Why the study?
Myocardial viability assessment aids therapeutic decision-making in ischemic heart disease, but whether established echocardiographic measurements of post-systolic shortening, strain, strain rate, and wall motion score can identify viable segments was unclear.
Does echocardiographic assessment of post-systolic shortening, strain, and wall motion score accurately detect myocardial viability compared to CMR in patients with ischemic heart disease?
Does echocardiographic assessment of post-systolic shortening, strain, and wall motion score accurately detect myocardial viability compared to CMR in patients with ischemic heart disease?
Post-systolic shortening assessed by echocardiography does not add value to standard systolic function assessment for determining segmental myocardial viability.
PSS adds no value to echo viability assessment; leaves open whether refined parameters warrant larger validation studies.
BACKGROUND: Myocardial viability assessment adds value to the therapeutic decision-making of patients with ischemic heart disease. In this feasibility study, we investigated whether established echocardiographic measurements of post-systolic shortening (PSS), strain, strain rate and wall motion score (WMS) can discover viable myocardial segments. Our hypothesis is that non-viable myocardial segments are both akinetic and without PSS. METHODS: The study population consisted of 26 examinations strictly selected by visible dysfunction. We assessed WMS, strain by speckle tracking and strain rate by tissue Doppler. The segments (16*26 = 416) were categorized into either normokinetic/hypokinetic or akinetic/dyskinetic and whether there was PSS. The reference method was the presence of scar with segmental percentage volume scar fraction >50%, detected by late gadolinium-enhanced cardiovascular magnetic resonance. Agreement with echocardiography was evaluated by Kappa coefficient. RESULTS: WMS had Kappa coefficient 0.43 (sensitivity 99%, specificity 35%). Kappa coefficient of strain was 0.28 (sensitivity 98%, specificity 23%). By combining PSS in akinetic segments with WMS and strain, the Kappa coefficient was 0.06 and 0.08 respectively. CONCLUSION: Segmental viability was best shown by the presence of systolic function. Post-systolic shortening adds no value to the assessment of segmental myocardial viability.
No takes yet. Share an insight, caveat, or question.
Halvorsrød et al. (2023) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:
More on EchocardiographyMore from Scandinavian Cardiovascular Journal