New concept of myocardial longitudinal strain reserve assessed by a dipyridamole infusion using 2D-strain echocardiography: the impact of diabetes and age, and the prognostic value

Abstract

AimsAlthough dipyridamole is a widely used pharmacological stress agent, the direct effects on myocardium are not entirely known. Diabetic cardiomyopathy can be investigated by 2D-strain echocardiography. The aim of this study was to assess myocardial functional reserve after dipyridamole infusion using speckle-tracking echocardiography.MethodsSeventy-five patients referred for dipyridamole stress myocardial perfusion gated SPECT (MPGS) were examined by echocardiography to assess a new concept of longitudinal strain reserve (LSR) and longitudinal strain rate reserve (LSRR) respectively defined by the differences of global longitudinal strain (GLS) and longitudinal strain rate between peak stress after dipyridamole and rest. Twelve patients with myocardial ischemia were excluded on the basis of MPGS as gold standard.ResultsMean LSR was −2.28±2.19% and was more important in the 28 (44%) diabetic patients (−3.27±1.93%; p = 0.001). After multivariate analyses, only diabetes improved LSR (p = 0.011) after dipyridamole infusion and was not associated with glycaemic control (p = 0.21), insulin therapy (p = 0.46) or duration of the disease (p = 0.80). Conversely, age (p = 0.002) remained associated with a decrease in LSR. LSSR was also correlated to age (p = 0.005). Patients with a LSR < 0% have a better survival after 15 months (log-rank p = 0.0012).ConclusionLSR explored by 2D speckle-tracking echocardiography after dipyridamole infusion is a simple and new concept that provides new insights into the impact of diabetes and age on the myocardium with a potential prognostic value.

The prognostic role of myocardial strain indices and dipyridamole stress test in renal transplantation patients

“…The potential prognostic role of DIPSEinduced changes has not been previously reported. It has been suggested that DIPSE could serve as a means to assess the systolic and diastolic reserve of myocardial function in these patient groups [40][41][42]. Currently, we showed that DIPSE-induced changes at baseline in selected indices such as GLS, GRS, and LVEF were associated with deterioration of these indices at follow-up.…”

“…36 DIPSE has been traditionally used to assess myocardial ischemia and CFR 4-6 but it has been suggested that it could be also used as a stress test to assess the systolic and diastolic cardiac function. [40][41][42] Currently, we showed that DIPSE-induced changes at baseline in selected indices such as GLS, GRS, and LVEF were associated with deterioration of these indices at follow-up. To our knowledge, this is the first study to describe in detail the effects of DIPSE on various indices of LV deformation besides GLS.…”

“…39 DIPSE has been traditionally used to assess myocardial ischemia and CFR 4-6 but it has been suggested that it could be also used as a stress test to assess the systolic and diastolic cardiac function. [40][41][42] Currently, we demonstrated in RT patients that dipyridamole caused a significant increase in heart rate (ie, 25%-…”

Impaired coronary microcirculation is associated with left ventricular diastolic dysfunction in end‐stage chronic kidney disease patients

“…This effect may be related to the attenuated change in LV stroke volume in patients with CFR < 1.5 following dipyridamole and a worse LV diastolic function profile (ie, increased E / E ' and left atrial volume) in these patients suggesting an impaired cardiac performance reserve. Apart from CFR measurement that is derived following dipyridamole administration, it has been suggested that the dipyridamole stress echocardiography could be also be used as a stress test to assess the systolic and diastolic cardiac function reserve . Myocardial performance index is considered as an indicator of combined LV systolic and diastolic function and has been associated with clinical prognosis in various cardiac conditions .…”

Coronary microvascular dysfunction and myocardial contractile reserve in women with angina and no obstructive coronary artery disease

“…Global longitudinal strain (GLS) is a marker of future cardiovascular adverse events in both community-based cohorts and in patients with existing cardiovascular disease. 18,19 Global longitudinal strain (GLS) reserve measured by dipyridamole-induced stress is a novel measure that gives insight into the LV contractile reserve with potential prognostic value, 20 and measurement of GLS reserve has been introduced in guidelines for the clinical use of stress echocardiography. 21 We investigated whether CMD was associated with LV systolic and diastolic function assessed by echocardiographic parameters at rest and during dipyridamole-induced stress in women with angina and no obstructive CAD.…”