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Lu Z, Liu T, Wang C, Xuan H, Yan Y, Chen J, Lu Y, Li D, Xu T. The evaluation of coronary microvascular obstruction in patients with STEMI by cardiac magnetic resonance T2-STIR image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography. Heart Vessels 2023; 38:40-48. [PMID: 35915265 DOI: 10.1007/s00380-022-02131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/29/2022] [Indexed: 01/06/2023]
Abstract
This study was designed to assess coronary microvascular obstruction (MVO) in patients with acute ST-segment elevation myocardial infarction (STEMI) by cardiac magnetic resonance T2-weighted short tau inversion recovery (T2-STIR) image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography (LDDSE-LS2D-STE). 32 patients were enrolled to perform cardiac magnetic resonance and echocardiography 5-7 days after primary percutaneous coronary intervention. Infarcted myocardium was categorized into MVO+ group and MVO- group by late gadolinium enhancement as gold standard. At T2-weighted image, the area of hyper-intense region and hypo-intense core inside were marked as A1, A2 and A2/A1 > 0 represented MVO. Strain parameters were composed of longitudinal strain (LS), circumferential strain and radial strain at rest and dobutamine stress. There were 94 MVO+ segments, 136 MVO- segments according to gold standard. 96 segments had hypo-intense core at T2-STIR image. The sensitivity and specificity of T2-STIR in detecting MVO were 91.49 and 92.65%. Endocardial LS was superior to other parameters, and stress endocardial LS was higher than that of resting endocardial LS (sensitivity: 77.11% vs 72.29%, specificity: 93.28% vs 83.19%, AUC: 0.87 vs 0.82, P < 0.05). The combination of T2-STIR and stress endocardial LS in parallel test could improve sensitivity significantly (98.05% vs 91.49%). T2-STIR has higher diagnostic value in detecting MVO with some limitations. However, LDDSE-LS2D-STE with cost-effective and handling may be a good alternative to T2-STIR. It provides additional and reliable diagnostic tools to identify MVO in STEMI patients after reperfusion.
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Affiliation(s)
- Zhihao Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Tao Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Yan Yan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Yuan Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China.
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China.
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Liu T, Wang C, Yin J, Wang L, Xuan H, Yan Y, Chen J, Bao J, Li D, Xu T. Comparison of Diagnostic Value Between STE+LDDSE and CMR-FT for Evaluating Coronary Microvascular Obstruction in Post-PCI Patients for STEMI. Ther Clin Risk Manag 2022; 18:813-823. [PMID: 35996553 PMCID: PMC9391944 DOI: 10.2147/tcrm.s374866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Coronary microvascular obstruction (CMVO) is closely associated with poor prognosis of ST-segment elevation myocardial infarction (STEMI) patients. However, data showing the comparison between cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) combined with low-dose dobutamine stress echocardiography (LDDSE) in evaluating CMVO was scarcely available. We aimed to explore and compare the predictive value between CMR-FT and STE+LDDSE in detecting CMVO. Methods Sixty-one STEMI patients were executed cardiac magnetic resonance and echocardiography within the first 5–7 days after primary percutaneous coronary intervention (PCI). The myocardial strain analysis was performed in STE, STE+LDDSE, and CMR-FT, and strain parameters included radial strain (RS), circumferential strain (CS), and longitudinal strain (LS). ROC curves were performed to predict infarcted myocardium segments with CMVO. Results Finally, 324 infarcted myocardium segments were analyzed, including 100 infarcted segments with CMVO and 224 segments without CMVO by the gold standard assessment of late gadolinium-enhancement cardiac magnetic resonance imaging (LGE-CMR). The results showed that CS was generally superior to RS and LS in identifying CMVO. CS in CMR-FT facilitated the detection of CMVO, with a sensitivity, specificity, and accuracy of 78.00%, 81.25%, and 80.25%, respectively. The sensitivity, specificity, and accuracy of CS in STE combined with LDDSE were better than STE alone (76.00% vs 60.00%, 79.91% vs 64.29%, and 78.70% vs 62.96%, P < 0.05). In addition, CMR-FT is not superior to STE+LDDSE for detection of CMVO (P > 0.05). Conclusion Low-dose dobutamine can improve the clinical value of STE for evaluating CMVO in STEMI patients. Compared with CMR-FT, STE+LDDSE might be a better choice for STEMI patients because of its safety, convenience, and low-cost.
