Abstract 13456: Echocardiographic Estimation of Myocardial Scar by Segmental Longitudinal Strain in Patients with Ischemic Cardiomyopathy and Left Bundle Branch Block: Comparison with Quantitative Cardiac Magnetic Resonance Imaging Late Gadolinium Enhancement
Introduction: Determination of myocardial scar is of great clinical importance in patients with ischemic cardiomyopathy (ICM) but conventional echocardiography methods are limited and left bundle branch block (LBBB) is problematic. The objective of this study was to utilize myocardial deformation imaging by two-dimensional (2D) speckle tracking echocardiography (STE) to estimate scar in patients with ICM and LBBB in comparison to quantitative assessment by cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE).
Methods: Transthoracic echocardiography was performed on 25 patients aged 74±8 years with ischemic cardiomyopathy (mean ejection fraction 28±8) and LBBB. Segmental longitudinal strain was measured by STE from three standard apical views with 6 segments per view. A 16 segment model was used with averaging of apical segments. Extent of segmental scar was quantified by contrast enhanced CMR and expressed in percentage of segmental LGE in all patients.
Results: Feasibility for assessment of segmental longitudinal strain was 85% (382/450). Paired data of both LGE and strain was available in 314/400 (79%) segments. Out of 314 segments, 35 segments had evidence of non-mural infarction (LGE = 25 to 49%) and 20 segments had evidence of transmural infarction (LGE ≥ 50%). The mean segmental strain was -13.3±5.6% for normal segments with no scar. Segments with non-transmural scar had significantly lower longitudinal strain than non-scarred segments: -9.6±5.1%*, and segments with transmural scar had the lowest strain: -8.9±4.4%* (p<0.001, figure left panel). By ROC analysis the cut-off value was -9.7% with a significant area under the curve of 0.71 (0.60-0.83, p<0.001; figure right panel).
Conclusions: Segmental deformation imaging by 2D speckle tracking has the potential to estimate the extent of myocardial scar in patients with ischemic cardiomyopathy and LBBB and has promise for future clinical applications.
Author Disclosures: B. Tayal: None. N. Risum: None. A. Delgado-Montero: None. A. Iversion: None. T.F. Hansen: None. J. Gorcsan: Research Grant; Modest; St jude, Biotronik, Medtronic, Toshiba, GE. P. Søgaard: Research Grant; Modest; Biotronik, GE health care.
- © 2014 by American Heart Association, Inc.