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Strain and strain rate imaging by echocardiography - basic concepts and clinical applicability.

Dandel M, Lehmkuhl H, Knosalla C, Suramelashvili N, Hetzer R - Curr Cardiol Rev (2009)

Bottom Line: Echocardiographic strain and strain-rate imaging (deformation imaging) is a new non-invasive method for assessment of myocardial function.Due to its ability to differentiate between active and passive movement of myocardial segments, to quantify intraventricular dyssynchrony and to evaluate components of myocardial function, such as longitudinal myocardial shortening, that are not visually assessable, it allows comprehensive assessment of myocardial function and the spectrum of potential clinical applications is very wide.Strain and strain rate data also provide valuable prognostic information, especially prediction of future reverse remodelling after left ventricular restoration surgery or after cardiac resynchronization therapy and prediction of short and median-term outcome without transplantation or ventricular assist device implantation of patients referred for heart transplantation.The Review explains the fundamental concepts of deformation imaging, describes in a comparative manner the two major deformation imaging methods (TDI-derived and speckle tracking 2D-strain derived) and discusses the clinical applicability of these new echocardiographic tools, which recently have become a subject of great interest for clinicians.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.

ABSTRACT
Echocardiographic strain and strain-rate imaging (deformation imaging) is a new non-invasive method for assessment of myocardial function. Due to its ability to differentiate between active and passive movement of myocardial segments, to quantify intraventricular dyssynchrony and to evaluate components of myocardial function, such as longitudinal myocardial shortening, that are not visually assessable, it allows comprehensive assessment of myocardial function and the spectrum of potential clinical applications is very wide. The high sensitivity of both tissue Doppler imaging (TDI) derived and two dimensional (2D) speckle tracking derived myocardial deformation (strain and strain rate) data for the early detection of myocardial dysfunction recommend these new non-invasive diagnostic methods for extensive clinical use. In addition to early detection and quantification of myocardial dysfunction of different etiologies, assessment of myocardial viability, detection of acute allograft rejection and early detection of allograft vasculopathy after heart transplantation, strain and strain rate data are helpful for therapeutic decisions and also useful for follow-up evaluations of therapeutic results in cardiology and cardiac surgery. Strain and strain rate data also provide valuable prognostic information, especially prediction of future reverse remodelling after left ventricular restoration surgery or after cardiac resynchronization therapy and prediction of short and median-term outcome without transplantation or ventricular assist device implantation of patients referred for heart transplantation.The Review explains the fundamental concepts of deformation imaging, describes in a comparative manner the two major deformation imaging methods (TDI-derived and speckle tracking 2D-strain derived) and discusses the clinical applicability of these new echocardiographic tools, which recently have become a subject of great interest for clinicians.

No MeSH data available.


Related in: MedlinePlus

Left ventricular strain and strain rate images in heart transplant recipients with focal stenoses of coronary arteries. A and B: Circumferential strain and strain rate in a patient with stenosis of the right coronary artery. C and D: Longitudinal strain and strain rate in a patient with stenosis of the left anterior descending coronary artery. [Dandel et al. JHLT 2008; 27(2): S95-96].
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Figure 9: Left ventricular strain and strain rate images in heart transplant recipients with focal stenoses of coronary arteries. A and B: Circumferential strain and strain rate in a patient with stenosis of the right coronary artery. C and D: Longitudinal strain and strain rate in a patient with stenosis of the left anterior descending coronary artery. [Dandel et al. JHLT 2008; 27(2): S95-96].

