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Abazid RM, Pati N, Elrayes M, Chandy M, Hassanin M, Mathew A, De S, Bagur R, Tzemos N. Role of myocardial strain imaging in diagnosing inducible myocardial ischemia with treadmill contrast-enhanced stress echocardiography. BMC Cardiovasc Disord 2024; 24:254. [PMID: 38750460 PMCID: PMC11097493 DOI: 10.1186/s12872-024-03926-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION The aim of this study is to analyze the diagnostic value of global longitudinal strain (GLS) in detecting inducible myocardial ischemia in patients with chest pain undergoing treadmill contrast-enhanced stress echocardiography (SE). METHODS We retrospectively enrolled all patients who underwent invasive coronary angiography after treadmill contrast-enhanced SE. Rest and peak-stress myocardial GLS, segmental LS, and LS of 4-chamber (CH), 2-CH, and 3-CH views were reported. Luminal stenosis of more than 70% or fractional flow reserve (FFR) of < 0.8 was considered significant. RESULTS In total 33 patients were included in the final analysis, among whom sixteen patients (48.4%) had significant coronary artery stenosis. Averaged GLS, 3-CH, and 4-CH LS were significantly lower in patients with critical coronary artery stenosis compared to those without significant stenosis (-17.1 ± 7.1 vs. -24.2 ± 7.2, p = 0.041), (-18.2 ± 8.9 vs. -24.6 ± 8.2, p = 0.045) and (-14.8 ± 6.2 vs. -22.8 ± 7.8, p = 0.009), respectively. Receiver operating characteristic (ROC) analysis of ischemic and non-ischemic segments demonstrated that a cut-off value of -20% of stress LS had 71% sensitivity and 60% specificity for ruling out inducible myocardial ischemia (Area under the curve was AUC = 0.72, P < 0.0001). CONCLUSION Myocardial LS measured with treadmill contrast-enhanced stress echocardiography demonstrates potential value in identifying patients with inducible myocardial ischemia.
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Affiliation(s)
- Rami M Abazid
- Northern Ontario Medical School (NOSM) University, Department of Medicine, Sault Area Hospital, Sault Ste. Marie, Canada.
| | - Nilkanth Pati
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, PO Box 5010, London, ON, N6A 5A5, Canada
| | - Maged Elrayes
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, PO Box 5010, London, ON, N6A 5A5, Canada
| | - Mark Chandy
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, PO Box 5010, London, ON, N6A 5A5, Canada
| | - Magdi Hassanin
- Northern Ontario Medical School (NOSM) University, Department of Medicine, Sault Area Hospital, Sault Ste. Marie, Canada
| | - Andrew Mathew
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, PO Box 5010, London, ON, N6A 5A5, Canada
| | - Sabe De
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, PO Box 5010, London, ON, N6A 5A5, Canada
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, PO Box 5010, London, ON, N6A 5A5, Canada
| | - Nikolaos Tzemos
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, PO Box 5010, London, ON, N6A 5A5, Canada
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Su Y, Peng Q, Yin L, Li C. Evaluation of Exercise Tolerance in Non-obstructive Hypertrophic Cardiomyopathy With Myocardial Work and Peak Strain Dispersion by Speckle-Tracking Echocardiography. Front Cardiovasc Med 2022; 9:927671. [PMID: 35958415 PMCID: PMC9361015 DOI: 10.3389/fcvm.2022.927671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe aim of this study was to evaluate exercise tolerance in non-obstructive hypertrophic cardiomyopathy (HCM) by investigating the value of myocardial work (MW) combined with strain peak dispersion.MethodsA total of 65 patients with non-obstructive HCM and normal left ventricular ejection fraction were enrolled and 60 healthy subjects were selected as controls. The automated function imaging (AFI)-two-dimensional ultrasonic speckle-tracking technology was used to obtain the values for peak global longitudinal strain (GLS), longitudinal strain peak time dispersion (PSD), 18-segment systolic