scholarly journals The physiologic and prognostic value of regional longitudinal strain during dipyridamole stress echocardiography

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
RA Rosina Arbucci ◽  
DML Diego Maximiliano Lowenstein ◽  
AKS Ariel Karim Saad ◽  
MGR Maria Graciela Rousee ◽  
NG Natalio Gastaldello ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Event Free Survival ◽  
Private Company ◽  
Free Survival ◽  
Myocardial Infraction ◽  
Dipyridamole Stress Echocardiography ◽  
Dipyridamole Stress

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Investigaciones Médicas, Cardiodiagnostic Background.  Regional apical longitudinal strain (RALS) allows to corroborate the diagnosis of regional wall motion abnormalities (RWMA) during dipyridamole stress echocardiography (DSE) on a quantitative basis but data on the prognostic value are missing. Objectives.  The to evaluate the physiologic correlates and prognostic value of RALS vs. RWMA during DSE. Methods.  In a single center, observational design we initially evaluated 150 patients (pts), mean age 68.3 ± 9.6 years, 50.7% men referred for DSE.  RALS was defined as the average of the four apical segments from the 3 apical views.  Any increase in the percentage of deformation was considered normal. Coronary flow velocity reserve (CFVR) was also assessed in mid-distal left anterior descending (LAD) coronary artery by pulsed-wave Doppler. Pts were divided into two groups (G). G1: patients with normal RALS, and G2: patients with abnormal RALS.  Major cardiovascular event was considered to be: cardiovascular death, acute myocardial infraction (AMI), stroke or needs for revascularization after 3 months All patients were followed-up. Results. RALS success rate was 94.6% (142 pts), since 8 pts were excluded for inadequeate window. Eighty-seven patients (61.3%) were included in G1 and 55 (38.7%) pts in G2. The mean follow-up was 36 ± 0.93 months. There were no differences in the resting RALS between the G1 and G2 (-22.3% ± 3.3 vs -21.25% ± 4.9, p = NS), but significant differences in the peak dipyridamole effect (-26.3% ± 4.2 vs -18.8% ± 4.1, p < 0.001). Pts G1  showed less RWMA  than pts G2 (G1 3.4% vs  G2 90 %), p < 0.001) and higher CFVR (G1= 2.6 ± 0.5 vs G2 = 1.6 ± 0.4, p < 0.001). Adequeate CFVR showed high concordance with the increase in RALS evaluated  by Kappa Index 0.95, p 0.001 (Pts G1= 98.9% vs pts G2= 96.4%).  In the long-term follow up, 24 pts experienced events: 3 deaths, 3 non-fatal myocardial infarctions, 2 stroke and 16 late revascularizations. Pts with normal RALS had a better event-free survival (G1= 90.8% vs G2 = 70.9%, log Rank p < 0.007, HR: 2.92; 95% CI: 1.27-6.68, p 0.011) (figure 1). In the multivariate analysis of logistic regression, adjusted for age, the RALS was an independent predictor of event. In G2 no significant differences were detected in event free survival in pts with and without visual dyssynergies during DSE (73.7 vs 67.7, respectively (p = ns) Conclusions. A mismatch between RALS and visually assessed RWMA occurs in a significant proportion of patients, and RALS is better correlated to physiologic (CFVR) and prognostic standards. Abnormal RALS during DSE predicted worse outcome, regardless of the RWMA.  Quantitative stress echocardiography is possible feasible and useful during DSE. Abstract Figure. RALS in DSE and Event Free Survival

scholarly journals Speckle-tracking during dipyridamole stress echocardiography in the detection of myocardial ischemia in patients with suspected coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Moderato ◽  
G Pastorini ◽  
D Lazzeroni ◽  
A Monello ◽  
G Rusticali ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Model Average ◽  
Significant Difference ◽  
Artery Disease ◽  
Dipyridamole Stress Echocardiography ◽  
Dipyridamole Stress

