ECHO 2013 / Quantifying Myocardial Mechanics Strain and Torsion
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•38 pts with severe MR studied before undergoing MVR
•Echo parameters analyzed to predict a fall in EF of 10% or more.
Volumes |
Strain |
SR |
AUC=0.88
de Isla et al. JASE 2009; 22: 831-38 |
Strain2012:31 |
•47 pts with chronic AR studied before MVR, 31 controls
•Strain analyzed pre and post operatively.
Global longitudinal strain
p<0.01
Normalized strain
p=0.01
Smedsrud et al. JASE 2011; 24: 1253-1259 |
Strain2012:32 |
Impact of AR on Strain
Preand post-op
•Abnormal GLS deteriorated with surgery
•Normalized GLS predicts post-op EDV
–Note normization is by pre-op EDV, which gave a BETTER predictor of post-op EDV (0.62) than normalized strain (0.58)
Normalized strain
Vs post-op EDV
Global longitudinal strain
r=0.58
p<0.01
p=0.01
Smedsrud et al. JASE 2011; 24: 1253-1259 |
Strain2012:33 |
Impact of Strain on Post MVr LV function
233 Pts, Prediction of 12+ month LVEF<50%
GLS = - 19.9% |
90% sensitivity, 79% specificity |
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Witkowski et al. JATS 2012 (in press) |
Strain2012:34 |
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
Strain2012:35
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HCM |
AS |
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Phelan, Collier et al. Heart 2012 (on-line first) |
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Strain2012:36 |
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Amyloid: Apex > 2x Base & Mid
Phelan, Collier et al. Heart 2012 (on-line first) |
Strain2012:37 |
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
Strain2012:38
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Suffoletto et al. Circ 2006; 113: 960-8 |
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Strain2012:39 |
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Radial Dyssynchrony Predicts
Functional Improvement
Suffoletto et al. Circ 2006; 113: 960-8 |
Strain2012:40 |