Role of left ventricle deformation analysis in stress echocardiography for significant coronary artery disease detection: A diagnostic study meta‐analysis

Abstract

Background We compared the diagnostic accuracy of longitudinal strain (LS) imaging during stress echocardiography with visual assessment of wall motion (WM) for detecting significant coronary artery disease (CAD). Methods Our systematic search included studies reporting diagnostic measures for LS imaging and visual assessment of WM for detecting significant CAD during stress echocardiography. Summary diagnostic accuracy measures including area under the curve (AUC), sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios (LRs) were estimated. Results In thirteen studies with 978 patients, ten studies used invasive coronary angiography as the reference standard. Pooled AUC for diagnosing significant CAD was 0.92 (95% confidence interval [CI] 0.89–0.94) for LS imaging as compared to 0.83 (95% CI 0.80–0.86), P < 0.001 for visual assessment of WM. LS imaging had higher sensitivity (88% [95% CI 84–92] vs 74% [95% CI 68–80], P < 0.001) and comparable specificity to visual assessment of WM (80% [95% CI 72–87] vs 83% [95% CI 74–90], P = 0.592). The DOR for LS imaging and visual assessment of WM was 31 and 15, P = 0.254, respectively. The positive LR was 4.5 for both; negative LR was 0.14 and 0.31, P = 0.002 for LS imaging and visual assessment of WM, respectively. Conclusions Longitudinal strain imaging during stress echocardiography has better diagnostic accuracy for detecting significant CAD as compared to visual assessment of WM. Studies using larger sample size and standardized techniques of strain measurement are required to further ascertain the added advantage of strain measurement over visual assessment alone.

Speckle Tracking Stress Echocardiography on Treadmill in Assessment of the Functional Significance of the Degree of Coronary Artery Disease

“…В недавно опубликованном мета-анализе K. Gupta и соавт. [25] показано, что анализ деформации миокарда во время стресс-ЭхоКГ выполним и обладает более высокой диагностической точностью для выявления клинически значимой ИБС по сравнению с визуальной оценкой только НЛС. По нашим данным, в группе пациентов с выраженным стенозом КА наблюдалось снижение ГПСД ЛЖ по сравнению с исходной, хотя оно и не достигало статистической значимости (17,8±2,8 в сравнении с 15,9±4,6 %; р=0,15).…”

“…[11], так и по данным мета-анализа K. Gupta и соавт. [25], были выше, чем полученные нами. Вероятно, это обусловлено особенностями стресс-ЭхоКГ с использованием тредмил-теста, а именно тем, что регистрация данных для расчета ГПСД ЛЖ при этом виде нагрузки проводится сразу после прекращения пробы, а не на пике нагрузки, как это выполнялось в исследовании M. J. Mansour и соавт.…”

“…Вероятно, это обусловлено особенностями стресс-ЭхоКГ с использованием тредмил-теста, а именно тем, что регистрация данных для расчета ГПСД ЛЖ при этом виде нагрузки проводится сразу после прекращения пробы, а не на пике нагрузки, как это выполнялось в исследовании M. J. Mansour и соавт. и в других исследованиях, включенных в метаанализ K. Gupta и соавт., где большинство проб выполнялось с введением фармакологических препаратов [11,25]. Косвенным подтверждением этого предположения могут служить данные исследования Y. Yu и соавт.…”

Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography

“…The assessment of regional strain can also be useful in apical and middle segments, since not all segments were created equal. This can be done not only by visual estimation but also with deformation imaging [ 23 , 24 ]. Most importantly, the state-of-the-art ABCDE-SE is able to evaluate not only coronary plaque but it can also comprehensively assess patient vulnerabilities by taking advantage of the extraordinary versatility of the technique.…”

Left ventricular assessment with artificial intelligence increases the diagnostic accuracy of stress echocardiography

“…Recent meta-analysis has demonstrated that use of quantitative measures of left ventricular systolic function, including left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) may provide similar diagnostic accuracy for CAD on stress echocardiography (SE) as WMS. 3 , 4 However, the benefit of quantitative measurements has not yet been translated in routine clinical practice. This is, in part, because GLS measurement by speckle tracking is less accurate during the tachycardia induced by SE.…”