Mentions: Before myocardial deformation imaging became available it had already been shown that in heart transplant recipients TDI wall motion assessment is useful for rejection diagnosis and early detection of patients with relevant transplant coronary artery disease (TxCAD) [77-79]. In our department TDI has been routinely used since 1998 and became a cornerstone for the monitoring of cardiac allograft function and for the timing of follow-up myocardial biopsies and coronary angiographies. After 2D-strain imaging became available, its usefulness for post-transplant follow-up monitoring of cardiac function was also investigated [40,80-82]. Comparing the deformation parameters obtained from patients who underwent routine endomyocardial biopsies, Marciniak et al. found significantly lower LV longitudinal and radial peak systolic strain and strain rate values in patients with acute rejection ≥ grade 1B in comparison to those with biopsies graded between 0 and 1A [82]. In patients with biopsy-proven acute rejection episodes ≥ grade 3, we found a significant (p<0.05) reduction of LV systolic and diastolic radial, circumferential and longitudinal global peak strain and strain rate values in comparison to the values measured before rejection. The same changes were also detected in patients with cellular rejections grade ≤ 2 who had clinical symptoms and/or additional immune-histological signs of vascular (humoral) rejection. An example of myocardial strain changes during acute rejection is shown in Fig. (7). Systolic and diastolic global strain rate reduction appeared to be more sensitive for the early detection of acute rejection than the reduction of systolic and early diastolic global strain values. As shown in Fig. (8), even mild acute rejection (grade 1) in completely asymptomatic patients, without any change in conventional echocardiographic parameters, can be associated with relevant strain rate changes. A sudden drop of ≥15% of the radial global strain rate in heart transplanted patients appeared highly predictive for acute biopsy proven rejection [80]. Two-dimensional strain imaging is also useful for the evaluation of anti-rejection treatment efficacy. In patients without visible alterations in LV kinetics, 2D-strain imaging also appeared reliable for non-invasive prediction of TxCAD with and without focal stenoses (>50% narrowing) of main epicardial coronary arteries [40,83,84]. Eroglu et al. found that strain and strain-rate imaging in combination with dobutamine stress echocardiography is useful for early detection of TxCAD before the development of relevant stenoses detectable with conventional angiography [84]. The high predictive value for coronary stenoses of systolic strain dyssynchrony and dyssynergy indexes found in our patients even at rest (positive and negative predictive values of 90%-95% and 91-97%, respectively) recommended 2D-strain imaging as a non-invasive tool with the potential to facilitate early detection of stenoses and to enable angiographies to be timed, sparing patients frequent routine heart catheterizations [40]. Fig. (9) shows examples of strain and strain rate images obtained from heart transplant recipients with focal stenoses of the coronary arteries.


Strain and strain rate imaging by echocardiography - basic concepts and clinical applicability.

Dandel M, Lehmkuhl H, Knosalla C, Suramelashvili N, Hetzer R - Curr Cardiol Rev (2009)

Left ventricular strain and strain rate images in heart transplant recipients with focal stenoses of coronary arteries. A and B: Circumferential strain and strain rate in a patient with stenosis of the right coronary artery. C and D: Longitudinal strain and strain rate in a patient with stenosis of the left anterior descending coronary artery. [Dandel et al. JHLT 2008; 27(2): S95-96].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2805816&req=5

