title: Global longitudinal strain measured by two-dimensional speckle tracking echocardiography is closely related to myocardial infarct size in chronic ischaemic heart disease.
abstract: 2D-STE (two-dimensional speckle tracking echocardiography) is a novel echocardiographic modality that enables angle-independent assessment of myocardial deformation indices. In the present study, we tested whether peak systolic epsilon(parallel) (longitudinal strain) values measured by 2D-STE could identify areas of MI (myocardial infarction) as determined by CE MRI (contrast-enhanced magnetic resonance imaging). Conventional echocardiographic apical long-axis recordings were performed in 38 patients, 9 months after a first MI. Peak systolic epsilon(parallel) measured by 2D-STE in 16 left ventricle segments was compared with segmental infarct mass and transmurality assessed by CE MRI. Segmental values were averaged to global and territorial values for assessment of global function and myocardial function in the coronary distribution areas. CE MRI identified transmural infarction in 27 patients, and a mean infarct size of 36+/-25 g. Peak systolic epsilon( parallel) correlated with the infarct mass at the global level (r=0.84, P<0.001). A strain value of -15% identified infarction with 83% sensitivity and 93% specificity at the global level and 76% and 95% at the territorial level, and a strain value of -13% identified transmural infarction with 80% sensitivity and 83% specificity at the segmental level. Global infarct mass correlates with the wall motion score index (r=0.70, P<0.001), and left ventricular ejection fraction measured by MRI or echocardiography (r=-0.71 and -0.58, both P<0.001). In chronic infarction, peak systolic epsilon(parallel) measured by 2D-STE correlates with the infarct mass assessed by CE MRI at a global level, and separates infarcted from non-infarcted tissue. Global strain is an excellent predictor of myocardial infarct size in chronic ischaemic heart disease.
authors.affiliation: Department of Cardiology, Faculty of Medicine, University of Oslo/Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway.
authors.forename: Ola
authors.initials: O
authors.lastname: Gjesdal
authors.forename: Einar
authors.initials: E
authors.lastname: Hopp
authors.forename: Trond
authors.initials: T
authors.lastname: Vartdal
authors.forename: Ketil
authors.initials: K
authors.lastname: Lunde
authors.forename: Thomas
authors.initials: T
authors.lastname: Helle-Valle
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.forename: Hans-Jørgen
authors.initials: HJ
authors.lastname: Smith
authors.forename: Halfdan
authors.initials: H
authors.lastname: Ihlen
authors.forename: Thor
authors.initials: T
authors.lastname: Edvardsen
mesh_terms: D000368:Aged; D019540:Area Under Curve; D016022:Case-Control Studies; D002908:Chronic Disease; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D017202:Myocardial Ischemia / Q000473:pathology; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D016277:Ventricular Function, Left