Ischemic heart disease

5-key points

All LV global strain measurements are significantly decreased in patients with acute coronary occlusion, with peak systolic strain as highest predictor for infarct size. For regional longitudinal strain a cut-off value of -12% can be used to identify enhanced segments. A cutoff value of -15% for GLS directly after revascularization is accurate for identifying MI larger than 20% of the total heart mass.

Both longitudinal and circumferential segmental strain measurements have the capability to separate subendocardial from transmural infarctions. A cutoff value of -13.3% for circumferential peak systolic strain and -15.1% for longitudinal peak systolic strain has been suggested.

Post-systolic shortening (PSS) occurs in affected myocardial regions during ischaemia and infarction with post-systolic index and peak velocity of PSS as the most accurate parameters. In general, larger amplitude and longer duration indicates pathologic PSS.

Duration of early systolic lengthening prolongs significantly in ischaemic / infarcted segments, cuttof values are jet to be determined.

GLS is a good predictor for recovery after PCI. For global functional improvement and global LV remodeling, a cutoff value of respectively -12.9% and -12.8% can be used. GLS less negative than -15% is associated with higher risk of adverse cardiac events in two years after revascularization.

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