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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Cardiovascular Ultrasound 1/2012

Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography

Zeitschrift:
Cardiovascular Ultrasound > Ausgabe 1/2012
Autoren:
Jelena Celutkiene, Diana Zakarkaite, Viktor Skorniakov, Vida Zvironaite, Virginija Grabauskiene, Jelizaveta Burca, Laura Ciparyte, Aleksandras Laucevicius
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7120-10-31) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contribution

JC participated in design creation, performed quantitative imaging during dobutamine stress tests, measured study parameters, participated in data analysis and drafting article. DZ participated in concept formulation and drafting article. VS performed statistical data analysis, helped to interpret the data and draft article. VZ participated in design creation and drafting article, performed critical revision of article. VG participated in data analysis, performed critical revision of article. JB collected and measured study parameters, participated in data analysis. LC collected and measured study parameters, participated in data analysis. AL participated in design creation and drafting article, performed critical revision of article. All authors read and approved the final manuscript.

Abstract

Background

A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE).

Methods

Prospective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis.

Results

The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52.

Conclusions

Multiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD.
Zusatzmaterial
Additional file 1:Celutkiene_ additional file 1.doc: Additional file 1. Full list of measured and calculated parameters. (PDF 114 KB)
12947_2012_434_MOESM1_ESM.pdf
Additional file 2:Celutkiene additional file 2 70.doc: Additional file 2. Mean values of significant predictors of stenosis in NON-STENOSED and STENOSED segments. (DOC 84 KB)
12947_2012_434_MOESM2_ESM.doc
Authors’ original file for figure 1
12947_2012_434_MOESM3_ESM.tiff
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