Experimental Validation of Circumferential, Longitudinal, and Radial 2-Dimensional Strain During Dobutamine Stress Echocardiography in Ischemic Conditions

INSERM U828 and IFR4, University of Bordeaux 2, Bordeaux, France.
Journal of the American College of Cardiology (Impact Factor: 16.5). 01/2008; 51(2):149-57. DOI: 10.1016/j.jacc.2007.07.088
Source: PubMed


The aim of this study was to assess and validate 2-dimensional (2D) strain for the detection of ischemia during dobutamine stress echocardiography (DSE).
Evaluation of abnormalities of left ventricular (LV) function from wall thickening during DSE is unsatisfactory and requires a high level of expertise.
In 10 open-chest anesthetized pigs, myocardial deformation was studied before and during dobutamine infusion, under control and ischemic conditions produced by various degrees of coronary artery constriction: 2 of nonflow-limiting stenoses (NFLS) of increasing severity reducing left anterior descending artery hyperemic flow by 40% and 70% and 2 flow-limiting stenoses (FLS) reducing resting coronary flow by 25% and 50%. Agreement between 2D strain echocardiography and sonomicrometry (reference method) was evaluated by linear regression and Bland-Altman analysis.
Good correlation and agreement were observed between 2-dimensional strain and sonomicrometry at rest and during dobutamine infusion; longitudinal strain: r = 0.77, p < 0.001 and r = 0.80, p < 0.001; radial strain: r = 0.57, p < 0.05 and r = 0.63, p < 0.05; and circumferential strain: r = 0.74, p < 0.001 and r = 0.58, p < 0.001. Circumferential and longitudinal strains in the risk area were significantly decreased at rest in the presence of FLS and during dobutamine infusion in the presence of NFLS. By contrast, radial strain was significantly decreased in the presence of severe FLS only during dobutamine infusion.
The 2D strain provides accurate assessment of LV regional function. Evaluation of circumferential and longitudinal strains during DSE has real potential for quantitative evaluation of LV deformation in the routine assessment of ischemia.

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Available from: Xavier Pillois, Jul 22, 2014
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    • "2DSTE is a relatively angle-independent technology that can measure global and regional strains, strain rate, displacement , and velocity in longitudinal, radial, and circumferential directions [1]. 2DSTE has been used widely in clinical research settings and was found to be clinically useful in the assessment of cardiac systolic and diastolic function, ischemia [2] [3] [4], dyssynchrony [5] [6], and other cardiac conditions [7]. However, it has not been widely adopted in clinical practice partly because data acquisition and analysis are time-consuming. "
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    • "Doppler tissue imaging and 2D speckle tracking. 2D speckle tracking is a new technique that is able to quantify circumferential and radial motion, validated non-invasively by magnetic resonance imaging (MRI) tagging and invasively by sonomicrometry in animal models.44–46 New developments in echocardiography enable a much fuller assessment of LV systolic and diastolic function, including measurement of myocardial deformation or strain.44,45,47 "
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    • "Overall, the different combinations of STE smoothing settings did only result in small changes in the strain values and differences between most of the individual measurements remained within the variability of each strain estimate. Moreover, independent of the degree of smoothing, all strain values corresponded well to findings from previous studies in both normal and ischemic myocardium [10,18,20,27-30]. Different smoothing settings are therefore not likely to be a major contributor to the variances in strain reported in the literature [4]. "
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