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Asanuma T. Myocardial motion in acute ischemia: revealing invisible deformation by echocardiography. J Echocardiogr 2024; 22:71-78. [PMID: 38615090 DOI: 10.1007/s12574-024-00650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/15/2024]
Abstract
Echocardiography has been used clinically to assess regional myocardial wall motion for the diagnosis of acute myocardial ischemia or stress-induced ischemia, but it is often difficult to distinguish hypokinetic motion from normal motion. Myocardial wall motion is affected by loading conditions as well as intrinsic contractility, making it challenging to define a normal range of wall motion. Therefore, hypokinesis is usually diagnosed by comparing target areas with other areas of myocardium considered normal (relative hypokinesis). Myocardial strain analysis by tissue Doppler echocardiography and speckle-tracking echocardiography has enabled objective and quantitative evaluation of regional myocardial wall motion. Peak systolic strain decreases during acute ischemia, but subtle and invisible myocardial motion, such as early systolic lengthening (ESL) and postsystolic shortening (PSS), also occurs, and the analysis of these subtle motions can improve the diagnostic accuracy of ischemia. However, the diagnosis of ischemic myocardium by strain analysis is not widely performed in clinical practice at this time due to several limitations. This article reviews the features of myocardial motion during acute ischemia, the mechanisms of ESL and PSS, the diagnosis of ischemic myocardium using strain analysis, and current approaches and future challenges to overcome the limitations in the detection of relative hypokinesis. This article also explains the use of ESL and PSS to detect myocardial ischemic memory that remains after brief ischemia.
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Affiliation(s)
- Toshihiko Asanuma
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan.
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2
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Zhou F, Yuan H, Sun J, Ran H, Pan H, Wu P, Yang Q. Two-dimensional speckle tracking imaging cardiac motion-based quantitative evaluation of global longitudinal strain among patients with coronary Heart Disease and functions of left ventricular ischemic myocardial segment. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:351-359. [PMID: 37953370 DOI: 10.1007/s10554-023-02993-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/21/2023] [Indexed: 11/14/2023]
Abstract
To investigate two-dimensional speckle tracking imaging (2D-STI)-based quantitative evaluation of the influences of different levels of coronary artery stenosis on left ventricular functions and its clinical diagnostic values, 120 patients with coronary heart disease (CHD) were divided into control group (30 cases), mild stenosis group (30 cases), moderate stenosis group (30 cases), and severe stenosis group (30 cases) according to coronary angiography (CAG) results. They underwent routine ultrasound examination and 2D-STI examination. Receiver operating characteristic (ROC) curves were drawn to evaluate the sensitivity and specificity of different levels of coronary artery stenosis. Global longitudinal strain (GLS) of left ventricular myocardium among patients in moderate and severe stenosis groups remarkably declined (P < 0.05). Global radial strain (GRS) and global circular strain (GCS) among patients in severe stenosis group dramatically reduced (P < 0.05). ROC curves revealed that available GLS=-17.2 was the cut-off value for screening moderate coronary stenosis. The sensitivity, specificity, and area under the curve (AUC) amounted to 57.3%, 58.4%, and 0.573, respectively. GLS, GRS, and GCS could be used to screen severe coronary stenosis. When GLS=-16.5 was the cut-off value for screening severe coronary stenosis, sensitivity, specificity, and AUC amounted to 84.3%, 82.5%, and 0.893, respectively. With the aggravation of stenosis, left ventricular systolic function of CHD patients was impaired more significantly. 2D-STI technique could be adopted for the quantitative evaluation of left ventricular strain of patients with coronary stenosis and provided a new method for early clinical diagnosis of CHD.
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Affiliation(s)
- Feiou Zhou
- Department of Cardiovascular, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang Province, China
| | - Hong Yuan
- Department of Cardiovascular, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang Province, China
| | - Jindong Sun
- Department of Cardiovascular, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang Province, China
| | - Hongmei Ran
- Department of Ultrasound, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang Province, China
| | - Hong Pan
- Department of Cardiovascular, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang Province, China
| | - Peian Wu
- Department of Cardiovascular, First People's Hospital of Linping District, Hangzhou, 311100, Zhejiang Province, China
| | - Qian Yang
- Department of Cardiovascular, The Second Affillated Hospital of Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang Province, China.
