Dobutamine Stress Echocardiography with B-Mode Speckle Tracking in Patients after Acute Coronary Syndromes: Diagnostic and Prognostic Value

Keywords: coronary arteries disease, acute coronary syndrome, speckle tracking, stress echocardiography

Abstract

 

Background. Speckle tracking echocardiography (STE) provides valuable data on myocardial function. STE during dobutamine stress echocardiography (DSE) allows reliable myocardial ischemia diagnosis.

Aim. To evaluate STE during DSE in patients with coronary artery disease (CAD) after acute coronary syndrome (ACS) and its accuracy in ischemia diagnosis, assessment of myocardial viability and coronary reserve. Methods. We examined 58 patients (55 [94,8 %] men and 3 [5,2 %] women) men) with CAD after ACS admitted to our Institute for defining indications for coronary interventions. All the patients underwent DSE with STE for longitudinal strain quantification.

Results. Mean left ventricular ejection fraction (LVEF) was 52.4±5.8%. Significant CAD according to coronary angiography (CAG) prior to DSE was proved in 38 (65.5%) patients. All the patients had a history of ACS up to 12 years before the examination (38 [65.5%] patients after percutaneous coronary intervention (PCI), including 18 [31.0%] primary PCI; 9 [15.5%] patients after coronary artery bypass grafting (CABG); 3 [5.2%] after graft PCI, 1 [1.72%] patient after aortic valve replacement (AVR) with dilated cardiomyopathy (DCM) phenotype). There were no significant complications during DSE: 5 (8.6%) cases of relatively low grade transient arrhythmia with no need for intervention. As per DSE results, we performed 35 (60.3%) revascularization interventions: 31 (58.6%) PCI’s and 4 (6.9%) CABG procedures with good outcomes. It was shown that DSE with STE sensitivity and specificity were 89.7% and 94.7% (AUC 0.92), respectively, with positive and negative predictive values of 97.2% and 81.8%, respectively, with extremely high OR 157.5, p<0.0001. Combined quantification of ΔGLS and ΔWMSI showed insignificantly lower sensitivity (86.3% [p=0.57]) and specificity (87.8% [p=0.19]) vs. integral semiquantitative ischemia markers with significantly lower overall method accuracy (AUC 0.79, p=0.047).

Conclusions. DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis, as well as for myocardial viability and coronary reserve assessment in patients with CAD after ACS with the aim of risk stratification and defining indications for interventions and myocardial revascularization.

