Velocity vector imaging in assessing myocardial systolic function of hypertensive patients with left ventricular hypertrophy

BACKGROUND: To date, most studies about strain and strain rate (SR) are based on Doppler tissue imaging (DTI), which is dependent on the angle between ultrasonic scan line and tissue. Velocity vector imaging (VVI) is a new echocardiographic method based on two-dimensional gray scale imaging, which is angle-independent and can provide more information about cardiac function than DTI. OBJECTIVES: To assess regional myocardial SR in hypertensive patients with left ventricular hypertrophy (LVH) but normal global ejection fraction (GEF) and fractional shortening (FS) using VVI. METHODS: Using VVI, two-dimensional images were performed in 20 hypertensive patients with LVH and 20 normal control subjects. The segmental systolic peak SR (SRs) in the short-axis view and the apical SRs in the long-axis view were analyzed by offline software. RESULTS: The segmental SRs in the long-axis and short-axis views were significantly lower in the LVH group than in the corresponding segments of the control group. There was no significant difference between the circumferential SRs of different segments in the short-axis view in the LVH and control groups. The circumferential SRs decreased significantly from the endocardium to the middle layer of the myocardium in the short-axis view in the LVH group and in the control group. CONCLUSIONS: Hypertensive patients with LVH may have regional LV systolic function impairment despite having normal GEF and FS. The GEF and FS were not the decisive factors of myocardial systolic function in the present study. There was an obvious systolic gradient from the endocardium to the middle layer of myocardium in circumferential SRs in the short-axis view. VVI can be used to accurately recognize and quantify abnormalities of regional myocardial deformation.     

Quantitative assessment of left ventricular systolic function in patients with coronary heart disease by velocity vector imaging

Objective: To assess the left ventricular (LV) longitudinal systolic function and asynchrony in patients with coronary atherosclerotic heart disease (CAD) by syngo velocity vector imaging (VVI). Methods: Twenty‐eight control subjects and 79 patients with CAD were examined, including 28 patients with myocardial infarction, 26 patients with coronary lumen stenosis <50%, and 25 patients with myocardial ischemia. According to the results of coronary arteriography and electrocardiogram (ECG), the myocardial segments of the LV of CAD patients were divided into four groups: ischemic, infarcted, nonischemic, and normal. Dynamic imaging was performed on all subjects. The systolic peak strain (Smax), systolic strain rate (SRmax), time to peak strain (PTs), and time to peak strain rate (PTsr) in every cardiac cycle were measured. Results: A total of 1,253 out of 1,712 (96.5%) segments were successfully analyzed with VVI. Smax and SRmax of the ischemic and infarcted segments were impaired in CAD patients. Optimal sensitivity and specificity were obtained with strain and strain rate cutoffs of ?14.08% and ?0.83 s^?1, respectively, for detecting ischemic segments and ?6.65% and ?0.38 s^?1, respectively, for detecting infarcted segments. The PTs and PTsr were significantly longer in the ischemic and infarcted segments compared to those of the control group. Conclusions: Utilizing VVI, the longitudinal strain, strain rate, and peak time in CAD patients are easy to obtain and reproducible. Strain and strain rate cutoff values of abnormal myocardium are valuable for detecting ischemia and infarction. The PTs and PTsr values possibly estimate myocardium asynchrony in CAD patients. (Echocardiography 2012;29:340‐345)     

速度向量成像技术评价心肌梗死患者左室壁非同步性运动的初步探讨

目的:运用速度向量成像(VVI)技术评价心肌梗死患者左心室壁节段心肌运动的同步性。方法:对15例正常人和8例心肌梗死患者进行VVI,测量左心室局部心肌纵向运动达峰时间(TL-V)及径向运动达峰时间(TR-V),计算纵向、径向运动达峰时间差(T-SD)及最早与最迟达峰时间标准差(T-MX)。结果:①正常心脏各节段间TL-V及TR-V差异无统计学意义。②心肌梗死节段TL-V、TR-V较非梗死节段及对照组显著延长(P<0.05);与对照组比较,心肌梗死组纵向运动T-SD和T-MX、径向运动T-SD和T-MX均显著增大(均P<0.05)。结论:VVI技术有望成为评价心肌梗死患者左心室壁非同步性运动及判断梗死节段的有效方法。     

