panels) Left ventricular (LV) short-axis shortening at mid-ventricular level (left) and apical level (right). (Middle panels) Long-axis strain in the septum (left) and lateral wall (right). (Lower panels) LV pressure (LVP) for timing. Reduced short-axis systolic shortening and lateral wall strain indicate ischemic dysfunction. Dashed line = sonomicrometry, solid line = speckle tracking echocardiography.

View larger version (15K): [in a new window]   Figure 6 (A) Long-axis strains measured by magnetic resonance imaging (MRI) tagging and speckle tracking echocardiography (STE). (B) Bland-Altman plot showing the mean difference (dotted middle line) and 95% limits of agreement (dashed lines).