longitudinal peak strain (LPS), 18-segment longitudinal strain peak time (TTPLS), global waste work (GWW), global constructive work (GCW), global work index (GWI), global work efficiency (GWE), and exercise metabolic equivalents (METS).Results(1) Values for LV-GLS (−17.77 ± 0.20 vs. −21.66 ± 0.42%) were lower and PSD (95.10 ± 8.15 vs. 28.97 ± 1.50 ms) was prolonged in patients with HCM (p < 0.01). (2) An increasing trend was shown in the basal segment < intermediate segment < apical segment for both patients with HCM and controls, although each segment had lower values in the HCM group. (3) TTPLS was prolonged in the HCM group (p < 0.01). (4) GWE, GWI, and GCW were all lower (p < 0.01) and GWW was higher in patients with HCM (p < 0.01). (5) Values of GWE were less than 92.5%, GWI less than 1,200 mmHg, GCW less than 1,399 mmHg, these abnormal values are helpful for the diagnosis of impaired exercise tolerance and poor prognosis (6) The METS and LV-GLS of HCM in the asymmetric group were significantly lower than that in AHCM group, but the PSD was significantly greater than that in the AHCM group. Values of LPS-BL (−13.13% ± 2.51% vs −10.17% ± 2.20%) in the apical HCM group were better than in the asymmetric HCM group (p < 0.05).ConclusionGCW, GWI, and GWE can be safely measured by resting echocardiography to evaluate exercise tolerance in patients with HCM who cannot perform an exercise-based examination. Such measurements provide a basis for clinical decisions regarding exercise and drug prescription.
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Affiliation(s)
- Ye Su
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiovascular Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Qionghui Peng
- Department of Cardiovascular Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Lixue Yin
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiovascular Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- *Correspondence: Lixue Yin, ;
| | - Chunmei Li
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Cardiovascular Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Chunmei Li,
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Wang Y, Li W, Zhang H, Zhang Q, Ding G, Guo Z, Deng Y, Li C, Yin L. Echocardiographic Normal Reference of Left Ventricular Contractile Reserve During Treadmill Exercise Stress Echocardiography in Healthy Chinese Adults - New Non-Sex-Specific Parameter for Left Ventricular Contractile Reserve Evaluation. Int J Gen Med 2021; 14:7089-7098. [PMID: 34720598 PMCID: PMC8549965 DOI: 10.2147/ijgm.s334400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose Left ventricular (LV) contractile reserve is commonly used for LV systolic function assessment, while data on normal LV contractile reserve to exercise and the effect of gender on it are contradictory and limited, especially in Chinese adults. The aims of the present study are to clarify echocardiographic normal reference of LV contractile reserve during treadmill exercise stress echocardiography in healthy Chinese adults and to evaluate the sex-specific impact on it. Patients and Methods The study population consisted of 157 healthy Chinese adults. All subjects underwent comprehensive echocardiographic assessment at rest and immediately after a symptom-limited treadmill stress test. The impact of gender on LV contractile reserve was analyzed. Results The study population consisted of 157 healthy Chinese adults. All subjects underwent comprehensive echocardiographic assessment at rest and immediately after a symptom-limited treadmill stress test. The impact of gender on LV contractile reserve was analyzed. Conclusion Traditional LV contractile reserve of men was much higher than that of women in a healthy Chinese population. The difference might be because of higher BSA in men. ΔGLS was less influenced by METs and CI at rest compared to ΔEF. ΔGLS, and especially the ΔGLS index, might be considered as a more preferable contractile reserve parameter for clinical cardiac function evaluation.