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3
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Zhang W, Cai Q, Lin M, Tian R, Jin S, Qin Y, Lu X. Diagnostic potential of myocardial early systolic lengthening for patients with suspected non-ST-segment elevation acute coronary syndrome. BMC Cardiovasc Disord 2023; 23:364. [PMID: 37468828 DOI: 10.1186/s12872-023-03364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND During early systole, ischemic myocardium with reduced active force experiences early systolic lengthening (ESL). This study aimed to explore the diagnostic potential of myocardial ESL in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF). METHODS Overall, 195 suspected NSTE-ACS patients with normal wall motion and LVEF, who underwent speckle tracking echocardiography (STE) before coronary angiography, were included in this study. Patients were stratified into the coronary artery disease (CAD) group when there was ≥ 50% stenosis in at least one major coronary artery. The CAD patients were further stratified into the significant (≥ 70% reduction of vessel diameter) stenosis group or the nonsignificant stenosis group. Myocardial strain parameters, including global longitudinal strain (GLS), duration of early systolic lengthening (DESL), early systolic index (ESI), and post-systolic index (PSI), were analyzed using STE and compared between groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic accuracy. Logistic regression analysis was conducted to establish the independent and incremental determinants for the presence of significant coronary stenosis. RESULTS The DESL and ESI values were higher in patients with CAD than those without CAD. In addition, CAD patients with significant coronary stenosis had higher DESL and ESI than those without significant coronary stenosis. The ROC analysis revealed that ESI was superior to PSI for identifying patients with CAD, and further superior to GLS and PSI for predicting significant coronary stenosis. Moreover, ESI could independently and incrementally predict significant coronary stenosis in patients with CAD. CONCLUSIONS The myocardial ESI is of great value for the diagnosis and risk stratification of clinically suspected NSTE-ACS patients with normal LVEF and wall motion.
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Affiliation(s)
- Wanwei Zhang
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qizhe Cai
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Mingming Lin
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Runyu Tian
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Shan Jin
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yunyun Qin
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Xiuzhang Lu
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
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Anderson WL, Bateman PV, Ofner S, Li X, Maatman B, Green-Hess D, Sawada SG, Feigenbaum H. Assessment of Postsystolic Shortening and Global Longitudinal Strain Improves the Sensitivity of Dobutamine Stress Echocardiography in End-Stage Liver Disease. J Am Soc Echocardiogr 2023:S0894-7317(23)00095-0. [PMID: 36828259 DOI: 10.1016/j.echo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Dobutamine stress echocardiography (DSE) remains a widely used method for detection of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) despite low sensitivity. Speckle-tracking assessment of strain may enhance the sensitivity of DSE in the general population, but the value of strain analysis in ESLD is unknown. METHODS Dobutamine stress echocardiography with two-dimensional speckle-tracking and quantitative coronary angiography were performed in 146 patients with ESLD. Thirty-six patients (25%) had CAD (≥50% diameter stenosis of a major vessel). Global longitudinal strain at rest (GLSr) and at peak stress (GLSp) and an index of postsystolic (PSSi) shortening ([maximal extent of shortening - extent of shortening in systole]/[extent of shortening in systole]) were determined. A PSSi of ≥ 0.25 was considered evidence for CAD. Receiver operating characteristic analysis was used to determine the optimal thresholds of GLSr and GLSp for CAD and to assess the diagnostic performance of visual assessment of wall motion (WMA) and strain parameters. The sensitivity and specificity of WMA, GLSr, GLSp, and PSSi were compared. RESULTS Thirty-six patients (25%) had significant CAD. The areas under the curve for WMA, GLSr, GLSp, and PSSi were 0.60, 0.72, 0.68, and 0.78, respectively. Visual assessment of wall motion had a sensitivity of 28%. The sensitivity of each of the strain parameters, GLSr (53%, P = .016), GLSp (69%, P = .004), and PSSi (78%, P < .001), exceeded the sensitivity for WMA. Visual assessment of wall motion specificity was 92%, which exceeded the specificity for each of the strain parameters (GLSr = 82%, P = .037; GLSp = 63%, P < .001; and PSSi =78%, P = .009). Of the strain parameters, PSSi had the best balance between sensitivity and specificity (both 78%). CONCLUSION Assessment of GLS and PSSi with DSE yields better sensitivity than WMA in ELSD patients. Index of postsystolic shortening had the best diagnostic performance of all parameters in this population with a low prevalence of CAD.
