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Halvorsrød MI, Kiss G, Dahlslett T, Støylen A, Grenne B. Automated tissue Doppler imaging for identification of occluded coronary artery in patients with suspected non-ST-elevation myocardial infarction. Int J Cardiovasc Imaging 2023; 39:757-766. [PMID: 36715881 PMCID: PMC10104945 DOI: 10.1007/s10554-022-02786-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/24/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Identification of regional dysfunction is important for early risk stratification in patients with suspected non-ST-elevation myocardial infarction (NSTEMI). Strain echocardiography enables quantification of segmental myocardial deformation. However, the clinical use is hampered by time-consuming manual measurements. We aimed to evaluate whether an in-house developed software for automated analysis of segmental myocardial deformation based on tissue Doppler imaging (TDI) could predict coronary occlusion in patients with suspected NSTEMI. METHODS Eighty-four patients with suspected NSTEMI were included in the analysis. Echocardiography was performed at admission. Strain, strain rate and post-systolic shortening index (PSI) were analyzed by the automated TDI-based tool and the ability to predict coronary occlusion was assessed. For comparison, strain measurements were performed both by manual TDI-based analyses and by semi-automatic speckle tracking echocardiography (STE). All patients underwent coronary angiography. RESULTS Seventeen patients had an acute coronary occlusion. Global strain and PSI by STE were able to differentiate occluded from non-occluded culprit lesions (respectively - 15.0% vs. -17.1%, and 8.1% vs. 5.1%, both p-values < 0.05) and identify patients with an acute coronary occlusion (AUC 0.66 for both strain and PSI). Measurements of strain, strain rate and PSI based on TDI were not significantly different between occluded and non-occluded territories. CONCLUSION Automated measurements of myocardial deformation based on TDI were not able to identify acute coronary occlusion in patients with suspected NSTEMI. However, this study confirms the potential of strain by STE for early risk stratification in patients with chest pain.
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Affiliation(s)
- Marlene Iversen Halvorsrød
- Center for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences (MH), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St. Olavs University hospital, Trondheim, Norway
| | - Gabriel Kiss
- Center for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences (MH), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Computer Science (IDI), Faculty of Information Technology and Electrical Engineering (IE), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Asbjørn Støylen
- Center for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences (MH), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St. Olavs University hospital, Trondheim, Norway
| | - Bjørnar Grenne
- Center for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences (MH), Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Clinic of Cardiology, St. Olavs University hospital, Trondheim, Norway.
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Tibaldi MA, Ruiz C, Servato ML, Urinovsky M, Moreyra EA, Sarmiento PE, Moreyra C, Moreyra E. Left Ventricular Longitudinal Global Strain to Predict Severe Coronary Disease in Patients with Precordial Pain Suggestive of Non-ST-Segment Elevation Acute Coronary Syndrome. J Cardiovasc Echogr 2021; 30:187-192. [PMID: 33828939 PMCID: PMC8021081 DOI: 10.4103/jcecho.jcecho_57_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/19/2020] [Accepted: 10/18/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Diagnosing non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not always straightforward. Left ventricular global longitudinal strain (LVGLS) is an echocardiographic method capable of detecting subclinical regional and global ventricular contractile dysfunction due to myocardial ischemia. The objectives of this study were to evaluate the efficacy of LVGLS in diagnosing severe coronary disease in patients with chest pain suggestive of NSTE-ACS and to assess the relationships between LVGLS reduction and ultrasensitive troponin T (UsTnT) elevation, electrocardiographic changes suggestive of ischemia, and the number of vessels with severe obstructions. Methods: This prospective, observational study evaluated hospitalized patients with chest pain of presumed coronary etiology. All patients underwent electrocardiography (ECG), UsTnT measurement, Doppler echocardiography, LVGLS measurement, and coronary angiography Coronary angiogram (CA) within 48 h of hospitalization. Results: A total of 75 patients with a mean age of 58 ± 17 years were included, of whom 84% (63 patients) were men. An LVGLS value of <-16.5, as determined by the Youden index proved to be useful for the detection of severe coronary obstructions (lesions >70%). The sensitivity, specificity, and positive and negative predictive values were 96%, 88%, 92%, and 92%, respectively. The number of coronary arteries involved had a direct relationship with the degree of LVGLS reduction (P < 0.001). Elevated UsTnT levels occurred more frequently in patients with reduced LVGLS than in those with normal LVGLS (83% vs. 17%, P < 0.0001). Abnormal strain was not associated with electrocardiographic changes suggestive of ischemia. Conclusions: LVGLS measurement in patients with presumed NSTE-ACS is efficient in predicting the presence of severe coronary disease. The number of coronary arteries involved has a direct relationship with the degree of LVGLS reduction. Abnormal strain is associated with UsTnT elevations but not with electrocardiographic changes suggestive of ischemia.
