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Regional Diastolic and Systolic Function by Strain Rate Imaging for the Detection of Intramural Viability during Dobutamine Stress Echocardiography in a Porcine Model of Myocardial Infarction
Author(s) -
Schneider Carsten,
Jaquet Kai,
Geidel Stephan,
Malisius Rainer,
Boczor Sigrid,
Rau Thomas,
Zienkiewicz Tomacz,
Hennig Detlef,
Kuck KarlHeinz,
Krause Korff
Publication year - 2010
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.2009.01066.x
Subject(s) - cardiology , medicine , diastole , dobutamine , myocardial infarction , strain rate imaging , diastolic function , strain rate , strain (injury) , hemodynamics , blood pressure , materials science , metallurgy
The aim of this study was to evaluate diastolic and systolic strain rate measurements for differentiation of transmural/nontransmural infarction during dobutamine stress echocardiography (DSE). An ameroid constrictor was placed around the circumflex artery in 23 pigs inducing chronic vessel occlusion. Five pigs without constrictor served as controls. During high‐dose DSE systolic strain rates (SR sys ), systolic and postsystolic strain values (ɛ sys , ɛ ps ) and early and late diastolic strain rates (SR E and SR A ) were determined. At week 6, animals were evaluated regarding myocardial fibrosis. Histology revealed nontransmural in 14 and transmural infarction in 9 animals. In controls, dobutamine induced a linear increase of SR sys to 12.3 ± 0.4 s −1 at 40 μg/kg per minute (P = 0.001) and a linear decrease of SR E to −6.6 ± 0.3 s −1 (P = 0.001). In the nontransmural group, SR sys , ɛ sys , ɛ ps at rest, and during DSE were higher and SR E was lower than in the transmural infarction group (P = 0.01). Best predictors for viability were SR sys (ROC 0.96, P = 0.0003), SR E at 10 μg/kg per minute dobutamine stimulation (ROC 0.94, P = 0.001) and positive SR values during isovolumetric relaxation at 40 μg/kg per minute dobutamine (ROC 0.86, P = 0.004). The extension of fibrosis correlated with SR sys at rest, ɛ sys at rest, and SR E at rest (P < 0.001). For the detection of viability similar diagnostic accuracies of SR E and SRsys were seen (sensitivity 93%/93%, specificity 96%/94%, respectively). Diastolic SR analysis seems to be equipotent for the identification of viable myocardium in comparison to systolic SR parameters and allows the differentiation of nontransmural from transmural myocardial infarction with high diagnostic accuracy. (Echocardiography 2010;27:552‐562)