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Affiliation(s)
- Wesley L Anderson
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana.
| | - Pantila V Bateman
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana; Loyola University Medical Center, Division of Cardiology, Maywood, Illinois
| | - Susan Ofner
- Department of Biostatics, and Health Data Science, Indiana University, Indianapolis, Indiana
| | - Xiaochun Li
- Department of Biostatics, and Health Data Science, Indiana University, Indianapolis, Indiana
| | - Benjamin Maatman
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana; Community Physicians Network, Cardiology, Indianapolis, Indiana
| | - Deborah Green-Hess
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana
| | - Stephen G Sawada
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana
| | - Harvey Feigenbaum
- Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana
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Wan M, Liu D, Zhang P, Xie P, Liang L, He W. Postsystolic shortening and early systolic lengthening for early detection of myocardial involvement in patients with systemic lupus erythematosus. Echocardiography 2022; 39:1284-1290. [PMID: 36074004 DOI: 10.1111/echo.15442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/29/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cardiac involvement predicts a poor prognosis in patients with systemic lupus erythematosus (SLE). Two-dimensional speckle-tracking echocardiography (2D-STE) are used to identify subclinical myocardial involvement in various diseases. This study objected to evaluate postsystolic shortening (PSS) and early systolic lengthening (ESL) by 2D-STE for early detection of myocardial involvement in patients with SLE. METHODS A total of 121 patients with preserved left ventricular ejection fraction (LVEF) in SLE and 30 healthy controls underwent standard 2D-STE in our study. According to SLE disease activity index (SLEDAI), we divided SLE patients into two groups: the group of inactive disease (SLEDAI ≤ 4) and active disease (SLEDAI ≥ 5). The maximum of postsystolic strain index (PSImax ) and early systolic strain index (ESImax ) were acquired from 17 segments of left ventricular (LV). We also compared the PSImax and ESImax of basal, medial, and apical segments between SLE patients and controls. RESULTS Compared with healthy controls and the group of SLEDAI ≤ 4, the group of SLEDAI ≥ 5 had higher PSImax and ESImax value of global LV and basal segments. The absolute value of global longitudinal strain (GLS) had no difference between the group of active disease and inactive disease. Multivariate analysis demonstrated that PSS was independently associated with SLEDAI and diabetes mellitus. CONCLUSIONS Detection of PSS and ESL enable to identify LV systolic impairment in SLE patients at an early stage.
