摘要
Background: Dobutamine stress echocardiography (DSE) is a well-established method for detecting myocardial ischemia. The classic echocardiographic findings of ischemia are new or worsening abnormalities of radial wall thickening. However, interpretation of these findings is subjective and dependent on experience. Speckle tracking strain imaging (STI) has been introduced as a novel method to overcome these limitations. Objective: The aim of the study is to evaluate the value of speckle tracking imaging (STI) by estimating the mean global longitudinal systolic (GLS) and the mean global circumferential systolic (GCS) strain imaging at recovery period of dobutamine stress echocardiography for prediction of significant coronary artery disease (CAD) in patients with chest discomfort. Methods: Fifty three patients presented for evaluation of chest discomfort underwent dobutamine stress echocardiography and coronary angiography at Cardiology Department,Menoufia University Hospital. The mean global left ventricular longitudinal systolic strain (GLS) at apical views—3 chambers, 4 chambers & 2 chambers apical views and global left ventricular circumferential systolic strain (GCS) at short axis view at level of papillary muscle were measured at rest and during recovery period of dobutamine stress echocardiography using automated functional imaging (AFI). Coronary angiography was done for all patients. Significant coronary artery lesion was defined as having a ≥ 70% diameter stenosis on coronary angiography. Patients were divided into two groups based on the presence or absence of significant coronary artery lesion into CAD positive (+ve) group vs. CAD negative (-ve) group. Results: In both groups,there were no statistically significant differences in the clinical characteristics and baseline conventional transthoracic echocardiography. GLS and GSC at recovery were lower in the CAD (+ve) group than in the CAD (-ve) group (-16.69% ± 1.10% vs -19.05% ± 1.41% p ). GLS and GCS during recovery period of DSE were valuable for prediction of CAD when cutoff at recovery is less than -17.95% (sensitivity of 84% & specificity of 84%) for GLS and less than -20.2% (sensitivity of 76% & specificity of 84%) for GCS. Also, we observed that the GLS and GCS percentile decreased from baseline to recovery period of DSE by about -9.95% ± 4.82% and -7.72% ± 3.90% respectively. Conclusion: Speckle tracking Imaging GLS and GCS at recovery period of Dobutamine Stress Echocardiography is feasible and offers an objective technique for prediction of significant coronary artery disease with increasing the accuracy of DSE in patient with chest discomfort.
Background: Dobutamine stress echocardiography (DSE) is a well-established method for detecting myocardial ischemia. The classic echocardiographic findings of ischemia are new or worsening abnormalities of radial wall thickening. However, interpretation of these findings is subjective and dependent on experience. Speckle tracking strain imaging (STI) has been introduced as a novel method to overcome these limitations. Objective: The aim of the study is to evaluate the value of speckle tracking imaging (STI) by estimating the mean global longitudinal systolic (GLS) and the mean global circumferential systolic (GCS) strain imaging at recovery period of dobutamine stress echocardiography for prediction of significant coronary artery disease (CAD) in patients with chest discomfort. Methods: Fifty three patients presented for evaluation of chest discomfort underwent dobutamine stress echocardiography and coronary angiography at Cardiology Department,Menoufia University Hospital. The mean global left ventricular longitudinal systolic strain (GLS) at apical views—3 chambers, 4 chambers & 2 chambers apical views and global left ventricular circumferential systolic strain (GCS) at short axis view at level of papillary muscle were measured at rest and during recovery period of dobutamine stress echocardiography using automated functional imaging (AFI). Coronary angiography was done for all patients. Significant coronary artery lesion was defined as having a ≥ 70% diameter stenosis on coronary angiography. Patients were divided into two groups based on the presence or absence of significant coronary artery lesion into CAD positive (+ve) group vs. CAD negative (-ve) group. Results: In both groups,there were no statistically significant differences in the clinical characteristics and baseline conventional transthoracic echocardiography. GLS and GSC at recovery were lower in the CAD (+ve) group than in the CAD (-ve) group (-16.69% ± 1.10% vs -19.05% ± 1.41% p ). GLS and GCS during recovery period of DSE were valuable for prediction of CAD when cutoff at recovery is less than -17.95% (sensitivity of 84% & specificity of 84%) for GLS and less than -20.2% (sensitivity of 76% & specificity of 84%) for GCS. Also, we observed that the GLS and GCS percentile decreased from baseline to recovery period of DSE by about -9.95% ± 4.82% and -7.72% ± 3.90% respectively. Conclusion: Speckle tracking Imaging GLS and GCS at recovery period of Dobutamine Stress Echocardiography is feasible and offers an objective technique for prediction of significant coronary artery disease with increasing the accuracy of DSE in patient with chest discomfort.