References

  1. Лазоришинець ВВ, Коваленко ВМ, Руденко АВ, Іванів ЮА, Бешляга ВМ, Поташев СВ та ін. Визначення загального стандарту для 2D-спекл-трекінг ехокардіографії. Кардіологія та кардіохірургія: безперервний професійний розвиток. 2019;(2):105-29.
  2. Lazoryshynets VV, Kovalenko VM, Rudenko AV, Ivaniv YA, Beshlyaga VM, Potashev SV, et al. [Definition for 2D-speckle tracking echocardiography general standard]. Cardiology and cardiac surgery: continuous professional development. 2019;(2):105-29. Ukrainian. https://doi.org/10.30702/ccs.201905.02.2DST105129
  3. Aggeli C, Felekos I, Tousoulis D, Gialafos E, Rapti A, Stefanadis C. Myocardial mechanics for the early detection of cardiac sarcoidosis. Int J Cardiol. 2013;168(5):4820-1. https://doi.org/10.1016/j.ijcard.2013.07.010
  4. Aggeli C, Lagoudakou S, Felekos I, Panagopoulou V, Kastellanos S, Toutouzas K, Roussakis G, et al. Two- dimensional speckle tracking for the assessment of coronary artery disease during dobutamine stress echo: clinical tool or merely research method. Cardiovascular Ultrasound. 2015 Oct 24;13:43. https://doi.org/10.1186/s12947-015-0038-z
  5. Biering-Sørensen T, Jensen JS, Pedersen SH, Galatius S, Fritz-Hansen T, Bech J, et al. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction. PLoS ONE. 2016;11(6):e0158280. https://doi.org/10.1371/journal.pone.0158280
  6. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation. 2002;105(4):539-42. https://doi.org/10.1161/hc0402.102975
  7. Fujimoto H, Honma H, Ohno T, Mizuno K, Kumita S. Longitudinal Doppler strain measurement for assessment of damaged and/or hibernating myocardium by dobutamine stress echocardiography in patients with old myocardial infarction. J Cardiol. 2010 May;55(3):309-16. https://doi.org/10.1016/j.jjcc.2009.12.013
  8. Hanekom L, Cho GY, Leano R, Jeffriess L, Marwick TH. Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation. Eur Heart J. 2007;28(14):1765-72. https://doi.org/10.1093/eurheartj/ehm188
  9. Huang SJ, Orde S. From speckle tracking echocardiography to torsion: research tool today, clinical practice tomorrow. Curr Opin Crit Care. 2013;19(3):250-7. https://doi.org/10.1097/MCC.0b013e32836092b7
  10. Joyce E, Hoogslag GE, Al Amri I, Debonnaire P, Katsanos S, Bax JJ, et al. Quantitative Dobutamine Stress Echocardiography Using Speckle-Tracking Analysis versus Conventional Visual Analysis for Detection of Significant Coronary Artery Disease after ST-Segment Elevation Myocardial Infarction. J Am Soc Echocardiogr. 2015;28(12):1379-89.e1. https://doi.org/10.1016/j.echo.2015.07.023
  11. Keddeas VW, Swelim SM, Selim GK. Role of 2D speckle tracking echocardiography in predicting acute coronary occlusion in patients with non ST-segment elevation myocardial infarction. The Egyptian Heart Journal. 2017; 69(2):103-10. https://doi.org/10.1016/j.ehj.2016.10.005
  12. Mele D, Trevisan F, D’Andrea A, Luisi GA, Smarrazzo V, Pestelli G, et al. Speckle Tracking Echocardiography in Non–ST-Segment Elevation Acute Coronary Syndromes. 2019. https://doi.org/10.1016/j.cpcardiol.2019.03.007
  13. Montgomery DE, Puthumana JJ, Fox JM, Ogunyankin KO. Global longitudinal strain aids the detection of non-obstructive coronary artery disease in the resting echocardiogram. Eur Heart J Cardiovasc Imaging. 2012;13(7):579-87. https://doi.org/10.1093/ejechocard/jer282
  14. Nesbitt GC, Mankad S, Oh JK. Strain imaging in echocardiography: methods and clinical applications. Int J Cardiovasc Imaging. 2009;25 (Supll 1):9-22. https://doi.org/10.1007/s10554-008-9414-1
  15. Popović ZB, Kwon DH, Mishra M, Buakhamsri A, Greenberg NL, Thamilarasan M, et al. Association between regional ventricular function and myocardial fibrosis in hypertrophic cardiomyopathy assessed by speckle tracking echocardiography and delayed hyperenhancement magnetic resonance imaging. J Am SocEchocardiogr. 2008;21(12):1299-305. https://doi.org/10.1016/j.echo.2008.09.011
  16. Rumbinaitė E, Žaliaduonytė-Pekšienė D, Vieželis M, Čeponienė I, Lapinskas T, Žvirblytė R, et al. Dobutamine-stress echocardiography speckle-tracking imaging in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of coronary artery disease. Medicina (Kaunas). 2016;52(6):331-9. https://doi.org/10.1016/j.medici.2016.11.005
  17. Wierzbowska-Drabik K, Hamala P, Roszczyk N, Lipiec P, Plewka M, Krecki R, et al. Feasibility and correlation of standard 2D speckle tracking echocardiography and automated function imaging derived parameters of left ventricular function during dobutamine stress test. Int J Cardiovasc Imaging. 2014;30(4):729-37. https://doi.org/10.1007/s10554-014-0386-z
  18. Yang B, Daimon M, Ishii K, Kawata T, Miyazaki S, Hirose K, et al. Prediction of coronary artery stenosis at rest in patients with normal left ventricular wall motion. Segmental analyses using strain imaging diastolic index. Int Heart J. 2013;54(5):266-72. https://doi.org/10.1536/ihj.54.266
Published
2020-09-18
How to Cite
Potashev, S. V., Salo, S. V., Gavrylyshyn, A. Y., Rudenko, S. A., & Holtvian, O. M. (2020). Dobutamine Stress Echocardiography with B-Mode Speckle Tracking in Patients after Acute Coronary Syndromes: Diagnostic and Prognostic Value. Ukrainian Journal of Cardiovascular Surgery, (3 (40), 28-37. https://doi.org/10.30702/ujcvs/20.4009/031028-037