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Affiliation(s)
- Minjie Wan
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Donghong Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Pengyuan Zhang
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peihan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liuqin Liang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei He
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Dai Y. VALUE OF ECHOCARDIOGRAPHIC DIASTOLIC FUNCTION REACTIVITY UNDER EXERCISE LOAD. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228022021_0477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Left ventricular diastolic dysfunction is one of the important long-term survival and prognosis factors in patients with coronary heart disease. Objective: To evaluate the diastolic function of the left ventricle in patients with coronary heart disease (CHD) using 3D speckle tracking echocardiography (3D-STE). Methods: Full volume images of four apical cavities were collected, and 4D Auto LVQ software was used for offline analysis to obtain longitudinal strain (GLS), circumferential strain (GCS), area strain (GAS) and radial strain (GRS) of the left ventricle as a whole (four three-dimensional strain indicators). Results: The receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of GLS in predicting left ventricular diastolic dysfunction were both 68% at −15.5%. The sensitivity and specificity of GCS for predicting left ventricular diastolic dysfunction at −17.5% were 76% and 81%, and those of GAS at −29.5% were 84% and 68%, respectively. Conclusions: The strain parameters of 3D-STE can be used to predict LVEDP in patients with coronary heart disease with normal left ventricular ejection fraction, and can be used as a new ultrasonic diagnostic index to evaluate left ventricular diastolic function in patients. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Affiliation(s)
- Yuanliang Dai
- University Putra Malaysia, Malaysia; Qingdao Huanghai University, China
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7
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Lu S, Hu X, Zhang J, Zhu Y, Zhou W, Liu Y, Deng Y. Post-systolic shortening is superior to global longitudinal strain in predicting adverse events in patients with stable coronary artery disease and preserved systolic function. Insights Imaging 2022; 13:35. [PMID: 35237872 PMCID: PMC8891405 DOI: 10.1186/s13244-022-01174-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Post-systolic shortening (PSS) is an important indicator for early identifying myocardial dysfunction. We aimed to investigate the predictive value of PSS assessed with speckle tracking automated functional imaging (AFI) on adverse events in patients with stable coronary artery disease (CAD) and preserved systolic function. Methods A total of 204 consecutive patients clinically diagnosed with stable CAD and left ventricular ejection fraction (LVEF) > 50% were included. Multiple parameters were analyzed with AFI technique. The composite endpoint included all-cause mortality, heart failure, myocardial infarction and stroke. Results During a median follow-up of 24 months (IQR 19–28 months), 30 patients (14.7%) reached the endpoint. Patients experiencing the endpoint had a lower absolute global longitudinal strain (GLS), a higher post-systolic index (PSI), and more left ventricle walls displaying PSS than patients without events. PSI (hazard ratio, 1.15; 95% CI, 1.04–1.27; p = 0.005) and per 1 increase in the number of left ventricle walls with PSS (hazard ratio 1.52, 95% CI 1.21–1.91, p < 0.000) were independent predictors of the endpoint, whereas GLS was not significantly associated with the endpoint after adjustment models. For patients with absolute value of GLS > 15.4%, a significant prognostic superiority was found in PSI compared with GLS (AUC = 0.73 [PSI] vs. 0.58 [GLS], p = 0.024). Conclusions PSS is an independent predictor for adverse events in stable CAD patients with preserved systolic function, and the prognostic value may be superior to GLS in patients with normal or mildly reduced GLS. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01174-y.
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Affiliation(s)
- Shirui Lu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Xin Hu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Jun Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Ying Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China.
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
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Early systolic lengthening: a niche within strain imaging with prognostic value in cardiovascular disease. Int J Cardiovasc Imaging 2021; 38:169-170. [PMID: 34932176 DOI: 10.1007/s10554-021-02500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
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9
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Ishigaki T, Asanuma T, Yagi N, Izumi H, Shimizu S, Fujisawa Y, Ikemoto T, Kushima R, Masuda K, Nakatani S. Incremental value of early systolic lengthening and postsystolic shortening in detecting left anterior descending artery stenosis using nonstress speckle-tracking echocardiography. Sci Rep 2021; 11:19359. [PMID: 34588577 PMCID: PMC8481238 DOI: 10.1038/s41598-021-98900-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023] Open
Abstract
The diagnosis of coronary artery disease (CAD) with nonstress echocardiography remains challenging. Although the assessment of either early systolic lengthening (ESL) or postsystolic shortening (PSS) allows the sensitive detection of CAD, it is unclear whether the integrated analysis of ESL and PSS in addition to the peak systolic strain can improve the diagnostic accuracy. We investigated the incremental value of ESL and PSS in detecting left anterior descending artery (LAD) stenosis using nonstress speckle-tracking echocardiography. Fifty-nine patients with significant LAD stenosis but without visual wall motion abnormalities on echocardiography at rest (30 single-vessel stenosis, 29 multivessel stenosis) and 43 patients without significant stenosis of any vessel were enrolled. The peak systolic strain, the time to ESL (TESL), and the time to PSS (TPSS) were analyzed in all LAD segments, and the incremental values of the TESL and TPSS in detecting LAD stenosis and the diagnostic accuracy were evaluated. In the apical anterior segment, the peak systolic strain was significantly lower and TESL and TPSS were significantly longer in the single-vessel group than in the no stenosis group. In the single-vessel group, the addition of TESL and TPSS to the peak systolic strain significantly increased the model power in detecting stenosis, and the integrated analysis improved diagnostic accuracy compared with the peak systolic strain alone. In contrast, this incremental value was not demonstrated in the multivessel group. The integrated analysis of the peak systolic strain, ESL, and PSS may allow better screening of single-vessel LAD stenosis using nonstress speckle-tracking echocardiography.