利用QTVI技术评价心肌梗死患者局部收缩功能

目的 :超声评价三支病变的心肌梗死患者局部收缩功能。方法 :超声测量 3 0例心肌梗死患者 (MI组 )和 3 0例正常人 (control组 )局部心肌各时相的峰值速度 (Sm 、Em、Am)、收缩期应变率峰值(SRS)、最大时间 速度积分 (TVImax)以及最大应力 (εmax)、二尖瓣最大下移距离 (D)。结果 :心肌梗死患者局部Sm、Em、Am 、TVImax、εmax、SRS 和D均较对照组明显下降。对照组应变率曲线较一致 ,而梗死组较杂乱。结论 :三支病变的心肌梗死患者局部收缩功能明显减低 ,其中TVImax和D是评价局部收缩功能的良好指标     

定量组织速度成像评价冠状动脉内支架植入术对左室心肌局部功能的影响

目的　应用定量组织速度成像 (QTVI)技术评价急性心肌梗死 (AMI)病人支架术对左室心肌各节段舒缩功能的影响。方法　用QTVI技术获取 2 0例正常人和 2 4例急性前壁心肌梗死病人左室心尖 3个长轴切面6个室壁各节段心肌长轴方向的同步运动曲线 ,测量 12个节段心内膜下心肌的VS、VE和VA。结果　正常和缺血状态下 ,长轴方向主要的心肌运动速度从基底向心尖都明显减低。AMI支架术后 3d与术前比较 ,各部位的VS、VE都无显著差异 ;目测评分正常且冠脉造影回旋支有病变的患者 ,心尖四腔观基底段和中间段的VS显著降低。术后 3个月与术前比较 ,运动恢复节段的VS、VE都有明显升高 ,运动未恢复节段的VS无显著差异 ,而VE有升高趋势且差异显著。结论　QTVI技术能同步定量定位分析左室局部心肌功能 ,判断室壁运动较目测评分法更准确 ;冠脉内支架植入术能明显改善远期左室局部心肌功能 ,尤以舒张功能改善显著     

Treatment with ramipril improves systolic function even in patients with mild systolic dysfunction and symptoms of heart failure after acute myocardial infarction

Background: Clinical signs of heart failure such as pulmonary rales and dyspnea, ventricular dysfunction, and ventricular arrhythmia are independent predictors of a poor prognosis after acute myocardial infarction (AMI). Hypothesis: The study aimed to assess the effect of ramipril treatment on mildly depressed left ventricular (LV) systolic function, assessed by atrioventricular (AV) plane displacement in patients with congestive heart failure after AMI. Methods:The study was a substudy in the Acute Infarction Ramipril Efficacy Study, a double-blind, randomized, placebo-controlled trial of ramipril versus placebo in patients with symptoms of heart failure after AMI. In all, 56 patients were included in the main study, 4 refused to participate in the substudy, and 4 were excluded for logistical reasons. Echocardiography was performed at entry and after 6 months. Patients who underwent coronary artery bypass grafting during the follow-up period were excluded. Results: At baseline, the patients had modest LV dysfunction, and mean AV plane displacement of 9.7 mm. During follow-up, AV plane displacement increased in ramipril-treated patients from 9.5 to 10.9 mm (p < 0.01). No statistically significant changes were seen in the placebo group. Conclusions: Ramipril improves LV systolic function in patients with clinical signs of heart failure and only modest systolic dysfunction after AMI. Measurement of AV plane displacement is a simple and reproducible method for detection of small changes in systolic function and may be used instead of ejection fraction in patients with poor image quality.     

平衡法门控心血池显像评价不同分级前壁心肌梗死患者左室收缩及舒张功能

目的我们应用平衡法门控心血池显像技术对不同Killip分级的前壁心肌梗死患者进行左室总体和局部收缩和舒张功能参数的对比分析。方法对照组15例（G0）,前壁心肌梗死KillipⅠ级17例（G1）,前壁心肌梗死KillipⅡⅢ级12例（G2）。利用平衡法门控心血池显像技术评价3组的左室总体和局部的收缩与舒张功能。结果①左室整体收缩功能,在LVEF,ESC 2个参数中,G1比G0有显著差异（P<0.05）,G2分别比G1和G0有显著差异（P<0.05）。在PER、1/3EF、1/3ER 3个参数中,G2分别比G1和G0显著下降（P<0.05）。②左室总体舒张功能,在PFR、1/3FF、1/3FR、EDC中,G1比G0有显著差异（P<0.05）,G2分别比G1和G0有显著差异（P<0.05）。③左室局部收缩功能,在以LVREF为参数时,G1在4个节段比G0显著差异（P<0.05）,G2在所有6个节段中比G1和G0均显著下降（P<0.05）。④左室局部舒张功能,在以LVR1/3FF为参数时,G1在4个节段比G0显著下降（P<0.05）,G2在所有6个节段比G0和G1均显著下降（P<0.05）。结论前壁心肌梗死后出现心功能受损或心力衰竭的主要原因为左室重构。     