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Affiliation(s)
- Yi Wang
- Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Wenhua Li
- Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Hongmei Zhang
- Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Qingfeng Zhang
- Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Geqi Ding
- Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Zhiyu Guo
- GE Cardiovascular Ultrasound Clinical & Research Department, Chengdu, People's Republic of China
| | - Yan Deng
- Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Chunmei Li
- Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Lixue Yin
- Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
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d'Entremont MA, Fortin G, Huynh T, Croteau É, Farand P, Lemaire-Paquette S, Brochu MC, Do DH, Lepage S, Mampuya WM, Couture ÉL, Nguyen M, Essadiqi B. The feasibility, reliability, and incremental value of two-dimensional speckle-tracking for the detection of significant coronary stenosis after treadmill stress echocardiography. Cardiovasc Ultrasound 2021; 19:27. [PMID: 34301240 PMCID: PMC8305986 DOI: 10.1186/s12947-021-00259-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background Two-dimensional speckle-tracking echocardiography (STE) may help detect coronary artery disease (CAD) when combined with dobutamine stress echocardiography. However, few studies have explored STE with exercise stress echocardiography (ESE). We aimed to evaluate the feasibility, reliability, and incremental value of STE combined with treadmill ESE compared to treadmill ESE alone to detect CAD. Methods We conducted a case–control study of all consecutive patients with abnormal ESE in 2018–2020 who subsequently underwent coronary angiography within a six-month interval. We 1:1 propensity score-matched these patients to those with a normal ESE. Two blinded operators generated a 17-segment bull's-eye map of longitudinal strain (LS). We utilized the mean differences between stress and baseline LS values in segments 13–17, segment 17, and segments 15–16 to create receiver operator curves for the overall examination, the left anterior descending artery (LAD), and the non-LAD territories, respectively. Results We excluded 61 STEs from 201 (30.3%) eligible ESEs; 47 (23.4%) because of suboptimal image quality and 14 (7.0%) because of excessive heart rate variability precluding the calculation of a bull's-eye map. After matching, a total of 102 patients were included (51 patients in each group). In the group with abnormal ESE patients (mean age 66.4 years, 39.2% female), 64.7% had significant CAD (> 70% stenosis) at coronary angiogram. In the group with normal ESE patients (mean age 65.1 years, 35.3% female), 3.9% were diagnosed with a new significant coronary stenosis within one year. The intra-class correlation for global LS was 0.87 at rest and 0.92 at stress, and 0.84 at rest, and 0.89 at stress for the apical segments. The diagnostic accuracy of combining ESE and STE was superior to visual assessment alone for the overall examination (area under the curve (AUC) = 0.89 vs. 0.84, p = 0.025), the non-LAD territory (AUC = 0.83 vs. 0.70, p = 0.006), but not the LAD territory (AUC = 0.79 vs. 0.73, p = 0.11). Conclusions Two-dimensional speckle-tracking combined with treadmill ESE is relatively feasible, reliable, and may provide incremental diagnostic value for the detection and localization of significant CAD. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-021-00259-w.
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Affiliation(s)
- Marc-André d'Entremont
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Gabriel Fortin
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Thao Huynh
- McGill Health University Center, Montreal, QC, Canada
| | - Étienne Croteau
- Sherbrooke University Hospital Research Center (CRCHUS), Sherbrooke, QC, Canada
| | - Paul Farand
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | - Marie-Claude Brochu
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Doan Hoa Do
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Serge Lepage
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Warner Mbuila Mampuya
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Étienne L Couture
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Michel Nguyen
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Btissama Essadiqi
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS) , 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
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Li C, Li K, Yuan M, Bai W, Rao L. Peak strain dispersion within the left ventricle detected by two-dimensional speckle tracking in patients with uncomplicated systemic lupus erythematosus. Int J Cardiovasc Imaging 2021; 37:2197-2205. [PMID: 33661409 DOI: 10.1007/s10554-021-02201-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/22/2021] [Indexed: 02/05/2023]
Abstract
Systemic lupus erythematosus (SLE) often leads to various cardiovascular diseases. We aimed to investigate the value of peak strain dispersion (PSD) in evaluating left ventricular dysfunction in patients with uncomplicated SLE. Eighty-seven female SLE patients and fifty-nine healthy female controls were recruited. The SLE patients were divided into inactive disease (SLE disease activity index (SLEDAI) ≤ 4; n = 48) and active disease (SLEDAI ≥ 5; n = 39) subgroups. Traditional echocardiography and two-dimensional speckle-tracking echocardiography were performed using a GE VividE9 ultrasound diagnostic system and an advanced quantitative analysis EchoPAC workstation (version 201), respectively. The global longitudinal strain (GLS) in the SLE with SLEDAI ≤ 4 group was comparable to that in the control group (- 19.89% vs - 20.7%; P = 0.061). However, GLS was obviously damaged in the SLE with SLEDAI ≥ 5 group compared with that in the control group (- 19.07% vs - 20.7%; P < 0.001). PSD impairment was observed in the SLE with SLEDAI ≤ 4 group (33.83 ms vs 31.44 ms; P = 0.012) and SLE with SLEDAI ≥ 5 groups (52.31 ms vs 31.44 ms; P < 0.001), but the largest difference was observed in the active disease group. Linear regression analysis showed that PSD was moderately correlated with the SLEDAI (r = 0.535; P < 0.001) in SLE patients with SLEDAI ≤ 4 and showed the best correlation with the SLEDAI (r = 0.646; P < 0.001) in the SLE patients with SLEDAI ≥ 5. A correlation between GLS and the SLEDAI (r = 0.359; P = 0.025) was found in the active disease group but not in the inactive disease group (r = 0.253; P = 0.082). PSD is more comprehensive and accurate for evaluating left ventricular subclinical dysfunction in SLE patients. In inactive SLE patients, PSD is a more sensitive index to evaluate early systolic dysfunction of the left ventricle. GLS may be a more vulnerable indicator of early left ventricular cardiac dysfunction in active SLE patients. Controlling disease activity may reduce the events of cardiac dysfunction.