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Affiliation(s)
- Takako Ishigaki
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Noriaki Yagi
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiromi Izumi
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shoko Shimizu
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshihisa Fujisawa
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Toshiyuki Ikemoto
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Ryoji Kushima
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kasumi Masuda
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Brainin P. Myocardial Postsystolic Shortening and Early Systolic Lengthening: Current Status and Future Directions. Diagnostics (Basel) 2021; 11:diagnostics11081428. [PMID: 34441362 PMCID: PMC8393947 DOI: 10.3390/diagnostics11081428] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
The concept of paradoxical myocardial deformation, commonly referred to as postsystolic shortening and early systolic lengthening, was originally described in the 1970s when assessed by invasive cardiac methods, such as ventriculograms, in patients with ischemia and animal experimental models. Today, novel tissue-based imaging technology has revealed that these phenomena occur far more frequently than first described. This article defines these deformational patterns, summarizes current knowledge about their existence and highlights the clinical potential associated with their understanding.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, DK-2900 Gentofte, Denmark
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11
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Vitarelli A. Myocardial strain and refractory angina: an intriguing puzzle. Int J Cardiovasc Imaging 2021; 37:2491-2495. [PMID: 34213675 DOI: 10.1007/s10554-021-02310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Antonio Vitarelli
- Department of Medicine and Cardiology, Sapienza University, Rome, Italy. .,Cardiodiagnostica, Via Lima 35, 00198, Rome, Italy.
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12
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Dannenberg V, Christiansen F, Schneider M, Kastl S, Hofbauer TM, Scherz T, Mascherbauer J, Beitzke D, Testori C, Lang IM, Mangold A. Exploratory echocardiographic strain parameters for the estimation of myocardial infarct size in ST-elevation myocardial infarction. Clin Cardiol 2021; 44:925-931. [PMID: 34117638 PMCID: PMC8259148 DOI: 10.1002/clc.23608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 12/20/2022] Open
Abstract
Background Outcome after ST‐elevation myocardial infarction (STEMI) can be most reliably estimated by cardiac magnetic resonance (CMR) imaging. However, CMR is expensive, laborious, and has only limited availability. In comparison, transthoracic echocardiography (TTE) is widely available and cost‐efficient. Hypothesis TTE strain parameters can be used as surrogate markers for CMR‐measured parameters after STEMI. Methods TTE strain analysis was performed of patients included in a controlled, prospective STEMI trial (NCT01777750) 4 ± 2 days after the event. Longitudinal peak strain (LPS), post‐systolic shortening, early systolic lengthening, early systolic lengthening time, and time to peak shortening were measured, and index parameters were computed. Global longitudinal strain (GLS) and ejection fraction (EF) were compiled. Parameters were correlated with CMR‐measured variables 4 ± 2 days after STEMI. Results In 70 STEMI patients, high quality CMR and TTE data were available. Highest correlation with CMR‐measured infarct size was observed with GLS (r = 0.577, p < 0.0001), LPS (r = 0.571, p < 0.0001), and EF (r = −0.533, p < 0.0001). Highest correlation with CMR‐measured area at risk was observed with GLS (r = 0.666, p < 0.0001), LPS (0.661, p < 0.0001) and early systolic lengthening index (r = 0.540, p < 0.0001). Receiver operating characteristics for the detection of large infarcts (quartile with highest infarct size) showed the highest area under the curve for LPS, GLS, EF, and myocardial dysfunction index. Multiple linear regression displayed the best association between GLS and infarct size. Conclusion Exploratory strain parameters significantly correlate with CMR‐measured area at risk and infarct size and are of potential interest as endpoint variables in clinical trials.