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Affiliation(s)
| | - Cecilia Ruiz
- Department of Cardiology, Sanatorium Allende, Córdoba, Argentina
| | | | | | | | | | - Camila Moreyra
- Department of Cardiology, Sanatorium Allende, Córdoba, Argentina
| | - Eduardo Moreyra
- Department of Cardiology, Sanatorium Allende, Córdoba, Argentina
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Shenouda RB, Bytyçi I, Sobhy M, Henein MY. Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome. Clin Physiol Funct Imaging 2019; 40:21-29. [PMID: 31549763 DOI: 10.1111/cpf.12597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS. METHODS In 80 consecutive patients with ACS (age 55·7 ± 9·4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention. RESULTS Of the 80 patients, one-vessel stenosis (>70%) was present in 53 (66%), two-vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending - LAD (r = 0·35, P = 0·005), circumflex LCx (r = 0·32, P = 0·03) and right coronary RCA (r = 0·37, P = 0·01). Only ECG changes in the LAD territory (r = 0·26, P = 0·04) correlated with the culprit lesion. SR of LAD territories ≤-0·74 was 71% sensitive and 70% specific (AUC = 0·70, CI = 0·67-0·93, P = 0·01), SR of LCx territories of ≤-0·67 was 75% sensitive and 63% specific (AUC = 0·72, CI = 0·58-0·87, P = 0·02) and SR of RCA territories ≤-0·83 was 73% sensitive and 71% specific (AUC = 0·80, CI = 0·66-0·93, P = 0·001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion. CONCLUSION In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.
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Affiliation(s)
- Rafik B Shenouda
- International Cardiac Centre, Alexandria, Egypt.,Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Albania
| | - Mohammed Sobhy
- International Cardiac Centre, Alexandria, Egypt.,Cardiology Department, Alexandria University, Alexandria, Egypt
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Molecular and Clinic Research Institute, St George University, London, UK.,Brunel University, Uxbridge, UK
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Zhang Z, Ma Q, Cao L, Zhao Z, Zhao J, Lu Q, Zeng L, Zhang M, Pohost GM, Li K. Correlation between left ventricular myocardial strain and left ventricular geometry in healthy adults: a cardiovascular magnetic resonance-feature tracking study. Int J Cardiovasc Imaging 2019; 35:2057-2065. [PMID: 31402413 DOI: 10.1007/s10554-019-01644-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022]
Abstract
This study was aimed to investigate the correlation between left ventricular (LV) myocardial strain and LV geometry in healthy adults using cardiovascular magnetic resonance-feature tracking (CMR-FT). 124 gender-matched healthy adults who underwent healthy checkup using CMR cine imaging were retrospectively analyzed. Peak global radial, circumferential, longitudinal strain (GRS, GCS and GLS) for left ventricle were measured. LV geometry was assessed by the ratio of LV mass (LVM) and end-diastolic volume (EDV). GRS, GCS and GLS were 34.18 ± 6.71%, - 22.17 ± 2.28%, - 14.76 ± 2.39% for men, and 33.40 ± 6.95%, - 22.49 ± 2.27%, - 15.72 ± 2.36% for women. Multiple linear regression showed that LVM/EDV was associated with decreased GLS (β = - 0.297, p = 0.005), but was not significantly associated with GRS and GCS (both p > 0.05). There was an increase in the magnitude of GRS, GCS and GLS with advancing age (β = 0.254, β = 0.466 and β = 0.313, all p < 0.05). Greater BMI was associated with decreased GRS, GCS and GLS (β = - 0.232, β = - 0. 249 and β = - 0.279, all p < 0.05). In conclusion, compared with GRS and GCS, GLS is more sensitive to assess LV concentric remodeling in healthy adults. GRS, GCS and GLS are all independently positively associated with age and negatively associated with BMI. Sex-based LV strain reference values for healthy Chinese adults are established.
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Affiliation(s)
- Zhen Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Qiaozhi Ma
- Department of Magnetic Resonance, the Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lizhen Cao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zhiwei Zhao
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Jun Zhao
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Qing Lu
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Linan Zeng
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Mingzhu Zhang
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Gerald M Pohost
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China.
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