Echocardiographic strain and strain-rate imaging: a new tool to study regional myocardial function

We describe a new method for quantitative imaging of strain and elastic modulus distributions in soft tissues. The method is based on external tissue compression, with subsequent computation of the strain profile along the transducer axis, which is derived from cross-correlation analysis of pre- and post-compression A-line pairs. The strain profile can then be converted to an elastic modulus profile by measuring the stresses applied by the compressing device and applying certain corrections for the nonuniform stress field. We report initial results of several phantom and excised animal tissue experiments which demonstrate the ability of this technique to quantitatively image strain and elastic modulus distributions with good resolution, sensitivity and with diminished speckle. We discuss several potential clinical uses of this technique.

Tissue Doppler echocardiography-derived strain rate and strain measurements (SDE) are new quantitative indices of intrinsic cardiac deformation. The aim of this study was to validate and compare these new indices of regional cardiac function to measurements of 3-dimensional myocardial strain by tagged MRI. The study population included 33 healthy volunteers, 17 patients with acute myocardial infarction, and 8 patients with suspected coronary artery disease who were studied during dobutamine stress echocardiography. Peak systolic myocardial velocities were measured by tissue Doppler echocardiography, peak systolic strain rates and strains by SDE, and strains by tagged MRI. In healthy individuals, longitudinal myocardial Doppler velocities decreased progressively from base to apex, whereas myocardial strain rates and strains were uniform in all segments. In patients with acute infarction, abnormal strains clearly identified dysfunctional areas. In infarcted regions, SDE showed 1.5+/-4.3% longitudinal stretching compared with -15.0+/-3.9% shortening in remote myocardium (P<0.001), and radial measurements showed -6.9+/-4.1% thinning and 14.3+/-5.0% thickening (P<0.001), respectively. During dobutamine infusion, longitudinal strains by SDE increased significantly from -13.5% to -23.8% (P<0.01) and radial strains increased from 13.1+/-3.1% to 29.3+/-11.5% (P<0.01). Comparisons between myocardial strains by SDE and tagged MRI in healthy individuals (n=11), in infarct patients (n=17), and during stress echo (n=4) showed excellent correlations (r=0.89 and r=0.96 for longitudinal and radial strains, respectively, P< 0.001). The present study demonstrates the ability of Doppler echocardiography to measure myocardial strains in a clinical setting. Myocardial strains by Doppler may represent a new powerful method for quantifying left ventricular function noninvasively in humans.

Time delay estimation (TDE) is commonly performed in practice by crosscorrelation of digitized echo signals. Since time delays are generally not integral multiples of the sampling period, the location of the largest sample of the crosscorrelation function (ccf) is an inexact estimator of the location of the peak. Therefore, one must interpolate between the samples of the ccf to improve the estimation precision. Using theory and simulations, we review and compare the performance of several methods for interpolation of the ccf. The maximum likelihood approach to interpolation is the application of a reconstruction filter to the discrete ccf. However, this method can only be approximated in practice and can be computationally intensive. For these reasons, a simple method is widely used that involves fitting a parabola (or other curve) to samples of the ccf in the neighborhood of its peak. We describe and compare two curve-fitting methods: parabolic and cosine interpolation. Curve-fitting interpolation can yield biased time-delay estimates, which may preclude the use of these methods in some applications. The artifactual effect of these bias errors on elasticity imaging by elastography is discussed. We demonstrate that reconstructive interpolation is unbiased. An iterative implementation of the reconstruction procedure is proposed that can reduce the computation time significantly.