Evaluation of myocardial viability in patients with acute myocardial infarction: Layer-specific analysis of 2-dimensional speckle tracking echocardiography.
Medicine
BACKGROUND:The value of layer-specific two-dimensional speckle tracking echocardiography (LS2D-STE) for evaluating viable myocardium (VM) in patients with acute myocardial infarction (AMI) was unclear, this study provides new insights into it and to make a comparison with dualisotope simultaneous acquisition single photon emission computed tomography ( DISA-SPECT). METHODS:Forty hospitalized patients with AMI and left ventricular systolic dysfunction (left ventricular ejection fraction <50%) underwent LS2D-STE and DISA-SPECT before percutaneous coronary intervention (PCI). The longitudinal, circumferential, and radial peak systolic strains and the peak systolic strain rates of 3 myocardiallayers (endocardium, mid-myocardium, and epicardium), as well as the total wall thickness, were determined by LS2D-STE. Routine echocardiography was followedup at 1, 3, 6 months after PCI, with the improvement of the wall motion as the goldenstandard for evaluating VM. RESULTS:The sensitivity, specificity and accuracy of DISA-SPECT for evaluating VM were 82.1%, 74.3%, and 79.3%, respectively. Among the layer-specific parameters, only endocardial (endo-) longitudinal strain (LS) and endo- longitudinal strain rate (LSr) were used as independent parameters for evaluating VM (P < .05), and the sensitivity, specificity and accuracy of endo-LS and endo-LSr in evaluation of VM were 77.1%, 65.4%, and 72.9% vs 72.9%, 65.4%, and 69.7%. Endo-LS and endo-LSr were superior to total wall thickness LS and LSr (AUC endo-LS 0.767 vs total-LS 0.669; endo-LSr 0.743 vs total-LSr 0.682). The parallel test and the serial test of combination of endo-LS and endo-LSr showed similar sensitivity, specificity and accuracy to DISA-SPECT (P > .05). CONCLUSION:The endo-LS and endo-LSr analysis of LS2D-STE can evaluate the VM well, and its sensitivity, specificity and accuracy in detection of VM are similar to those of DISA-SPECT, resulting in LS2D-STE being a good option for the assessment of VM.
10.1097/MD.0000000000013959
Assessment of myocardial viability in patients with acute myocardial infarction by two-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography.
Gong Lei,Li Dongye,Chen Junhong,Wang Xiaoping,Xu Tongda,Li Wenhua,Ren Shaoyang,Wang Cheng
The international journal of cardiovascular imaging
It is clinically important to determine the myocardial viability of regional wall motion abnormality segments in patients with acute myocardial infarction (AMI). The purpose of this study was to ascertain the ability and value of a combination of speckle tracking echocardiography (STE) and low dose dobutamine stress echocardiography (LDDSE) for the evaluation of viable myocardium in patients with AMI. Forty-two hospitalized patients with AMI and left ventricular systolic dysfunction (left ventricular ejection fraction <50%) were underwent STE in conjunction with LDDSE and dual isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT). Percutaneous coronary intervention (PCI) was performed subsequently in all patients. STE was used to measure radial, circumferential, and longitudinal end-systolic strain and peak systolic strain rate. The movement of each segment was observed by routine echocardiography 1, 3, and 6 months after PCI, and its improvement over time was the criterion of viable myocardium. The sensitivity, specificity and accuracy of DISA-SPECT for the assessment of viable myocardium were 83.6, 74.4, and 80.7%, respectively. Among the radial, circumferential, and longitudinal strain and strain rate parameters, only longitudinal strain (LS) and longitudinal strain rate (LSr) at rest and LDDSE emerged as independent predictors of viable myocardium, When combining LS and LSr at LDDSE, the sensitivity, specificity and accuracy for the assessment of viable myocardium rose to 89.8, 90.2 and 89.9%, respectively. The sensitivity of STE in conjunction with LDDSE was similar to DISA-SPECT for detecting viable myocardium in patients with AMI, but the specificity and accuracy of STE performed with LDDSE were higher than DISA-SPECT.
10.1007/s10554-013-0185-y
Predictive value of speckle tracking technique for coronary artery stenosis in patients with coronary heart disease.
