The online version of this article (doi:10.1186/1476-7120-10-31) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
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.
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).
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.
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.
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.
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 112947_2012_434_MOESM3_ESM.tiff
Kowalski M, Herregods MC, Herbots L, Weidemann F, Simmons L, Strotmann J, Dommke C, D'hooge J, Claus P, Bijnens B, Hatle L, Sutherland GR: The feasibility of ultrasonic regional strain and strain rate imaging in quantifying dobutamine stress echocardiography. Eur J Echocardiogr. 2003, 4: 81-91. 10.1053/euje.4.2.81 CrossRefPubMed
Davidavicius G, Kowalski M, Williams RI, D’Hooge J, Di Salvo G, Pierre-Justin G, Claus P, Rademakers F, Herregods MC, Fraser AG, Piérard LA, Bijnens B, Sutherland GR: Can regional strain and strain rate measurement be performed during both dobutamine and exercise echocardiography, and do regional deformation responses differ with different forms of stress testing?. J Am Soc Echocardiogr. 2003, 16: 299-308. 10.1016/S0894-7317(02)74428-3 CrossRefPubMed
von Bibra H, Tuchnitz A, Klein A, Schneider-Eicke J, Schömig A, Schwaiger M: Regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing: a comparison with stress echocardiography and perfusion scintigraphy. J Am Coll Cardiol. 2000, 36: 444-52. 10.1016/S0735-1097(00)00735-X CrossRefPubMed
Ilic MD, Ilic S, Petrovic D, Ilic B, Djordjevic D: Index of postsystolic motion as a marker of the severity of stress induced myocardial ischaemia [abstract]. Eur Heart J. 2002, 4: s655-10.1016/S1388-9842(02)00160-5. CrossRef
Jamal F, Kukulski T, Strotmann JM, Szilard M, D’hooge J, Bijnens B, Rademakers F, Hatle L, De Scheerder I, Sutherland GR: Quantitation of the spectrum of changes in regional myocardial function during acute ischemia in closed chest pigs: an ultrasonic strain rate and strain study. J Am Soc Echocardiogr. 2001, 14: 874-84. 10.1067/mje.2001.112037 CrossRefPubMed
Voigt J-U, Exner B, Schmiedehausen K, Huchzermeuer C, Reulbach U, Nixdorff U, Platsch G, Kuwert T, Daniel WG, Flachskampf FA: Strain-Rate Imaging During Dobutamine Stress Echocardiography Provides Objective Evidence of Inducible Ischemia. Circulation. 2003, 107: 2120-6. 10.1161/01.CIR.0000065249.69988.AA CrossRefPubMed
Armstrong G, Pasquet A, Fukamachi K, Cardon L, Olstad B, Marwick T: Use of peak systolic strain as an index of regional left ventricular function: comparison with tissue Doppler velocity during dobutamine stress and myocardial ischemia. J Am Soc Echocardiogr. 2000, 13 (8): 731-7. 10.1067/mje.2000.105912 CrossRefPubMed
Yip G, Khandheria B, Belohlavek M, Pislaru C, Seward J, Bailey K, Tajik AJ, Pellikka P, Abraham T: Strain echocardiography tracks dobutamine-induced decrease in regional myocardial perfusion in nonocclusive coronary stenosis. J Am Coll Cardiol. 2004, 44: 1664-71. 10.1016/j.jacc.2004.02.065 CrossRefPubMed
Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, Voigt J-U: Zamorano JL on behalf of the European Association of Echocardiography: Stress echocardiography expert consensus statement. Eur J Echocardiography. 2008, 9: 417-437. 10.1093/ejechocard/jen024. CrossRef
Haug G: Stress echocardiography. 222-Steinkopff Verlag, Darmstadt, 2, 1998.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ: Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee. J Am Soc Echocardiogr. 2005, 18: 1440-63. 10.1016/j.echo.2005.10.005 CrossRefPubMed
Bogaert J, Rademakers FE: Regional nonuniformity of normal adult human left ventricle. Am J Physiol Heart Circ Physiol. 2001, 280: H610-20. PubMed
Mädler CF, Payne N, Wilkenshoff U, Cohen A, Derumeaux GA, Piérard LA, Engvall J, Brodin LA, Sutherland GR: Fraser AG for the 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. 2003, 24: 1584-94. 10.1016/S0195-668X(03)00099-X CrossRefPubMed
Ishii K, Imai M, Suyama T, Maenaka M, Nagai T, Kawanami M, Seino Y: Exercise-induced post-ischemic left ventricular delayed relaxation or diastolic stunning. is it a reliable marker in detecting coronary artery disease?. J Am Coll Cardiol. 2009, 53: 698-705. 10.1016/j.jacc.2008.09.057 CrossRefPubMed
Ishii K, Miwa K, Sakurai T, Kataoka K, Imai M, Kintaka A, Aoyama T, Kawanami M: Detection of post-ischemic regional left ventricular delayed outward wall motion or diastolic stunning after exercise-induced ischemia in patients with stable effort angina by using color kinesis. J Am Soc Echocardiogr. 2008, 21: 309-14. 10.1016/j.echo.2007.10.006 CrossRefPubMed
Argyle RA, Ray SG: Stress and strain: double trouble or useful tool?. Eur J Echocardiography. 2009, 10 (6): 716-22. 10.1093/ejechocard/jep066. CrossRef
Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt J-U, Zamorano JL: Current and Evolving Echocardiographic Techniques for the Quantitative Evaluation of Cardiac Mechanics: ASE/EAE Consensus Statement on Methodology and Indications. J Am Soc Echocardiogr. 2011, 24: 277-313. 10.1016/j.echo.2011.01.015 CrossRefPubMed
- Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II