Evaluation of site, transmurality and extension of ischemic myocardial scar is very important in clinical practice for the study of left ventricular (LV) remodeling and recognition of non-viable myocardial territories, both for prognostic classification of patients to start a cardiac resynchronization therapy and to guide left catheter implantation of biventricular pacemaker. Speckle tracking echocardiography (STE) has the ability to recognize, using segmental analysis of LV, individual myocardial segments with transmural ischemic scar, but there isn’t information on its ability to quantify full extension of transmural...

We studied 13 patients with history of ischemic myocardial heart failure (HF). Selection criteria were: execution of cardiac MR after 6 months from HF; within 1 week of cardio MR, execution of STE. Patients without evidence of transmural scar were excluded from the examination with cardio MR. Cardio MR images were analyzed using Segment software; coloured bull's eye maps were generated to identify distribution of myocardial scar. These maps had to isolate area of transmural scar, defined as having >=80% of thickness of entire myocardial...

STE correctly identified site of transmural myocardial scar in all patients examined. The 2 techniques showed a significant correlation of 0.67. Bland-Altman analysis showed no presence of over/underestimating by STE in comparison with cardio MR.

STE is able to accurately identify site and extension of ischemic transmural scar. Preliminary data are encouraging, and will be confirmed in a larger population of patients, but they already show advantage of being able to adequately assess LV remodeling and to guide implantation of biventricular pacemaker, also in patients who can not be evaluated with cardio MR.

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