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Longitudinal peak strain detects a smaller risk area than visual assessment of wall motion in acute myocardial infarction
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Department of Clinical Physiology, Ryhov County Hospital, Jönköping, Sweden.
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
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2010 (English)In: Cardiovascular ultrasound, ISSN 1476-7120, Vol. 8, no 2, p. 1-12Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Opening of an occluded infarct related artery reduces infarct size and improves survival in acute ST-elevation myocardial infarction (STEMI). In this study we performed tissue Doppler analysis (peak strain, displacement, mitral annular movement (MAM)) and compared with visual assessment for the study of the correlation of measurements of global, regional and segmental function with final infarct size and transmurality. In addition, myocardial risk area was determined and a prediction sought for the development of infarct transmurality >or=50%.

METHODS: Twenty six patients with STEMI submitted for primary percutaneous coronary intervention (PCI) were examined with echocardiography on the catheterization table. Four to eight weeks later repeat echocardiography was performed for reassessment of function and magnetic resonance imaging for the determination of final infarct size and transmurality.

RESULTS: On a global level, wall motion score index (WMSI), ejection fraction (EF), strain, and displacement all showed significant differences (p or=50%, but strain added no significant information to that obtained with WMSI in a logistic regression analysis.

CONCLUSIONS: In patients with acute STEMI, WMSI, EF, strain, and displacement showed significant changes between the pre- and post PCI exam. In a ROC-analysis, strain had 64% sensitivity at 80% specificity and WMSI around 90% sensitivity at 80% specificity for the detection of scar with transmurality >or=50% at follow-up.

Place, publisher, year, edition, pages
2010. Vol. 8, no 2, p. 1-12
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54292DOI: 10.1186/1476-7120-8-2ISI: 000275201700001PubMedID: 20064264OAI: oai:DiVA.org:liu-54292DiVA, id: diva2:302570
Note

Original Publication: Lene Rosendahl, Peter Blomstrand, Lars Brudin, Tim Tödt and Jan E Engvall, Longitudinal peak strain detects a smaller risk area than visual assessment of wall motion in acute myocardial infarction, 2010, Cardiovascular ultrasound, (8), 2, 1-12. http://dx.doi.org/10.1186/1476-7120-8-2 Licensee: BioMed Central http://www.biomedcentral.com/

Available from: 2010-03-08 Created: 2010-03-08 Last updated: 2014-01-17Bibliographically approved
In thesis
1. Infarct size and myocardial function: A methodological study
Open this publication in new window or tab >>Infarct size and myocardial function: A methodological study
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The size of a myocardial infarction (MI) and the concurrent effect on left ventricular (LV) function are essential for decisions regarding patient care and treatment. Images produced with the late gadolinium enhancement (LGE) technique visualize the scar with high spatial resolution. The general aim of this thesis was to study methods to assess scar size in chronic MI, primarily with the use of LGE, and to relate area‐at‐risk and LV function to scar size.

Myocardial perfusion single photon emission computed tomography (MPS) is a well established technique for the assessment of MI size. Our study showed that there is a fairly good agreement between MPS and LGE in the determination of scar size. Wall motion score index (WMSI) correlated moderately with both infarct size and infarct extent determined with LGE.

Manual delineation of myocardium and scar is time consuming and subjective and there is a need for help in objective assessment. We showed that the semi‐automatic computer software, Segment, reduced the evaluation time ≥50% with maintained clinical accuracy.

The segmented scar sequence ‐ inversion recovery fast gradient echo, IR_FGRE, is a well documented sequence for scar determination, however, the sequence requires regular heart rhythm and breath holding for good imaging. We showed that a single shot scar sequence ‐ steady state free precession, SS_SSFP ‐ acquired under free breathing in patients with ongoing atrial fibrillation, had significantly better image quality than IR_FGRE. The scar size and the error of determination were equal for both sequences and the examination time was shorter with SS_SSFP.

In an acute MI it is essential to know the myocardial area‐at‐risk. WMSI is clinically the most common way of assessing LV function, but is highly subjective. Tissue Doppler imaging with strain measurements is considered objective and quantitative in assessing both global and regional LV function compared to WMSI. Our results showed that WMSI is superior to strain for the detection of scar with transmurality ≥50% in patients with acute MI. Also WMSI correlated better than strain on all levels (global, regional, segmental) with final scar size determined with LGE.

LGE images visualize myocardial scar much more distinctly than any other modality. This new technique needs clinical validation but promises intense competition with existing modalities such as myocardial scintigraphy and echocardiography.

However, in individual patient care all modalities should be used according to their own advantages and limitation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. p. 85
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1169
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-53943 (URN)9789173934374 (ISBN)
Public defence
2010-03-26, Originalet, Qulturum, Hus B4, Länssjukhuset Ryhov, Jönköping, 09:00 (Swedish)
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Available from: 2010-03-09 Created: 2010-02-15 Last updated: 2017-12-13Bibliographically approved

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Rosendahl, LeneBlomstrand, PeterBrudin, LarsTödt, TimEngvall, Jan E

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