Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography

Abstract

BackgroundA number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE).MethodsProspective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis.ResultsThe value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52.ConclusionsMultiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD.

Early and late diastolic strain rate vs global longitudinal strain at rest and during dobutamine stress for the assessment of significant coronary artery stenosis in patients with a moderate and high probability of coronary artery disease

“…Global and regional systolic myocardial deformation abnormalities at rest and during dobutamine stress in patients with CAD have been demonstrated in previous studies . Our study results indicate that GLS had a better predictive value than other diastolic and systolic strains and SR parameters or visual assessment.…”

“…Global and regional systolic myocardial deformation abnormalities at rest and during dobutamine stress in patients with CAD have been demonstrated in previous studies. [15][16][17][18][19][20][21][22][23][24][25][26] Our study results indicate that GLS had a better predictive value than other diastolic and systolic strains and SR parameters or visual assessment. GLS at high dobutamine doses has an AUC close to 1 and seems to be a very potent predictor of hemodynamically significant CAD.…”

Prognostic Value of Speckle Tracking Echocardiography in Patients with ST‐Elevation Myocardial Infarction Treated with Late Percutaneous Intervention

“…In recent years, new non-Doppler speckle tracking techniques were validated for quantifying regional function. 17,19,27 The reason for this difference maybe that in our study, the patients were treated with late PCI, while in prior studies, patients were treated with pPCI, and our follow-up duration was longer, i.e., 6-9 months. 10,11,17,26 LV systolic characteristics post-MI can be evaluated by STE, including the myocardium peak systolic magnitude or velocity of different directions (peak systolic strain or strain rate of longitudinal, circumferential, and radial directions), LV mechanical dyssynchrony (SD of time to peak systolic strain), and postsystolic motion (postsystolic strain); however, which parameter can more powerfully predict LVr or clinical prognosis is unknown, particularly in AMI patients treated with late PCI.…”

“…Earlier studies by Balcells et al 23 and Swinburn et al 24 showed a correlation between regional wall-motion abnormalities and the results of perfusion contrast echocardiography assessing the viability of infarcted segments. 10,11,17,26 LV systolic characteristics post-MI can be evaluated by STE, including the myocardium peak systolic magnitude or velocity of different directions (peak systolic strain or strain rate of longitudinal, circumferential, and radial directions), LV mechanical dyssynchrony (SD of time to peak systolic strain), and postsystolic motion (postsystolic strain); however, which parameter can more powerfully predict LVr or clinical prognosis is unknown, particularly in AMI patients treated with late PCI. These techniques are angle independent and can differentiate between active contraction and passive displacement; thus, they are more accurate than Doppler tissue imaging for evaluating the regional function of the LV, 25 and several studies have reported that STE can be used to predict LVr or clinical prognosis.…”

Comparison of the Efficacy of Conventional Echocardiographic Parameters in the Diagnosis of Significant Coronary Artery Stenosis

“…A number of myocardial Doppler derived velocity, strain myocardial imaging parameters and speckle tracking imaging and wall motion score index have been proposed for the quantification of myocardial ischemia during stress echocardiography (12-15). But in the routine echocardiographic examination, they all have difficulties in the early detection of the presence of myocardial ischemia to some extent, especially when angina or myocardial infarction has not yet occurred.…”