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Transmural Myocardial Strain Gradient: A New and Robust Quantitative Index of Left Ventricular Wall Motion Based on Myocardial Strain Imaging
Author(s) -
Chen Xin,
Nakatani Satoshi
Publication year - 2011
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.1540-8175.2010.01287.x
Subject(s) - medicine , cardiology , strain (injury) , myocardial infarction , radial stress , coronary artery disease , basal (medicine) , reproducibility , deformation (meteorology) , materials science , mathematics , insulin , composite material , statistics
Background: Peak strain has been promising as an index of wall motion but it is sometimes susceptible to the image quality. Objective: We investigated the feasibility of a novel index, transmural myocardial strain gradient (TMSG), derived from myocardial strain M‐mode imaging (TDI‐Q, Toshiba) for quantifying regional systolic wall motion. Method: We measured transmural myocardial strain distribution at the left ventricular lateral, posterior, inferior, septal, anteroseptal and anterior walls in the basal and midventricular short‐axis images using TDI‐Q. Twenty normals (35 ± 3 years) and 35 consecutive patients (63 ± 9 years) with coronary artery disease (CAD, 19 patients with old myocardial infarction, 4 patients with acute myocardial infarction, 12 patients with angina pectoris) were studied. Peak strain, endocardial‐ and epicardial‐half strain and TMSG ((peak strain, − epicardial strain)/distance between peak and epicardial points) were obtained. Coefficient of variation (CV) of each index was calculated. Results: In control subjects, the best reproducibility of the variables was obtained for TMSG with the smallest CV (11.6%) (27.8%, 28.1%, and 35.5%, respectively for CV of peak strain, endocardial‐ and epicardial‐half strain). All segments in control subjects and normal segments in CAD patients showed no significant difference in TMSG (15.1 ± 1.8 vs. 15.1 ± 1.6%/mm, P = ns). TMSG was the lowest for akinetic segments and highest for the normal segments (P < 0.001). Conclusion: TMSG was more robust than simple strain values to quantitatively assess wall motion. This could successfully identify subtle regional differences in wall function. (Echocardiography 2011;28:181‐187)