Clinical studies evaluating deformation parameters during DSE for detection of ischaemia and/or presence of CAD
| Author | No. of subjects | Method of deformation analysis | Patient characteristics | Confirmation of ischaemia/CAD | Parameters | Ischaemic response* | Predictive value† |
|---|---|---|---|---|---|---|---|
| Voigt et al8 | 44 | TDI | Known or suspected CAD | SPECT and coronary angiogram (on angiography, CAD defined as >50% diameter stenosis) | SS (peak and ejection time), PSSR, PSS, PSI, timing parameters | ↓PSSR increase, ↓SS, PSS 100% (ischaemic) vs 47% (non-ischaemic), ↑timing parameters | Sensitivity and specificity 86% and 95% vs 81% and 82% for WMS assessment; AUC for PSI 0.90, PSI cut-off >35%, 82% sensitivity and 85% specificity |
| Weidemann et al12 | 30 | TDI | Known intermediate stenosis in a large coronary artery, without other CAD | Coronary angiography+ FFR (ischaemic group defined as FFR <0.75) | PSSR, SS (peak and end-systolic), PSS | In the target region, ↑PSSR in the non-ischaemic group but no ↑in the ischaemic group; ↓SS in the ischaemic group vs no change in the non-ischaemic group; ↑↑PSS in the ischaemic group vs ↑ in non-ischaemic group | On ROC curve analysis the change in strain rate from rest to peak was the best parameter to detect ischaemia: AUC 0.90, sensitivity 89% and specificity 86% |
| Ingul et al9 | 197 | TDI STE | N=76 CAD N=61 no CAD N=60 low risk CAD | Coronary angiography (N=136) (CAD ≥50% diameter stenosis) | PSSR, SS (end-systolic), PSS, PSI, timing parameters | PSSR significantly ↓ in segments at risk versus normal segments, p<0.001 | AUC PSSR 0.90 (both TDI+STE) AUC SS 0.87 (both TDI+STE) AUC PSI 0.86 (TDI) and 0.75 (STE) Sensitivity of PSSR using both TDI (87%) and STE (84%) >WMS (75%), p=0.02 and 0.03, respectively |
| Hanekom et al11 | 150 | TDI STE Sentinel segment approach | Clinically indicated DSE for evaluation of ischaemia (excluded severely depressed LVEF, LBBB, previous CABG, significant valvular heart disease) | Coronary angiography (CAD ≥70% diameter stenosis) | PSSR, SS (end-systolic), PSS, PSI, delta SR (value at peak stress-value at baseline) | ↓PSSR, delta SR + SS in those with significant CAD vs those without CAD (p<0.0001) ↑PSI in those with significant CAD vs those without CAD (p<0.0001) | AUC PSSR 0.71 (TDI) and 0.67 (STE ) Accuracy of WMS (75%) vs PSSR by TDI (74%) and STE (69%) were similar Accuracy of PSSR by TDI+STE was similar for LAD (79% vs 78%) and LCx (73% vs 67%) territories but lower for STE in RCA territory (74% vs 59%, p=0.008) |
| Ng et al10 | 102 | STE | Clinically indicated DSE for evaluation of ischaemia | Coronary angiography (CAD ≥50% diameter stenosis) | Global longitudinal peak systolic strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) | All 3 orthogonal strains significantly ↓ at peak stress in patients with CAD | Sensitivities for GLS, GCS, GRS, and WMSI were 84.2%, 73.9%, 78.3%, and 76% respectively GLS and WMSI had comparable accuracy (85.2% vs 82.1%, p=0.70) while accuracies of GCS (75.7%) and GRS (70.3%) were lower Combination of GLS + WMSI had highest sensitivity (100%) and accuracy (96.3%) |
| Yu et al13 | 76 | STE | N=34 patients with severe 3-vessel CAD+preserved LVEF N=42 controls | Coronary angiography (CAD ≥70% diameter stenosis in 3 vessels) | Global and segmental longitudinal strain (SS), PSSR, circumferential strain and strain rate (CSS, CSR), timing parameters | Patients with CAD vs controls showed significantly ↓SS, PSSR, CSS and CSR at both low and peak doses | On multivariate analysis, global PSSR at low dose was an independent predictor of multivessel CAD (OR 1.63, 95% CI 1.12 to 2.82) |
*Indicates response of parameters at peak-dose stress unless indicated.
†Indicates predictive value of peak dose stress parameters unless indicated.
AUC, area under the curve; CAD, coronary artery disease; DSE, dobutamine stress echocardiography; FFR, fractional flow reserve; LAD, left anterior descending artery; LBBB, left bundle branch block; LCx, left circumflex artery; RCA, right coronary artery; ROC, receiver operating characteristics curve; PSI, post-systolic shortening index; PSS, post-systolic strain; PSSR, peak systolic strain rate; SPECT, single photon emission CT; SS, systolic strain; STE, speckle tracking echocardiography; TDI, tissue Doppler imaging; WMS, wall motion scoring; WMSI, wall motion score index.