Changes in Three-Dimensional Speckle-Tracking–Derived Myocardial Strain during Percutaneous Coronary Intervention

Background The aim of this study was to evaluate changes in three-dimensional (3D) speckle-tracking–derived myocardial strain during ischemia. Methods Twenty patients referred for percutaneous coronary intervention were studied (mean age, 65 ± 11 years; mean left ventricular ejection fraction, 56 ± 7%). Of the 20 study patients, 12 had severe left anterior descending coronary artery stenosis. A full-volume apical view using multibeat 3D modality and two-dimensional (2D) apical views (four chamber, two chamber, and three chamber) were recorded during coronary occlusion before wall motion abnormalities. After percutaneous coronary intervention, ultrasound contrast agent was selectively delivered through the target lesion to delineate ischemic and peri-ischemic segments (ischemia-adjacent segments). Strain values derived from 2D and 3D speckle-tracking echocardiography were compared in ischemic and nonischemic segments. Results Despite no changes in wall motion and 2D left ventricular ejection fraction (56 ± 7% vs 56 ± 7%), global longitudinal strain by 2D imaging was impaired during percutaneous coronary intervention (−16 ± 3% vs −14 ± 3%, P = .01). Similar changes were observed for all 3D strain components: −11 ± 16% for longitudinal (−15 ± 4% vs −13 ± 4%, P = .03), −13 ± 25% for circumferential (−15 ± 4% vs −12 ± 4%, P = .02), −12 ± 16% for area (−25 ± 5% vs −22 ± 6%, P = .009), and −12 ± 25% for radial global strain (39 ± 12% vs 33 ± 12%, P = .04). During coronary occlusion, 2D longitudinal peak strain and all 3D peak strain components decreased in ischemic segments, while no changes was observed in nonischemic segments. In peri-ischemic segments, only 3D longitudinal and area strain were impaired during ischemia. Conclusions Changes in myocardial deformation related to ischemia can be characterized by 3D speckle-tracking echocardiography before the stage of wall motion abnormality.