Quantitative assessment of myocardial acceleration in normal left ventricle with velocity vector imaging

Background: Application of two-dimensional myocardial acceleration map derived from tissue Doppler imaging is limited by inherent angle dependency and substantial reader variability in the visualization of the origin of ventricular activation site. In this study we investigated the characteristics of myocardial acceleration in normal left ventricular (LV) walls with velocity vector imaging (VVI). Methods: VVI was applied to the parasternal short-axis two-dimensional echocardiographic images at basal, mid, and apical levels of the LV in 30 normal volunteers. Peak acceleration during early systole (ACC_s) and time to ACC_s (TACC_s) were calculated for each segment of the standard 16-segment model. Results: The time point of onset of active myocardial contraction corresponding to the QRS complex could not be determined in 409 (85.21%) of all 480 segments. No significant differences were found in TACC_s among different LV levels and walls. In LV-free walls, there were no significant differences in ACC_s among different LV levels and walls. Conclusions: The time point of onset of myocardial active contraction during early systole cannot be determined in most of normal myocardial segments. Also, there is homogeneity of the time to early systolic peak acceleration in the whole normal LV walls. Myocardial acceleration seems to have limited potential in the assessments of the site of initial electrical stimulation and the sequence of ventricular depolarization.     

应变率成像对急性前壁心肌梗死冠脉介入治疗后左室局部收缩功能的评价

目的运用应变率成像（SRI）技术定量评价急性前壁心肌梗死患者经皮冠状动脉介入术（PCI）前后梗死相关血管供血区域局部收缩功能。方法对62例急性前壁心肌梗死患者行PCI术。血管开通后无复流13例（无复流组）,心肌灌注良好49例（灌注组）。分别于PCI术前、术后3d、1个月及6个月测量左前降支参与供血的9个室壁节段的沿长轴收缩期应变率（SR）并与术前比较,确定异常节段。结果两组各时点sR降低,灌注组术后不同时间点的SR均显著高于无复流组,绝大多数心肌节段SR较术前增加,且随着时间的推移,其SR逐渐增加;无复流组术后3d及1个月除极少数节段SR降低外,其他节段心肌SR与术前无明显差异;术后6个月部分心肌节段SR较术前及术后3d有所增加。结论SRI可动态观察急性前壁心肌梗死PCI术前、术后梗死相关血管供血区域心肌收缩功能,间接评估心肌灌注情况。     

Use of velocity vector imaging technology to evaluate the motion of myocardial infarction

Background The velocity vector imaging is an ultrasound speckle imaging that was recently developed,which is based on the two-dimensional gray scale image,with more accurate tracking process and more convenient and time-saving operation method can quantitatively displays the varied curve of myocardial velocity and direction sampling taking from multiple parts in one cardiac cycle by tracking the space motion of echo spots of the cardiovascular tissue,and then analyze their movements,avoiding the angular dependence and the limitations of analysis section that could effect on Doppler technology.The technology provides a new auxiliary method for the diagnosis and treatment of cardiovascular disease and is valuable on clinical diagnosis and scientific research and a wide horizon of development.     

Quantitative systolic and diastolic transmyocardial velocity gradients assessed by M-mode colour Doppler tissue imaging as reliable indicators of regional left ventricular function after acute myocardial infarction.

