Abstract
Background
Major cause of death across the world is coronary artery disease. The choice of treatment strategy should be primarily based on the hemodynamic significance of coronary artery stenosis. Two-dimensional speckle tracking provides valuable information for regional wall motion abnormalities. The purpose of this study was to determine the diagnostic value of left ventricular longitudinal strain and torsion to diagnose coronary artery disease during dobutamine stress echocardiography.
Purpose
The purpose of this study was to evaluate the diagnostic value of speckle tracking imaging-derived myocardial deformation parameters at rest and during dobutamine stress to determine the hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of CAD.
Methods
We studied 204 patients (mean age 54.2±9.8 years, 128 male and 76 female) with known or suspected coronary artery disease, excluding those with prior history of transmural infarction. All of them underwent dobutamine stress echo and coronary angiography within one month. Wall-motion score index, left ventricular global longitudinal strain and torsion were measured at rest and peak stress. Optimal cut-offs were derived from receiver operating characteristic curves for strain and torsion values. Additionally, the respective differences between rest and stress were also calculated.
Results
During dobutamine stress echocardiography we revealed mean left ventricular ejection fraction was 53±6.2%. Coronary angiography revealed significant stenotic lesions in 124 patients (60.7%). Values regarding sensitivity, and specificity for wall motion score index difference were 76% and 84% respectively (area under curve 0.84). Global longitudinal strain difference (median 0.6%) illustrated 83% sensitivity and 74% specificity for disease detection (area under curve 0.82, cut-off value ≤0.5%). The respective values for torsion difference (median 5.1°) were 84% and 79% (area under curve 0.80, cut-off value ≤5.9°). Combination of wall motion score index difference and torsion difference for disease detection showed 89% sensitivity and 77% specificity (area under curve 0.84).
Conclusions
Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD. The implementation of speckle tracking during dobutamine stress echo could serve as an adjunct method for coronary artery disease assessment, providing quantitative diagnostic information.
Tissue Doppler imaging for diagnosis of coronary artery disease: a systematic review and meta-analysis
