J Cardiovasc Ultrasound.  2014 Sep;22(3):127-133. 10.4250/jcu.2014.22.3.127.

The Value of Assessing Myocardial Deformation at Recovery after Dobutamine Stress Echocardiography

• Hwang HJ
• Lee HM
• Yang IH
• Lee JL
• Pak HY
• Park CB
• Jin ES
• Cho JM
• Kim CJ
• Sohn IS

• KMID: 2045428
• DOI: http://doi.org/10.4250/jcu.2014.22.3.127

Abstract

BACKGROUND
The purpose of this study was to evaluate whether performing an assessment of myocardial deformation using speckle tracking imaging during the recovery period after dobutamine stress echocardiography (DSE) allows detection of significant coronary artery disease (CAD) in patients with chest discomfort.
METHODS
DSE and coronary angiography were performed in 44 patients with chest discomfort. The mean global longitudinal peak systolic strain (GLS) was measured at rest, at low stress (dobutamine infusion rate of 10 microg/kg/min) and at recovery (5 min after cessation of dobutamine infusion) of DSE using automated function imaging with apical views. Fractional flow reserve (FFR) was also performed in patients with intermediate coronary stenosis. CAD was defined as having a > or = 70% diameter stenosis on coronary angiography or as having a FFR < 0.8. Patients were divided two groups based on the absence or presence of CAD [CAD (-) group vs. CAD (+) group].
RESULTS
There were no significant differences in the clinical characteristics and results of conventional echocardiography between the two groups. GLS at recovery was lower in the CAD (+) group than in the CAD (-) group (-18.0 +/- 3.4% vs. -21.0 +/- 1.9%, p = 0.003). The optimal cutoff of GLS at recovery for detection of CAD was -19% (sensitivity of 70.6%, specificity of 83.3%).
CONCLUSION
Assessment of GLS at recovery of DSE is a reliable and objective method for detection of CAD. This finding may suggest that systolic myocardial stunning remains even after recovery of wall motion abnormalities in patients with CAD.

Keyword

Dobutamine; Stress echocardiography; Myocardial stunning; Speckle tracking imaging

MeSH Terms

Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Dobutamine
Echocardiography
Echocardiography, Stress*
Humans
Myocardial Stunning
Sensitivity and Specificity
Thorax
Dobutamine

Figure

• 

  Fig. 1 Changes in hemodynamics at each dobutamine stress stage: systolic blood pressure (BP) (A), heart rate (B). The group with significant coronary artery disease (CAD) has higher heart rates at rest than the group without CAD. NS: non-significant p value.

• 

  Fig. 2 Representative cases with longitudinal strain curves and bull's eye plots showing segmental longitudinal peak systolic strain. A: A 75-year-old female without coronary artery stenosis. The bull's eye plot shows high and homogeneous peak systolic longitudinal strain for the entire left ventricle at each dobutamine stress stage and more increased contractility at low stress and at recovery compared with rest. B: A 55-year-old male with significant stenosis in the left main and proximal left circumflex arteries. The bull's eye plot shows decreased peak systolic longitudinal strain in the inferolateral and anterolateral segments at low stress, which extends into the anterior segments at recovery. These findings are consistent with the region of significant coronary stenosis on coronary angiography. Additionally, decreased values of mean global longitudinal peak systolic strain are observed at low stress and at recovery compared with rest. GLS: global longitudinal peak systolic strain.

• 

  Fig. 3 Changes in values of global longitudinal peak systolic strain (GLS) during dobutamine stress echocardiography. Lower values of GLS are observed in the CAD (+) group compared with the CAD (-) group at low stress and at recovery. CAD: coronary artery disease, NS: non-significant p value.

• 

  Fig. 4 Receiver-operating characteristic curves of global longitudinal peak systolic strain (GLS) at each dobutamine stress stage for the prediction of coronary artery disease (CAD). A sensitivity of 70.6% and a specificity of 83.3% are observed when the cutoff value of GLS at recovery is less than -19% for the prediction of CAD. AUC: area under the receiver operating characteristic curve, CI: confidence interval of AUC.

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