Journal of the American Society of Echocardiography
Clinical InvestigationCoronary Artery DiseaseQuantitative Dobutamine Stress Echocardiography Using Speckle-Tracking Analysis versus Conventional Visual Analysis for Detection of Significant Coronary Artery Disease after ST-Segment Elevation Myocardial Infarction
Section snippets
Patient Population
All first STEMI patients presenting to our institution between November 2010 and February 2012 and treated according to the MISSION! protocol were evaluated for inclusion in this retrospective study. This protocol is designed to improve care around all aspects of STEMI and is based on the most recent American College of Cardiology Foundation and American Heart Association and European Society of Cardiology guidelines.2, 16, 17 Diagnosis of acute myocardial infarction was made on the basis of
Patient Population
Of 135 first STEMI patients meeting the initial inclusion criteria, 7% (n = 10) were excluded because of the occurrence of a dobutamine stress echocardiographic end point other than completion of the protocol (Figure 1). A further 15% (n = 20) were excluded because of either inadequate image quality at rest or peak dose or inaccurate tracking involving a full regional wall or more than two segments within the same coronary territory. Clinical characteristics of the remaining 105 patients (mean
Discussion
Analysis of 2D speckle-tracking echocardiographic longitudinal strain parameters during full-protocol DSE alongside conventional visual analysis was feasible in the majority of patients after STEMI at peak dose as well as at rest. At the global level, ΔPLSS was independently associated with the presence of significant CAD at follow-up, unlike ΔWMS, and provided incremental value to conventional visual analysis for the detection of significant CAD at follow-up. Segmental ΔPLSS similarly
Conclusions
Two-dimensional speckle-tracking echocardiographic strain analysis is feasible on full-protocol DSE after STEMI and represents a promising new quantitative technique to detect significant angiographic CAD at follow-up.
PLSS investigated at rest and the peak stage of DSE was the optimal parameter to detect the ischemic substrate in stable patients after myocardial infarction and provided incremental value to conventional visual wall analysis. However, low specificity, segment-to-segment
References (40)
- et al.
Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography
J Am Coll Cardiol
(1997) - et al.
Stress echocardiography and the human factor: the importance of being expert
J Am Coll Cardiol
(1991) - et al.
Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms
J Am Coll Cardiol
(1996) - et al.
Two-dimensional strain—a Doppler-independent ultrasound method for quantitation of regional deformation: validation in vitro and in vivo
J Am Soc Echocardiogr
(2005) - et al.
Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging
J Am Coll Cardiol
(2006) - et al.
Experimental validation of circumferential, longitudinal, and radial 2-dimensional strain during dobutamine stress echocardiography in ischemic conditions
J Am Coll Cardiol
(2008) - et al.
Incremental value of 2-dimensional speckle tracking strain imaging to wall motion analysis for detection of coronary artery disease in patients undergoing dobutamine stress echocardiography
Am Heart J
(2009) - et al.
Third universal definition of myocardial infarction
J Am Coll Cardiol
(2012) - et al.
Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction
J Am Coll Cardiol
(1999) - et al.
American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography
J Am Soc Echocardiogr
(2007)
Factors affecting sensitivity and specificity of diagnostic testing: dobutamine stress echocardiography
J Am Soc Echocardiogr
Incidence, predictors, and outcome of new, subsequent lesions treated with percutaneous coronary intervention in patients presenting with myocardial infarction
Am J Cardiol
Prognostic value of dobutamine echocardiography early after uncomplicated acute myocardial infarction: a comparison with exercise electrocardiography
J Am Coll Cardiol
Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range
JACC Cardiovasc Imaging
Reproducibility of regional and global longitudinal strains derived from two-dimensional speckle-tracking and Doppler tissue imaging between expert and novice readers during quantitative dobutamine stress echocardiography
J Am Soc Echocardiogr
Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography
J Am Soc Echocardiogr
A randomized cross-over study for evaluation of the effect of image optimization with contrast on the diagnostic accuracy of dobutamine echocardiography in coronary artery disease The OPTIMIZE Trial
JACC Cardiovasc Imaging
Coronary flow reserve during coronary angioplasty in patients with a recent myocardial infarction: relation to stenosis and myocardial viability
J Am Coll Cardiol
Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian Study)
Eur Heart J
ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation
Eur Heart J
Cited by (32)
Echocardiographic Strain Imaging in Coronary Artery Disease: The Added Value of a Quantitative Approach
2020, Cardiology ClinicsCitation Excerpt :The routine adoption of speckle tracking during stress echocardiography is still a matter of debate,16 as there are issues of applicability due to excessive myocardial motion at higher heart rates and the lack of definition of cutoff levels for each major coronary artery region. Joyce and colleagues17 reported variable diagnostic accuracy using the same cutoff value for the strain parameter in different coronary perfusion regions. The adoption of cut-offs based on “sentinel segments” may be useful, but the heterogeneity of the perfusion territory distal to the stenosis makes it not always accurate.16
Left Ventricular Strain and Strain Rate during Submaximal Semisupine Bicycle Exercise Stress Echocardiography in Healthy Adolescents and Young Adults: Systematic Protocol and Reference Values
2020, Journal of the American Society of EchocardiographyGuidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography
2020, Journal of the American Society of EchocardiographyDobutamine Stress Echocardiography Unmasks Early Left Ventricular Dysfunction in Asymptomatic Patients with Uncomplicated Type 2 Diabetes: A Comprehensive Two-Dimensional Speckle-Tracking Imaging Study
2018, Journal of the American Society of EchocardiographyIs Speckle-Tracking Echocardiography a Panacea? Experience Is Still Required
2017, Journal of the American Society of EchocardiographyStrain Imaging with a Bull's-Eye Map for Detecting Significant Coronary Stenosis during Dobutamine Stress Echocardiography
2017, Journal of the American Society of EchocardiographyCitation Excerpt :Whether the cutoff value for each major coronary artery should be different is another issue. Joyce et al.8 reported variable diagnostic accuracy using the same cutoff value for the strain parameter in different coronary arteries. Thus, various diagnostic criteria have been used when applying strain imaging on DSE.
Dr Joyce and Ms Hoogslag contributed equally to this work and share first authorship.
Dr Joyce was supported during the period of this research by a European Society of Cardiology Training Grant and an Irish national educational bursary sponsored by Merck, Sharp & Dohme. Ms Hoogslag received a PhD grant provided by the Leiden University Medical Center. Dr Debonnaire was supported by a Sadra Medical Research Grant (Boston Scientific).
The Department of Cardiology at Leiden University Medical Center receives unrestricted grants from Biotronik (Berlin, Germany), Boston Scientific (Natick, MA), GE Healthcare (Buckinghamshire, United Kingdom), and Medtronic (Minneapolis, MN). Dr Delgado received consulting fees from Medtronic and St. Jude Medical (St. Paul, MN).