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Affiliation(s)
- Varius Dannenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Finn Christiansen
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Schneider
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Stefan Kastl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Martin Hofbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Scherz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Department of Dermatology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine, Karl Landsteiner University of Health Sciences, University Hospital St. Poelten, Krems, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-guided therapy, Medical University of Vienna, Vienna, Austria
| | - Christoph Testori
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Vienna, Austria.,Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Irene Marthe Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas Mangold
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Early systolic lengthening by speckle tracking echocardiography predicts outcome after coronary artery bypass surgery. IJC HEART & VASCULATURE 2021; 34:100799. [PMID: 34124339 PMCID: PMC8175274 DOI: 10.1016/j.ijcha.2021.100799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022]
Abstract
Early systolic lengthening (ESL) is a paradoxical lengthening of myocardial fibers. Speckle tracking echocardiography is a common imaging tool for assessment of ESL. ESL was a predictor of cardiovascular and all-cause death in CABG patients. Specifically, the prognostic value of ESL was enhanced in women undergoing CABG.
Background Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to loss of myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients. Methods We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox models adjusted for clinical risk assessed as EuroSCORE II. Results During median follow-up of 3.8 years [IQR 2.7–4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, each 1% increase in amplitude of ESL was associated with CVD (HR 1.35 [95%CI 1.09–1.68], P = 0.006) and all-cause mortality (HR 1.29 [95%CI 1.08–1.54], P = 0.004). Similar findings applied to duration of ESL (per 10ms increase) and CVD (HR 1.12 [95%CI 1.02–1.23], P = 0.016) and all-cause mortality (HR 1.09 [95%CI 1.01––1.17], P = 0.031). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that the prognostic value was greater in women for both endpoints. When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality. Conclusions Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients.
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Key Words
- A, late transmitral inflow velocity
- CABG, coronary artery bypass graft
- CK-MB, creatine kinase myocardial band
- Deformation
- E, early transmitral inflow velocity
- ESL, early systolic lengthening
- GLS, global longitudinal strain
- HR, hazard ratio
- IDI, integrated discrimination improvement
- IQR, interquartile range
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NRI, net reclassification index
- Prognosis
- Revascularization
- Systolic lengthening
- e’, early diastolic tissue velocity
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Alekhin MN, Stepanova AI. [Echocardiography in the Assessment of Postsystolic Shortening of the Left Ventricle Myocardium of the Heart]. KARDIOLOGIIA 2021; 60:110-116. [PMID: 33522475 DOI: 10.18087/cardio.2020.12.n1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/14/2020] [Accepted: 03/20/2020] [Indexed: 06/12/2023]
Abstract
Echocardiography allows evaluating left ventricular (LV) myocardial contractility; however, the visual assessment of contractility is subjective and requires considerable experience. Modern technologies for assessment of LV myocardial contractility, such as tissue Doppler and speckle-tracking echocardiography, provide quantitative estimation of various parameters of myocardial strain, including the LV postsystolic shortening. Several studies have demonstrated the value of postsystolic shortening for evaluation of myocardial ischemia and "ischemic memory" in patients with cardiovascular diseases. This review analyzes experimental and clinical studies that addressed LV postsystolic shortening.
