Abstract
Strain and strain rate (SR) measured with 2-dimensional speckle tracking echocardiography (2-D STE) can quantitatively assess myocardial function. Our aim was to evaluate whether we could detect abnormalities in strain, strain rate, and dyssynchrony by applying 2-D STE in patients with severe coronary artery disease during early stages of dobutamine stress echocardiography. Thirty-four patients with angiographically documented severe 3-vessel coronary artery disease and preserved left ventricular ejection fraction were compared with 42 control patients without evidence of coronary artery disease. Circumferential and longitudinal strain, SR, and left ventricular synchrony using standard deviation (SD) of time to systolic peak strain and SR were analyzed with 2-D STE at rest and at intermediate doses of dobutamine stress echocardiography. Compared with control subjects, patients with coronary artery disease showed lower circumferential SR [−1.42 (0.34) s−1 vs −1.64 (0.34) s−1; P < .02] and significantly lower longitudinal strain [−15.41 % (3.52 %) vs −19.37 % (3.21 %); P < .001] and SR [−0.91 (0.18) s−1 vs −1.19 (0.24) s−1; P < .001] at intermediate doses; these values were also compromised at peak dose. The SD of longitudinal time to systolic peak strain at intermediate dose was significantly greater in patients with coronary artery disease than in control patients [37.89 (12.32) vs 27.21 (10.86); P < .001]. The 2-D STE-derived strain and SR detected myocardial dysfunction and asynchrony in patients with coronary artery disease during intermediate doses of dobutamine stress, with minimal changes in regional wall motion abnormalities at this stage.
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Abbreviations
- ANOVA:
-
Analysis of variance
- AUC:
-
Area under the curve
- CI:
-
Confidence interval
- CSR:
-
Circumferential strain rate
- LS:
-
Longitudinal strain
- LSR:
-
Longitudinal strain rate
- OR:
-
Odds ratio
- SD:
-
Standard deviation
References
Hoffmann R, Marwick TH, Poldermans D, Lethen H, Ciani R, van der Meer P et al (2002) Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms. Eur Heart J 23(10):821–829
Moonen M, Lancellotti P, Zacharakis D, Pierard L (2009) The value of 2D strain imaging during stress testing. Echocardiography 26(3):307–314
Cho GY, Chan J, Leano R, Strudwick M, Marwick TH (2006) Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging. Am J Cardiol 97(11):1661–1666. Epub 2006 Apr 19
Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E et al (2006) Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 47(4):789–793. Epub 2006 Jan 26
Reant P, Labrousse L, Lafitte S, Bordachar P, Pillois X, Tariosse L et al (2008) Experimental validation of circumferential, longitudinal, and radial 2-dimensional strain during dobutamine stress echocardiography in ischemic conditions. J Am Coll Cardiol 51(2):149–157
Hanekom L, Cho GY, Leano R, Jeffriess L, Marwick TH (2007) Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation. Eur Heart J 28(14):1765–1772. Epub 2007 Jun 15
Wei Z, Su H, Zhang H, Zhou X, Zhu T, Liu L et al (2008) Assessment of left ventricular wall motion in diabetic rats using velocity vector imaging combined with stress echocardiography. Echocardiography 25(6):609–616. Epub 2008 May 9
Govind SC, Gopal AS, Netyo A, Nowak J, Brodin LA, Patrianakos A et al (2009) Quantification of low-dose dobutamine stress using speckle tracking echocardiography in coronary artery disease. Eur J Echocardiogr 10(5):607–612. Epub 2009 Feb 7
Tanaka H, Oishi Y, Mizuguchi Y, Emi S, Ishimoto T, Nagase N et al (2007) Three-dimensional evaluation of dobutamine-induced changes in regional myocardial deformation in ischemic myocardium using ultrasonic strain measurements: the role of circumferential myocardial shortening. J Am Soc Echocardiogr 20(11):1294–1299. Epub 2007 Jul 2
Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA (2007) American Society of Echocardiography. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 20(9):1021–1041
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463
Quinones MA, Waggoner AD, Reduto LA, Nelson JG, Young JB, Winters WL Jr et al (1981) A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation 64(4):744–753
Yu CM, Lin H, Zhang Q, Sanderson JE (2003) High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 89(1):54–60
Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Oki T (2008) The functional role of longitudinal, circumferential, and radial myocardial deformation for regulating the early impairment of left ventricular contraction and relaxation in patients with cardiovascular risk factors: a study with two-dimensional strain imaging. J Am Soc Echocardiogr 21(10):1138–1144
Buckberg G, Hoffman JI, Mahajan A, Saleh S, Coghlan C (2008) Cardiac mechanics revisited: the relationship of cardiac architecture to ventricular function. Circulation 118(24):2571–2587
Reimer KA, Lowe JE, Rasmussen MM, Jennings RB (1977) The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size versus duration of coronary occlusion in dogs. Circulation 56(5):786–794
Madler CF, Payne N, Wilkenshoff U, Cohen A, Derumeaux GA, Pierard LA et al (2003) Myocardial Doppler in stress echocardiography (MYDISE) study investigators. Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography: optimal diagnostic models using off-line tissue Doppler in the MYDISE study. Eur Heart J 24(17):1584–1594
Ingul CB, Stoylen A, Slordahl SA, Wiseth R, Burgess M, Marwick TH (2007) Automated analysis of myocardial deformation at dobutamine stress echocardiography: an angiographic validation. J Am Coll Cardiol 49(15):1651–1659. Epub 2007 Apr 2
Park TH, Tayan N, Takeda K, Jeon HK, Quinones MA, Zoghbi WA (2007) Supine bicycle echocardiography improved diagnostic accuracy and physiologic assessment of coronary artery disease with the incorporation of intermediate stages of exercise. J Am Coll Cardiol 50(19):1857–1863. Epub 2007 Oct 23
Pitzalis MV, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G et al (2002) Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol 40(9):1615–1622
Gorcsan J 3rd, Kanzaki H, Bazaz R, Dohi K, Schwartzman D (2004) Usefulness of echocardiographic tissue synchronization imaging to predict acute response to cardiac resynchronization therapy. Am J Cardiol 93(9):1178–1181
Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J et al (2008) Results of the predictors of response to CRT (PROSPECT) trial. Circulation 117(20):2608–2616. Epub 2008 May 5
Delgado V, Ypenburg C, van Bommel RJ, Tops LF, Mollema SA, Marsan NA et al (2008) Assessment of left ventricular dyssynchrony by speckle tracking strain imaging comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy. J Am Coll Cardiol 51(20):1944–1952
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Yu, Y., Villarraga, H.R., Saleh, H.K. et al. Can ischemia and dyssynchrony be detected during early stages of dobutamine stress echocardiography by 2-dimensional speckle tracking echocardiography?. Int J Cardiovasc Imaging 29, 95–102 (2013). https://doi.org/10.1007/s10554-012-0074-9
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DOI: https://doi.org/10.1007/s10554-012-0074-9