title: Two-dimensional speckle tracking-derived strain to distinguish acute coronary syndrome from a marked early repolarization in a patient with chest pain: a fancy gadget or a useful tool?
abstract: BACKGROUND
  With a potential of detecting subtle myocardial injury, two-dimensional (2D) speckle tracking-derived strain could help to distinguish between ischemic and nonischemic ST-segment elevation. Little is known if limitations of strain imaging could prevent its applicability in acute cardiac care settings.
  
  
  METHODS
  We present a 56-year-old male with persistent ST-segment elevation in the inferolateral leads and suspected hypokinesia of the inferior wall. Semiautomated 2D speckle tracking strain analysis showed normal longitudinal peak systolic strain (LPSS) in all segments of the inferior wall, ruling out wall-motion abnormalities in this region. Stationary reverberations and spuriously low values of LPSS in the posterolateral wall required operator's expertise to distinguish pathological myocardial deformation from artifacts. Additional workup revealed that early repolarization pattern was mistaken for the inferior wall acute myocardial infarction in our patient.
  
  
  CONCLUSIONS
  Semiautomated quantification of regional left ventricular function by 2D speckle tracking echocardiography could facilitate decision making even in the emergency settings. Due to intrinsic limitations of this novel method, its actual clinical value in acute cardiac care settings may depend on the expertise of the operator and is yet to be determined.
authors.affiliation: Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Stankovic
authors.forename: Vojkan
authors.initials: V
authors.lastname: Cvorovic
authors.forename: Biljana
authors.initials: B
authors.lastname: Putnikovic
authors.forename: Ivica
authors.initials: I
authors.lastname: Vuksanovic
authors.forename: Milos
authors.initials: M
authors.lastname: Panic
authors.forename: Aleksandar N
authors.initials: AN
authors.lastname: Neskovic
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003422:Critical Care / Q000379:methods; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology*
keywords: strain; strain-strain rate