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Affiliation(s)
- Tao Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Jie Yin
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Lili Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yan Yan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Jieli Bao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
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Gräni C, Stark AW, Fischer K, Fürholz M, Wahl A, Erne SA, Huber AT, Guensch DP, Vollenbroich R, Ruberti A, Dobner S, Heg D, Windecker S, Lanz J, Pilgrim T. Diagnostic performance of cardiac magnetic resonance segmental myocardial strain for detecting microvascular obstruction and late gadolinium enhancement in patients presenting after a ST-elevation myocardial infarction. Front Cardiovasc Med 2022; 9:909204. [PMID: 35911559 PMCID: PMC9329615 DOI: 10.3389/fcvm.2022.909204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMicrovascular obstruction (MVO) and Late Gadolinium Enhancement (LGE) assessed in cardiac magnetic resonance (CMR) are associated with adverse outcome in patients with ST-elevation myocardial infarction (STEMI). Our aim was to analyze the diagnostic performance of segmental strain for the detection of MVO and LGE.MethodsPatients with anterior STEMI, who underwent additional CMR were enrolled in this sub-study of the CARE-AMI trial. Using CMR feature tracking (FT) segmental circumferential peak strain (SCS) was measured and the diagnostic performance of SCS to discriminate MVO and LGE was assessed in a derivation and validation cohort.ResultsForty-eight STEMI patients (62 ± 12 years old), 39 (81%) males, who underwent CMR (i.e., mean 3.0 ± 1.5 days) after primary percutaneous coronary intervention (PCI) were included. All patients presented with LGE and in 40 (83%) patients, MVO was additionally present. Segments in all patients were visually classified and 146 (19%) segments showed MVO (i.e., LGE+/MVO+), 308 (40%) segments showed LGE and no MVO (i.e., LGE+/MVO–), and 314 (41%) segments showed no LGE (i.e., LGE–). Diagnostic performance of SCS for detecting MVO segments (i.e., LGE+/MVO+ vs. LGE+/MVO–, and LGE–) showed an AUC = 0.764 and SCS cut-off value was –11.2%, resulting in a sensitivity of 78% and a specificity of 67% with a positive predictive value (PPV) of 30% and a negative predictive value (NPV) of 94% when tested in the validation group. For LGE segments (i.e., LGE+/MVO+ and LGE+/MVO– vs. LGE–) AUC = 0.848 and SCS with a cut-off value of –13.8% yielded to a sensitivity of 76%, specificity of 74%, PPV of 81%, and NPV of 70%.ConclusionSegmental strain in STEMI patients was associated with good diagnostic performance for detection of MVO+ segments and very good diagnostic performance of LGE+ segments. Segmental strain may be useful as a potential contrast-free surrogate marker to improve early risk stratification in patients after primary PCI.
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Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Christoph Gräni,
| | - Anselm W. Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Monika Fürholz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Wahl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A. Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik P. Guensch
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - René Vollenbroich
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Ruberti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Xia R, He B, Zhu T, Zhang Y, Chen Y, Wang L, Zhou Y, Liao J, Zheng J, Li Y, Lv F, Gao F. Low-dose dobutamine cardiovascular magnetic resonance segmental strain study of early phase of intramyocardial hemorrhage rats. BMC Med Imaging 2021; 21:173. [PMID: 34800982 PMCID: PMC8605595 DOI: 10.1186/s12880-021-00709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background This study investigates the segmental myocardial strain of the early phase of intramyocardial hemorrhage (IMH) caused by reperfused myocardial infarction (MI) in rats by low-dose dobutamine (LDD) cardiovascular magnetic resonance (CMR) feature-tracking. Methods Nine sham rats and nine rats with 60-min myocardial ischemia followed by 48-h reperfusion were investigated using CMR, including T2*-mapping sequence and fast imaging with steady-state precession (FISP)–cine sequence. Another FISP–cine sequence was acquired after 2 min of dobutamine injection; the MI, IMH, and Non-MI (NMI) areas were identified. The values of peak radial strains (PRS) and peak circumferential strains (PCS) of the MI, IMH and NMI segments were acquired. The efficiency of PRS and PCS (EPRS and EPCS, respectively) were calculated on the basis of the time of every single heartbeat. Results The PRS, PCS, EPRS, and EPCS of the sham group increased after LDD injection. However, the PRS, PCS, EPRS, and EPCS of the IMH segment did not increase. Moreover, the PRS and PCS of the MI and NMI segments did not increase, but the EPRS and EPCS of these segments increased. The PRS, PCS, EPRS, and EPCS of the IMH segment were lower than those of the MI and NMI segments before and after LDD injection, but without a significant difference between MI segment and NMI segment before and after LDD injection. Conclusions LDD could help assess dysfunctions in segments with IMH, especially using the efficiency of strain. IMH was a crucial factor that decreased segmental movement and reserved function.