Figure 9: Left ventricular strain and strain rate images in heart transplant recipients with focal stenoses of coronary arteries. A and B: Circumferential strain and strain rate in a patient with stenosis of the right coronary artery. C and D: Longitudinal strain and strain rate in a patient with stenosis of the left anterior descending coronary artery. [Dandel et al. JHLT 2008; 27(2): S95-96].
Mentions: Before myocardial deformation imaging became available it had already been shown that in heart transplant recipients TDI wall motion assessment is useful for rejection diagnosis and early detection of patients with relevant transplant coronary artery disease (TxCAD) [77-79]. In our department TDI has been routinely used since 1998 and became a cornerstone for the monitoring of cardiac allograft function and for the timing of follow-up myocardial biopsies and coronary angiographies. After 2D-strain imaging became available, its usefulness for post-transplant follow-up monitoring of cardiac function was also investigated [40,80-82]. Comparing the deformation parameters obtained from patients who underwent routine endomyocardial biopsies, Marciniak et al. found significantly lower LV longitudinal and radial peak systolic strain and strain rate values in patients with acute rejection ≥ grade 1B in comparison to those with biopsies graded between 0 and 1A [82]. In patients with biopsy-proven acute rejection episodes ≥ grade 3, we found a significant (p<0.05) reduction of LV systolic and diastolic radial, circumferential and longitudinal global peak strain and strain rate values in comparison to the values measured before rejection. The same changes were also detected in patients with cellular rejections grade ≤ 2 who had clinical symptoms and/or additional immune-histological signs of vascular (humoral) rejection. An example of myocardial strain changes during acute rejection is shown in Fig. (7). Systolic and diastolic global strain rate reduction appeared to be more sensitive for the early detection of acute rejection than the reduction of systolic and early diastolic global strain values. As shown in Fig. (8), even mild acute rejection (grade 1) in completely asymptomatic patients, without any change in conventional echocardiographic parameters, can be associated with relevant strain rate changes. A sudden drop of ≥15% of the radial global strain rate in heart transplanted patients appeared highly predictive for acute biopsy proven rejection [80]. Two-dimensional strain imaging is also useful for the evaluation of anti-rejection treatment efficacy. In patients without visible alterations in LV kinetics, 2D-strain imaging also appeared reliable for non-invasive prediction of TxCAD with and without focal stenoses (>50% narrowing) of main epicardial coronary arteries [40,83,84]. Eroglu et al. found that strain and strain-rate imaging in combination with dobutamine stress echocardiography is useful for early detection of TxCAD before the development of relevant stenoses detectable with conventional angiography [84]. The high predictive value for coronary stenoses of systolic strain dyssynchrony and dyssynergy indexes found in our patients even at rest (positive and negative predictive values of 90%-95% and 91-97%, respectively) recommended 2D-strain imaging as a non-invasive tool with the potential to facilitate early detection of stenoses and to enable angiographies to be timed, sparing patients frequent routine heart catheterizations [40]. Fig. (9) shows examples of strain and strain rate images obtained from heart transplant recipients with focal stenoses of the coronary arteries.

Bottom Line: Echocardiographic strain and strain-rate imaging (deformation imaging) is a new non-invasive method for assessment of myocardial function.Due to its ability to differentiate between active and passive movement of myocardial segments, to quantify intraventricular dyssynchrony and to evaluate components of myocardial function, such as longitudinal myocardial shortening, that are not visually assessable, it allows comprehensive assessment of myocardial function and the spectrum of potential clinical applications is very wide.Strain and strain rate data also provide valuable prognostic information, especially prediction of future reverse remodelling after left ventricular restoration surgery or after cardiac resynchronization therapy and prediction of short and median-term outcome without transplantation or ventricular assist device implantation of patients referred for heart transplantation.The Review explains the fundamental concepts of deformation imaging, describes in a comparative manner the two major deformation imaging methods (TDI-derived and speckle tracking 2D-strain derived) and discusses the clinical applicability of these new echocardiographic tools, which recently have become a subject of great interest for clinicians.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.

ABSTRACT
Echocardiographic strain and strain-rate imaging (deformation imaging) is a new non-invasive method for assessment of myocardial function. Due to its ability to differentiate between active and passive movement of myocardial segments, to quantify intraventricular dyssynchrony and to evaluate components of myocardial function, such as longitudinal myocardial shortening, that are not visually assessable, it allows comprehensive assessment of myocardial function and the spectrum of potential clinical applications is very wide. The high sensitivity of both tissue Doppler imaging (TDI) derived and two dimensional (2D) speckle tracking derived myocardial deformation (strain and strain rate) data for the early detection of myocardial dysfunction recommend these new non-invasive diagnostic methods for extensive clinical use. In addition to early detection and quantification of myocardial dysfunction of different etiologies, assessment of myocardial viability, detection of acute allograft rejection and early detection of allograft vasculopathy after heart transplantation, strain and strain rate data are helpful for therapeutic decisions and also useful for follow-up evaluations of therapeutic results in cardiology and cardiac surgery. Strain and strain rate data also provide valuable prognostic information, especially prediction of future reverse remodelling after left ventricular restoration surgery or after cardiac resynchronization therapy and prediction of short and median-term outcome without transplantation or ventricular assist device implantation of patients referred for heart transplantation.The Review explains the fundamental concepts of deformation imaging, describes in a comparative manner the two major deformation imaging methods (TDI-derived and speckle tracking 2D-strain derived) and discusses the clinical applicability of these new echocardiographic tools, which recently have become a subject of great interest for clinicians.

No MeSH data available.


Related in: MedlinePlus