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Speckle tracking echocardiography: a new window into coronary artery disease

ESC Congress 2010

Modern technologies of echocardiography are more and more implemented into the clinical routine. Tissue Doppler imaging and two-dimensional speckle tracking are established in most of the modern echo laboratories. However, further improvements like multidimensional speckle tracking technologies enter the scenario.

In the first lecture, Prof. J.D. Thomas (Cleveland, US) presented the physical background of speckle tracking and deformation. He gave us insight into the different physical definitions of strain and shear strain and showed the clinical possibilities to detect longitudinal, circumferential and radial strain by echocardiography. He discussed the problem of spatial and temporal resolution causing limitations of this new technology with respect to image quality. Focal lesions of 2-3mm, however, will be detectable by speckle tracking, if image quality is high enough. At the end, he focused on the pros and cons of 3D strain. The pros include the possibility of strain measurements in all directions, and the complete appearance of the speckles/voxels in the data set, while the cons include the low spatial and temporal resolution.

In the second lecture, Prof. T. Edvardsen (Oslo, NO) focused on the possibilities of detecting global and regional dysfunction by speckle tracking. Firstly, he discussed the objective visualization of regional deformation in a young female patient with severe myocardial dysfunction due to anterior myocardial infarction and the criteria for cardiac resynchronization therapy in ischemic heart disease. Secondly, he presented a patient after heart transplantation with preserved systolic function, but severe differences in radial, circumferential and longitudinal strain with nearly a complete loss of regional longitudinal strain in the septal regions documenting the possibility to detect distinct changes of myocardial deformation in pathological situations.

In the third lecture, Prof. R. Hoffmann (Aachen, DE) illustrated the possibility of analyzing systolic and diastolic dysfunction by strain. He elucidated the parameter SI-DI (systolic/diastolic strain index): (A-B)/ A x 100 for accurate detection of diastolic dysfunction during preserved systolic function. Then, he presented the data of his own laboratory discriminating non-transmural and transmural myocardial infarction by regional radial strain analysis in the endo- mid- and epimyocardial layers. He demonstrated that strain analysis of myocardial viability is at least as good as late enhancement detection by cardiac MR. The main limitation, however, using strain analysis, is the necessity for adequate image quality.

In the last lecture, Prof. G.A. Derumeaux (Bron, FR) discussed the prognostic implications of speckle tracking analysis. The rationale for using strain as an index of prognosis is the possibility to objectively detect myocardial infarct size, myocardial obstruction and contractile reserve. She illustrated interesting examples of follow-up investigations in patients with myocardial infarction documenting the dynamics in regional myocardial function. Speckle tracking makes it possible to visualize the infarction area as well as the penumbra of the infarction, which reflects the potential area at risk in case of repetitive ischemic episodes. In this content she reviewed the actual literature documenting that global longitudinal strain is superior to conventional echocardiographic parameters like ejection fraction and wall motion scores to predict outcome of our patients with ischemic heart disease.

In summary, the session convincingly demonstrated the new possibilities of this new, still developing technology of echocardiography in monitoring patients with reduced myocardial function.




Speckle tracking echocardiography: a new window into coronary artery disease
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.