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Affiliation(s)
- M N Alekhin
- Central State Medical Academy of Department of Presidential Affairs, Moscow; Central Clinical Hospital of the Management Affair of President Russian Federation, Moscow
| | - A I Stepanova
- Central State Medical Academy of Department of Presidential Affairs, Moscow
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Qin Y, Wu X, Wang J, Li Y, Ding X, Guo D, Jiang Z, Zhu W, Cai Q, Lu X. Value of territorial work efficiency estimation in non-ST-segment-elevation acute coronary syndrome: a study with non-invasive left ventricular pressure-strain loops. Int J Cardiovasc Imaging 2020; 37:1255-1265. [PMID: 33226551 DOI: 10.1007/s10554-020-02110-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal left ventricular (LV) ejection fraction (LVEF) and wall motion require a non-invasive tool to detect LV risk areas. This study utilized non-invasive LV pressure-strain loops to evaluate territorial myocardial work efficiency (WE) for identifying obstructive coronary artery stenosis, in patients with non-obstructive or obstructive coronary artery stenosis NSTE-ACS, the latter with or without occlusion. Global and territorial longitudinal strain (LS) analyses were performed via speckle-tracking imaging before coronary angiography. LV pressure-strain loops estimated global and territorial myocardial work index (MWI), constructive work (CW), wasted work (WW), and WE. Receiver operating characteristic curve analysis was used to determine the optimal cutoff value of independent parameters to detect obstructive coronary artery stenosis. Compared with non-obstructive, obstructive coronary artery stenosis showed significantly lower global and territorial LS, MWI, CW, and WE, and higher WW. Territorial LS, MWI, CW, and WE were significantly worse in territories of coronary occlusion. Territorial WE was the best parameter for predicting obstructive coronary artery stenosis (AUC 0.80, cutoff < 96%, sensitivity 73%, specificity 70%, P < 0.001). In patients with NSTE-ACS with normal wall motion and LVEF, territorial WE is more accurate than territorial LS or MWI to identify LV risk areas.
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Affiliation(s)
- YunYun Qin
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - XiaoPeng Wu
- Department of Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | | | - YiDan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - XueYan Ding
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - DiChen Guo
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhe Jiang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - WeiWei Zhu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - QiZhe Cai
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - XiuZhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
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Brainin P, Haahr-Pedersen S, Olsen FJ, Holm AE, Fritz-Hansen T, Jespersen T, Gislason G, Biering-Sørensen T. Early Systolic Lengthening in Patients With ST-Segment-Elevation Myocardial Infarction: A Novel Predictor of Cardiovascular Events. J Am Heart Assoc 2020; 9:e013835. [PMID: 31973603 PMCID: PMC7033900 DOI: 10.1161/jaha.119.013835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early systolic lengthening (ESL) may occur in ischemic myocardial segments with reduced contractile force. We sought to evaluate the prognostic potential of ESL in patients with ST‐segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. Methods and Results We prospectively enrolled 373 patients with ST‐segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. All patients underwent a speckle tracking echocardiographic examination a median of 2 days (interquartile range, 1–3 days) after the percutaneous coronary intervention. We assessed a novel viability index, the ESL index, defined as follows: [−100×(peak positive systolic strain/peak negative strain in cardiac cycle)]. We also calculated ESL duration, defined as time from onset of QRS complex on the ECG to time of peak positive systolic strain. Both parameters were averaged from 18 myocardial segments. During a median follow‐up of 5.3 years (interquartile range, 2.5–6.0 years), 145 (39%) experienced major adverse cardiovascular events, a composite of incident heart failure, new myocardial infarction, and all‐cause mortality. The ESL index and ESL duration were significantly increased in culprit lesion areas (6.7±6.2% versus 5.0±4.1% and 43±33 ms versus 33±24 ms, respectively; P<0.001 for both). In Cox proportional hazard models, the ESL index (hazard ratio, 1.27 per 1% increase; 95% CI, 1.13–1.43; P<0.001) and ESL duration (hazard ratio, 1.49 per 1‐ms increase; 95% CI, 1.15–1.92; P=0.002) yielded prognostic information on major adverse cardiovascular events. Both associations remained significant after adjusting for clinical, echocardiographic, and invasive confounders. Conclusions Assessment of ESL after primary percutaneous coronary intervention in patients with ST‐segment–elevation myocardial infarction yields independent and significant prognostic information on the future risk of cardiovascular events.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Sune Haahr-Pedersen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Flemming Javier Olsen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Anna Engell Holm
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences University of Copenhagen Denmark
| | - Gunnar Gislason
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark.,Department of Biomedical Sciences University of Copenhagen Denmark
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Ge Y, Leong-Poi H. Ischemic Memory Imaging: The Quest for the Holy Grail Continues. J Am Soc Echocardiogr 2019; 32:1487-1490. [PMID: 31679582 DOI: 10.1016/j.echo.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Yin Ge
- Division of Cardiology, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Howard Leong-Poi
- Division of Cardiology, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.
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