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Affiliation(s)
- Rui Xia
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Bo He
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Tong Zhu
- Department of Radiology, TongJi Hospital, TongJi Medical College, HuaZhong University of Science & Technology, Hankou, 430030, Wuhan, China
| | - Yu Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yushu Chen
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Lei Wang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yang Zhou
- Department of Pathology, Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Jichun Liao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Saint Louis, MO, 63110, USA
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Fabao Gao
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xuexiang Road, Wuhou District, Chengdu, 610041, Sichuan, China.
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Cardiac magnetic resonance-tissue tracking for the early prediction of adverse left ventricular remodeling after ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2019; 35:2095-2102. [DOI: 10.1007/s10554-019-01659-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/26/2019] [Indexed: 01/20/2023]
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Fang S, Zhang Z, Wang Y, Jiang F, Yang K, He F, Zhang C. Predictive value of left ventricular myocardial strain by four-dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction. Echocardiography 2019; 36:1074-1083. [PMID: 31162738 DOI: 10.1111/echo.14373] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The diagnostic difficulty of heart failure with preserved ejection fraction (HFpEF) is differentiating it in patients with similar symptoms and signs. This study aimed to assess the potential predictive value of left ventricular global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), and global area strain (GAS) measured by four-dimensional speckle tracking echocardiography (4DSTE) combined with red cell distribution width (RDW) in patients with HFpEF. METHODS One hundred and sixty-nine patients with symptoms or signs indicative of chronic heart failure and a left ventricular ejection fraction (LVEF) ≥ 50% and fifty controls with normal LVEF were recruited in this study. Standard echocardiography and 4DSTE examinations were performed. Laboratory examinations including RDW were performed on the same day as the echocardiographic study. RESULTS GLS, GCS, GRS, and GAS in the patient cohort were significantly lower, and RDW was significantly higher than those in the control cohort (P < 0.01), and the strain parameters in definite HFpEF patients were also dramatically lower than the rest patients (P < 0.01). The associations of age, gender, NYHA classification, hypertension history, left ventricular end-diastolic volume index, interventricular septal thickness, and diastolic dysfunction with HFpEF were significantly improved by adding 4DSTE parameters (P < 0.01) and further improved by adding RDW (P < 0.01). CONCLUSIONS In suspected HFpEF patients, who have symptoms or signs of heart failure, even without other conventional evidence of this diagnosis, GLS, GRS, and GCS have potential independent predictive value, while RDW has independent incremental predictive value for HFpEF.
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Affiliation(s)
- Sihua Fang
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhihua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Ying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Fan Jiang
- Department of Ultrasound, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kai Yang
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fei He
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chaoxue Zhang
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, Donal E, Sade LE, Ernande L, Garbi M, Grapsa J, Hagendorff A, Kamp O, Magne J, Santoro C, Stefanidis A, Lancellotti P, Popescu B, Habib G. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2018; 18:1301-1310. [PMID: 29045589 DOI: 10.1093/ehjci/jex244] [Citation(s) in RCA: 406] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022] Open
Abstract
Aims This European Association Cardiovascular Imaging (EACVI) Expert Consensus document aims at defining the main quantitative information on cardiac structure and function that needs to be included in standard echocardiographic report following recent ASE/EACVI chamber quantification, diastolic function, and heart valve disease recommendations. The document focuses on general reporting and specific pathological conditions such as heart failure, coronary artery and valvular heart disease, cardiomyopathies, and systemic diseases. Methods and results Demographic data (age, body surface area, blood pressure, and heart rhythm and rate), type (vendor and model) of ultrasound system used and image quality need to be reported. In addition, measurements should be normalized for body size. Reference normal values, derived by ASE/EACVI recommendations, shall always be reported to differentiate normal from pathological conditions. This Expert Consensus document suggests avoiding the surveillance of specific variable using different ultrasound techniques (e.g. in echo labs with high expertise in left ventricular ejection fraction by 3D and not by 2D echocardiography). The report should be also tailored in relation with different cardiac pathologies, quality of images, and needs of the caregivers. Conclusion The conclusion should be concise reflecting the status of left ventricular structure and function, the presence of left atrial and/or aortic dilation, right ventricular dysfunction, and pulmonary hypertension, leading to an objective communication with the patient health caregiver. Variation over time should be considered carefully, taking always into account the consistency of the parameters used for comparison.
