Background
Methods
Dobutamine echocardiography and visual assessment
Acquirement of quantitative parameters
Pulsed-wave doppler myocardial imaging
Color coded doppler myocardial imaging
Speckle tracking myocardial imaging
Measurement of quantitative parameters
Post-systolic index = post-systolic strain – systolic strain
Interobserver and intraobserver agreement
Coronary angiography
Statistical analysis
Results
Stress echocardiography
Characteristics | Study group (n = 151) |
---|---|
Age, years | 61.77 ± 9.21 |
Male | 89 (58.9 %) |
Typical angina | 63 (41.7 %) |
Exercise ECG not performed | 59 (39.1 %) |
Exercise ECG negative | 16 (10.6 %) |
Exercise ECG positive | 30 (19.9 %) |
Exercise ECG non-diagnostic | 46 (30.5 %) |
Hypertension | 141 (93.4 %) |
Hypercholesterolemia | 118 (78.1 %) |
Diabetes | 29 (19.2 %) |
Overweight | 101 (66.9 %) |
Smoking | 28 (18.5 %) |
Family history of CAD | 39 (25.8 %) |
Beta-blockers | 96 (63.6 %) |
Ca channel blockers | 56 (37.1 %) |
ACEI/ARB | 105 (69.5 %) |
Nitrates | 38 (25.2 %) |
Diuretics | 40 (26.5 %) |
Aspirin | 71 (47.0 %) |
MMI, g/m2
| 99.42 ± 17.13 |
EF rest, % | 54.49 ± 1.76 |
EF stress, % | 59.86 ± 6.63 |
HR rest, min-1
| 69.88 ± 11.13 |
HR stress, min-1
| 132.43 ± 10.92 |
Systolic BP rest, mm Hg | 139.89 ± 30.44 |
Systolic BP stress, mm Hg | 144.22 ± 26.13 |
Diastolic BP rest, mm Hg | 81.96 ± 11.44 |
Diastolic BP stress, mm Hg | 71.38 ± 13.72 |
ECG changes during stress | 77 (51.0 %) |
Chest pain during stress | 87 (57.6 %) |
WMSI rest | 1.02 ± 0.04 |
WMSI stress | 1.21 ± 0.23 |
Angiographic results
Feasibility and reproducibility of quantitative data
Visual | PW-DMI | CC-DMI | STI | |||||
---|---|---|---|---|---|---|---|---|
WMSI
|
velocities
|
velocities
|
strain
|
strain rate
|
velocities
|
strain
|
strain rate
| |
Interobserver
| 0.035 | 0.059 | 0.038 | 0.036 | 0.007 | 0.031 | 0.077 | 0.009 |
Intraobserver
| 0.028 | 0.091 | 0.004 | 0.116 | 0.016 | 0.037 | 0.109 | 0.016 |
Single parameters - predictors of stenosis
Method | Parameter | Cut-off | AUC (95 % CI) | Sensitivity % (95 % CI) | Specificity % (95 % CI) | Accuracy % (95 % CI) | Youden index |
---|---|---|---|---|---|---|---|
Basal inferoseptal segment
| |||||||
PW-DMI | T to S'
stress
| 70.5 | 0.66* (0.54;0.78) | 56.7 (37.4;74.5) | 76.7 (68.1;83.9) | 72.7 (64.8;79.6) | 0.33 |
S'
stress
- S'
rest
