- 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.
Findings in acute ischemia and infarction
- Edvardsen T, Aakhus S, Endresen K, Bjomerheim R, Smiseth OA, Ihlen H. Acute regional myocardial ischemia identified by 2-dimensional multiregion tissue Doppler imaging technique. J Am Soc Echocardiogr 2000;13:986–994.
- Skulstad H, Edvardsen T, Urheim S, Rabben SI, Stugaard M, Lyseggen E, Ihlen H, Smiseth OA. Postsystolic shortening in ischemic myocardium: active contraction or passive recoil? Circulation 2002;106:718–724.
- Voigt JU, Lindenmeier G, Exner B, et al. (2003). Incidence and characteristics of segmental post-systolic longitudinal shortening in normal, acutely ischemic and scarred myocardium.
- Kukulski T, Jamal F, Herbots L, D’Hooge J, Bijnens B, Hatle L, De Scheerder I, Sutherland GR. Identification of acutely ischemic myocardium using ultrasonic strain measurements. A clinical study in patients undergoing coronary angioplasty. J Am Coll Cardiol 2003;41:810–819.
- Grenne B, Eek C, Sjoli B, Dahlslett T, Uchto M, Hol PK, Skulstad H, Smiseth OA, Edvardsen T, Brunvand H. Acute coronary occlusion in non-ST-elevation acute coronary syndrome: outcome and early identification by strain echocardiography. Heart 2010;96:1550–1556.
Determining the transmurality of infarction
- Becker M, Hoffmann R, Kuhl HP, Grawe H, Katoh M, Kramann R, Bucker A, Hanrath P, Heussen N. Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction. Eur Heart J 2006;27:2560–2566.
- Altiok E, Tiemann S, Becker M, et al. Myocardial deformation imaging by two-dimensional speckle-tracking echocardiography for prediction of global and segmental functional changes after acute myocardial infarction: a comparison with late gadolinium enhancement cardiac magnetic resonance. Journal of the American Society of Echocardiography 2014, 27(3):249-57.
- Gjesdal O, Hopp E, Vartdal T, Lunde K, Helle-Valle T, Aakhus S, Smith HJ, Ihlen H, Edvardsen T. Global longitudinal strain measured by two-dimensional speckle tracking echocardiography is closely related to myocardial infarct size in chronic ischaemic heart disease. Clin Sci (Lond). 2007 Sep;113(6):287-96.
- Voigt JU, Exner B, Schmiedehausen K, Huchzermeyer C, Reulbach U, Nixdorff U, Platsch G, Kuwert T, Daniel WG, Flachskampf FA. Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 2003;107:2120–2126.
- Roes SD, Mollema SA, Lamb HJ, van der Wall EE, de Roos A, Bax JJ. Validation of echocardiographic two-dimensional speckle tracking longitudinal strain imaging for viability assessment in patients with chronic ischemic left ventricular dysfunction and comparison with contrast-enhanced magnetic resonance imaging. Am J Cardiol 2009;104:312–317.
- Lyseggen E, Skulstad H, Helle-Valle T, Vartdal T, Urheim S, Rabben SI, Opdahl A, Ihlen H, Smiseth OA. Myocardial strain analysis in acute coronary occlusion: a tool to assess myocardial viability and reperfusion. Circulation 2005;112:3901–3910.
Value of GLS in long term outcome
- Munk K, Andersen NH, Terkelsen CJ, et al. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention. Journal of the American Society of Echocardiography 2012, 25(6):644-51
- Ersboll M, Valeur N, Mogensen UM, Andersen MJ, Moller JE, Velazquez EJ, Hassager C, Sogaard P, Kober L. Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction. J Am Coll Cardiol 2013;61:2365–2373.