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Affiliation(s)
- Chunmei Li
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Kun Li
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Wenjuan Bai
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Li Rao
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China.
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Plonek T, Rylski B, Nawrocki P, Beyersdorf F, Jasinski M, Kuliczkowski W. Systolic stretching of the ascending aorta. Arch Med Sci 2021; 17:25-30. [PMID: 33488852 PMCID: PMC7811307 DOI: 10.5114/aoms.2019.82997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Longitudinal stretching of the aorta due to systolic heart motion contributes to the stress in the wall of the ascending aorta. The objective of this study was to assess longitudinal systolic stretching of the aorta and its correlation with the diameters of the ascending aorta and the aortic root. MATERIAL AND METHODS Aortographies of 122 patients were analyzed. The longitudinal systolic stretching of the aorta caused by the contraction of the heart during systole and the maximum dimensions of the aortic root and ascending aorta were measured in all patients. RESULTS The maximum dimension of the aortic root was on average 34.9 ±4.5 mm and the mean diameter of the ascending aorta was 33.9 ±5.4 mm. The systolic aortic stretching negatively correlated with age (r = -0.49, p < 0.001) and the diameter of the tubular ascending aorta (r = -0.44, p < 0.001). There was no significant correlation between the stretching and the dimension of the aortic root (r = -0.11, p = 0.239). There was a statistically significant (p < 0.001) difference in the longitudinal aortic stretching values between patients with a normal aortic valve (10.6 ±3.1 mm) and an aortic valve pathology (8.0 ±3.2 mm in all patients with an aortic valve pathology; 7.5 ±4.3 mm in isolated aortic stenosis, 8.5 ±2.9 mm in the case of isolated insufficiency, 8.2 ±2.8 mm for valves that were both stenotic and insufficient). CONCLUSIONS Systolic aortic stretching negatively correlates with the diameter of the tubular ascending aorta and the age of the patients, and does not correlate with the diameter of the aortic root. It is lower in patients with an aortic valve pathology.
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Affiliation(s)
- Tomasz Plonek
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Rylski
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pawel Nawrocki
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Friedhelm Beyersdorf
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
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Picano E, Zagatina A, Wierzbowska-Drabik K, Borguezan Daros C, D’Andrea A, Ciampi Q. Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography. J Clin Med 2020; 9:E3184. [PMID: 33008112 PMCID: PMC7601661 DOI: 10.3390/jcm9103184] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022] Open
Abstract
For the past 40 years, the methodology for stress echocardiography (SE) has remained basically unchanged. It is based on two-dimensional, black and white imaging, and is used to detect regional wall motion abnormalities (RWMA) in patients with known or suspected coronary artery disease (CAD). In the last five years much has changed and RWMA is not enough on its own to stratify patient risk and dictate therapy. Patients arriving at SE labs often have comorbidities and are undergoing full anti-ischemic therapy. The SE positivity rate based on RWMA fell from 70% in the eighties to 10% in the last decade. The understanding of CAD pathophysiology has shifted from a regional hydraulic disease to a systemic biologic disease. The conventional view of CAD encouraged the use of coronary anatomic imaging for diagnosis and the oculo-stenotic reflex for the deployment of therapy. This has led to a clinical oversimplification that ignores the lessons of pathophysiology and epidemiology, and in fact, CAD is not synonymous with ischemic heart disease. Patients with CAD may also have other vulnerabilities such as coronary plaque (step A of ABCDE-SE), alveolar-capillary membrane and pulmonary congestion (step B), preload and contractile reserve (step C), coronary microcirculation (step D) and cardiac autonomic balance (step E). The SE methodology based on two-dimensional echocardiography is now integrated with lung ultrasound (step B for B-lines), volumetric echocardiography (step C), color- and pulsed-wave Doppler (step D) and non-imaging electrocardiogram-based heart rate assessment (step E). In addition, qualitative assessment based on the naked eye has now become more quantitative, has been improved by contrast and based on cardiac strain and artificial intelligence. ABCDE-SE is now ready for large scale multicenter testing in the SE2030 study.