| 4.15 | 0.65* (0.53;0.76) | 56.7 (37.4;74.5) | 73.1 (64.2;80.8) | 69.8 (61.7;77.0) | 0.30 | |
A'
stress
| 12.3 | 0.64* (0.53;0.75) | 46.7 (28.3;65.7) | 81.4 (73.0;88.1) | 74.1 (66.1;81.1) | 0.28 | |
CC-DMI | E'/A'
rest
| 0.64 | 0.66* (0.55;0.76) | 64.3 (44.1;81.4) | 68.2 (58.6;76.7) | 67.4 (58.9;75.1) | 0.33 |
STI | E'
stress
| 4.5 | 0.70* (0.58;0.83) | 66.7 (44.7;84.4) | 71.6 (61.0;80.7) | 70.5 (61.2;78.8) | 0.38 |
E'/A'
stress
| 0.34 | 0.66* (0.52;0.80) | 47.6 (25.7;70.2) | 88.1 (79.2;94.1) | 80.0 (71.1;87.2) | 0.36 | |
Mid inferoseptal segment
| |||||||
CC-DMI | PSI
stress
/SS
stress
| 0.13 | 0.65* (0.54;0.77) | 58.1 (39.1;75.5) | 69.1 (59.6;77.6) | 66.7 (58.2;74.4) | 0.27 |
SSR
stress
- SSR
rest
| −0.21 | 0.64* (0.53;0.74) | 74.2 (55.4;88.1) | 55.9 (46.1;65.3) | 59.9 (51.3;68.0) | 0.30 | |
Apical inferoseptal segment
| |||||||
STI | PSI
rest
/SS
rest
| −0.15 | 0.65*(0.54;0.76) | 70.0 (50.6;85.3) | 57.9 (48.3;67.1) | 60.4 (51.9;68.5) | 0.28 |
PSI
rest
| 3.85 | 0.65*(0.54;0.76) | 70.0 (50.6;85.3) | 56.1 (46.5;65.4) | 59.0 (50.5;67.1) | 0.26 | |
RSSR
rest
| 1.95 | 0.63*(0.53;0.74) | 90.0 (73.5;97.9) | 34.2 (25.6;43.7) | 45.8 (37.5;54.3) | 0.24 | |
Basal inferior segment
| |||||||
PW-DMI | S'
stress
| 10.8 | 0.65* (0.53;0.76) | 48.3 (29.4;67.5) | 77.3 (68.7;84.5) | 71.6 (63.6;78.7) | 0.26 |
S'
stress
- S'
rest
| 4.8 | 0.64* (0.53;0.75) | 75.9 (56.5;89.7) | 52.1 (42.8;61.3) | 56.8 (48.4;64.9) | 0.28 | |
T to S'
stress
- T to S'
rest
| −45.5 | 0.64* (0.53;0.75) | 62.1 (42.3;79.3) | 65.5 (56.3;74.0) | 64.9 (56.6;72.5) | 0.28 | |
(T to S'
stress
- T to S'
rest
)/T to S'
rest
| −0.44 | 0.66* (0.55;0.76) | 69.0 (49.2;84.7) | 58.0 (48.6;67.0) | 60.1 (51.8;68.1) | 0.27 | |
E'
rest
| 9.35 | 0.64* (0.54;0.74) | 93.3 (77.9;99.2) | 34.2 (25.8;43.4) | 46.0 (37.8;54.3) | 0.28 | |
E'
stress
| 7.53 | 0.72* (0.62;0.82) | 72.4 (52.8;87.3) | 66.1 (56.7;74.7) | 67.4 (59.1;74.9) | 0.39 | |
CC-DMI | PSI
stress
/PSS
stress
| 0.06 | 0.65* (0.52;0.78) | 66.7 (44.7;84.4) | 61.9 (51.4;71.5) | 62.8 (53.6;71.4) | 0.29 |
STI | SS
rest
| −13.0 | 0.65* (0.54;0.77) | 41.4 (23.5;61.1) | 88.7 (81.4;93.8) | 79.2 (71.6;85.5) | 0.30 |
Mid inferior segment
| |||||||
PW-DMI | T to S'
stress
- T to S'
rest
| −41.9 | 0.64* (0.53;0.75) | 66.7 (47.2;82.7) | 64.1 (54.7;72.8) | 64.6 (56.3;72.3) | 0.31 |
CC-DMI | SS
stress
| −14.5 | 0.66* (0.56;0.76) | 75.0 (55.1;89.3) | 55.8 (46.1;65.1) | 59.6 (51.0;67.7) | 0.31 |
