Left ventricular endocardial and epicardial strain changes with apical myocardial ischemia in an open‐chest porcine model. Issue 24 (30th December 2016)

• Record Type: Journal Article
• Authors: Howard‐Quijano, Kimberly; McCabe, Melissa; Cheng, Alexander; Zhou, Wei; Yamakawa, Kentaro; Mazor, Einat; Scovotti, Jennifer C.; Mahajan, Aman
• Is Part Of: Physiological reports. Volume 4:Issue 24(2016)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2016-12-30
• Subjects: Echocardiography -- ischemia -- left ventricular function -- strain; Physiology -- Periodicals; 571
• DOI: 10.14814/phy2.13042
• Languages: English
• ISSNs: 2051-817X

Abstract

Abstract: Early detection of acute myocardial ischemia is critical to prevent permanent myocardial damage. The impact of apical ischemia on global left ventricular (LV) function can be difficult to characterize using traditional volume‐based echocardiography measures. Myocardial strain imaging is a sensitive, quantitative marker of myocardial deformation that can measure ventricular function. Recent advances allow layer‐specific measurement of endo‐ and epicardial strain, enhancing the ability to evaluate myocardial ischemia. This study investigates the effects of apical ischemia on LV function using epi‐ and endocardial strain. We hypothesize that myocardial strain will identify changes in regional and global myocardial function associated with focal apical ischemia as compared to ejection fraction (EF), and that longitudinal strain will be a better indicator of myocardial dysfunction compared to circumferential or radial strain. In a porcine model ( n = 9), acute ischemia was induced by left anterior descending coronary artery occlusion. Echocardiograms were performed at baseline, during 15‐min ischemia, and after reperfusion. Global longitudinal strain decreased with acute focal ischemia of the left ventricular apical region (baseline: −16.4% vs. ischemia: −12.2%; P = 0.010), with no change observed in global circumferential and radial strain or EF. Both endocardial and epicardial longitudinal strain decreased by 68% ( P < 0.001) in the ischemic and peri‐ischemic zone, while circumferential and radial strain only decreased in endocardium of the ischemic zone. Longitudinal strain was more sensitive to ischemia, being able to detect changes in global LV function and thus may confer clinical diagnostic advantage in the evaluation of acute LV apical ischemia. Abstract : In this study, we have investigated the effects of focal apical myocardial ischemia on global and regional ventricular function. Our aims were to identify the effects of isolated apical ischemia on global left ventricular function using strain imaging and to delineate the potential diagnostic advantage of longitudinal strain in this setting.