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Affiliation(s)
- Eugenio Picano
- Biomedicine Department, CNR Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Clinic, Saint Petersburg State University, 199034 Saint Petersburg, Russia;
| | - Karina Wierzbowska-Drabik
- First Department and Chair of Cardiology, Bieganski Hospital, Medical University, 90926 Lodz, Poland;
| | | | | | - Quirino Ciampi
- Cardiolody Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
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Cadeddu Dessalvi C, Deidda M, Farci S, Longu G, Mercuro G. Early ischemia identification employing 2D speckle tracking selective layers analysis during dobutamine stress echocardiography. Echocardiography 2019; 36:2202-2208. [PMID: 31742770 DOI: 10.1111/echo.14535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/30/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Two-dimensional (2D) strain derived from speckle tracking proved to be feasible and accurate in the quantitative evaluation of myocardial ischemia during stress echocardiography. We compared the accuracy in detecting myocardial ischemia of the transmural segmental analysis with an endocardial specific evaluation in 20 patients undergoing dobutamine stress echocardiography (DSE) and coronary angiography. METHODS Peak systolic global strain (G-ε) and at the subendocardial level (Endo-ε) were measured off-line at rest, a low dose, and peak stress; then, we compared the results with wall-motion analysis and significant coronary artery disease (CAD > 70% diameter stenosis). Endocardial strain variation from basal to low and peak dose was computed both for global or subendocardial analysis. The utilization of the ROC curve allowed us to derive optimal cutoffs, sensibility and specificity for ischemic segments. RESULTS The subendocardial analysis at high dose showed to be able to increase significantly the accuracy of the test to detect the ischemic segments (sens 90.2% vs 85.4%; spec 93.1% vs 92.2%). Moreover, at the low dose, the subendocardial analysis showed to be able to increase significantly, mostly the specificity of the test (sens 69.6% vs 68.3%; spec 92.2% vs 86.2%). Notably, the strain subendocardial analysis at low dose showed to reach a high specificity, similar to the peak dose transmural analysis. CONCLUSIONS Measurement of subendocardial strain during DSE is feasible and can increase the accuracy of the test. Moreover, the subendocardial strain during DSE can reach a high specificity, even limiting the test at a low dose infusion.
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Affiliation(s)
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Salvatore Farci
- Azienda Ospedaliero-Universitaria di Cagliari - Clinica Cardiologica, Monserrato-Cagliari, Italy
| | - Giorgio Longu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Abstract
PURPOSE OF REVIEW Myocardial strain imaging has gained popularity during the last decade in various clinical scenarios. The objective of this article was to review the potential application of two-dimensional (2D) and three-dimensional (3D) strains in patients with coronary artery disease. RECENT FINDINGS Reports on the diagnostic accuracy of myocardial deformation analysis using 2D and 3D speckle-tracking analyses to detect significant coronary stenosis at rest or during stress and to evaluate myocardial viability are limited. A newer 2D strain approach that uses layer-specific strain analysis might be sensitive in the detection of subtle regional myocardial dysfunction induced by myocardial ischemia. However, its potential accuracy is controversial. The regional assessment of wall motion by 2D/3D strain is not recommended because of measurement variabilities. SUMMARY Further studies are required for the adoption of this technology in patients with coronary artery disease.