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Affiliation(s)
- Maurizio Galderisi
- Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Naples, Italy
| | - Bernard Cosyns
- CHVZ (Centrum voor Hart en Vaatziekten)-Universitair ziekenhuis Brussel; and ICMI (In Vivo Cellular and Molecular Imaging) laboratory, Brussels, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Nuno Cardim
- Echocardiography Laboratory, Hospital da Luz, Lisbon, Portugal
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden 2300RC, The Netherlands
| | - Giovanni Di Salvo
- Pediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Erwan Donal
- Cardiologie, LTSI-INSERM U 1099, CHU Rennes, Université Rennes 1, Rennes, France
| | | | - Laura Ernande
- Department of Physiology, INSERM U955, Université Paris-Est Creteil, Henri Mondor Hospital, DHU-ATVB, AP-HP, Créteil, France
| | - Madalina Garbi
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS UK
| | - Julia Grapsa
- Department of Cardiovascular Sciences, Imperial College of London, London, UK
| | - Andreas Hagendorff
- Department of Cardiology-Angiology, Echokardiographie-Labore des Universitätsklinikums AöR, University of Leipzig, Leipzig, Germany
| | - Otto Kamp
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042 France
| | - Ciro Santoro
- Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Naples, Italy
| | - Alexandros Stefanidis
- 1st Department of Cardiology, General Hospital of Nikea, 3 P. Mela str., 184 54, Athens, Greece
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Bogdan Popescu
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Gilbert Habib
- Aix- Aix-Marseille Univ, URMITE, Aix Marseille Université-UM63, CNRS 7278, IRD 198, INSERM 1095.,Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille 13005, France
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Everaars H, Robbers LFHJ, Götte M, Croisille P, Hirsch A, Teunissen PFA, van de Ven PM, van Royen N, Zijlstra F, Piek JJ, van Rossum AC, Nijveldt R. Strain analysis is superior to wall thickening in discriminating between infarcted myocardium with and without microvascular obstruction. Eur Radiol 2018; 28:5171-5181. [PMID: 29948065 PMCID: PMC6223851 DOI: 10.1007/s00330-018-5493-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/09/2018] [Accepted: 04/17/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the diagnostic performances of strain and wall thickening analysis in discriminating among three types of myocardium after acute myocardial infarction: non-infarcted myocardium, infarcted myocardium without microvascular obstruction (MVO) and infarcted myocardium with MVO. METHODS Seventy-one patients with a successfully treated ST-segment elevation myocardial infarction underwent cardiovascular magnetic resonance imaging at 2-6 days after reperfusion. The imaging protocol included conventional cine imaging, myocardial tissue tagging and late gadolinium enhancement. Regional circumferential and radial strain and associated strain rates were analyzed in a 16-segment model as were the absolute and relative wall thickening. RESULTS Hyperenhancement was detected in 418 (38%) of 1096 segments and was accompanied by MVO in 145 (35%) of hyperenhanced segments. Wall thickening, circumferential and radial strain were all significantly diminished in segments with hyperenhancement and decreased even further if MVO was also present (all p < 0.001). Peak circumferential strain (CS) surpassed all other strain and wall thickening parameters in its ability to discriminate between hyperenhanced and non-enhanced myocardium (all p < 0.05). Furthermore, CS was superior to both absolute and relative wall thickening in differentiating infarcted segments with MVO from infarcted segments without MVO (p = 0.02 and p = 0.001, respectively). CONCLUSIONS Strain analysis is superior to wall thickening in differentiating between non-infarcted myocardium, infarcted myocardium without MVO and infarcted myocardium with MVO. Peak circumferential strain is the most accurate marker of regional function. KEY POINTS • CMR can quantify regional myocardial function by analysis of wall thickening on cine images and strain analysis of tissue tagged images. • Strain analysis is superior to wall thickening in differentiating between different degrees of myocardial injury after acute myocardial infarction. • Peak circumferential strain is the most accurate marker of regional function.
