Validation of Echocardiographic Two-Dimensional Speckle Tracking Longitudinal Strain Imaging for Viability Assessment in Patients with Chronic Ischemic Left Ventricular Dysfunction and Comparison with Contrast-Enhanced Magnetic Resonance Imaging

OBJECTIVES: The purpose of the present study was to compare longitudinal strain assessed by two-dimensional speckle tracking with scar tissue on contrast-enhanced magnetic resonance imaging (MRI) in patients with chronic ischemic left ventricular (LV) dysfunction. The aim was also to define a cutoff value for regional strain to discriminate between viable myocardium and transmural scar.

METHODS: Ninety patients with chronic ischemic LV dysfunction underwent transthoracic echocardiography to measure global and segmental (regional) longitudinal LV strain using two-dimensional speckle tracking and cine MRI followed by contrast-enhanced MRI to assess segmental LV function and the segmental/global (transmural) extent of scar tissue. The optimal cutoff value for regional strain to discriminate between segments with viable myocardium and segments with transmural scar was also determined.

RESULTS: A good correlation was found between global LV strain and the global extent of scar tissue on contrast-enhanced MRI (R = 0.62, p <0.001). The mean segmental strain in segments without scar tissue was -10.4% +/- 5.2% compared with 0.6% +/- 4.9% in segments with transmural scar tissue (p <0.001). A strain value of -4.5% discriminated between segments with viable myocardium and segments with transmural scar tissue on contrast-enhanced MRI with a sensitivity of 81.2% and specificity of 81.6%.

CONCLUSIONS: In conclusion, global and regional longitudinal strain measured with two-dimensional speckle tracking is associated with the global and regional (transmural) extent of scar tissue on contrast-enhanced MRI. A cutoff value of -4.5% for regional strain discriminated between segments with viable myocardium and those with transmural scar tissue on contrast-enhanced MRI with a sensitivity of 81.2% and specificity of 81.6%.

PMID: 19616660

Posted in Echo, Magnetic Resonance Imaging and tagged .

One Comment

  1. In addition to dobutamine stress echo, PET-FDG imaging, and cardiac MR for assessing myocardial viability, longitudinal strain is the latest technique to be added to the imaging toolbox. A value of -4.5% for regional strain discriminated; viable from scarred myocardium with high (~81%) sensitivity and specificity.

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