ECHO 2013 / Quantifying Myocardial Mechanics Strain and Torsion
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Clinical Applications of Strain Imaging
•Coronary artery disease
–Detection and sizing of myocardial infarction
–Detection of myocardial ischemia
–Assessment of myocardial viability
–Prediction of post-MI arrhythmias
•Detection of subclinical LV dysfunction
–Chemotherapy
–Valvular heart disease
•Cardiomyopathy
–Amyloid
• Guidance of cardiac resynchronization
Strain2012:11
MRI vs Echo Strain for Infarct Size
Large infarct |
Medium infarct |
115 g |
36 g |
r
r
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c |
l |
l |
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c |
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Gjesdal et al. Circ Img 2008; 1: 189-96 |
Strain2012:12 |
Detection of 30 g MI Size
Strain |
WMSI |
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Echo EF |
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Area under Curve |
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Echo EF |
0.81 |
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MRI EF |
0.90 |
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MRI EF |
WMSI |
0.90 |
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Strain |
0.95 |
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Gjesdal et al. Clinical Science 2007; 113: 287-96 |
Strain2012:13 |
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Clinical Applications of Strain Imaging
•Coronary artery disease
–Detection and sizing of myocardial infarction
–Detection of myocardial ischemia
–Assessment of myocardial viability
–Prediction of post-MI arrhythmias
•Detection of subclinical LV dysfunction
–Chemotherapy
–Valvular heart disease
•Guidance of cardiac resynchronization
Strain2012:14
Strain Imaging Diastolic Index
SI-DI = % of systolic wall thickening lost in the first 1/3 of diastole:
(A-B)/A
Ishii et al.
JACC 2009; 53: 698-705
60-year-old Male: Exertional Angina
Radial Strain Before and After Exercise
mid-sep mid-post
Baseline |
immediately after |
5 min after |
Ishii et al. JACC 2009; 53: 698-705 |
Strain2012:16 |
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60-year-old Male: Effort Angina
Left coronary artery |
Right coronary artery |
(#7: 99% #9:90% stenosis) |
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Ishii et al. JACC 2009; 53: 698-705 |
Strain2012:17 |
Predictive Accuracy of SI-DI for Detecting Coronary Stenoses
Ishii et al. JACC 2009; 53: 698-705 |
Strain2012:18 |
Clinical Applications of Strain Imaging
•Coronary artery disease
–Detection and sizing of myocardial infarction
–Detection of myocardial ischemia
–Assessment of myocardial viability
–Prediction of post-MI arrhythmias
•Detection of subclinical LV dysfunction
–Chemotherapy
–Valvular heart disease
•Guidance of cardiac resynchronization
Strain2012:19
Improvement in Ejection Fraction
vs Resting Radial Strain and MRI Markers
Echo Radial Strain |
Gd-MRI |
Becker et al. JACC 2008; 51: 1473-81 |
Strain2012:20 |