Review articleStrain and strain rate imaging: a new clinical approach to quantifying regional myocardial function
Section snippets
Technical aspects of ϵ/SR imaging
A prior review has comprehensively covered the technical aspects of ϵ/SR imaging.3 Thus, further explanation in this article would be superfluous.
Data acquisition
Although integration of a regional velocity curve measures regional displacement, the integration of a regional SR curve will derive the regional ϵ curve (Figure 1). Although regional systolic strain rates (SRs) measure the rate of local deformation, regional systolic strain (ϵ) express the percentage of deformation (note that regional ϵ estimation provides no information on absolute wall thickness but only measures relative changes). Each regional ϵ curve can be subdivided into component
Changes in preload, afterload, and contractility: how do they affect SR/ϵ measurement?
Myocardial deformation is the result of the complex interaction of intrinsic contractile force and extrinsic loading conditions applied to a tissue with variable elastic properties. Therefore, changes in preload and afterload, and the changes in myocardial stiffness, are important determinants of the pattern and the magnitude of myocardial deformation. Thus, SR and ϵ indices are not direct measures of contractility.
Mathematic modelling studies6 would predict that peak systolic ϵ values will
Ischemic heart disease
Despite several attempts to implement new cardiac ultrasound methods to quantify ischemia, the routine clinical evaluation of regional function in ischemic heart disease has remained firmly on the basis of visual assessment of wall motion and wall thickening. However, the eye has been shown to have limitations in assessing the timing of the complex changes in regional myocardial deformation that occur in differing ischemic substrates. Kvitting et al7 showed that healthy individuals can neither
RV disease
Despite the numerous diseases that alter RV function, the evaluation of RV regional function remains a challenge. Recent reports have demonstrated that using SR/ϵ is not only feasible for quantification of regional RV function but is usually applicable even where the acoustic window is poor, as is often the case in patients with chronic pulmonary hypertension. Peak SR has been shown to correlate with peak systolic pulmonary artery pressure. The same study also showed that an increase in
Conclusions
Ultrasonic deformation imaging can now be applied in the clinical setting. Data can be acquired at the bedside in real time and postprocessed either by the ultrasound machine or by an offline computer. Postprocessing tools have been developed that can reduce postprocessing time to minutes. Initial clinical studies have shown the technique to add significant new data on abnormalities of regional myocardial deformation in an important number of disease entities. These studies have also added to
References (60)
- et al.
Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imagingcomparison with peak dP/dt of the left ventricular pressure curve
J Am Soc Echocardiogr
(1998) - et al.
Can natural strain and strain rate quantify regional myocardial deformation? A study in healthy subjects
Ultrasound Med Biol
(2001) - et al.
How accurate is visual assessment of synchronicity in myocardial motion? An in vitro study with computer simulated regional delay in myocardial motion. Clinical implications for rest and stress echocardiography studies
J Am Soc Echocardiogr
(1999) - et al.
Assessment of regional longitudinal myocardial strain rate derived from Doppler myocardial imaging indexes in normal and infracted myocardium
J Am Soc Echocardiogr
(2000) - et al.
Quantification of the spectrum of changes in regional myocardial function during acute ischemia in closed chest pigsan ultrasonic strain rate and strain study
J Am Soc Echocardiogr
(2001) - et al.
The effects of acute coronary occlusion on noninvasive echocardiographic derived systolic and diastolic myocardial strain rates
Curr Surg
(2000) - et al.
Use of peak systolic strain as an index of regional left ventricular functioncomparison with tissue Doppler velocity during dobutamine stress and myocardial ischemia
J Am Soc Echocardiogr
(2000) - et al.
Abnormal post-systolic thickening in acutely ischemic myocardium during coronary angioplastya velocity, strain and strain rate Doppler myocardial imaging study
J Am Soc Echocardiogr
(1999) - et al.
Acute changes in systolic and diastolic events during clinical coronary angioplastya comparison of regional velocity, strain rate, and strain measurement
J Am Soc Echocardiogr
(2002) - et al.
Strain rate measurement by Doppler echocardiography allows improved assessment of myocardial viability in patients with depressed left ventricular function
J Am Coll Cardiol
(2002)
Could we apply strain and strain rate measurement during all forms of stress echocardiography?
J Am Soc Echocardiogr
One-dimensional ultrasonic strain and strain rate imaginga new approach to the quantitation of regional myocardial function in patients with aortic stenosis
Ultrasound Med Biol
Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation
Am J Cardiol
Pulsed tissue Doppler imaging of left ventricular systolic and diastolic wall motion velocities to evaluate differences between long and short axes in healthy subjects
J Am Soc Echocardiogr
The role of short- and long-axis function in determining late diastolic left ventricular filling in patients with hypertensionassessment by pulsed Doppler tissue imaging
J Am Soc Echocardiogr
Effect of aging on diastolic left ventricular myocardial velocities measured by pulsed tissue Doppler imaging in healthy subjects
J Am Soc Echocardiogr
Doppler tissue imaginga non-invasive technique for evaluation of left ventricular relaxation and estimation of filling pressures
J Am Coll Cardiol
Analysis by pulsed Doppler tissue imaging of ventricular interaction in long-distance competitive swimmers
Am J Cardiol
Use of pulsed Doppler tissue imaging to assess regional left ventricular diastolic dysfunction in hypertrophic cardiomyopathy
Am J Cardiol
Right and left ventricular wall motion velocities as diagnostic indicators of constrictive pericarditis
Am J Cardiol
Does atrioventricular ring motion always distinguish constriction from restriction? A Doppler myocardial imaging study
J Am Soc Echocardiogr
Strain rate imaging for assessment of preload dependent changes in regional left ventricular diastolic longitudinal function
J Am Soc Echocardiogr
Strain rate imaging in normal and reduced diastolic functioncomparison with pulsed Doppler tissue imaging of the mitral annulus
J Am Soc Echocardiogr
Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodelling during long-term cardiac resynchronization therapy
J Am Coll Cardiol
Cardiac resynchronization therapy can reverse abnormal myocardial strain distribution in patients with heart failure and left bundle branch block
J Am Coll Cardiol
Quantification of regional left and right ventricular radial and longitudinal function in healthy children using ultrasound based strain rate and strain imaging
J Am Soc Echocardiogr
Quantification of regional right and left ventricular function by ultrasonic strain rate and strain indexes after surgical repair of tetralogy of Fallot
Am J Cardiol
Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate
Am J Physiol Heart Circ Physiol
Regional strain and SR measurements by cardiac ultrasoundprinciples, implementation and limitations
Eur J Echocardiogr
Assessment of circumferential-radial shear strains in normal and ischemic myocardium based on ultrasonic strain/strain rate imaging [abstract]
Eur Heart J
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