STI | PSSR
rest
| −0.65 | 0.64* (0.52;0.76) | 41.4 (23.5;61.1) | 87.0 (79.4;92.5) | 77.8 (70.1;84.3) | 0.28 |
(PSI
stress
- PSI
rest
)/PSI
rest
| −0.08 | 0.67* (0.56;0.78) | 48.3 (29.4;67.5) | 81.3 (72.8;88.0) | 74.5 (66.4;81.4) | 0.30 | |
Basal anterior segment
| |||||||
PW-DMI | S'
stress
| 8.2 | 0.63* (0.52;0.74) | 75.8 (57.7;88.9) | 44.2 (34.9;53.9) | 51.4 (43.0;59.7) | 0.20 |
CC-DMI | S'
stress
| 6.2 | 0.69* (0.59;0.79) | 51.7 (32.5;70.6) | 81.3 (72.8;88.0) | 75.2 (67.2;82.1) | 0.33 |
(PS'
stress
- PS'
rest
)/PS'
rest
| 3.1 | 0.69* (0.54;0.84) | 53.3 (26.6;78.7) | 83.1 (71.0;91.6) | 77.0 (65.8;86.0) | 0.36 | |
SSR
stress
| −2.4 | 0.65* (0.54;0.75) | 80.0 (61.4;92.3) | 52.7 (43.0;62.2) | 58.5 (49.9;66.7) | 0.33 | |
STI | PSI
stress
- PSI
rest
| −5.5 | 0.64* (0.53;0.75) | 40.0 (22.7;59.4) | 87.3 (79.6;92.9) | 77.1 (69.3;83.8) | 0.27 |
PSSR
rest
| −1.1 | 0.68* (0.58;0.78) | 80.0 (61.4;92.3) | 47.4 (37.9;56.9) | 54.2 (45.7;62.5) | 0.27 | |
PSSR
stress
- PSSR
rest
| −0.39 | 0.67* (0.56;0.78) | 80.0 (61.4;92.3) | 56.8 (47.0;66.1) | 61.7 (53.1;69.8) | 0.37 | |
Basal inferolateral segment
| |||||||
PW-DMI | S'
stress
| 12.1 | 0.65* (0.54;0.76) | 70.4 (49.8;86.2) | 57.3 (47.8;66.4) | 59.7 (51.2;67.8) | 0.28 |
E'
stress
| 8.1 | 0.66* (0.53;0.78) | 64.0 (42.5;82.0) | 68.7 (59.4;77.0) | 67.9 (59.4;75.5) | 0.33 | |
E'/A'
stress
| 0.51 | 0.69* (0.57;0.80) | 56.0 (34.9;75.6) | 76.3 (67.4;83.8) | 72.7 (64.5;79.9) | 0.32 | |
Mid inferolateral segment
| |||||||
CC-DMI | E'/A'
rest
| 0.5 | 0.65* (0.54;0.76) | 61.5 (40.6;79.8) | 70.9 (61.5;79.2) | 69.1 (60.6;76.8) | 0.32 |
SS
stress
| −16.0 | 0.72* (0.62;0.82) | 80.8 (60.6;93.4) | 59.8 (50.1;69.0) | 63.8 (55.2;71.8) | 0.41 | |
SSR
stress
| −1.4 | 0.68* (0.56;0.80) | 64.0 (42.5;82.0) | 71.2 (61.8;79.4) | 69.9 (61.4;77.4) | 0.35 | |
Mid anteroseptal segment
| |||||||
PW-DMI | PS'
stress
- PS'
rest
| 1.8 | 0.66* (0.55;0.76) | 86.2 (68.3;96.1) | 52.3 (42.5;62.1) | 59.6 (50.8;67.9) | 0.39 |
(PS'
stress
- PS'
rest
)/PS'
rest
| 0.86 | 0.70* (0.58;0.82) | 81.8 (59.7;94.8) | 70.2 (59.3;79.7) | 72.6 (63.1;80.9) | 0.52 | |
CC-DMI | E'
stress
| 3.5 | 0.72* (0.61;0.83) | 84.6 (65.1;95.6) | 51.2 (39.9;62.4) | 59.3 (49.4;68.6) | 0.36 |
STI | PSI
stress
/SS
stress
| 0.14 | 0.64* (0.54;0.75) | 67.9 (47.6;84.1) | 59.0 (49.0;68.5) | 60.9 (52.1;69.2) | 0.27 |