Clinical InvestigationLeft Ventricular and Atrial MechanicsLeft Ventricle Longitudinal Deformation Assessment by Mitral Annulus Displacement or Global Longitudinal Strain in Chronic Ischemic Heart Disease: Are They Interchangeable?
Section snippets
Patients
Sixty-one patients (mean age 57 ± 10 years; 13 women) previously treated with primary percutaneous coronary intervention for acute ST elevation MIs were included in the study. Patients with contraindications to MRI were excluded, but no patients were excluded because of impaired echocardiographic image quality. The clinical data and infarct characteristics are displayed in Table 1, Table 2. Patients were examined with CE-MRI and echocardiography 9 months after the index MI, typically the same
Feasibility and Reliability
Infarct mass was analyzed in all (n = 976) LV segments using CE-MRI. The assessment of longitudinal strain was feasible in 93% of the LV segments and in ≥2 segments in 92% of the LV walls on 2D-STE. MA displacement or velocity was analyzed in 96% of the basal LV segments using DTI (P = ns vs strain). Remaining segments were excluded because of reverberations or poor image quality. Global deformation parameters were calculated as the averages of analyzed values in each patient.
Reliability
Discussion
The assessment of myocardial infarct size and transmural distribution provides prognostic information in acute or chronic MI,1, 2 even when the clinical event is not recognized.4
To our knowledge, the present study is the first to test the correlation between MA displacement by echocardiography and infarct mass assessed by CE-MRI, commonly accepted as the gold standard for clinical myocardial infarct size assessment. The mitral annulus is pulled toward the apex during systole by longitudinal
Conclusions
Global longitudinal strain and MA displacement and velocity indices correlate well with global infarct mass and distinguish among small, medium-sized, and large myocardial infarcts. Global strain is slightly better able to identify the smallest infarcts. The assessment of MA displacement is a clinically acceptable alternative to global longitudinal strain assessment in chronic ischemic heart disease.
References (36)
- et al.
Prognostic significance of location and type of myocardial infarction: independent adverse outcome associated with anterior location
J Am Coll Cardiol
(1988) - et al.
Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function
J Am Coll Cardiol
(2006) - et al.
Early prediction of infarct size by strain Doppler echocardiography after coronary reperfusion
J Am Coll Cardiol
(2007) - et al.
Grading of myocardial dysfunction by tissue Doppler echocardiography: a comparison between velocity, displacement, and strain imaging in acute ischemia
J Am Coll Cardiol
(2006) - et al.
Descent of the base of the left ventricle: an echocardiographic index of left ventricular function
J Am Soc Echocardiogr
(1989) - et al.
Usefulness of systolic excursion of the mitral annulus as an index of left ventricular systolic function
Am J Cardiol
(1991) - et al.
Regional left ventricular wall motion abnormalities in myocardial infarction and mitral annular descent velocities studied with pulsed tissue Doppler imaging
J Am Soc Echocardiogr
(1998) - et al.
Prognostication and risk stratification by assessment of left atrioventricular plane displacement in patients with myocardial infarction
Int J Cardiol
(2002) - et al.
Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography
J Am Coll Cardiol
(2001) - et al.
Quantification of regional contractile function after infarction: strain analysis superior to wall thickening analysis in discriminating infarct from remote myocardium
J Am Coll Cardiol
(2001)
Two-dimensional strain—a novel software for real-time quantitative echocardiographic assessment of myocardial function
J Am Soc Echocardiogr
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
Non-Doppler two-dimensional strain imaging by echocardiography—from technical considerations to clinical applications
J Am Soc Echocardiogr
Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function
Circulation
Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction
Circulation
Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease
Circulation
Effects of acute myocardial infarction on the displacement of the atrioventricular plane: an echocardiographic study
J Intern Med
Global longitudinal strain measured by two-dimensional speckle tracking echocardiography is closely related to myocardial infarct size in chronic ischaemic heart disease
Clin Sci (Lond)
Cited by (42)
Detection of congestive heart failure by mitral annular displacement in cats with hypertrophic cardiomyopathy – concordance between tissue Doppler imaging–derived tissue tracking and M-mode
2021, Journal of Veterinary CardiologyCitation Excerpt :Studies in humans indicate a good correlation between longitudinal displacement measured by TT (TT-LD) and MAPSE, although the two are not interchangeable [18,21–23]. Tissue tracking derived from tissue Doppler imaging has been validated as a more robust method of measuring the longitudinal displacement in human medicine [23–25]. However, although tissue Doppler imaging has been validated in both dogs and cats and has high repeatability and reproducibility [12,26–28], to the author's knowledge, the potential contribution of TT in terms of assessing feline HCM and CHF has not been investigated or validated.
Monitoring Canine Myocardial Infarction Formation and Recovery via Transthoracic Cardiac Strain Imaging
2020, Ultrasound in Medicine and BiologyCitation Excerpt :Instead of using global strain metrics, ME was capable of accurate measurement of regional deformation and strain, allowing for diagnosis of individual myocardial segments as infarcted or healthy. Although previous referenced studies using strain or strain rate imaging to identify MI patients did not have the same level of diagnostic resolution, they were performed in patients in the clinic (Edvardsen et al. 2002; Zhang et al. 2005; Gjesdal et al. 2007, 2009; Delgado et al. 2008; Eek et al. 2010; Grenne et al. 2010). While ME for MI diagnosis needs to be validated in a patient model, a previous study using ME to diagnose 66 patients with suspected CAD revealed that ME was capable of localizing ischemia to a specific perfusion territory (Grondin et al. 2017).
A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography
2017, Journal of the American College of CardiologyMitral annular displacement by doppler tissue imaging may identify coronary occlusion and predict mortality in patients with non-ST-elevation myocardial infarction
2013, Journal of the American Society of EchocardiographyCitation Excerpt :Providing such a service in emergency departments can be challenging. Assessment of MAD, on the other hand, requires visualization of the mitral annulus only, which is possible in virtually all patients, and the method is potentially more robust when parts of the LV wall are poorly visualized.41 MAD can be obtained easily and quickly and in our study was available in all participants.
Drs Gjesdal, Vartdal, and Lunde received research fellowships from the Norwegian Council on Cardiovascular Diseases (Oslo, Norway).