Segmental myocardial viability by echocardiography at rest

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Myocardial viability assessment is crucial for guiding treatment in ischemic heart disease.
• Established echocardiographic parameters like post-systolic shortening (PSS), strain, strain rate, and wall motion score (WMS) are used to evaluate myocardial segments.
• The study hypothesizes that akinetic and PSS-absent segments indicate non-viable myocardium.

Purpose of the Study:

• To determine if echocardiographic measurements of PSS, strain, strain rate, and WMS can identify viable myocardial segments.
• To assess the diagnostic value of these echocardiographic parameters in patients with ischemic heart disease.

Main Methods:

• A feasibility study involving 26 echocardiographic examinations with visible myocardial dysfunction.
• Assessment of WMS, strain (speckle tracking), and strain rate (tissue Doppler).
• Comparison with late gadolinium-enhanced cardiovascular magnetic resonance (scar >50% by volume) as the reference standard.

Main Results:

• Wall motion score (WMS) showed a Kappa coefficient of 0.43 (sensitivity 99%, specificity 35%).
• Strain imaging yielded a Kappa coefficient of 0.28 (sensitivity 98%, specificity 23%).
• Combining PSS with WMS or strain in akinetic segments resulted in low Kappa coefficients (0.06 and 0.08, respectively).

Conclusions:

• Systolic function is the primary indicator of segmental myocardial viability.
• Post-systolic shortening (PSS) does not add significant value to the assessment of myocardial viability when using current echocardiographic methods.