Differentiation of pseudodyskinesis of inferior left ventricular wall from inferior myocardial infarction by assessment of regional myocardial strain using two-dimensional speckle tracking echocardiography

Purpose

To differentiate pseudodyskinesis (PD) of the inferior left ventricular (LV) wall from inferior myocardial infarction (IMI) noninvasively, we performed focal site evaluation using two-dimensional speckle tracking transthoracic echocardiography (TTE).

Materials and methods

Speckle tracking TTE was carried out in 57 patients, with 19 subjects in each of three groups (Group A, suspected PD; Group B, LV IMI; and Group C, controls). Inferior wall PD was defined as follows: compression of the inferior LV wall by the diaphragm in the LV short axis view with a normal electrocardiogram and no evidence of previous ischemic events.

Results

Respective values in Groups A-C for LV ejection fraction (EF) were 63.6 ± 4.2%, 52.3 ± 7.6%, and 61.5 ± 3.8%, for inferior wall speckle tracking focal site evaluation peak radial strain of 30.0 ± 14.3%, 7.5 ± 7.1%, and 42.1 ± 22.9%, for peak circumferential strain of 23.1 ± 6.0%, 16.8 ± 8.4%, and 22.7 ± 7.1%, and for longitudinal strain in the mid-inferior wall of 18.4 ± 3.4%, 11.4 ± 4.0% and 15.8 ± 5.9%. LVEF values were significantly lower in Group B than Groups A and C (P < 0.001), as were those of radial, circumferential, and longitudinal strains (P < 0.05). In receiver-operating characteristic analysis the optimal cut-off values with corresponding sensitivities and specificities for differentiation of PD from IMI were > 19% with 84.2% and 94.7% for radial, > 15% with 89.4% and 52.6% for circumferential, and > 15% with 73.6% and 100% for longitudinal strain, respectively.

Conclusions

Determination of regional strain from speckle tracking TTE, especially radial and longitudinal strains, can provide focal and quantitative noninvasive evaluation for distinguishing PD of the inferior wall from IMI.