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European Heart Journal Advance Access published online on October 11, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl288
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received January 2, 2006
Revised September 10, 2006
Accepted September 14, 2006

Clinical research

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

Michael Becker 1, Rainer Hoffmann 1 *, Harald P. Kühl 1, Helena Grawe 1, Markus Katoh 2, Rafael Kramann 1, Arno Bücker 2, Peter Hanrath 1, and Nicole Heussen 3

1 Medical Clinic I, University Hospital RWTH Aachen, Pauwelsstraße 30, 52057 Aachen, Germany
2 Department of Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52057 Aachen, Germany
3 Department of Medical Statistics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52057 Aachen, Germany

* To whom correspondence should be addressed.
Rainer Hoffmann, E-mail: rhoffmann{at}ukaachen.de


  Abstract

Aims Pixel tracking-derived myocardial deformation imaging is a new echocardiographic modality which allows quantitative analysis of segmental myocardial function on the basis of tracking of natural acoustic markers in 2D echocardiography. This study evaluated whether myocardial deformation parameters calculated from 2D echocardiography allow assessment of transmurality of myocardial infarction as defined by contrast-enhanced cardiac magnetic resonance imaging (ceMRI).

Methods In 47 patients with ischaemic left ventricular dysfunction, transmurality of myocardial infarction was assessed using pixel-tracking-derived myocardial deformation imaging and ceMRI. For each left ventricular segment in a 16-segment model, peak systolic radial strain, circumferential strain, radial strain rate, and circumferential strain rate were calculated from parasternal 2D echocardiographic views using an automatic frame-by-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound). Myocardial deformation parameters were related to the segmental extent of hyperenhancement by ceMRI. The relative amount of contrast-enhanced myocardial tissue per segment was used to define no infarction (0% hyperenhancement), non-transmural infarction (1-50% hyperenhancement), or transmural infarction (51-100% hyperenhancement).

Results Analysis of myocardial deformation parameters was possible in 659 segments (88%). Systolic strain and strain rate parameters decreased with increasing relative hyperenhancement defined by ceMRI. Radial strain was 27.7 ± 8.0, 20.5 ± 9.7, and 11.6 ± 8.5% for segments with no infarction (n = 422), non-transmural infarction (n = 106), and transmural infarction (n = 131), respectively (P < 0.0001). Radial strain allowed distinction of non-transmural infarction from transmural infarction with a sensitivity of 70.0% and a specificity of 71.2% (cut-off value for radial strain 16.5%).

Conclusion 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.

Keywords: Echocardiography; Magnetic resonance imaging; Myocardial infarction; Viability.
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