scholarly journals Rest global longitudinal 2D strain to detect coronary artery disease in patients undergoing stress echocardiography: a comparison with wall-motion and coronary flow reserve responses

2014 ◽  
Vol 1 (2) ◽  
pp. 61-70 ◽  
Author(s):  
Nicola Gaibazzi ◽  
Filippo Pigazzani ◽  
Claudio Reverberi ◽  
Thomas R Porter
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Wall Motion ◽  
Clinical Indication ◽  
Youden Index ◽  
2D Strain ◽  
Artery Disease

Myocardium subtended by obstructive coronary artery disease (CAD) may show reduced left ventricle (LV) global longitudinal strain (GLS), as well as early systolic lengthening (ESL) before shortening; these can be measured at rest and may predict obstructive CAD. This study investigated whether baseline resting LV longitudinal strain measurements may be able to detect significant CAD in patients undergoing stress echocardiography (SE) and coronary angiography, who have normal resting wall motion. We selected patients with a clinical indication of coronary angiography who were previously referred for SE. Patients with known CAD, rest wall-motion (WM) abnormalities, or rhythm/conduction abnormalities were excluded. Speckle tracking strain analyses were retrospectively performed on digitally archived 2D video-loops, using vendor independent software. Peak GLS and duration of ESL were recorded. Diagnostic accuracy of each parameter to predict obstructive (≥50%) CAD was assessed and multivariate logistic regression models fitted and compared. Eighty-two patients were enrolled and 49 had significant CAD by quantitative angiography. Patients with CAD were more often male (P=0.01) and more frequently presented with typical angina (P<0.01). Among rest and stress variables, GLS showed a Youden index of 0.665, while SE WM assessment showed a Youden index of 0.599. These were the only two parameters that remained predictive in multivariate analyses. In conclusion, rest GLS demonstrated comparable accuracy with stress-echo data for prediction of angiographically obstructive CAD; it also added significant CAD prediction when combined with clinical data, similar to SE WM assessment.

scholarly journals P1555 Delta mapse: an easy-to-use tool to evaluate coronary artery stenosis during dypiridamole pharmacological stress echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Moderato ◽  
S M Binno ◽  
G Pastorini ◽  
C Dallospedale ◽  
G Benatti ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Receiver Operating Curve ◽  
Circumflex Artery ◽  
Reversible Ischemia ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Abstract Background Dypiridamol stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD); nonetheless the results of the test are related to visualization of wall motion abnormalities, moderately operator-dependent, and left anterior descending (LAD) artery reserve, resulting in a moderate sensibility and specificity. Aim of our study was to evaluate whether an an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE. Methods We prospectively enrolled 300 patients with suspected CAD and perform a DSE; at rest and peak MAPSE was acquired. 59 patients with reversibile ischemia during stress echocardiography (positive) were referred to perform coronary angiography. Patients were divided according to MAPSE behaviour during DSE: group 1 (MAPSE ≤ 0) and group 2 (delta MAPSE &gt; 0 mm). Results The mean age of was 63 ± 11 years, male gender was prevalent (73%); no differences were found in risk factors and left vetnricular ejection fraction (LV-EF) between two groups.Coronary arteries were normal in 14 patients (23%), while significant stenosis (&gt;70%) was found in 45 patients (77%); in 31 patients (53%) left main (LM) or proximal LAD artery were involved, while in 17 (29%) and 22 (37%) right coronary artery and circumflex artery were affected respectively. Patients with CAD showed a lower (blunted or no increase) MAPSE after dypiridamole infusion, with a significative difference in Delta Mapse (Mapse peak-Mapse rest) between groups (0,2 mm vs 2,8 mm p = 0,004) (Figure 1B). By using a Receiver Operating Curve, the Area under the curve was 0,757, with the best cut-off value for CAD prediction at Delta Mapse= +2.5 mm (sensibility 0,667 and specificity 0,809 – p = 0.012 - Figure 1b). In particular, Delta Mapse was able to predict LM/LAD stenosis (Figure 1B AUC = 0.679 ;p = 0.019), rather than right coronary artery and circumflex artery disease, with higher predictivity than delta LV-EF (AUC = 0.577; p = 0.077). Discussion To our knowledge, this is the first study that compared the behaviour of MAPSE during dypiridamole infusion in patient with and withouth coronary artery disease. MAPSE is a well-known surrogate of longitudinal systolic function and have increased sensitivity over traditional methods of systolic performance such as LV-EF; in this context, dypiridamole induced reversible ischemia could affect prematurely MAPSE then EF or wall motion abnormalities. In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD, mostly driven by LM/LAD disease, on top of other well known markers of ischemia. Incorporating this easy-to-use parameter could improve specificity of DSE and strenghten the suspect of reversibile ischemia when clear wall motion abnormalities are not found. Abstract P1555 Figure 1A and 1B

