Value of Resting Echocardiographic Findings and Dobutamine Stress Echocardiography for Diagnosing Myocardial Ischemia in Patients with Suspected Angina Pectoris

Abstract

Integration of DSE and resting echocardiographic findings describing degree of heart calcification, impaired LAD flow, and extent of delayed ejection motion of the myocardium improves detection of coronary angiogram-based FFR-guided ischemia.

Recognition of Resting Heart Calcification as a Means to an End: An Eye‐Opener in the Application of Dobutamine Stress Echocardiography in Subjects with Chest Pain

“…Whatever be the background etiology of chest pain, noninvasive imaging particularly DSE would continue to remain valuable in the clinical decision making process. The data published by Utsunomiya et al . in this issue of the Journal are just a confirmation of the need of compulsory continuation of research in DSE for further refinement of this cheap, noninvasive, safe, and bedside echocardiographic technique, available almost in every corner of the earth.…”

“…So what is the relevance of the total heart calcification (THC) score and what is the relationship between total heart calcification score and functionally and hemodynamically significant coronary artery disease? As Utsunomiya et al have shown in Table III of their article, a THC score of >2 performed equally well as an LAD‐DSVR of <1.5 . Although they have not performed a specific correlation test to show the association between these two variables, there is a rather strong, although not universally proven, association between aortic stenosis and coronary atherosclerosis, both presumably having an underlying common inflammatory process, as has been highlighted in a review by Hermans, et al …”

“…In the study published in this issue of the Journal, Utsunomiya and colleagues have studied 110 subjects presenting with angina pectoris. The authors have incorporated heart calcium score (taking into consideration, valvular and aortic root sclerosis/calcification visible on gray scale 2D echocardiography), duration of color tissue Doppler–obtained isovolumic relaxation (IVR) periods, and, transthoracic, Doppler‐based, diastolic–systolic velocity ratio of the left anterior descending coronary artery (LAD‐DSVR) at rest and integrated them with the wall motion score at peak dobutamine stress.…”

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.…”

“…We found that early longitudinal, circumferential, and radial diastolic SR had a tendency to be lower in patients with significant coronary stenosis even at rest; however, according to our results, they were not sensitive and specific enough to detect significant coronary artery stenosis even at peak doses (the greatest predictive value was of late radial diastolic SR at the low dobutamine dose (AUC 0.789 with 66.7% sensitivity and 91.7% specificity). Previous small clinical studies have demonstrated ischemia‐related diastolic abnormalities using tissue Doppler–derived strain echocardiography in CAD at rest . The study by Liang et al .…”