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Affiliation(s)
- Henk Everaars
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Lourens F H J Robbers
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Netherlands Heart Institute (NHI), Utrecht, The Netherlands
| | - Marco Götte
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | | | - Alexander Hirsch
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul F A Teunissen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan J Piek
- Department of Cardiology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Netherlands Heart Institute (NHI), Utrecht, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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D'Andrea A, Radmilovic J, Mele D, D'Ascenzi F, Agricola E, Carbone A, Lo Iudice F, Novo G, Ancona F, Righini FM, Mondillo S, Bossone E, Galderisi M. Speckle tracking analysis in intensive care unit: A toy or a tool? Echocardiography 2018; 35:506-519. [PMID: 29600543 DOI: 10.1111/echo.13879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The use of conventional echocardiography in the intensive care unit (ICU) is today established to assess left and right ventricular systolic function, for preload determination and procedural guidance. Next step in ICU echocardiography could be the use of novel ultrasound techniques such as strain echocardiography to assist in the management of patients with acute coronary syndrome, heart failure, or pulmonary embolism. This review has gathered the available evidence supporting the incremental value of strain in the diagnostic workup of cardiac diseases treated in ICU.
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Affiliation(s)
| | - Juri Radmilovic
- Monaldi Hospital, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Donato Mele
- University Hospital of Ferrara, Ferrara, Italy
| | | | | | - Andreina Carbone
- Monaldi Hospital, Luigi Vanvitelli University of Naples, Naples, Italy
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10
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Yin X, Xu R, Wang Y, Cheng T, Zhou H. Implication of coronary CT angiography combined with four-dimensional speckle tracking echocardiography for predicting major adverse cardiac events. Int J Cardiovasc Imaging 2018; 34:1287-1293. [DOI: 10.1007/s10554-018-1337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
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11
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Sugano A, Seo Y, Ishizu T, Watabe H, Yamamoto M, Machino-Ohtsuka T, Takaiwa Y, Kakefuda Y, Aihara H, Fumikura Y, Nishina H, Noguchi Y, Aonuma K. Value of 3-Dimensional Speckle Tracking Echocardiography in the Prediction of Microvascular Obstruction and Left Ventricular Remodeling in Patients With ST-Elevation Myocardial Infarction. Circ J 2017; 81:353-360. [DOI: 10.1253/circj.cj-16-0944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akinori Sugano
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Hiroaki Watabe
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | | | | | - Yui Takaiwa
- Department of Cardiology, Tsukuba Medical Center Hospital
| | - Yuki Kakefuda
- Department of Cardiology, Tsukuba Medical Center Hospital
| | - Hideaki Aihara
- Department of Cardiology, Tsukuba Medical Center Hospital
| | - Yuko Fumikura
- Department of Cardiology, Tsukuba Medical Center Hospital
| | | | - Yuichi Noguchi
- Department of Cardiology, Tsukuba Medical Center Hospital
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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12
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Prediction of Left Ventricular Remodeling after a Myocardial Infarction: Role of Myocardial Deformation: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0168349. [PMID: 28036335 PMCID: PMC5201304 DOI: 10.1371/journal.pone.0168349] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/29/2016] [Indexed: 12/22/2022] Open
Abstract
Aims Left ventricular (LV) adverse or reverse remodeling after ST-segment elevation myocardial infarction (MI) is the best outcome to assess the benefit of revascularization. Speckle tracking echocardiography (STE) may accurately identify early deformation impairment, while also being predictive of LV remodeling during follow-up. This systematic analysis aimed to provide a comprehensive review of current findings on STE as a predictor of LV remodeling after MI. Methods PubMed databases were searched through December 2014 to identify studies in adults targeting the association between LV remodeling and STE. Meta-regression was performed for longitudinal analysis. Results A total of 23 prospective studies (3066 patients) were found eligible. Eleven studies reported an association between STE and adverse remodeling and twelve studies with reverse remodeling. Using peak systolic longitudinal strain, the most accurate cut-off to predict adverse remodeling and reverse remodeling ranged from -12.8% to -10.2% and from -13.7% to -9.5%, respectively. In smaller studies, assessment of circumferential strain and torsion showed additive value in predicting remodeling. Meta-regression analysis revealed that longitudinal STE was associated with adverse remodeling (pooled univariable OR = 1.27, 1.17–1.38, p<0.001; pooled multivariable OR = 1.38, 1.13–1.70, p = 0.002) while pooled ORs of longitudinal STE only tended to predict reverse remodeling (pooled OR = 0.75, 0.54–1.06, p = 0.09). Conclusions This systematic review suggests that STE is associated with changes in LV volume or function regardless of underlying mechanisms and deformation direction. Meta-regression demonstrates a strong association between peak longitudinal systolic strain and adverse remodeling. Added STE predictive value over other clinical, biological and imaging variables remains to be proven.
