Speckle tracking echocardiography (STE) is a method of quantitative assessment of myocardial function complementary to ejection fraction and visual evaluation. Standard STE analysis, demands manual tracing of the myocardium whereas automated function imaging (AFI) offers more convenient (based on selection of three points) assessment of longitudinal strain. Nevertheless, feasibility and correlation between both methods were not thoroughly examined, especially during tachycardia at peak stage of dobutamine stress echocardiography (DSE). We performed DSE in 238 patients (pts) with recording of apical views during baseline (0) and peak (1) DSE and analyzed them by STE and AFI. According to angiography, 127/238 pts had significant (≥70 %) lesions in coronary arteries. We assessed correlations between STE and AFI derived peak systolic longitudinal strain values for global and regional parameters, feasibility, time of analysis and interobserver agreement. Global systolic longitudinal strain measured during baseline and peak stage of DSE by AFI showed very good correlation with standard STE parameters, with correlation coefficients r = 0.90 and r = 0.86 respectively (p < 0.0001). For regional parameters correlation coefficients ranged from 0.83 to 0.85 for baseline and from 0.70 to 0.79 for peak DSE. Both methods provided good and similar feasibility with only 1 % segments excluded from analysis at peak stage of DSE with shorter time and lower coefficient of variance offered by AFI. Global and regional longitudinal strain achieved by faster and less operator-dependent AFI method correlate well with standard more time-consuming STE analysis during baseline and peak stage of DSE.

ORIGINAL ARTICLE Effect of sex on the diagnostic efficacy of dobutamine stress echocardiography... 105INTRODUCTION Coronary artery disease (CAD) and its complications remain the leading cause of premature mortality in men and women. Diagnosis and treatment of CAD requires use of a wide range of methods and is associated with significant costs.1-4 Sex differences are observed in diagnosis, prognosis, and treatment of cardiovascular diseases, particularly with regards to the incidence of risk factors, diastolic function, and the outcomes of interventions. 5-11 Lower diagnostic accuracy of the exercise stress test in women with CAD has been well-documented by a meta-analysis including more than 24,000 patients. It showed the sensitivity and specificity of 68% and 77%, respectively, in men, and only 61% and 70% in women.12 According to the concept of the ischemic cascade, a decrease in perfusion and impaired myocardial contractility precedes both ischemic electrocardiographic (ECG) changes and angina, which is consistent with the advantages ORIGINAL ARTICLEEffect of sex on the diagnostic efficacy of dobutamine stress echocardiography with early atropine administration in the detection of coronary artery disease

Isolated critical stenosis of left main coronary artery (LMCA) due to atherosclerosis is very rare and affects about 0.2% of patients. We present the case of a 39-year-old, non-smoker women with risk factors for diseases of the cardiovascular system in the form of hypercholesterolaemia and hypertension, in addition to positive family history and chronic oral contraception. Sick from occurring since atypical angina masked depressive symptoms, with a critical stenosis of LMCA and little suggestive symptoms of ischaemia because of the existing collateral circulation.

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