Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography

OBJECTIVES We sought to evaluate if echocardiographic strain measurements c ould detect acute myocardial ischemia, and to compare this new method with myocardial velocity measurements and wall motion score index. BACKGROUND Tissue Doppler echocardiography (TDE) is a promising method for assessing regional myocardial function. However, myocardial velocities meas ured by tissue Doppler echocardiography (TDE) vary throughout the left vent ricle (LV) because of tethering effects from adjacent tissue. Strain Dopple r echocardiography (SDE) is a new tool for measuring regional myocardial de formation excluding the effect of adjacent myocardial tissue. METHODS Seventeen patients undergoing angioplasty of the left anterior desc ending coronary artery (LAD) were studied. Left ventricular longitudinal wa ll motion was assessed by TDE and SDE from the apical four-chamber view bef ore, during and after angioplasty from multiple myocardial segments simulta neously. RESULTS Systolic strain values were uniformly distributed in the different nonischemic LV segments, whereas systolic velocities decreased from basis t o apex. During LAD occlusion, strain measurement showed expansion in the ap ical septal segment in 16 of 17 patients (7.5 +/- 6.5% vs. -17.7 +/- 7.2%, p < 0.001) and reduced compression in the mid-septal segment (p < 0.05) com pared with baseline. Segments not supplied by LAD remained unchanged. Tissu e Doppler echocardiography showed reduced velocities in all septal segments (p ( 0.05) during angioplasty even though LAD does not supply the basal se ptal segment. Negative systolic velocities were present in 11 of 17 patient s. Wall motion score index increased during ischemia (1.3 +/- 0.4, p < 0.05 ). CONCLUISONS The new SDE approach might be a more accurate marker than TDE f or detecting systolic regional myocardial dysfunction induced by LAD occlus ion. (J Am Coil Cardiol 2001;37: 726-30) (C) 2001 by the American College o f Cardiology.