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13
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Zhao H, Lee APW, Li Z, Qiao Z, Fan Y, An D, Xu J, Pu J, Shen X, Ge H, He B. Impact of Intramyocardial Hemorrhage and Microvascular Obstruction on Cardiac Mechanics in Reperfusion Injury: A Speckle-Tracking Echocardiographic Study. J Am Soc Echocardiogr 2016; 29:973-982. [PMID: 27523265 DOI: 10.1016/j.echo.2016.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intramyocardial hemorrhage (IMH) and microvascular obstruction (MVO) are two major mechanisms of reperfusion injury of the left ventricle after acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess the impact of IMH and MVO on left ventricular (LV) cardiac mechanics using two-dimensional speckle-tracking echocardiography during the acute phase of STEMI and on LV functional recovery. METHODS Eighty-one patients with STEMI who received primary reperfusion therapy were prospectively studied. Infarct segments were classified by cardiac magnetic resonance according to infarct transmurality and the presence or absence of IMH and/or MVO. Segmental systolic longitudinal strain, circumferential strain (CS), and radial strain were measured by two-dimensional speckle-tracking echocardiography. Adverse LV remodeling and major adverse cardiovascular events were assessed at 1 year. RESULTS MVO without IMH was much less frequent in nontransmural infarct segments than in transmural infarct segments (6.0% vs 19.1%, P = .000), while IMH was present only in transmural infarct segments. In nontransmural infarct segments, MVO was not associated with any significant changes in strain (P > .5). In transmural infarct segments, there were no differences in all types of strain between segments without reperfusion injury and those with MVO alone (P > .20). IMH was evident in the midmyocardial layer within the infarct zone in 196 segments (46.1%). The presence of IMH in addition to MVO decreased CS significantly (P = .004), but not longitudinal and radial strain (P > .5). A receiver operating characteristic curve analysis with cross-validation by k-folding showed that the sensitivity and specificity of CS using a cutoff of >-11.66% to diagnose IMH were 78.00% and 79.45%, respectively (area under the curve = 0.86; P = .0001). At 1 year, patients with major adverse cardiovascular events and LV remodeling had significantly lower baseline measurements of all types of global strain (P < .05). CONCLUSIONS In the acute phase of STEMI, reperfusion MVO and IMH injury have differential effects on cardiac mechanics. IMH preferentially affects CS, presumably related to its location in the midmyocardial layer.