AIMS: The aim of this study was to determine whether myocardial velocity gradients assessed by M-mode colour Doppler tissue imaging could be of clinical relevance and represent reliable indicators of regional left ventricular function after acute myocardial infarction. METHODS AND RESULTS: Among 64 consecutive patients with a first acute myocardial infarction, in 50 who had a marked asynergy in the parasternal short-axis view at the mid-papillary muscle level, myocardial velocities and velocity gradients were assessed in the anteroseptum and posterior wall by M-mode Doppler tissue imaging. Similar measurements were obtained in 11 matched healthy volunteers who served as a control group. In patients with anterior myocardial infarction, the peak myocardial velocity gradient in the anteroseptum was significantly lower when compared with controls (mean +/- [SD] 0.0 +/- 0.5 vs 1.1 +/- 0.7 s-1 during systole, P < 0.01; and 0.3 +/- 0.6 vs 2.0 +/- 0.5 s-1 during diastole, P < 0.01). Conversely, the peak systolic myocardial velocity gradient in the posterior wall was significantly higher than in controls (2.6 +/- 1.2 vs 1.8 +/- 1.2 s-1, P < 0.05). In patients with inferior myocardial infarction, the peak velocity gradient in the posterior wall was significantly lower when compared with healthy subjects (0.9 +/- 0.6 vs 1.8 +/- 1.2 s-1 during systole and 1.4 +/- 1.4 vs 4.9 +/- 1.2 s-1 during diastole, both P < 0.01). The peak systolic tissue velocity gradient in the anteroseptum was significantly higher than in controls (2.1 +/- 1.0 vs 1.1 +/- 0.7 s-1, P < 0.01). CONCLUSION: The present study indicates that myocardial velocity gradients assessed by M-mode Doppler tissue imaging are of clinical relevance for the characterization of ischaemic myocardial dysfunction after infarction and may provide quantitative assessment of segmental left ventricular function in this clinical setting.     

The effect of carvedilol in patients with impaired left ventricular systolic function following an acute myocardial infarction

In previous beta-blocker trials, post-myocardial infarction (MI) patients were essentially treated with a beta-blocker or placebo. In the CAPRICORN trial, patients were selected on the basis of a left ventricular (LV) ejection fraction (EF) <40% following the index MI and randomised to carvedilol or placebo, in addition to modern secondary prophylaxis with ACE inhibitors, aspirin and statins. In 1959 patients with a mean LVEF of 33%, treatment with carvedilol over a mean follow-up period of 15 months reduced total mortality from 15.3% with placebo to 11.9% with carvedilol [relative risk reduction (RRR) =23%, absolute risk reduction (ARR) =3.4%]. The incidence of recurrent MI was reduced from 5.8 to 2.3% (RRR 41%, ARR 2.3%). The number needed to treat (NNT) to prevent one death was 28 for the entire study period and 43 for 1 year of treatment. The results of the CAPRICORN trial are compared with three previous beta-blocker post-MI trials: the Gothenburg metoprolol trial (GMT), the Norwegian timolol trial (NTT) and the beta-blocker heart attack trial (BHAT). The RRRs for total mortality were 36% in the GMT and NTT, and 27% in BHAT. The respective NNTs for total mortality were 32, 18 and 38. NNT for 1 year of treatment was 25 in NTT and 80 in BHAT. The RRR for recurrent MIs were 28% in NTT and 16% in BHAT. The reduction of mortality and recurrent MIs in CAPRICORN is within the range of previous post-MI beta-blocker studies. In post-MI patients with LVEF<40%, add-on treatment with a beta-blocker should be given >48 h after initiation with an angiotensin-converting enzyme inhibitor (ACEI) and then with a slow dose escalation as applied in CAPRICORN.     

Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications

AIMS: To characterise the prevalence, in-hospital complications, management, and long-term outcome of patients with congestive heart failure but preserved left ventricular systolic function after acute myocardial infarction. METHODS: 3166 consecutive patients screened for entry in the Bucindolol Evaluation in Acute Myocardial Infarction Trial with definite acute myocardial infarction and echocardiographic assessment of left ventricular systolic function were included between 1998 and 1999 in this prospective observational study. Main outcome measures were occurrences of in-hospital complications and all cause mortality. RESULTS: Congestive heart failure was seen during hospitalisation in 1464 patients (46%), 717 patients had preserved left ventricular systolic function (wall motion index > or =1.3 corresponding to ejection fraction > or =0.40), and 732 patients had systolic dysfunction (wall motion index <1.3). One year mortality in patients with no heart failure, heart failure with preserved systolic function, and heart failure with systolic dysfunction were 6, 22 and 35%, P<0.0001. Unadjusted risk of death from all causes associated with heart failure and preserved systolic function was 3.3 (95% CI 2.8-4.0), and after adjustment for baseline characteristics and left ventricular systolic function in multivariate Cox proportional hazards analysis the risk was 2.1 (95% CI 1.7-2.6), P<0.0001. CONCLUSIONS: Congestive heart failure is frequently present in patients with preserved left ventricular systolic function, and is associated with increased risk of in-hospital complications and death following acute myocardial infarction.     

