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      Transmural Peak Systolic Strain and Strain Rate Predict Transmural Myocardial Blood Flow in a Pig Myocardial Infarction Model

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          Abstract

          Objective: To test the hypothesis that the transmural variation of the longitudinal myocardial peak systolic strain (Sp) and strain rate (SRp) can predict the transmural distribution of myocardial blood flow (MBF) in a pig model of acute myocardial infarction. Methods: The longitudinal Sp and SRp were measured by echocardiography in both subendocardium (Sp-endo, SRp-endo) and subepicardium (Sp-epi, SRp-epi) in the normal, ischemic and infarct segments, respectively. The MBF in corresponding sites was measured by colored microspheres technique. The subendocardial to subepicardial ratio of Sp (Sp-EER), SRp (SRp-EER) and MBF (MBF-EER) were calculated. Results: In the normal segments, Sp-endo and SRp-endo were significantly higher than Sp-epi and SRp-ep, respectively. In the ischemic segments, Sp-endo and SRp-endo decreased to a greater extent than Sp-epi and SRp-epi, respectively. In the infarct segments, Sp-endo, SRp-endo Sp-epi and SRp-epi were all remarkably reduced. High correlations were found between Sp and SRp measurements and MBF in both subendocardium and subepicardium (r = –0.75 to –0.84, p < 0.001). Conclusion: Strain and strain rate imaging provides a reliable approach to the noninvasive estimation of the transmural blood distribution across the normal, ischemic and infarct segments.

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          Most cited references 8

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          Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function.

          This study sought to differentiate the transmural extent of infarction (TME) by assessment of the short-axis and long-axis function of the left ventricle (LV) using 2-dimensional (2D) strain. The differentiation of subendocardial infarction from transmural infarction has significant prognostic and clinical implications. Contrast-enhanced magnetic resonance imaging (CE-MRI) and dobutamine stress echocardiography (DBE) were performed in 80 patients (age 63 +/- 10 years) with chronic ischemic LV dysfunction. Myocardial function was assessed in the short axis at the midventricular level using peak strain rate (SR) and strain (S) in circumferential and radial dimensions, and was assessed in the long axis using longitudinal SR and S. Wall motion analysis was performed during DBE to assess for contractile reserve. Transmural infarct segments had lower circumferential S (-10.7 +/- 6.3) and SR (-1.0 +/- 0.4) than subendocardial infarcts (S: -15.4 +/- 7.0, p < 0.0001; SR: -1.4 +/- 0.8, p = 0.02) and normal myocardium (S: p < 0.0001; SR: p < 0.0001). Transmural and subendocardial infarct segments had similar radial S and SR. Subendocardial infarct segments showed significant reduction of longitudinal S (-13.2 +/- 5.6) and SR (-0.91 +/- 0.45) compared with normal myocardium (S: -17.8 +/- 5.4, p < 0.0001; SR: -1.1 +/- 0.41, p < 0.0001), but there were no significant differences between subendocardial and transmural infarct segments (p = 0.09). Wall motion analysis by DBE could not identify subendocardial infarction on CE-MRI (TME 1% to 50%: DBE scar 38%, DBE viable 38%, DBE ischemic 24%, p = NS). The combined assessment of long-axis and short-axis function using 2D strain may be used to identify TME.
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            Application of Tissue Doppler Imaging in Cardiology

            Tissue Doppler imaging (TDI) is a new echocardiographic technique employing the Doppler principle to measure the velocity of myocardial segments and other cardiac structures. It is well suited for the measurement of long-axis ventricular function. Impairment of longitudinal myocardial fiber motion is a sensitive marker of early myocardial dysfunction and ischaemia, and TDI might therefore become an important tool in routine echocardiography. The technique allows truly quantitative measurement of regional myocardial function both at rest and during stress echocardiography. TDI has great potential in the diagnosis of diastolic left ventricular dysfunction, overcoming the load-dependence of conventional Doppler techniques. Right ventricular function, intracardiac and pulmonary artery pressures, transplant rejection and intraventricular dyssynchrony can also be assessed. This article reviews the current and evolving applications of TDI in cardiology.
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              Strain and strain rate echocardiography.

              Strain and strain rate echocardiography is an emerging technique for assessing myocardial systolic and diastolic function. It is envisioned that this modality could change the quantitative assessment of regional wall motion and improve the accuracy and reproducibility of test readings. Myocardial strain and strain rate can detect inducible ischemia and at earlier stages than visual estimation of wall motion or wall thickening parameters. Changes in systolic strain rate and strain have potential to discriminate between different myocardial viability states. Measurement of diastolic rate of deformation can differentiate physiologic from pathologic hypertrophy, and restrictive from constrictive cardiomyopathy. This article reviews basic principles and current experimental and clinical applications of strain and strain rate echocardiography.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2009
                December 2008
                03 July 2008
                : 112
                : 2
                : 122-128
                Affiliations
                aKey Laboratory of Cardiovascular Remodelling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, bCenter for New Drugs Evaluation of Shandong University, Jinan, and cDepartment of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Fujian, China
                Article
                142722 Cardiology 2009;112:122–128
                10.1159/000142722
                18596373
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 3, References: 18, Pages: 7
                Categories
                Original Research

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