Comparison of Quantitative Wall‐Motion Analysis and Strain for Detection of Coronary Stenosis with Three‐Dimensional Dobutamine Stress Echocardiography

Abstract

Background Quantitative analysis of wall motion from three-dimensional (3D) dobutamine stress echocardiography (DSE) could provide additional diagnostic information not available from qualitative analysis. In this study we compare the effectiveness of 3D fractional shortening (3DFS), a measure of wall motion computed from 3D echocardiography (3DE), to strain and strain rate measured with sonomicrometry for detecting critical stenoses during DSE. Methods Eleven open-chest dogs underwent DSE both with and without a critical stenosis. 3DFS was measured from 3DE images acquired at peak stress. 3DFS was normalized by subtracting average 3DFS during control peak stress (Δ3DFS). Strains in the perfusion defect (PD) were measured from sonomicrometry, and PD size and location were measured with microspheres. Results A Δ3DFS abnormality indicated the presence of a critical stenosis with high sensitivity and specificity (88% and 100%, respectively), and Δ3DFS abnormality size correlated with PD size (R2=0.54). The sensitivity and specificity for Δ3DFS was similar to that for area strain (88%, 100%) and circumferential strain and strain rate (88%, 92% and 88%, 86%, respectively), while longitudinal strain and strain rate were less specific. Δ3DFS correlated significantly with both coronary flow reserve (R2=0.71) and PD size (R2=0.97), while area strain correlated with PD size only (R2=0.67), and other measures were not significantly correlated with flow reserve or PD size. Conclusion Quantitative wall motion analysis using Δ3DFS is effective for detecting critical stenoses during DSE, performing similarly to 3D strain, and provides potentially useful information on the size and location of a perfusion defect.

Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon: A Study of Speckle Tracking Echocardiography

“…They found that the discriminative power for the detection of regional myocardial abnormality was highest for circumferential strain with automated function imaging. In another study, Parker et al performed a dobutamine stress echocardiography study for the detection of critical stenoses and compared the efficacy of 3D fractional shortening measured by 3D echocardiography with strain and strain rate obtained from sonomicrometry. Similar sensitivity, specificity, and area under the curve values were found for 3D fractional shortening, area strain, and circumferential strain and strain rate, but those for longitudinal strain and strain rate were found to be less specific.…”

Four‐dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis

“…The developed tools of automated analysis of three‐dimensional stress echocardiography may provide useful quantitative and objective parameters to assist the clinical expert in the diagnosis of left ventricular function . Four‐dimensional echocardiography area strain, the fractional change in the area of the sonomicrometer triangle (Area ES ‐Area ED )/Area ED , equal to longitudinal strain multiplication by circumferential, was a novel strain parameter comprehensively derived from longitudinal strain and circumferential strain, has incremental value for the diagnosis of CAD in patients or animal model with severe coronary artery stenosis at rest . But the diagnosis value of area strain in patients with mild coronary artery stenosis remained uncertain.…”

Value of Resting Echocardiographic Findings and Dobutamine Stress Echocardiography for Diagnosing Myocardial Ischemia in Patients with Suspected Angina Pectoris

“…The MYDISE (myocardial Doppler in stress echocardiography) study has achieved the improvement in sensitivity by means of tissue Doppler‐derived quantitative DSE. Whether other quantitative analysis such as two‐dimensional or three‐dimensional strain rate imaging can complement the sensitivity of DSE is still controversial. In the present study, a THC score of ≥2 on baseline echocardiography can predict the presence of myocardial ischemia with a sensitivity of 64% and a specificity of 65%.…”