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Affiliation(s)
- Hang Zhao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqing Qiao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiting Fan
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dongaolei An
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Xu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuedong Shen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Garg P, Kidambi A, Foley JRJ, Musa TA, Ripley DP, Swoboda PP, Erhayiem B, Dobson LE, McDiarmid AK, Greenwood JP, Plein S. Ventricular longitudinal function is associated with microvascular obstruction and intramyocardial haemorrhage. Open Heart 2016; 3:e000337. [PMID: 27175286 PMCID: PMC4860848 DOI: 10.1136/openhrt-2015-000337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/25/2016] [Accepted: 02/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) are associated with adverse prognosis, independently of infarct size after reperfused ST-elevation myocardial infarction (STEMI). Mitral annular plane systolic excursion (MAPSE) is a well-established parameter of longitudinal function on echocardiography. OBJECTIVE We aimed to investigate how acute MAPSE, assessed by a four-chamber cine-cardiovascular MR (CMR), is associated with MVO, IMH and convalescent left ventricular (LV) remodelling. METHODS 54 consecutive patients underwent CMR at 3T (Intera CV, Philips Healthcare, Best, The Netherlands) within 3 days of reperfused STEMI. Cine, T2-weighted, T2* and late gadolinium enhancement (LGE) imaging were performed. Infarct and MVO extent were measured from LGE images. The presence of IMH was investigated by combined analysis of T2w and T2* images. Averaged-MAPSE (medial-MAPSE+lateral-MAPSE/2) was calculated from 4-chamber cine imaging. RESULTS 44 patients completed the baseline scan and 38 patients completed 3-month scans. 26 (59%) patients had MVO and 25 (57%) patients had IMH. Presence of MVO and IMH were associated with lower averaged-MAPSE (11.7±0.4 mm vs 9.3±0.3 mm; p<0.001 and 11.8±0.4 mm vs 9.2±0.3 mm; p<0.001, respectively). IMH (β=-0.655, p<0.001) and MVO (β=-0.567, p<0.001) demonstrated a stronger correlation to MAPSE than other demographic and infarct characteristics. MAPSE ≤10.6 mm demonstrated 89% sensitivity and 72% specificity for the detection of MVO and 92% sensitivity and 74% specificity for IMH. LV remodelling in convalescence was not associated with MAPSE (AUC 0.62, 95% CI 0.44 to 0.77, p=0.22). CONCLUSIONS Postreperfused STEMI, LV longitudinal function assessed by MAPSE can independently predict the presence of MVO and IMH.
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Affiliation(s)
- Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - James R J Foley
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - David P Ripley
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
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15
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Favot M, Courage C, Ehrman R, Khait L, Levy P. Strain Echocardiography in Acute Cardiovascular Diseases. West J Emerg Med 2016; 17:54-60. [PMID: 26823931 PMCID: PMC4729419 DOI: 10.5811/westjem.2015.12.28521] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 01/19/2023] Open
Abstract
Echocardiography has become a critical tool in the evaluation of patients presenting to the emergency department (ED) with acute cardiovascular diseases and undifferentiated cardiopulmonary symptoms. New technological advances allow clinicians to accurately measure left ventricular (LV) strain, a superior marker of LV systolic function compared to traditional measures such as ejection fraction, but most emergency physicians (EPs) are unfamiliar with this method of echocardiographic assessment. This article discusses the application of LV longitudinal strain in the ED and reviews how it has been used in various disease states including acute heart failure, acute coronary syndromes (ACS) and pulmonary embolism. It is important for EPs to understand the utility of technological and software advances in ultrasound and how new methods can build on traditional two-dimensional and Doppler techniques of standard echocardiography. The next step in competency development for EP-performed focused echocardiography is to adopt novel approaches such as strain using speckle-tracking software in the management of patients with acute cardiovascular disease. With the advent of speckle tracking, strain image acquisition and interpretation has become semi-automated making it something that could be routinely added to the sonographic evaluation of patients presenting to the ED with cardiovascular disease. Once strain imaging is adopted by skilled EPs, focused echocardiography can be expanded and more direct, phenotype-driven care may be achievable for ED patients with a variety of conditions including heart failure, ACS and shock.
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Affiliation(s)
- Mark Favot
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Cheryl Courage
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Robert Ehrman
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Lyudmila Khait
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Phillip Levy
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