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Gupta K, Kakar TS, Gupta A, Singh A, Gharpure N, Aryal S, Hawi R, Lloyd SG, Booker J, Hage FG, Prabhu SD, Nanda NC, Bajaj NS. Role of left ventricle deformation analysis in stress echocardiography for significant coronary artery disease detection: A diagnostic study meta-analysis. Echocardiography 2019; 36:1084-1094. [PMID: 31116467 DOI: 10.1111/echo.14365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/27/2019] [Accepted: 04/24/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We compared the diagnostic accuracy of longitudinal strain (LS) imaging during stress echocardiography with visual assessment of wall motion (WM) for detecting significant coronary artery disease (CAD). METHODS Our systematic search included studies reporting diagnostic measures for LS imaging and visual assessment of WM for detecting significant CAD during stress echocardiography. Summary diagnostic accuracy measures including area under the curve (AUC), sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios (LRs) were estimated. RESULTS In thirteen studies with 978 patients, ten studies used invasive coronary angiography as the reference standard. Pooled AUC for diagnosing significant CAD was 0.92 (95% confidence interval [CI] 0.89-0.94) for LS imaging as compared to 0.83 (95% CI 0.80-0.86), P < 0.001 for visual assessment of WM. LS imaging had higher sensitivity (88% [95% CI 84-92] vs 74% [95% CI 68-80], P < 0.001) and comparable specificity to visual assessment of WM (80% [95% CI 72-87] vs 83% [95% CI 74-90], P = 0.592). The DOR for LS imaging and visual assessment of WM was 31 and 15, P = 0.254, respectively. The positive LR was 4.5 for both; negative LR was 0.14 and 0.31, P = 0.002 for LS imaging and visual assessment of WM, respectively. CONCLUSIONS Longitudinal strain imaging during stress echocardiography has better diagnostic accuracy for detecting significant CAD as compared to visual assessment of WM. Studies using larger sample size and standardized techniques of strain measurement are required to further ascertain the added advantage of strain measurement over visual assessment alone.
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Affiliation(s)
- Kartik Gupta
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tanya S Kakar
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Ankur Gupta
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Amitoj Singh
- Department of Noninvasive Cardiac Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nitin Gharpure
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sudeep Aryal
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Riem Hawi
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.,Section of Cardiology, Birmingham Veterans Affair Medical Center, Birmingham, Alabama
| | - Steven G Lloyd
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.,Section of Cardiology, Birmingham Veterans Affair Medical Center, Birmingham, Alabama
| | - Julian Booker
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.,Section of Cardiology, Birmingham Veterans Affair Medical Center, Birmingham, Alabama
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.,Section of Cardiology, Birmingham Veterans Affair Medical Center, Birmingham, Alabama
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Navkaranbir S Bajaj
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.,Section of Cardiology, Birmingham Veterans Affair Medical Center, Birmingham, Alabama.,Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Wierzbowska-Drabik K, Trzos E, Kurpesa M, Rechcinski T, Miskowiec D, Cieslik-Guerra U, Uznanska-Loch B, Sobczak M, Kasprzak JD. Diabetes as an independent predictor of left ventricular longitudinal strain reduction at rest and during dobutamine stress test in patients with significant coronary artery disease. Eur Heart J Cardiovasc Imaging 2019; 19:1276-1286. [PMID: 29236974 DOI: 10.1093/ehjci/jex315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
Aims Diabetes (DM) is a strong cardiovascular risk factor modifying also the left ventricular (LV) function that may be objectively assessed with echocardiographic strain analysis. Although the impact of isolated DM on myocardial deformation has been already studied, few data concern diabetics with coronary artery disease (CAD), especially in all stages of dobutamine stress echocardiography (DSE). We compared LV systolic function during DSE in CAD with and without DM using state-of-the art speckle-tracking quantification and assessed the impact of DM on LV systolic strain. Methods and results DSE was performed in 250 patients with angina who afterwards had coronarography with ≥50% stenosis in the left main artery and ≥70% in other arteries considered as significant. In this analysis, we included 127 patients with confirmed CAD: 42 with DM [DM(+); mean age 64 ± 9 years] and 85 patients without DM [DM(-); mean age 63 ± 9 years]. The severity of CAD and LV ejection fraction (EF) were similar in both groups. Global and regional LV peak systolic longitudinal strain (PSLS) revealed in all DSE phases lower values in DM(+) group: 14.5 ± 3.6% vs. 17.4 ± 4.0% at rest; P = 0.0001, 13.8 ± 3.9% vs. 16.7 ± 4.0% at peak stress; P = 0.0002, and 14.2 ± 3.1% vs. 15.5 ± 3.5% at recovery; P = 0.0432 for global parameters, although dobutamine challenge did not enhance further resting differences. LV EF, body surface area, and diabetes were independent predictors for strain in 16-variable model (R2 = 0, 51, P < 0.001). Conclusion PSLS although diminished in both groups with CAD was lower in diabetics at all DSE stages, and DM was an independent predictor of this impairment. However, the dobutamine challenge did not deepen the resting differences, suggesting that the direct impact of coronary stenoses effaces the influence of DM during DSE. The comparison with our previous data revealed synergistic, detrimental effect of coexisting CAD and DM on myocardial strain.
