Introduction: Myocardial longitudinal tissue velocity imaging (TVI) and strain rate imaging (SRI) indices may have a role in the prediction of significant proximal stenosis of left anterior descending (LAD) by echocardiography. Materials And Methods: Total 20 patients with proximal LAD stenosis >70% by angiography and ejection fraction ≥50%, without wall motion abnormality at resting echo (stenotic group) and 20 angiographically normal coronaries subjects with normal echocardiography (non-stenotic group) were included in the study. SRI and TVI were performed in nine segments of the LAD territory at rest. Parameters of interest included: peak systolic strain (ST, %), strain rate (SR, Second-1), and peak systolic velocity (Sm, cm/s). Results: Overal mean ST and SR showed a significant reduction in the stenotic group compared to non-stenotic group (P<0.001), while the mean Sm had no significant difference. A segment-by-segment comparison revealed a reduction of ST in 4/9 (two apical and two anteroseptal) and SR in 5/9 (three apical, septal, and anteroseptal midportion) in the stenotic group (P<0.05). Both ST and SR showed a significant reduction in three segments: anterior-apical, lateral-apical, and anteroseptal-midportion. When both ST and SR decreased in one segment, specificity and sensitivity for the diagnosis of proximal LAD stenosis was more than 80% and 55%, respectively, by Roc analysis. Conclusion: There is an overall reduction in the mean ST and SR in the segments of LAD territory with significant proximal stenosis and normal wall motion at rest and an acceptable specificity and sensitivity of SRI for the detection of stenosis in these segments.
Voigt JU, Nixdorffa U, Bogdana R, Exnera B, Schmiedehausenb K, Platschb G, Kuwertb T, Daniela WG, Flachskampfa FA. Comparison of Deformation Imaging and Velocity Imaging for Detecting Regional Inducible Ischaemia During Dobutamine Stress Echocardiography. Eur Heart J 2004; 25: 1517–1525.
Voigt JU, Arnold MF, Karlsson M et al. Assessment of Regional Longitudinal Myocardial Strain Rate Derived from Doppler Myocardial Imaging Indices in Normal and Infarcted Myocardium. J Am Soc Echocardiogr 2000;13:588–98.
Garcia-Fernandez MA, Azevedo J, Moreno M, Bermejo J, Perez-Castellano N, Puerta P, Desco M, Antoranz C, Serrano JA, Garcıa A, and Delcan JL. Regional Diastolic Function in Ischaemic Heart Disease Using Pulsed Wave Doppler Tissue Imaging. Eur Heart J 1999 20, 496–505.
Voigt JU, Lindenmeier G, Exner B et al. Incidence and Characteristics of Segmental Post-Systolic Longitudinal Shortening in Normal, Acutely Ischaemic and Scarred Myocardium. J Am Soc Echocardiogr 2003;16:415–23.
Edvardsen T, Gerber BL, Garot J, Bluemke DA, Lima JAC, and Smiseth OA. Quantitative Assessment of Intrinsic Regional Myocardial Deformation by Doppler Strain Rate Echocardiography in Humans: Validation against Three-Dimensional Tagged Magnetic Resonance Imaging. Circulation 2002; 106: 50-56.
Feigenbaum H, Armstrong WF, Ryan T. Feigenbaum's Echocardiography, 6th Edition, Philadehphia: Lipincott Williams and Wilkins, 2005, P: 488-522.
Himelman RB, Cassidy MM, Landzberg JS, Schiller NB. Reproducibility of Quantitative Two-Dimensional Echocardiography. Am Heart J 1988;115: 425– 431.
Dagianti A, Vitarelli A, Conde Y, Penco M, Fedele F, Dagianti A. Assessment of Regional Left Ventricular Function during Exercise Test with Pulsed Tissue Doppler Imaging. Am J Cardiol 2000; 86(suppl): 30G-32G.
Pellerin D, Sharma R, Elliott R, Veyrat C. Tissue Doppler, Strain, and Strain Rate Echocardiography for The Assessment of Left And Right Systolic Ventricular Function. Heart 2003; 86: 9-12.
Michael D, Hans L, Christoph K, Nino S, Roland H. Strain and Strain Rate Imaging by Echocardiography - Basic Concepts and Clinical Applicability. Ingenta 2009;16:133-148.
Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T. ESC Guidelines on The Management of Stable Coronary Artery Disease: The Task Force on The Management of Stable Coronary Artery Disease of The European Society of Cardiology. Eur Heart J (2013) 34 (38): 2949-3003.
Voigt JU, Exner B; Schmiedehausen K, Huchzermeyer C; Reulbach U, Nixdorff U, Platsch G, Kuwert T, Daniel WG, Flachskampf FA. Strain-Rate Imaging during Dobutamine Stress Echocardiography Provides Objective Evidence of Inducible Ischemia. Circulation. 2003; 107:2120.
Cain P, Khoury V, Short L, and Marwick TH. Usefulness of Quantitative Echocardiographic Techniques to Predict Recovery of Regional and Global Left Ventricular Function after Acute Myocardial Infarction. Am J Cardiol 2003; 91:391–396.
Urheim S, Edvardsen T, Trop H, Angelsen B and Smiseth OA. Myocardial Strain by Doppler Echocardiography. Validation of a New Method to Quantify Regional Myocardial Function. Circulation 2000; 102: 1158-64.
Hoit BD. Strain and Strain Rate Echocardiography and Coronary Artery Disease. Circ Cardiovasc Imaging 2011;4:179-190.
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