Time to onset of regional relaxation: feasibility, variability and utility of a novel index of regional myocardial function by strain rate imaging

Objectives Time to onset of regional relaxation (TR) has been proposed as a novel index of regional myocardial function. This study sought to prospectively establish the feasibility and variability of TR in healthy volunteers (CONTROL) and to examine its utility in patients with inducible ischemia (PATIENT). Background Strain rate imaging (SRI) depicts myocardial deformation and enables quantitation of regional myocardial function with high temporal and spatial resolution. Thus, regional mechanical events can be accurately timed with SRI. The time point of regional transition from contraction to relaxation is altered in pathologic states. Methods Resting mean segmental TR was determined in 60 subjects: 20 in the CONTROL group and 40 in the PATIENT group. TR was also measured at peak dobutamine stress in the PATIENT group. An automated image analysis program determined the time point of transition from regional contraction to relaxation activity, and calculated TR, defined as the time, in milliseconds, from the electrocardiogram R-wave to this transition point. Results Automated TR measurements were feasible in more than 90% of the segments in CONTROL and PATIENT groups. Mean TR was 353 ± 24 ms and was shorter in the mid segments compared to apical and basal segments. Intra- and interobserver variability were low (6% and 9%, respectively). In the PATIENT group, the percent decrease in TR during dobutamine stress was significantly higher in normal compared to ischemic segments (30% vs. 19%, respectively, P = 0.01). A percent change >20% in TR identified patients with an ischemic response during dobutamine infusion (sensitivity 92%, specificity 75%). Conclusions TR, a novel quantitative index of regional myocardial function, can be determined with low variability and satisfactory feasibility in routine clinical settings. Percent change in TR identifies ischemic segments during dobutamine stress echocardiography (DSE) and may allow quantitative assessment of DSE.