European Journal of Echocardiography Advance Access published online on March 20, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen127
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Tissue Doppler strain-mapping in the assessment of the extent of chronic myocardial infarction: validation using magnetic resonance imaging
1 Division of Cardiology, Cardiovascular Laboratory, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 340, 00029 HUS Helsinki, Finland
2 BioMag Laboratory, Hospital District of Helsinki and Uusimaa HUSLAB, Helsinki University Central Hospital, Haartmaninkatu 4, 00029 HUS Helsinki, Finland
3 Department of Radiology, Helsinki University Central Hospital, Haartmaninkatu 4, 00029 HUS Helsinki, Finland
Received 1 November 2007; .
* Corresponding author. Tel: +358 405245735; fax: +358 9 471 74574.E-mail address: mika.laine{at}hus.fi
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Abstract |
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Aims: The distribution of myocardial strain values can be visualized by colour-coded strain images. We examined for the first time if this strain-mapping function can be used to study the extent of prior myocardial infarction.
Methods and results: Echocardiography and cardiac magnetic resonance imaging with delayed contrast enhancement were performed in 26 patients with chronic myocardial infarction. Two-dimensional strain images of the left ventricle were obtained in all standard apical views. Myocardial segments (n = 416) were assigned a score ranging from one to four based on the strain-coded colour of the segment, with higher scores representing worse myocardial function. Strain-mapping scores and quantitative strain values averaged, respectively, 1.3 ± 0.6 and –16.4 ± 7.6% in segments without infarction, 1.7 ± 1.0 and –15.0 ± 8.6% in non-transmural infarctions, and 2.8 ± 1.2 and –6.5 ± 8.6% in transmural infarctions. Strain-mapping had a sensitivity of 60% and a specificity of 95% in detecting segments with transmural myocardial infarction. Corresponding values for echocardiographic wall motion analysis were 50 and 96%. Strain-mapping was possible in 80% of the segments and inter-observer agreement was substantial (
= 0.63).
Conclusion: Strain-mapping is a clinically applicable method for the assessment of regional myocardial function in post-myocardial infarction patients. Strain-mapping has reasonable feasibility and is more sensitive in detecting infarction damage than routine wall motion analysis.
Keywords: Myocardial strain; Tissue Doppler imaging; Myocardial infarction; Cardiac magnetic resonance imaging; Delayed contrast enhancement