实时三平面组织追踪成像定量评价心肌梗死患者左心室长轴位移

目的:应用实时三平面组织追踪成像(Triplane-TTI)技术定量评价心肌梗死(MI)患者二尖瓣瓣环及左心室各节段心肌收缩期位移特点。方法:单纯左前降支MI患者17例(B组),左旋支或(和)右冠支MI患者19例(C组),包含左前降支病变的双支或多支患者23例(D组),健康志愿者25例作为对照组(A组)。采集Triplane-TTI图像,分析获得各室壁房室平面收缩期最大位移(AVPD)及各节段心肌收缩期最大位移(Dmax)。结果:B、C、D3组平均AVPD与A组比较均减低,D组尤为显著(P0.05)。B组下侧壁、下壁及后间隔位点,C组前间隔及前壁位点AVPD虽然减低,但与A组比较差异不具有统计学意义。A组同一水平各节段心肌Dmax差异不明显,同一室壁从基底段、中间段至心尖段Dmax逐渐减低,呈梯度变化。B、C、D 3组Dmax不同程度减低,与A组比较及3组间比较大部分心肌节段差异均具有统计学意义(P0.05)。AVPD和Dmax减低室壁与梗死相关冠状动脉供血区域基本符合。结论:对于心肌梗死患者应多位点测量AVPD,避免高估或低估;Dmax能准确反映MI患者左心室局部心肌收缩功能的变化。     

急性前壁心肌梗死不同形态的ST段抬高与梗死面积和左心室收缩功能的关系

目的 :观察急性前壁心肌梗死 (AAMI)患者急性期心电图ST段抬高形态与心肌梗死面积和左心收缩功能的关系。方法 :根据入院时心电图V3 导联ST段抬高的不同形态将 6 2例首次住院的AAMI患者分为 3组 :A组 (ST段呈弓背向下抬高 ) 18例 ,B组 (ST段呈斜坡状抬高 ) 2 7例 ,C组 (ST段呈弓背向上抬高 ) 17例 ;测定3组患者血清肌酸磷酸激酶 (CPK)峰值和左室射血分数 (LVEF)。结果 :A组患者血清CPK峰值明显低于B组和C组 ,差异有统计学意义 (P值分别 <0 .0 5、<0 .0 1) ,B组和C组比较 ,CPK峰值有显著性差异 (P <0 .0 5 ) ;A组患者LVEF明显高于B组和C组 ,差异有统计学意义 (P值分别 <0 .0 5、<0 .0 1) ,B组和C组比较 ,LVEF亦有显著性差异 (P <0 .0 5 )。结论 :AAMI早期V3 导联ST段抬高的不同形态可以反映心肌缺血性损伤的严重程度 ,对预测梗死心肌范围和心脏功能有一定的价值。     

应用速度向量成像技术评价胎儿右心室功能

目的:探讨速度向量成像技术在正常胎儿右心室功能评价中的临床应用价值。方法:采集62例正常胎儿动态标准四腔心切面,应用速度向量成像技术脱机分析右室游离壁及室间隔右室面共6个节段的速度、应变、应变率来反映胎儿右心室的收缩及舒张功能,并观察各项指标随孕周的变化趋势。结果:各组心肌收缩期峰值速度(Vs)及舒张期峰值速度(Vd)由基底段至心尖段逐渐减低(P<0.05),而各节段心肌收缩期峰值应变(S)、应变率(SRs)和舒张期应变率(SRd)差异无统计学意义;Vs和Vd随孕周的增长而增加,而S、SRs和SRd随孕周增加差异无明显变化。结论:速度向量成像技术相关参数的测量为临床提供非常有价值的诊断依据,速度向量成像技术可定量检测胎儿右心室的功能,为临床有效地评估胎儿心功能开辟了新的途径。     

Plasma atrial natriuretic peptide is related to systolic but not diastolic myocardial function: Determination by echocardiography 24 h after myocardial infarction

The relationship between plasma ANP and systolic and diastolicleft ventricular myocardial function, as determined by echocardiography,was investigated Thirty-one patients were examined 24 h afteronset of acute myocardial infarction. The systolic parametersmeasured were: wall motion index (WMI), ejection fraction, systolicvolume index and diastolic volume index. Diastolic functionwas evaluated by mitral flow analysis and isovolumic relaxationtime. The following parameters were measured in the mitral flow:peak velocity of early flow, peak velocity of atrial flow, theearlylatrial ratio, deceleration rate of the early flow andatrial filling fraction. A blood sample was drawn from eachpatient for ANP analysis at the same time as the echocardiographicexamination. A correlation between plasma-ANP and systolic functionwas found (ejection fraction: r= –060, P<0001; systolicvolume index: r=0.68, P<0.001; diastolic volume index: r=0.47,P<001; WMI: r= – 0.42, P<0.05) whereas no correlationwas found between any of the diastolic parameters and plasmaANP (P>010 for all the variables). We conclude that thereis a significant correlation between plasma ANP and systolicfunction, as evaluated by echocardiography 24 h after AMI, whereasthere was no corresponding relationship between plasma ANP anddiastolic function.     

