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CLINICAL RESEARCH

Grading of Myocardial Dysfunction by Tissue Doppler Echocardiography

A Comparison Between Velocity, Displacement, and Strain Imaging in Acute Ischemia

Department of Cardiology and the Institute for Surgical Research, Rikshospitalet University Hospital, Oslo, Norway

Manuscript received August 11, 2005; revised manuscript received November 7, 2005, accepted November 21, 2005.

^_* Reprint requests and correspondence: Dr. Otto A. Smiseth, Department of Cardiology, Rikshospitalet University Hospital, N-0027 Oslo, Norway (Email: o.a.smiseth{at}klinmed.uio.no).

OBJECTIVES: The aim of the study was to compare the ability of the tissue Doppler echocardiographic imaging (TDI) modalities velocity, strain, and displacement to quantify systolic myocardial function.

BACKGROUND: Several TDI modalities may be used to quantify regional myocardial function, but it is not clear how the different modalities should be applied.

METHODS: In 10 anesthetized dogs we measured left ventricular pressure, longitudinal myocardial velocity, strain, and displacement by TDI at baseline and during left anterior descending coronary artery (LAD) stenosis and occlusion. Reference methods were segmental shortening by sonomicrometry and segmental work. In 10 patients with acute anterior wall infarction (LAD occlusion) and 15 control subjects, velocity, strain, and displacement measurements were performed.

RESULTS: In the animal study, systolic strain correlated well with segmental shortening (r = 0.96, p < 0.01) and work (r = 0.90, p < 0.01), and differentiated well between non-ischemic (–13.5 ± 3.2% [mean ± SD]), moderately ischemic (–6.5 ± 2.8%), and severely ischemic myocardium (7.1 ± 13.2%). The ratio post-systolic strain/total strain also differentiated well between levels of ischemia. Displacement and ejection velocity had weaker correlations with segmental shortening (r = 0.92 and r = 0.74, respectively) and regional work (r = 0.85 and r = 0.69), and there was marked overlap between values at baseline and at different levels of ischemia. In the human study, systolic strain differentiated well between infarcted and normal myocardium (1.0 ± 5.0% vs. –17.8 ± 3.8%), whereas systolic displacement (–0.3 ± 1.3 mm vs. –2.3 ± 0.6 mm) and ejection velocity (0.9 ± 0.6 cm/s vs. 2.2 ± 0.6 cm/s) showed overlap. In the infarction group, strain was reduced in segments with infarcted tissue, while systolic velocity and displacement were reduced in all segments and did not reflect the extension of the infarct.

CONCLUSIONS: Strain was superior to velocity and displacement for quantification of regional myocardial function. Provided technical limitations can be solved, strain Doppler is the preferred TDI modality for assessing function in ischemic myocardium.

Abbreviations and Acronyms   dP/dt = time derivatives of left ventricular pressure   IVC = isovolumic contraction   IVR = isovolumic relaxation   LA = left atrial/atrium   LAD = left anterior descending coronary artery   LV = left ventricle/ventricular   MRI = magnetic resonance imaging   SDE = strain Doppler echocardiography   TDI = tissue Doppler imaging

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