Background: myocardial ischemia or infarction is usually assessed with 2-D echocardiography by detecting the segmental wall motion abnormalities.
With the introduction of color Doppler myocardial imaging (CDMI), it is currently possible to noninvasively quantify in-plane myocardial deformation (regional strain).
Objective: To assess and validate 2 Dimensional long axis myocardial strains for detection of myocardial ischemia.
Patients and methods: This study included 40 patients categorized into two groups, Group A that included 30 patients with significant coronary artery disease and no visual segmental wall motion abnormalities, who underwent coronary angiography within 6 months before inclusion in the study, their age ranged between 40-60 years, and Group B that included 10 patients with chest pain and normal coronary angiography, age matched with group A as a control group. All of these patients were subjected to full history taking, physical examination, resting 12 leads ECG, coronary angiography and trans-thoracic echocardiography (conventional 2D echo. and 2D myocardial strain).
Results: There is significant reduction in 2D long axis myocardial strains in mid anterior septal, mid inferior septal, mid inferior, apical anterior, apical septal and apex in patients have significant LAD disease in compare with control group (Group B)(p value <0.01), while in patients with significant right coronary artery disease, there is significant reduction on 2D myocardial strains at basal anterior, basal inferior septal, basal inferior, mid inferior septal, mid inferior & apical lateral segments compared to Group B(p<0.01). In patients with both significant LAD & RCA, there is significant reduction on 2D strains at basal anterior, basal anterior septal, basal inferior septal, basal inferior, basal posterior lateral, mid anterior, mid anterior septal, mid inferior septal, mid inferior, mid anterior lateral, apical anterior, apical septal and apical lateral segments compared to control group.
The sensitivity of 2D myocardial strains for detection of coronary artery disease was 89.6% and specifity 63.6%.
Conclusions: long axis 2D myocardial strain is a good diagnostic tool for diagnosis of coronary artery disease in compared to usual diagnostic wall motion scoring.
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