Longitudinal Strain by Speckle Tracking during Dobutamine Stress Echocardiography in Suspected Coronary Arteries Disease

DOI: https://doi.org/10.30702/ujcvs/20.4112/032015-025/73.7
Keywords: coronary heart disease, speckle tracking, stress echo

Abstract

Background. Speckle tracking echocardiography (STE) provides valuable information about global and regional myocardial function. STE during dobutamine stress-echocardiography (DSE) enables more reliable ischemia diagnosis.

The aim of the study was to evaluate STE feasibility as a DSE visualization method and its accuracy compared to coronary angiography (CAG) in the patients with moderate-to-high coronary arteries disease (CAD) risk.

Methods. We prospectively examined 140 patients (84 [60.0%] men and 56 [40.0%] women) with suspected CAD in order to verify diagnosis and evaluate myocardial viability and coronary reserve.

Results. Mean left ventricular ejection fraction (LVEF) was 54.4±15.8%. All the patients had normal blood pressure (BP) and heart rate (HR) during the test. There were no significant hemodynamics alterations during the test. There were no significant complications during DSE with only 15 (12.9%) cases of different relatively low grade supraventricular and ventricular arrhythmia, mainly transitory without interventions. There were 116 (82.9%) positive DSE results, of which 2 (1.72%) were false-positive. In 2 (8.3%) patients with negative DSE results, CAG revealed 1-vessel insignificant (50– 70%) lesions with developed collaterals (false-negative results). According to DSE and CAG results, 96 (82.3%) patients underwent revascularization interventions: 86 (89.6%) percutaneous coronary interventions (PCIs) and 10 (10.4%) coronary artery bypass grafting (CABG) surgery. Sensitivity and specificity of DSE with STE for primary CAD diagnosis according to the “golden standard” CAG results were 98.3% and 91.7%, respectively, with identical positive and negative predictive values and very high overall accuracy of the method (AUC = 0.98; OR = 627.0, p<0.0001). Sensitivity and specificity of DSE with STE for defining indications for intervention and revascularization were 97.9% and 91.7%, respectively, with high overall accuracy (AUC = 0.95; OR = 564.0, p<0.0001). Combined quantification of ΔGLS and ΔWMSI for primary CAD diagnosis showed significantly lower sensitivity 86.2%(p=0.0002)andspecificity80.4%(p=0.0064)withsignificantlylowerintegralmethodaccuracy(AUC0.83,p<0.0001).

Conclusions. DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis and evaluation of myocardial viability and coronary reserve in patients with suspected CAD. Given the lower ΔGLS and ΔWMSI accuracy compared to integral DSE with STE result evaluation, as well as frequent GLS growth in significant number of patients with definite positive test result, authors recommend evaluating integral test result rather than strain value.

References

  1. Lazoryshynets VV, Kovalenko VM, Rudenko AV, Ivaniv YA, Beshlyaga VM, Potashev SV, et al. [Definition for a Common Standard for 2D Speckle-Tracking Echocardiography]. Cardiology and cardiac surgery: continuous professional development. 2019;2:105-129. https://doi.org/10.30702/ccs.201905.02.2DST105129
  2. 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
  3. 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
  4. 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
  5. 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;105:539-42. https://doi.org/10.1161/hc0402.102975
  6. Choi JO, Cho SW, Song YB, Cho SJ, Song BG, Lee SC, et al. Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. Eur J Echocardiogr. 2009;10(5):695-701. https://doi.org/10.1093/ejechocard/jep041
  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. Journal of Cardiology. 2010 May;55(3):309-16. https://doi.org/10.1016/j.jjcc.2009.12.013
  8. Gong L, Li D, Chen J, Wang X, Xu T, Li W, et al. Assessment of myocardial viability in patients with acute myocardial infarction by two-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography. Int J Cardiovasc Imaging. 2013;29(5):1017-28. https://doi.org/10.1007/s10554-013-0185-y
  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. KeddeasVW,SwelimSM,SelimGK.Roleof2Dspeckletracking 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. Liang HY, Cauduro S, Pellikka P, Wang J, Urheim S, Yang EH, et al. Usefulness of two-dimensional speckle strain for evaluation of left ventricular diastolic deformation in patients with coronary artery disease. Am J Cardiol. 2006;98(12):1581-6. https://doi.org/10.1016/j.amjcard.2006.07.038
  13. MontgomeryDE,PuthumanaJJ,FoxJM,OgunyankinKO.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. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, DerumeauxG,etal.Currentandevolvingechocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr. 2011;12(3):167-205. https://doi.org/10.1093/ejechocard/jer021
  15. 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
  16. 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 Soc Echocardiogr. 2008;21(12):1299-305. https://doi.org/10.1016/j.echo.2008.09.011
  17. Sarvari S, Haugaa KH, Zahid W, Bendz B, Aakhus S, Aaberge L, et al. Layer-specific quantification of myocardial deformation by strain echocardiography may reveal significant CAD in patients with non-ST-segment elevation acute coronary syndrome. JACC Cardiovasc Imaging. 2013;6(5):535-44. http://dx.doi.org/10.1016/j.jcmg.2013.01.009
  18. 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
  19. Yu Y, Villarraga HR, Saleh HK, Cha SS, Pellikka PA. Can ischemia and dyssynchrony be detected during early stages of dobutamine stress echocardiography by 2-dimensional speckle tracking echocardiography? Int J Cardiovasc Imaging. 2013;29(1):95-102. https://doi.org/10.1007/s10554-012-0074-9
Published
2020-12-16
How to Cite
1.
Potashev SV, Salo SV, Gavrylyshyn AY, Hrubyak LM, Unitska OM, Fedkiv SV. Longitudinal Strain by Speckle Tracking during Dobutamine Stress Echocardiography in Suspected Coronary Arteries Disease. ujcvs [Internet]. 2020Dec.16 [cited 2024Dec.22];(4 (41):15-. Available from: http://cvs.org.ua/index.php/ujcvs/article/view/378
Issue
Ukrainian Journal of Cardiovascular Surgery No 4 (41) 2020
Section
ISCHEMIC HEART DISEASE