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European Heart Journal Advance Access originally published online on April 24, 2007
European Heart Journal 2007 28(9):1173-1174; doi:10.1093/eurheartj/ehm059
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction

Ze-Zhou Song

Department of Ultrasound
The First Affiliated Hospital
College of Medicine
Zhejiang University
79 Qingchun Road
Hangzhou
Zhejiang Province
Peoples Republic of China

Jing Ma

Department of Internal Medicine
Hangzhou 3rd Hospital
Hangzhou
Peoples Republic of China

Fax: +86 571 8723 6628, E-mail address: zezhou_song{at}126.com

We read with great interest the study by Becker et al.,1 which confirmed that radial strain allowed distinction of non-transmural infarction from transmural infarction with a sensitivity of 70.0% and a specificity of 71.2%, suggesting frame-to-frame tracking of acoustic markers in 2D echocardiographic images for the analysis of myocardial deformation allows discrimination between different transmurality states of myocardial infarction. The methods and interpretation of the results, however, raise several concerns:

It is well known that hypertension, hypercholesterolaemia, diabetes, chronic obstructive pulmonary disease, Graves' disease, and paroxysmal atrial fibrillation could affect LV or RV myocardial segments and global function to some extent. In this study, however, Becker et al.1 did not well describe such relevant history of the above-mentioned diseases in clinical baseline characteristics of the patients. Is there a relation of the decreased systolic strain and strain rate parameters with increasing relative hyperenhancement defined by ceMRI to the relevant history of the above-mentioned diseases? On the other hand, could the relevant history of the above-mentioned diseases affect the precise discrimination between different transmurality states of myocardial infarction by frame-to-frame tracking of acoustic markers in 2D echocardiographic images for the analysis of myocardial deformation?

It is well known that normal myocardial motion is complex, with three separate components: radial contraction, longitudinal shortening, and rotation. Myocardium has a transmural heterogeneity of contraction in normal conditions: contractility decreases from subendocardium to subepicardium, and that during a reduction of myocardial perfusion capable of inducing myocardial ischaemia, the subendocardial layer undergoes contractility impairment even in the absence of functional impairment of the subepicardial layer.2 The difference of myocardial longitudinal motion between subendocardial and subepicardial myocardium could also allow discrimination between different transmurality states of myocardial infarction. In addition, Zhang et al.3 confirmed that peak longitudinal myocardial deformation by SRI can differentiate transmural from non-transmural MI, and that it allows non-invasive determination of transmurality of the scar after MI and thereby the extent of non-viable myocardium. In this study by Becker et al.,1 however, myocardial longitudinal motion characteristics of the patients were not well described. Therefore, the respective and complementary value of myocardial radial contraction, longitudinal shortening, and rotation in discrimination between different transmurality states of myocardial infarction could need to be further studied.

References

  1. Becker M, Hoffmann R, Kühl HP, Grawe H, Katoh M, Kramann R, Bücker 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.[Abstract/Free Full Text]
  2. Lima JAC, Jeremy R, Guier W, Bouton S, Zerhouni EA, McVeigh E, Buchalter MB, Weisfeldt ML, Shapiro EP, Weiss JL. Accurate systolic wall thickening by nuclear magnetic resonance imaging with tissue tagging: correlation with sonomicrometers in normal and ischemic myocardium. J Am Coll Cardiol (1993) 21:1741–1751.[Abstract]
  3. Zhang Y, Chan AKY, Yu CM, Yip GWK, Fung JWH, Lam WWM, So NMC, Wang M, Wu EB, Wong JT, Sanderson JE. Strain rate imaging differentiates transmural from non-transmural myocardial infarction: a validation study using delayed-enhancement magnetic resonance imaging. J Am Coll Cardiol (2005) 46:864–871.[Abstract/Free Full Text]

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This Article
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28/9/1173-a    most recent
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