Clinical studies evaluating deformation parameters during DSE for the assessment of viability
| Author | No. of patients | Method of deformation analysis | Patient characteristics | Definition of viability | Parameters | Viability±scar response* | Predictive value† |
|---|---|---|---|---|---|---|---|
| Hoffmann et al17 | 37 | TDI | Previous myocardial infarction with reduced LVEF (mean LVEF 44±10%) | DSE: Improvement by ≥ 1 grade in WMS in segments abnormal at rest PET-18FDG: Tetrofosmin uptake ≤70% +a better preserved 18FDG uptake (18FDG—tetrofosmin uptake >20%) | PSSR | Viability: ↑ PSSR vs unchanged PSSR for non-viable segments | AUC for PSSR for prediction of scar was 0.89 (95% CI 0.88 to 0.90) Sensitivity and specificity of PSSR 83%+84% respectively vs 75% and 63% for WMS |
| Hanekom et al15 | 55 | TDI | Previous myocardial infarction; mean LVEF 36±8% | Regional (WMS) and global (≥5% ↑in LVEF) recovery in LV function on TTE 9 months post-revascularisation | SR, ΔSR, SS (end-systolic), ΔSS, PSS, PSI, ΔPSI, timing parameters | Scar: ↓SR, ↓ΔSR, ↓SS, ↓ΔSS, ↑timing parameters | Sensitivity and specificity of TDI magnitude parameters (highest 80% for ΔSR) better than WMS (73%) but similar specificity (77%); WMS+TDI (low dose SR+ΔSR) sensitivity 82% and specificity 80%; AUC 0.88 |
| Fujimoto et al18 | 48 | TDI | Previous myocardial infarction with ‘decrease in contractile myocardium but no necrosis’ in the territory supplied by the culprit artery Group 1 (n=38): DSE+coronary angiography Group 2 (n=10) DSE before+after PCI | DSE: Uniphasic (sustained improvement in WMS at peak stress) or biphasic (improvement at low dose followed by dis-improvement at peak dose) response Group 2 patients: Improvement in resting WMS by ≥1 grade in ≥2 segments | Total strain (TS), PSS, PSI, L/TS ratio (ratio of systolic lengthening to the sum of end- and post-systolic shortening) | Viability: Peak stress PSI ≥0.25 in 80% of viable segments Peak stress L/TS ratio >0 in 57% of viable segments | AUC of L/TS ratio to predict functional recovery was 0.89 vs 0.78 for WMS, p<0.05 L/TS ratio 84% sensitivity and 79% specificity vs 86% sensitivity and 71% specificity for WMS |
| Bansal et al16 | 55 | TDI STE | Known CAD+LVEF <45% | Improvement in resting wall motion (per segment) on TTE 9 months post-revascularisation | TDI: PSSR and SS (end-systolic) STE: longitudinal, circumferential and radial strain and strain rate (LSS/LSR, CSS/CSR, RS/RSR) | Viability: STE: ↑ strain in all 3 directions and ↑LSR+CSR at rest; ↑LSS and CSS/CSR at low dose TDI:↑PSSR+SS at rest and low dose | PSSR+SS at low dose and CSS at rest and low dose only independent predictors of LV functional recovery PSSR+SS showed incremental value over WMS (AUC 0.79, 0.79 and 0.74, respectively). |
| Rosner et al19 | 72 | TDI | N=57 patients scheduled for CABG (normal and moderately reduced LVEF; mean 49%)+undergoing pre-op MRI N=15 healthy controls | TTE: Difference in ET strain ≥4.4% between pre- and 8–10 months post-CABG resting TTE MRI: LGE <50% | SS (peak/ET), mean SSR, PSS, PSI, ΔSS, ΔSR | Viability: ΔSS significantly identified both hypokinetic and akinetic segments improving after CABG Peak SS+SR, PSS, ΔSR significantly identified akinetic segments improving after CABG | Sum of pre-op DSE SS increment and resting SS (had the highest correlation coefficient for strain defined viability (R=0.61, p<0.001)) AUC for DSE SS increment was 0.79 |
*Indicates response of parameters at low dose stress unless indicated.
†Indicates predictive value of peak dose stress parameters unless indicated.
AUC, area under the curve; CABG, coronary artery bypass grafting; CAD, coronary artery disease; DSE, dobutamine stress echocardiography; ET, ejection time; LGE, late gadolinium enhancement; PCI, percutaneous coronary intervention; PET-18FDG, positron emission tomography using 18F-flurodeoxyglucose; PSI, post-systolic shortening index; PSS, post-systolic strain; PSSR, peak systolic strain rate; SPECT, single photon emission CT; SR, strain rate; SS, systolic strain; STE, speckle tracking echocardiography; TDI, tissue Doppler imaging; TTE, transthoracic echocardiography; WMS, wall motion scoring; WMSI; wall motion score index.