Diagnostic utility of two‐dimensional speckle tracking echocardiography to identify ischemic etiology of left ventricular systolic dysfunction

Abstract

Background The differentiation between dilated cardiomyopathy (DCM) and systolic dysfunction caused by coronary artery disease (CAD) based on clinical and echocardiographic presentation can be difficult in some cases. Aim Our study aimed to define differences in myocardial function between patients with ischemic and nonischemic etiology of reduced left ventricular ejection fraction using 2D speckle tracking echocardiography (STE). Material and methods We retrospectively analyzed 90 patients (mean age 65 ± 11 years, 70% male) with de novo diagnosed reduced left ventricular ejection fraction (≤45% as determined by the transthoracic echocardiography), who were referred for coronary angiography to determine the presence of significant CAD. On the basis of coronary angiography results, patients were divided into two subgroups as follows: 45 subjects with significant CAD (group A) and 45 subjects without CAD (group B). Acquired transthoracic echocardiographic images were assessed off‐line using 2DSTE. In each patient, we calculated arithmetic mean, median value, and standard deviation of regional longitudinal strain and strain rate of 18 left ventricular segments. Results Standard deviation of the regional peak early diastolic strain rate was significantly higher in group A than in group B (P = 0.01). The cutoff value with the highest diagnostic value was >0.37/s—its sensitivity and specificity for the diagnosis of CAD were 73% and 53%, respectively. The remaining parameters did not differ significantly between the study groups. Conclusions Patients with systolic dysfunction resulting from CAD have significantly more heterogeneous regional longitudinal early diastolic strain rate assessed by 2DSTE than patients with DCM.

The value of 2D speckle-tracking strain echocardiography in evaluating the relationship between carotid elasticity and left ventricular systolic function in patients with diabetic nephropathy

“…It can predict severe coronary artery disease (CAD) in women with normal LV function [ 17 ]. It can be used to identify the ischemic etiology of LV systolic dysfunction [ 18 ]. The study by Atici et al showed that GLS (global longitudinal strain) evaluated through 2D-STE is a potential method for predicting CAD in patients with non-ST-segment elevation myocardial infarction [ 19 ].…”

Exploring speckle‐tracking echocardiography for the assessment of diastolic function: A step in the right direction

“…The remaining parameters as mentioned above did not differ significantly in the study groups. The area under the ROC curve was 0.64 (95% CI 0.5315–0.7381 and P = 0.018), with rather limited sensitivity and specificity for diagnosis of obstructive CAD, that is, 73% and 53%, respectively . Clearly, the concept is novel, and the results are provocative/exciting and perhaps hypothesis‐generating.…”

“…The area under the ROC curve was 0.64 (95% CI 0.5315-0.7381 and P = 0.018), with rather limited sensitivity and specificity for diagnosis of obstructive CAD, that is, 73% and 53%, respectively. 11 Clearly, the concept is novel, and the results are provocative/exciting and perhaps hypothesis-generating. The idea to discern the etiology of heart failure (ischemic vs nonischemic) needs to be further studied/…”