The Value of Assessing Myocardial Deformation at Recovery after Dobutamine Stress Echocardiography

Abstract

BackgroundThe purpose of this study was to evaluate whether performing an assessment of myocardial deformation using speckle tracking imaging during the recovery period after dobutamine stress echocardiography (DSE) allows detection of significant coronary artery disease (CAD) in patients with chest discomfort.MethodsDSE and coronary angiography were performed in 44 patients with chest discomfort. The mean global longitudinal peak systolic strain (GLS) was measured at rest, at low stress (dobutamine infusion rate of 10 µg/kg/min) and at recovery (5 min after cessation of dobutamine infusion) of DSE using automated function imaging with apical views. Fractional flow reserve (FFR) was also performed in patients with intermediate coronary stenosis. CAD was defined as having a ≥ 70% diameter stenosis on coronary angiography or as having a FFR < 0.8. Patients were divided two groups based on the absence or presence of CAD [CAD (-) group vs. CAD (+) group].ResultsThere were no significant differences in the clinical characteristics and results of conventional echocardiography between the two groups. GLS at recovery was lower in the CAD (+) group than in the CAD (-) group (-18.0 ± 3.4% vs. -21.0 ± 1.9%, p = 0.003). The optimal cutoff of GLS at recovery for detection of CAD was -19% (sensitivity of 70.6%, specificity of 83.3%).ConclusionAssessment of GLS at recovery of DSE is a reliable and objective method for detection of CAD. This finding may suggest that systolic myocardial stunning remains even after recovery of wall motion abnormalities in patients with CAD.

The Value of Speckle Tracking Strain Imaging at Recovery Period of Dobutamine Stress Echocardiography

“…In this study the amplitude cutoffs of GLS & GCS for the prediction of significant CAD at recovery period of DSE is lower when compared with rest with high diagnostic accuracy, similar result from Hui-Jeong Hwang, et al [26] for GLS, Patricia et al [27] for CS. Therefore, the values of speckle tracking Imaging GLS and GCS at recovery period of DSE may be offer useful method for prediction of significant CAD and added to the test to aid inexperienced interpreter of wall motion analysis.…”

“…In this study, the sensitivity of newly developed WMA at peak stress for detection of CAD was similar to Hui-Jeong Hwang, et al [26].…”

“…Several recent advances have been made focusing on quantitative methods for assessment, improved image quality and enhanced portability, however, evidence on the effectiveness and clinical utility of these enhancements is limited [21]. Hui-Jeong Hwang et al [26] suggest that systolic stunning after a transient ischemic event persists and that assessment by GLS during the recovery period allows this phenomenon to be objectively and quantitatively assessed.…”

Systolic longitudinal strain correlates with visual assessment of regional left ventricular function during dobutamine stress echocardiography and discriminates the segments with induced contractility impairment

“…Our group reported prolonged post‐stress impairment of GLS in diabetic patients without significant coronary artery stenoses which may reflect abnormal myocardial mechanics . Among the few published studies, Hwang et al . proposed cutoff value for absolute GLS of <19% at recovery stage of DSE for the detection of significant coronary artery disease (CAD).…”

“…Our group reported prolonged post-stress impairment of GLS in diabetic patients without significant coronary artery stenoses which may reflect abnormal myocardial mechanics. 16 Among the few published studies, Hwang et al 19 proposed cutoff value for absolute GLS of <19% at recovery stage of DSE for the detection of significant coronary artery disease (CAD). The change between peak-dose and low-dose GLS during dipyridamole stress test was postulated diagnostic for the detection of single-vessel CAD and superior to conventional wall-motion assessment.…”