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Affiliation(s)
| | - Ewa Trzos
- Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, Lodz, Poland
| | - Malgorzata Kurpesa
- Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, Lodz, Poland
| | - Tomasz Rechcinski
- Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, Lodz, Poland
| | - Dawid Miskowiec
- Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, Lodz, Poland
| | - Urszula Cieslik-Guerra
- Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, Lodz, Poland
| | - Barbara Uznanska-Loch
- Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, Lodz, Poland
| | - Maria Sobczak
- Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, Lodz, Poland
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12
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Wierzbowska-Drabik K, Miśkowiec D, Kasprzak JD. Systolic longitudinal strain correlates with visual assessment of regional left ventricular function during dobutamine stress echocardiography and discriminates the segments with induced contractility impairment. Echocardiography 2017; 34:1020-1028. [DOI: 10.1111/echo.13582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
| | - Dawid Miśkowiec
- Department of Cardiology; Medical University of Lodz; Lodz Poland
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13
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Roushdy A, Abou El Seoud Y, Abd Elrahman M, Wadeaa B, Eletriby A, Abd El Salam Z. The additional utility of two-dimensional strain in detection of coronary artery disease presence and localization in patients undergoing dobutamine stress echocardiogram. Echocardiography 2017; 34:1010-1019. [PMID: 28548371 DOI: 10.1111/echo.13569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Dobutamine stress echocardiogram (DSE) is a feasible and safe exercise-independent stress modality for diagnoses of coronary artery disease (CAD), but it is subjective, and operator dependant. Two-dimensional strain at peak stress could overcome these limitations and thus increase the accuracy of DSE. METHODS AND RESULTS This was a prospective observational study in which 80 patients underwent DSE, two-dimensional strain at peak stress, and coronary angiography. Global longitudinal strains (GLS) cutoff point of -16.75 had 77.42% sensitivity and 83.33% specificity to detect significant CAD. Global circumferential strain (GCS) cutoff point of -20.75 had 93.55% sensitivity and 66.67% specificity to detect significant CAD (P=.003, areas under the curve [AUC]=0.73). The average territorial strain cutoff point for significant left anterior descending (LAD) lesion was -15.4 with 77.78% sensitivity and 82.86% specificity (P=.0001, AUC=0.78) and for non-LAD lesion was -16.9 with 82.93% sensitivity and 53.85% specificity (P=.0009, AUC=0.69). Two-dimensional strain at peak stress showed better agreement than DSE as regard number of vessels affected (K=0.579 vs 0.107), LAD lesion detection (K=0.783 vs 0.438), and non-LAD lesion detection (K=0.699 vs 0.233). Global longitudinal strain (GLS) at peak stress reduced DSE false positivity by 83%; the number of false-positive patients was reduced from 18 patients to only three patients. CONCLUSION Two-dimensional strain at peak stress had an incremental value over DSE visual assessment/ wall-motion score index (WMSI) in reducing false-positive results of DSE. Two-dimensional strain at peak stress had greater accuracy than DSE alone not only in detection of significant CAD but also in detection of number of vessels with significant lesion as well as CAD localization.
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Affiliation(s)
- Alaa Roushdy
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
| | | | | | - Basem Wadeaa
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
| | - Adel Eletriby
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
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