(Circulation. 2000;102:1158.)
© 2000 American Heart Association, Inc.
Basic Science Reports |
Myocardial Strain by Doppler Echocardiography
Validation of a New Method to Quantify Regional Myocardial Function
From the Institute for Surgical Research and The Department of Cardiology, Rikshospitalet, University of Oslo, and the Norwegian University of Science and Technology, Trondheim (H.T., B.A.), Norway.
Correspondence to Otto A. Smiseth, Institute for Surgical Research, Rikshospitalet, The National Hospital, N-0027 Oslo, Norway. E-mail o.a.smiseth{at}rh.uio.no
Background—Myocardial strain is a measure of regional deformation, and by definition, negative strain means shortening and positive strain, elongation. This study investigates whether myocardial strain can be measured by Doppler echocardiography as the time integral of regional velocity gradients, using sonomicrometry as reference method.
Methods and Results—In 13 anesthetized dogs, myocardial longitudinal strain was measured on apical images as the time integral of regional Doppler velocity gradients. Ultrasonic segment-length crystals were placed near the left ventricular (LV) apex and near the base. Apical ischemia was induced by occluding the left anterior descending coronary artery (LAD), and preload was increased by saline. Percentage systolic strain by Doppler correlated well with strain by sonomicrometry (y=0.82x-1.79, r=0.92, P<0.01). During LAD occlusion, apical myocardium became dyskinetic, as indicated by positive strain values and negative Doppler velocities. At the LV base, myocardial strain by Doppler, strain by sonomicrometry, and velocity of shortening by sonomicrometry (dL/dt) were unchanged during apical ischemia. However, myocardial Doppler velocities at the base decreased from 4.2±0.7 (±SEM) to 2.7±0.4 cm/s (P<0.05), probably reflecting loss of motion caused by tethering to apical segments. Volume loading increased myocardial Doppler velocities from 2.2±0.3 to 4.1±0.8 cm/s (P<0.05) and Doppler-derived strain from -12±1% to -22±2% (P<0.05), whereas peak LV elastance remained unchanged.
Conclusions—Myocardial strain by Doppler echocardiography may represent a new, powerful method for quantifying regional myocardial function and is less influenced by tethering effects than Doppler tissue imaging. Like myocardial Doppler velocities, strain is markedly load-dependent.
Key Words: echocardiography • strain • ischemia • ultrasonics • contractility
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