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Meimoun P, Abouth S, Clerc J, Elmkies F, Martis S, Luycx-Bore A, Boulanger J. Usefulness of Two-Dimensional Longitudinal Strain Pattern to Predict Left Ventricular Recovery and In-Hospital Complications after Acute Anterior Myocardial Infarction Treated Successfully by Primary Angioplasty. J Am Soc Echocardiogr 2015; 28:1366-75. [DOI: 10.1016/j.echo.2015.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Indexed: 10/23/2022]
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17
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Global and regional myocardial deformation mechanics of microvascular obstruction in acute myocardial infarction: a three dimensional speckle-tracking imaging study. Int J Cardiovasc Imaging 2015; 31:1337-46. [PMID: 26044525 DOI: 10.1007/s10554-015-0690-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/01/2015] [Indexed: 12/13/2022]
Abstract
Microvascular obstruction (MVO) and transmural infarct size are prognostic factors after acute myocardial infarction (AMI). We assessed the value of myocardial deformation patterns using 3D speckle tracking imaging (3DSTI) in detecting myocardial and microvascular damage after AMI. One hundred patients with first ST-segment elevation MI from the REMI Study were prospectively included. Transthoracic echocardiography with 3DSTI and CMR were performed within 72 h after revascularization therapy. Global (3DG) and segmental (3DS) values of LV longitudinal (LS), circumferential and radial area strain were obtained. Late gadolinium enhancement (LGE) and MVO was quantified as transmural (>50%) or non-transmural (<50%). Predictive performance was assessed by area under the receiver operating curve characteristic (AUC). Mean LVEFCMR was 45.8 ± 9.2 % with 22.2 ± 12.7% transmural LGE. MVO was present in 55 patients (MVO transmural extent 11.4 ± 11.8%). In global analysis, all 3DG strain values were correlated with LVEFCMR and infarct size, with the best correlation obtained for 3DGAS (r = -0.678; p < 0.0001). All 3DG strain values, with the exception of LS, were significantly different between patients with and without MVO. In segmental analysis, all 3DS strain values were significantly lower in transmurally infarcted segments than in non-infarcted segments, and all 3DS values except 3DSRS were significantly lower in non-transmural infarcted segments than in non-infarcted segments. The best 3DS strain for detecting non-viable segments with MVO (MVO > 75%) was 3DSAS [AUC 0.867 (0.849-0.884), 78.0% sensitivity and 81.1% specificity for 3DSAS = -16.1%]. Importantly, 3DSRS and 3DSAS were associated with an increase in diagnostic accuracy of both transmural LGE and MVO over 3DSLS (all increase in AUC > 0.04, all p < 0.01). The newly developed 3DSTI, especially 3DSAS, is a sensitive and reproducible tool to predict and quantify the transmural extent of scar. This new early imaging strategy improve the prediction of MVO while enabling to assess the success of reperfusion and the risk of late systolic remodeling in STEMI.
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18
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Cyclosporine A reduces microvascular obstruction and preserves left ventricular function deterioration following myocardial ischemia and reperfusion. Basic Res Cardiol 2015; 110:18. [PMID: 25720581 PMCID: PMC4342514 DOI: 10.1007/s00395-015-0475-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/31/2015] [Accepted: 02/18/2015] [Indexed: 12/13/2022]
Abstract
Postconditioning and cyclosporine A prevent mitochondrial permeability transition pore opening providing cardioprotection during ischemia/reperfusion. Whether microvascular obstruction is affected by these interventions is largely unknown. Pigs subjected to coronary occlusion for 1 h followed by 3 h of reperfusion were assigned to control (n = 8), postconditioning (n = 9) or cyclosporine A intravenous infusion 10–15 min before the end of ischemia (n = 8). Postconditioning was induced by 8 cycles of repeated 30-s balloon inflation and deflation. After 3 h of reperfusion magnetic resonance imaging, triphenyltetrazolium chloride/Evans blue staining and histopathology were performed. Microvascular obstruction (MVO, percentage of gadolinium-hyperenhanced area) was measured early (3 min) and late (12 min) after contrast injection. Infarct size with double staining was smaller in cyclosporine (46.2 ± 3.1 %, P = 0.016) and postconditioning pigs (47.6 ± 3.9 %, P = 0.008) versus controls (53.8 ± 4.1 %). Late MVO was significantly reduced by cyclosporine (13.9 ± 9.6 %, P = 0.047) but not postconditioning (23.6 ± 11.7 %, P = 0.66) when compared with controls (32.0 ± 16.9 %). Myocardial blood flow in the late MVO was improved with cyclosporine versus controls (0.30 ± 0.06 vs 0.21 ± 0.03 ml/g/min, P = 0.002) and was inversely correlated with late-MVO extent (R2 = 0.93, P < 0.0001). Deterioration of left ventricular ejection fraction (LVEF) between baseline and 3 h of reperfusion was smaller with cyclosporine (−7.9 ± 2.4 %, P = 0.008) but not postconditioning (−12.0 ± 5.5 %, P = 0.22) when compared with controls (−16.4 ± 5.5 %). In the three groups, infarct size (β = −0.69, P < 0.001) and late MVO (β = −0.33, P = 0.02) were independent predictors of LVEF deterioration following ischemia/reperfusion (R2 = 0.73, P < 0.001). Despite both cyclosporine A and postconditioning reduce infarct size, only cyclosporine A infusion had a beneficial effect on microvascular damage and was associated with better preserved LV function when compared with controls.
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