Revascularization in patients with coronary artery disease and left ventricular (LV) dysfunction is known to improve LV function, heart failure symptoms and prognosis. Unfortunately, only a low percentage of revascularized patients show LV reverse remodeling. So, a pre-procedural assessment of MV is required. Transthoracic echocardiography (TTE) is more easily available and feasible modality and some studies suggest that strain measurements could serve as markers of viability.

The aim of this study was to evaluate the value of multilayer strain analysis to the assessment of myocardial viability (MV) through the comparison of both speckle tracking echocardiography and single photon emission computed tomography (SPECT) imaging. We also intended to determine which segmental longitudinal strain (LS) cut-off value would be optimal to discriminate viable myocardium.

We included 47 patients (average age 61±11 years) referred to our cardiac imaging center for MV evaluation. All patients underwent TTE with measures of LS, SPECT and coronary angiography.

Sven hundred and ninety-nine segments were analyzed. We correlated myocardial tracer uptake by SPECT with subendocardial, subepicardial and mean segmental LS values with a r=0.514 P<0.0001, r=0.501 P<0.0001 and r=0.520 P<0.0001, respectively. The measurements of each layer strain (subendocardial, subepicardial and mean) had the same performance to predict MV viability as defined by SPECT with areas under curve of 0.819 [0.778–0.861, P<0.0001], 0.809 [0.764–0.854, P<0.0001] and 0.817 [0.773–0.860, P<0.0001], respectively (Fig. 1). The receiver-operating characteristic analysis yielded a cut-off value of −6.5% for mean segmental LS with a sensitivity of 76% and specificity of 76% to predict segmental MV as defined by SPECT.

Multilayer strain analysis does not evaluate MV with more accuracy than standard segmental LS analysis.