Введение. Спекл-трекинг в В-режиме (СТЭ) позволяет получить ценную информацию о региональных нарушениях функции левого желудочка (ЛЖ), а использование СТЭ при стрессэхокардиографии с добутамином (ДСЭ) позволяет намного эффективнее диагностировать ишемию миокарда.Цель. Изучить диагностическую точность спекл-трекинга в В-режиме (СТЭ) при проведении стресс-эхокардиографии с добутамином (ДСЭ) у пациентов с подозрением на ИБС по сравнению с коронарной ангиографией (КАГ).Материалы и методы. Мы проспективно обследовали 140 пациентов (84 (60,0%) мужчины) с подозрением на ИБС. Всем была выполнена СТЭ-ДСЭ перед КАГ.Результаты. Средняя ФВ ЛЖ составляла 54,4±15,8%. Гемодинамика на протяжении проведения ДСЭ у пациентов значимо не страдала (15 (12,9%) случаев суправентрикулярных и желудочковых нарушений ритма низких градаций транзиторного характера, купировавшихся спонтанно в большинстве случаев).Количество положительных результатов ДСЭ составило 116 (82,9%), в том числе 2 (1,7%) ложноположительных. Также было 2 (8,3%) ложно-негативных результата: однососудистые незначимые (50–70%) поражения с хорошо развитыми коллатералями. По итогам теста и КАГ выполнено 96 (82,3%) вмешательств по реваскуляризации миокарда – 86 (89,6%) ПТКА и 10 (10,4%) А(М)КШ.Чувствительность и специфичность результатов ДСЭ с СТЭ относительно КАГ составили 98,3% и 91,7% соответственно, с очень высокой общей точностью метода (AUC=0,98) и отношением рисков (OR=627,0, p<0,0001). Чувствительность и специфичность ДСЭ с СТЭ относительно определения показаний к вмешательству составили 97,9% и 91,7% соответственно, с высокой общей точностью (AUC=0,95; OR=564,0, p<0,0001). Комбинированная оценка ΔGLS и ΔИЛС относительно выявления ишемии миокарда показала более низкую достоверную чувствительность 86,2% (р=0,0002) и специфичность 80,4% (р=0,0064) при более низкой интегральной точности методики (AUC 0,83, р<0,0001).Заключение. СТЭ-ДСЭ – безопасный оптимальный метод диагностики ишемии и оценки жизнеспособности и коронарного резерва у пациентов с подозрением на ИБС. Учитывая более низкую точность оценки ΔGLS и ΔИЛС по сравнению с данными общего результата теста ДСЭ с СТЭ, а также частый прирост стрейна у значительного количества пациентов с положительной пробой при диагностике ишемии и оценке коронарного резерва рекомендуется оценка общего результата теста, а не динамики значений стрейна. Introduction. Two-dimensional speckle tracking (STE) provides valuable information regarding regional left ventricle (LV) myocardial function. STE during dobutamine stress-echocardiography (DSE) significantly increases diagnostic effectiveness of myocardial ischemia.Purpose. To study the diagnostic accuracy of B-mode speckle tracking (STE) during dobutamine stress-echocardiography (DSE) in patients with CAD suspicion compared to coronary angiography (CAG).Materials and methods. We prospectively studied 140 patients (84 (60.0%) men) with CAD suspicion – all of them underwent STE-DSE before CAG.Results. The average LV EF was 54.4±15.8%. Hemodynamics during DSE did not alter significantly (15 (12.9%) cases of supraventricular and ventricular transitory low-grade arrhythmia, stopping spontaneously in most cases).There were 116 (82.9%) positive DSE results, including 2 (1.7%) false positive cases. In addition, there were 2 (8.3%) false negative results: 1-vessel insignificant lesions (50–70%) with well-developed collaterals. According to STE-DSE and CAG results, 96 (82.3%) revascularization interventions were performed – 86 (89.6%) PCI’s and 10 (10.4%) CABG surgeries.Sensitivity and specificity of STE-DSE results were 98.3% and 91.7%, respectively, with very high general method accuracy (AUC=0.98) and odds ratio (OR=627.0, p<0.0001). Sensitivity and specificity of STE-DSE results regarding the definition of indications for revascularization intervention were 97.9% and 91.7%, respectively, with high general accuracy (AUC=0.95; OR=564.0, p<0.0001). Combined quantification of ΔGLS and ΔWMSI regarding primary ischemia diagnosis showed significantly lower sensitivity 86.2% (р=0.0002) and specificity 80.4% (р=0.0064) with significantly lower integral method accuracy (AUC 0.83, р<0.0001).Conclusion. STE-DSE is a safe optimal method for diagnostics of myocardial ischemia, as well as for myocardial viability and coronary reserve evaluation in patients with CAD suspicion. Taking into account significantly lower accuracy of ΔGLS and ΔWMSI quantification if compared to integral STE-DSE test result, as well as frequent GLS growth during the test in significant proportion of patients with CAD, we recommend evaluating general test result, but not the GLS dynamics during diagnostics of primary ischemia and coronary reserve evaluation.
The aim of the work was to evaluate STE feasibility as DSE visualization method and its accuracy compared to coronary angiography (CAG) in the patients with moderate-tohigh coronary arteries disease (CAD) risk. Materials and methods: We prospectively examined 140 pts (84 (60.0%) men) with suspected CAD in order to verify diagnosis and evaluate myocardial viability and coronary reserve. Results: Mean LV EF was 54.4±15.8%. All pts had normal BP and HR during the test. There were no significant hemodynamics alterations during the test. There were no significant complications during DSE – 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%) pts 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%) pts underwent revascularization interventions – 86 (89.6%) PCI’s and (10.4%) CABG surgeries. Sensitivity and specificity of DSE with STE for primary CAD diagnosis according to “golden standard” CAG results were 98.3% and 91.7%, respectively, with identical positive and negative predictive value and very high method overall accuracy (AUC = 0.98) and 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% (р=0.0002) and specificity 80.4% (р=0.0064) with significantly lower integral method accuracy (AUC 0.83, р<0.0001). Conclusions: DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis and myocardial viability and coronary reserve evaluation in the pts with CAD suspicion. Given the lower ΔGLS and ΔWMSI accuracy compared to integral DSE with STE result evaluation, as well as frequent GLS growth in significant amount of patients with definite positive test result, authors recommend evaluating integral test result rather than strain value.
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