When is strain assessment mandatory?
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1 When is strain assessment mandatory? Geneviève Derumeaux University of Lyon France
2 Presenter Disclosure Information Geneviève Derumeaux When is strain assessment mandatory? DISCLOSURE INFORMATION: None UNLABELED/UNAPPROVED USE: None
3 Diagnosis of myocardial dysfunction Marwick T et al ; Circulation CVI 2008
4 Diagnosis of myocardial dysfunction - LV dimensions and mass - LV function (LVEF) - LV filling pressures - RV function and PAP - Mitral regurgitation - Mechanical dyssynchrony
5 Improve diagnosis of LV Dysfunction
6
7
8 Ernande L et al; J Am Soc Echocardiogr 2010;23:
9 Jacques C DM patient LVEF : 65% Global strain: 16.5%
10 Association of Imaging Markers of Myocardial Fibrosis With Metabolic and Functional Disturbances in Early Diabetic Cardiomyopathy C Jellis, Circ CVI 2011 L Ernande, ESC 2011
11 Pathophysiological Targets for Strain Structural Alterations in LVD Microcirculation Altered MBF Capillary rarefaction Myocytes Depletion of contractile elements Mitochondrial alteration Nuclei and sarcoplasmic reticulum abnormalities Extracellular Matrix Increased amounts of type I and III collagen, and fibronectin Increased number of fibroblasts and macrophages
12 EHJ 2007
13 EJE 2009
14 Circ Cardiovasc Imaging 2008
15 Circ Cardiovasc Imaging 2009
16 Diagnosis of myocardial dysfunction Marwick T et al ; Circulation CVI 2008
17 Diagnosis of ischemic cardiomyopathy Territorial circumferential strain enables early identification of acute coronary occlusions in patients with NSTE-ACS and may be used for detection of patients requiring urgent PTCA. Grenne B ; Heart 2010
18 Bax JJ; JACC 1997
19 Rationale of deformation evaluation Several of the methods for global assessment concentrate only on radial function, ignoring longitudinal function, which in most cardiac pathology is altered before changes occur in radial indices. B Bijns et al; EJE (2010)
20 Impact of ischemia on LV function Radial Function Longitudinal and Circonferential Function Réant P; J. Am. Coll. Cardiol. 2008;51;
21 55 patients with ICM and LVD (LVEF <0.45) underwent DbE for assessment of myocardial viability before myocardial revascularization. Among different strain parameters, only TVI-based longitudinal end-systolic strain and peak systolic SR at LDD had incremental value over wall-motion analysis (areas under the receiver operator characteristic curves of 0.79, 0.79, and 0.74,respectively). Bansal M ; JACC Imaging 2010
22 Assessment of infarct size and prediction of contractile reserve by CMR Kim Circulation 1999 Kim NEJM 2000 Shan Circulation 2003
23 Assessment of infarct size Strain vs RMN Edvardsen Clinical Science 2007
24 Prediction of LVEF EF (%) at 3 months R= patients Acute MI => primary PTCA 1st echo. 48h after MI; 2d echo at 1 year Prediction of recovery of LV function at 1-year follow-up SR (s -1 ) at 3 days Thibault H et al; Circulation CVI 2011 Mollema S; Circulation CVI 2010
25 AntSept Sept Ant Inf Lat Post
26 4D-strain and assessment of MI extend Hayat D; Am J Cardiol 2011
27 Evidence for predicting cardioprotection
28 Troponin I (IU/l) Control (n=20) postc (n=16) % (p=0.01) Base time (hours) Circulation 2008
29 Assessing prognosis Global longitudinal strain (GLS>-12%) is a superior predictor of outcome to either EF or WMSI 546 Pts (60.9±11.0 years), 91 died over a period of 5.2 ± 1.5 years. LV EF =58 ± 12%, WMSI =1.3 ± 0.4, GLS =-16.6 ± 4.3%. Incremental Value of GLS Stanton T et al ; Circulation CVI 2009
30 Assessing dyssynchrony Early contracting regions stretch not-yet activated remote regions This stretching further delays shortening of late activated segments and increases their force of local contraction (Frank-Starling) The late activated segments impose loading on the earlier activated segments, which now undergo systolic paradoxical stretch. Sweeney MO and Prinzen FW, JACC 2006 Early Parsai C et al ; European Heart Journal 2009 Late
31 Miazaki C et al, Circulation 2008
32 Conclusion Strain assessment is not mandatory Strain is an additional tool to : assess subclinical myocardial dysfunction in cardiomyopathies, valvular heart disease identify decreased myocardial blood flow in ischaemic heart disease Improve visual assessment of wall motion add important information about outcome Evaluate effect of new cardioprotective strategies
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