Longitudinal two-dimensional strain for the diagnosis of left ventricular segmental dysfunction in patients with acute myocardial infarction

  • Amnon Eitan
  • Izhak Kehat
  • Diab Mutlak
  • Gershom Lichtenberg
  • Dina Amar
  • Yoram Agmon
Original Paper


The objectives of this study were to assess whether 2-dimensional strain (2DS) can detect left ventricular (LV) segmental dysfunction and to compare the diagnostic accuracy of various 2DS parameters. Multiple segmental longitudinal 2DS parameters were measured in 54 patients with a first myocardial infarction and single vessel coronary artery disease (age: 56 ± 11 years, 74% men, LV ejection fraction: 47 ± 10%, left anterior descending artery occlusion in 63%) and 14 age-matched subjects. 2DS parameters were compared to visual assessment of segmental function by multiple observers. Using receiver-operating characteristics analysis, the area under the curve (AUC) for peak systolic strain in diagnosing segmental dysfunction (akinetic or hypokinetic LV segments) and for diagnosing akinetic segments was 0.85 (95% confidence interval 0.83–0.88) and 0.88 (0.85–0.90), respectively (all P values < 0.001). Other 2DS strain parameters had similar (peak strain, peak strain rate) or lower (post-systolic shortening, time-to-peak strain, diastolic 2DS parameters) AUC values. An absolute value of peak systolic strain <16.8% (25th percentile in normal subjects) had high sensitivity (0.89) and negative predictive values (0.88), but low specificity (0.55) and positive predictive values (0.59) for diagnosing segmental dysfunction. Similar findings were observed using a cutoff of <13.3% (absolute value of 10th percentile) for diagnosing akinetic segments. Diagnostic accuracy was significantly worse for segments in which visual segmental assessment was discordant between observers. In conclusion, 2DS can be used to diagnose segmental LV dysfunction with high sensitivity but limited specificity. The diagnostic limitation of 2DS is partially related to the visual echocardiographic definition of segmental abnormality.


Echocardiography Left ventricle Myocardial infarction Two-dimensional strain 





Two-dimensional strain


Aortic valve closure


Coronary artery disease


Infarct-related artery


Left anterior descending


Left ventricle/ventricular


Myocardial infraction


Negative predictive value


Positive predictive value


Post systolic shortening


Strain rate


Wall motion abnormality/abnormalities



This study was not funded.

Compliance with ethical standards

Conflict of interest

All authors declares that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving animal participants

This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Echocardiography Laboratory and Heart Valves Clinic, Department of Cardiology, Rambam Health Care Campus, Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael

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