Abstract Background The aim of this study was to investigate the incremental value of global longitudinal strain (GLS), postsystolic strain index (PSI) and prestretch (PSE) by automated function imaging with respect to wall motion (WM) and coronary flow reserve (CFR) for the diagnosis of significant coronary artery disease (CAD) during dipyridamole stress echocardiography. Methods We retrospectibely enrolled 227 patients with known or suspected CAD, approaching our echo lab to perform a DSE; all patient underwent coronary angiography within 1 month for clinical reasons. Obstructive CAD was defined as the evidence of >70% stenosis during coronary angiogram. Obstructive CAD was detected in 143 (63%) patients, while 84 (37%) had no significant CAD. Global longitudinal strain, PSI and PSE were measured at rest and peak of the stress (after 6 minutes of 0,84mg/kg of dipyridamole infusion). Results Patient with CAD showed a significantly lower GLS at rest (−16.9±4.2 vs −18.6±3.4; p<0.01) and peak (14.9±3.8 vs −21.50±3.3; p<0.01) Figure A; the behavior of GLS was opposite, in patient with CAD showed an increase while in patient without CAD a significant decrease after dipyridamole infusion. There was also a significant difference between groups for Delta PSI (PSIpeak − PSIrest) and Delta PSE (PSEpeak − PSErest), respectively 126±145 vs −40±97, (p<0.01) and 108±163 vs −41±106 (p<0.01) Figure C. ROC analyses produced a statistically valid model: Average GLS at peak (p 0.001; AUC=0.906, cut-off value −18%, sensitivity 83% and specificity 82%); on the basis of these results, we compared WM and myocardial deformation analysis and GLS was superior to CFR LAD, Delta EF, Delta ESV and Delta WMI (Figure B). Conclusions GLS, PSE and PSI show an opposite response to dipyridamole, in patients with CAD in patient without CAD and show much higher sensitivity and specificity compared to the conventional parameters like WMI, EF and CFR in detecting CAD Funding Acknowledgement Type of funding source: None

Prognostic Value of a Multiparametric Risk Score in Patients Undergoing Dipyridamole Stress Echocardiography

2005 ◽  
Vol 96 (4) ◽  
pp. 529-532 ◽  
Author(s):  
Lauro Cortigiani ◽  
Riccardo Bigi ◽  
Dario Gregori ◽  
Rosa Sicari ◽  
Eugenio Picano
Keyword(s):  
Risk Score ◽  
Prognostic Value ◽  
Stress Echocardiography ◽  
Dipyridamole Stress Echocardiography ◽  
Dipyridamole Stress

1227 Risk stratification of patients with asymptomatic moderate mitral regurgitation: the prognostic value of left atrial strain

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Cameli ◽  
M C Pastore ◽  
F M Righini ◽  
G E Mandoli ◽  
F D"ascenzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Mitral Regurgitation ◽  
Risk Stratification ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Event Free Survival ◽  
Free Survival

Abstract Background In asymptomatic moderate mitral regurgitation (MR), the criteria for risk stratification are still uncertain. Therefore, in these patients, optimal time of surgery remains controversial. Purpose Our aim was to compare left atrial (LA) strain to other echocardiographic parameters for the prediction of cardiovascular (CV) events in patients with asymptomatic moderate MR. Methods 401 patients with primary degenerative asymptomatic moderate MR was enrolled and prospectively followed for the development of CV events (i.e. atrial fibrillation, stroke/transient ischemic attack, acute heart failure, CV death). Patients with history of atrial fibrillation, myocardial infarction, heart failure, cardiac surgery or heart transplantation, severe MR, mitral valve surgery during follow-up were excluded. Results During a mean follow up of 3.4 ± 2 years, of the 326 patients eligible (mean age 65 ± 9 years), 122 patients had 149 new events. There were no significative differences in mean age and sex, clinical and therapeutic characteristics between the two groups. The event-group presented reduced global peak atrial longitudinal strain (PALS), LA emptying fraction, LV strain at baseline, and larger LA volume indexed (p <0.0001). Receiver operating characteristics curves proved the greatest predictive performance for global PALS < 35% (AUC 0.88). Bland-Altman analysis demonstrated good intra- and inter-observer agreement and Kaplan Meier analysis showed a graded association between PALS and event-free-survival. Conclusions Speckle tracking echocardiography could provide a useful index, global PALS, to estimate LA function in patients with asymptomatic moderate MR in order to optimize surgical timing before the development of irreversible myocardial dysfunction. Echo-data of our study population Variable No CV events (n = 204) CV events (n = 122) LV ejection fraction (%) 59 ± 9 58 ± 10 LV global longitudinal strain (%) - 18.5 ± 3.4 -17.6 ± 3.6* LA volume indexed (ml/m2) 32.5 ± 6.7 36.4 ± 7.1* LA emptying fraction (%) 68 ± 13 62 ± 15* Mitral E/A ratio 0.94 ± 0.14 0.95 ± 0.16 Mitral E/E’ ratio 11.2 ± 6.5 12.4 ± 7.1 Mitral regurgitant fraction (%) 38.9 ± 8.1 39.1 ± 9.4 End regurgitation orifice area (cm2) 0.34 ± 0.05 0.34 ± 0.06 Global PALS (%) 32.5 ± 8.5 19.7 ± 8.1* *Significative variation between groups. Cardiovascular, CV; Left atrial, LA; Left ventricular, LV; Peak atrial longitudinal strain, PALS Abstract 1227 Figure. Event-free survival according to PALS

Sign in / Sign up

Export Citation Format

Share Document