Two-dimensional strain–a novel software for real-time quantitative echocardiographic assessment of myocardial function

doi:10.1016/j.echo.2004.06.019

Journal of the American Society of Echocardiography

Volume 17, Issue 10, October 2004, Pages 1021-1029

https://doi.org/10.1016/j.echo.2004.06.019 Get rights and content

Abstract

Objectives

We sought to assess the feasibility of 2-dimensional strain, a novel software for real-time quantitative echocardiographic assessment of myocardial function.

Methods

Conventional and a novel non-Doppler–based echocardiography technique for advanced wall-motion analysis were performed in 20 patients with myocardial infarction and 10 healthy volunteers from the apical views. Two-dimensional strain is on the basis of the estimation that a discrete set of tissue velocities are present per each of many small elements on the ultrasound image. This software permits real-time assessment of myocardial velocities, strain, and strain rate. These parameters were also compared with Doppler tissue imaging measurements in 10 additional patients.

Results

In all, 80.3% of infarct and 97.8% of normal segments could be adequately tracked by the software. Peak systolic strain, strain rate, and peak systolic myocardial velocities, calculated from the software, were significantly higher in the normal than in the infarct segments. In the 10 additional patients, velocities, strain, and strain rate obtained with the novel software were not significantly different from those obtained with Doppler tissue imaging.

Conclusion

Two-dimensional strain can accomplish real-time wall-motion analysis, and has the potential to become a standard for real-time automatic echocardiographic assessment of cardiac function.

Section snippets

Methods

A total of 20 patients with acute MI, admitted to the intensive coronary care department, underwent conventional transthoracic echocardiography. The control group included 10 healthy individuals with normal echocardiography. Standard 4-chamber, 3-chamber (apical long axis), and 2-chamber views of the left ventricle (LV) (Vivid 7, General Electric, Horten, Norway) (2.5-MHz transducer) were obtained from the apex at end-expiratory apnea and were stored in cineloop format for subsequent offline

Comparison between myocardial velocities, strain, and strain rate by 2D strain and wall-motion analysis

Mean age was 58 years (43-74 years). Mean ejection fraction by conventional echocardiography was 35% (25%-45%). In all, 9 patients had inferoposterior MI, 1 had posterolateral MI, and 10 had anterior MI. Single-vessel coronary artery disease was detected in 8 patients, 2-vessel coronary artery disease in 7, and 3-vessel coronary artery disease in 5.

Wall-motion analysis

As shown in Table 1, on the basis of conventional imaging, 539 cardiac segments were suitable for analysis of wall motion. Among 172 infarct

Discussion

The quantification of segmental LV function has a central role in echocardiography. Quantitative ultrasonic tissue characterization with integrated backscatter had been proposed for differentiation of infarct tissue from normal myocardium. This technique is useful, however, it is limited to the parasternal views.⁷ Time to onset of regional relaxation has been proposed as a parameter of regional myocardial function and was defined as the time from the R wave of the electrocardiographic trace to

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Original articleTwo-dimensional strain–a novel software for real-time quantitative echocardiographic assessment of myocardial function

Abstract

Objectives

Methods

Results

Conclusion

Section snippets

Methods

Comparison between myocardial velocities, strain, and strain rate by 2D strain and wall-motion analysis

Wall-motion analysis

Discussion

Color Doppler myocardial imaging: a new technique for the assessment of myocardial function

J Am Soc Echocardiogr

Real-time strain rate imaging of the left ventricle by ultrasound

J Am Soc Echocardiogr

Quantitative assessment of intrinsic regional myocardial deformation by Doppler strain rate echocardiography in humans

Circulation

Recommendations for quantification of the left ventricle by two-dimensional echocardiography

J Am Soc Echocardiogr

Statistical methods for assessing agreement between two methods of clinical measurement

Lancet

Ultrasound integrated backscatter tissue characterization of remote myocardial infarction in human subjects

J Am Coll Cardiol

Time to onset of regional relaxation: feasibility, variability and utility of a novel index of regional myocardial function by strain rate imaging

J Am Coll Cardiol

Original article
Two-dimensional strain–a novel software for real-time quantitative echocardiographic assessment of myocardial function