The incremental diagnostic value of coronary flow reserve and left ventricular elastance during high-dose dipyridamole stress echocardiography in patients with normal wall motion at rest

2013 ◽  
Vol 168 (2) ◽  
pp. 1683-1684 ◽  
Author(s):  
Tonino Bombardini ◽  
Sonia Gherardi ◽  
Paolo Marraccini ◽  
Mathis Christian Schlueter ◽  
Rosa Sicari ◽  
...  
Keyword(s):  
Coronary Flow ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
High Dose ◽  
Ventricular Elastance ◽  
Flow Reserve ◽  
Normal Wall ◽  
Dipyridamole Stress Echocardiography

Inverse response of global longitudinal strain after dipyridamole stress echocardiography in patients with microvascular coronary dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Tagliamonte ◽  
C Montuori ◽  
L Riegler ◽  
A Forni ◽  
R Scarafile ◽  
...  
Keyword(s):  
Coronary Flow ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Global Longitudinal Strain ◽  
Inverse Correlation ◽  
Left Ventricular ◽  
Peak Dose ◽  
Different Response ◽  
Dipyridamole Stress Echocardiography ◽  
Dipyridamole Stress

Abstract Background Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. CMD can be identified, in patients with non-obstructive coronary artery disease (CAD), by a reduced transthoracic Doppler-derived coronary flow reserve (CFR), which is an index of coronary arterial reactivity, and can be impaired in both obstructive CAD and CMD. The aim of this study was to investigate the dipyridamole-induced changes of global longitudinal strain (GLS) in patients with CMD. Methods 43 patients (29M, 14F; mean age 68±7 years) without obstructive CAD, assessed by invasive coronary angiogram, underwent dipyridamole stress echocardiography. Coronary flow was assessed in the left anterior descending coronary artery (LAD) and was identified as the colour signal directed from the base to the apex of the left ventricle, containing the characteristic biphasic pulsed-Doppler flow signals. CFR were determined as the ratio of hyperaemic to baseline diastolic coronary flow velocity. CMD was defined as CFR <2. GLS was measured using automated function imaging, through the positioning of three endocardial markers (two markers at the mitral annulus and one at the apex) in each apical view. Subsequently, the obtained segmental values of GLS were visualized as a bull's-eye map in a quick and feasible manner. We had optimal left ventricular endocardial tracking in the overall population. In each patient, we used a frame rate of 70 frames/sec for adequate 2D strain analysis. We analyzed GLS at each step of stress test and compared peak-dose values with baseline. Results Thirteen patients (30%) among the overall population showed CMD. There were no significant differences in baseline characteristics between patients with or without CMD. GLS, at baseline, was significantly lower in patients with CMD (−16.9±3.78 vs. −17.8±3.77 – p<0.01). We observed a different response to dipyridamole stress echocardiography, between the two groups: GLS significantly increased up to peak dose in patients without CMD (from −17.8±3.77 to −19.3±4.09 – p<0.01), whereas on the other hand, a significant decrease from rest to peak dose was observed in patients with CMD (from −16.9±3.78 to −15.5±4.18 – p<0.01). There was a significant inverse correlation between CFR and delta GLS measured at rest and after dipyridamole peak dose (r=−0.82 – p<0.01). Conclusions GLS analysis, particularly performed by comparing dipyridamole peak-dose with baseline values, shows that in patients with CMD there is a different response of left ventricular myocardiim to stress test. It could be assumed that the inverse correlation between CFR and delta GLS reflects a progressive subclinical worsening of left ventricular myocardial function in these patients. Larger studies could confirm our data. Funding Acknowledgement Type of funding source: None

Stress echocardiography: diagnostic and prognostic values and specific clinical subsets

2016 ◽  
Author(s):  
Luc A. Pierard ◽  
Lauro Cortigiani
Keyword(s):  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Stress Echocardiography ◽  
Left Ventricular ◽  
Myocardial Imaging ◽  
Prognostic Information ◽  
Hypertensive Patients ◽  
Exercise Electrocardiography ◽  
Flow Reserve ◽  
Inducible Ischaemia

Stress echocardiography is a widely used method for assessing coronary artery disease, due to its high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future cardiac events. The method provides superior diagnostic and prognostic information than standard exercise electrocardiography and perfusion myocardial imaging in specific clinical subsets, such as women, hypertensive patients, and patients with left bundle branch block. Stress echocardiography allows effective risk assessment also in the diabetic population. The evaluation of coronary flow reserve of the left anterior descending artery by transthoracic Doppler adds diagnostic and prognostic information to that of standard stress test. Stress echocardiography is indicated in the cases when exercise electrocardiography is unfeasible, uninterpretable or gives ambiguous result, and when ischaemia during the test is frequently a false-positive response, as in hypertensive patients, women, and patients with left ventricular hypertrophy. Viability detection represents another application of stress echocardiography. The documentation of a large amount of viable myocardium predicts improved ejection fraction, reverse remodelling, and improved outcome following revascularization in patients with ischaemic cardiomyopathy. Moreover, stress echocardiography can aid significantly in clinical decision-making in patients with valvular heart disease through dynamic assessment of primary or secondary mitral regurgitation, transvalvular gradients, and pulmonary artery systolic pressure, as well as before vascular surgery due to the excellent negative predictive value. Finally, stress echocardiography allows effective risk stratification in patients with hypertrophic cardiomyopathy through evaluation of inducible ischaemia, coronary flow reserve, and intraventricular gradient.

Diagnostic Value of Dobutamine Stress Echocardiography in Patients With Normal Wall Motion at Rest

2007 ◽  
Vol 24 (5) ◽  
pp. 553-557 ◽  
Author(s):  
Marcel L. Geleijnse ◽  
Boudewijn J. Krenning ◽  
Attila Nemes ◽  
Osama I.I. Soliman ◽  
Tjebbe W. Galema ◽  
...  
Keyword(s):  
Stress Echocardiography ◽  
Wall Motion ◽  
Dobutamine Stress Echocardiography ◽  
Diagnostic Value ◽  
Dobutamine Stress ◽  
Normal Wall

scholarly journals Coronary Flow Reserve During Dipyridamole Stress Echocardiography Predicts Mortality

2012 ◽  
Vol 5 (11) ◽  
pp. 1079-1085 ◽  
Author(s):  
Lauro Cortigiani ◽  
Fausto Rigo ◽  
Sonia Gherardi ◽  
Francesco Bovenzi ◽  
Sabrina Molinaro ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Stress Echocardiography ◽  
Flow Reserve ◽  
Dipyridamole Stress Echocardiography ◽  
Dipyridamole Stress
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