核素心室造影评价不同部位心肌梗死患者的左室整体和局部功能

目的应用放射性核素心室造影技术对不同部位的左室心肌梗死（MI）患者进行左室整体和局部收缩和舒张功能参数的对比分析。方法选择对照组15例、下壁MI组24例、前壁MI组29例,利用放射性核素心室造影技术评价3组的左室整体和局部的收缩与舒张功能参数。结果①左室整体收缩功能,在左室射血分数和峰射血率二个参数中,下壁MI组与对照组相比有显著下降（P<0.05）,前壁MI组与对照组和下壁MI组相比,分别有显著下降（P<0.05）。②左室整体舒张功能,在峰充盈率和前1/3充盈分数二个参数中,前壁MI组与对照组和下壁MI组相比分别有显著下降（P<0.05）。③左室局部收缩功能,在以左室局部射血分数为参数时,下壁MI组在4个节段与对照组相比有显著下降（P<0.05）,前壁MI组在4个节段与对照组相比有显著下降（P<0.05）,前壁MI组在2个节段比下壁MI组有显著下降（P<0.05）。④左室局部舒张功能,在以LVR1/3FF为参数时,下壁MI组和前壁MI组分别与对照组相比在4个节段上有显著下降（P<0.05）,前壁MI组在2个节段上比下壁MI组有显著下降（P<0.05）。结论前壁MI对左室整体和局部收缩与舒张功能的损害重于下壁MI。     

Global and regional myocardial function quantification in Takotsubo cardiomyopathy in comparison to acute anterior myocardial infarction using two-dimensional (2D) strain echocardiography

Aims: This study sought to compare global and regional myocardial function in Takotsubo cardiomyopathy (TC) to that in acute anterior myocardial infarction (AMI) using 2D strain imaging. Methods: Twelve consecutive patients with TC (ten women, two men) and 12 patients with AMI (four women, eight men) underwent 2D echocardiography at initial presentation. 2D strain images were analyzed to measure longitudinal and radial strain. Global strain was calculated as the average longitudinal strain of the segments of two‐, three‐, and four‐chamber views. Biplane ejection fraction was assessed using Simpson's biplane method. Results: Significant differences in radial strain (TC vs. AMI) were found in lateral (13.5 ± 10.1% vs. 25.1 ± 11.2%, P = 0.035), posterior (15.2 ± 14.5% vs. 51.4 ± 14.2%, P < 0.001), and inferior (17.9 ± 15.5% vs. 49.4 ± 16.9%, P = 0.002) segments. Longitudinal strain was significantly lower in TC in basal‐inferior (?15.8 ± 9.2% vs. ?22.7 ± 3.8%, P = 0.037), midinferior (?8.3 ± 9.2% vs. ?16.8 ± 3.0%, P = 0.004), basal‐posterior (?12.2 ± 9.4% vs. ?21.6 ± 4.4%, P = 0.016), midposterior (?4.4 ± 8.0% vs. ?15.4 ± 3.5%, P = 0.002), apical‐posterior (2.3 ± 6.7% vs. ?6.4 ± 10.1%, P = 0.023), and midlateral (?3.4 ± 6.9% vs. ?9.5 ± 5.8%, P = 0.028) segments. Global strain and ejection fraction were significantly higher in patients with AMI (?3.5 ± 8.2% vs. ?10.3 ± 8.4%, P < 0.001 and 37 ± 11% vs. 46 ± 11%, P = 0.045). Conclusion: In TC, strain was reduced around the entire mid left‐ventricular circumference, whereas in AMI it was predominantly reduced in the anterior and anteroseptal wall. These observed differences confirm the notion that TC affects myocardium beyond the territory of a single coronary artery. They may allow noninvasive distinction between both entities. (Echocardiography 2011;28:715‐719)