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 &gt;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&lt;0.01) and peak (14.9±3.8 vs −21.50±3.3; p&lt;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&lt;0.01) and 108±163 vs −41±106 (p&lt;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

scholarly journals P673Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medicationP674Clinical presentation, echocardiographic findings and complications in patients with typical and atypical form of takotsubo cardiomyopathyP675Left ventricular mass/end-diastolic volume ratio with tridimensional echocardiography in newly-diagnosed hypertensive patients: which relation between left ventricular geometry and stroke volume?P676Endothelial dysfunction: the link between arterial hypertension, diabetes mellitus and heart diseaseP677Dynamic of changes of arterial stiffness evaluated by cardio-ankle vascular index(CAVI) during the growth and development of children and adolescentsP678Peripheral arterial stiffness in pulmonary hypertension and pulmonary embolism: assessment with cardio ankle vascular index, noninvasive markers of vascular diseaseP679Early detection and prediction of CHOP-induced cardiotoxicity in nonHodgkin lymphoma by 4D echocardiography, vascular ultrasound, and cardiac biomarkersP680Right ventricular remodeling in children engaged in endurance sports: a longitudinal study in preadolescent athletesP681Electrocardiographic criteria for atria enlargement are not useful in the evaluation of junior high-dynamic high-static athletesP682Prognostic value of right ventricle, pulmonary arterial pressure and biomarkers in patients with acute heart failure: one year follow upP683One-point carotid stiffness parameters by echo-tracking method in a wide-age range of healthy population. A single center experienceP684Role of bidimensional speckle tracking longitudinal strain in the evaluation of right and left ventricular function in adult patients with transposition of the great arteriesP685Interfaces between FBN1 gene polymorphism and biomechanical parameters estimated by speckle-tracking echocardiography of dilative pathology of ascending aorta P686Layer-specific speckle tracking analysis for the detection of coronary artery disease during dipyridamole stress echoP687Stress echo in Italy: state-of-the art 2015P688The declining frequency of Inducible myocardial ischemia during stress echocardiography over 27 consecutive years (1983-2009)P689Global longitudinal strain can unmask inducible myocardial ischemia at submaximal heart rate during dobutamine stress echocardiography.P690Low risk syntax score predicted by wall motion score index during dobutamine stress echocardiographyP691Outdoor stress echo by lung ultrasound for subclinical detection of high altitude pulmonary edema with B-linesP692Predictors and consequences of infective endocarditis with perivalvular extension - a subgroup with worse short and medium-term prognosisP693Analysis of left atrial auricle morphology and function to detect considerable risk factors regarding the prevention of strokeP694LAA closure - does size really matter?P695Real assessment of mitral regurgitation by three-dimensional transesophageal echocardiographyP696Myocardial contrast dobutamine stress echocardiography for detection of coronary artery disease

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii136-ii143
Author(s):  
I. Ikonomidis ◽  
M. Budnik ◽  
M. Lembo ◽  
A-M Vintila ◽  
T. Jurko ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Arterial Stiffness ◽  
Speckle Tracking ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Artery Disease
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