Strain and Strain Rate Echocardiography and Coronary Artery Disease

T he echocardiographic assessment of regional myocardial function plays a critical role in the diagnosis and management of ischemic heart disease and in most laboratories relies on the visual detection of endocardial wall motion abnormalities and assessment of left ventricular (LV) ejection fraction.However, this approach is subjective and operator dependent, demands complete visualization of the endocardium, and is subject to the vicissitudes of cardiac loading and heart rate.Although estimation of myocardial shortening and thickening reflect the radial mechanics of the heart, the contribution of longitudinal (and to a lesser extent circumferential) myocardial deformation is largely neglected.Thus, there is a need for an objective, comprehensive, noninvasive measurement of myocardial performance and contractility with acceptable interpretative variability.Doppler tissue imaging, which measures the velocity of myocardium (in the longitudinal direction from apical windows and in the radial direction from short-axis scans) during systole and diastole is used to quantify ventricular function and is more sensitive to subtle changes in contractility than ejection fraction. 1However, tissue velocities are affected by translational movement and tethering, making it difficult to discriminate akinetic segments that are pulled (or tethered) from actively contracting segments. 2In addition, velocities are not uniformly distributed across the myocardium, decreasing from base to apex, making difficult the establishment of reference values.Measurements of myocardial strain and strain rate (SR) are newer indices that have the potential to overcome these limitations.Strain and SRs represent the magnitude and rate, respectively, of myocardial deformation, which is an energyrequiring process that occurs in both systole and diastole.Abnormalities of myocardial deformation are seen early in the development of many pathophysiologic states, including ischemia, and thus provide a sensitive means for detecting regional myocardial dysfunction.The objective of this report is to review the use of strain and SR echocardiography in patients with coronary artery disease.