American journal of translational research
OBJECTIVE:To observe the predictive value of speckle tracking technique (STI) for the degree of coronary artery stenosis in patients with coronary heart disease (CHD). METHODS:The clinical data of 120 patients with coronary artery stenosis admitted to Affiliated Hospital of Chengde Medical University from Feb. 2022 to Sep. 2022 was analyzed retrospectively. The other 63 patients who sought for medical help because of chest pain underwent Coronary Arteriography (CAG) examination during the same period but with Gensini score > 0 were selected as the control group. Coronary artery stenosis was divided into three subgroups according to the coronary Gensini score: mild, moderate, and severe stenosis. Routine ultrasound and STI techniques were performed in all patients. In addition, left ventricular global radial peak systolic strain (GRS), left ventricular global longitudinal peak systolic strain (GLS), left ventricular global peak systolic strain (GAS) and left ventricular global circumferential peak systolic strain (GCS) were measured and compared between the two groups and among the three subgroups. RESULTS:There were no marked differences identified in conventional ultrasound parameters between the coronary artery stenosis group and control group, but the absolute values of GLS, GRS, GCS, and GAS were lower in the former group compared to control group; and the severe group had the lowest levels of above indexes, followed by moderate group, then mild group and control group (all P < 0.05). The results showed that the area under the curve (AUC) for GLS, GRS, GCS, and GAS in diagnosing coronary artery stenosis were 0.973, 0.933, 0.947, and 0.901, respectively. The AUCs of GLS, GRS, GCS, and GAS for the diagnosis of moderate/severe coronary artery stenosis were 0.968, 0.908, 0.901, and 0.942, respectively, with GAS and GLS assessed with the largest AUC values and higher sensitivity and specificity than other parameters. CONCLUSION:The global longitudinal strain of left ventricle obtained by STI technique was more sensitive to coronary artery stenosis than that by ultrasound technique, and it had a higher predictive value for coronary artery stenosis.
Left ventricular longitudinal function assessment in rabbits after acute occlusion of left anterior descending coronary artery by two-dimensional speckle tracking imaging.
Huang Jun,Yan Zi-Ning,Fan Li,Rui Yi-Fei,Song Xiang-Ting
BMC cardiovascular disorders
ABSTACT:BACKGROUND: To evaluate the left ventricular (LV) longitudinal function changes in rabbits after acute occlusion of the left anterior descending artery (LAD) by two-dimensional speckle tracking imaging (2D-STI). METHODS:Forty-eight New Zealand white rabbits underwent echocardiography examination. EchoPAC was used to measure LV peak systolic longitudinal strain (LS) of the endocardium, middle myocardium, and epicardium, peak longitudinal strain rate (LSr), segmental and global longitudinal rotation (LR) degrees. Ligated the LAD and repeated all measurements after 10 min. RESULTS:Peak LS and LSr were significantly different between the preoperative and postoperative rabbits among most LV walls (P < 0.05). In apical four-chamber view, there was significant difference in the degrees of rotation of the LV lateral wall in preoperative and postoperative rabbits (P < 0.05). In apical three-chamber view, the rotation degrees of the posterior wall and the LR were significantly lower in the postoperative than in the preoperative (P < 0.001). In apical two-chamber view, the rotation degrees of the inferior wall and the LR were significantly lower in the postoperative (P < 0.05). CONCLUSIONS:Left ventricular function was impaired after acute occlusion of LAD. Segmental rotational degrees and changes in LR could be useful indicators of cardiac function during the early phases of acute myocardial ischemia.
10.1186/s12872-017-0655-6
[Value of three-dimensional speckle-tracking echocardiography and the novel area strain in detecting wall motion abnormalities of coronary artery diseases].
Li Ya-Jiao,Li Chen,Li Chun-Mei,Zhang Li,Bai Wen-Juan,Zhang Xiao-Ling,Tang Hong,Rao Li
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition
OBJECTIVE:To investigate the value of three-dimensional speckle tracking echocardiography (3DSTE) and the novel areas train (AS) in detecting wall motion abnormalities caused by coronary artery diseases. METHODS:Conventional and 3D echocardiography was done on forty-six patients suspected with coronary heart diseases, immediately before they received cardiac catheterization. Segmental wall-motion score (WMS) and WMS index (WMSI) were assessed on conventional two-dimensional (2D) images, and strain-derived parameters were analyzed by speckle tracking technique based on 3D images. The accuracy of echocardiographic parameters to assess the regional myocardial ischemia was tested against coronary angiography results using ROC curve analysis and linear regression. RESULTS:Compared with controls, patients with severe coronary stenosis (> or = ;70% coronary stenosis) had lower left ventricular ejection fraction, higher WMSI and lower global strains. ROC curve analysis demonstrated that segmental WMS had relatively poor sensitivity for regional myocardial ischemia and infarction. The segmental strains measured using 3DSTE provided accurate assessment of the regional wall motion abnormalities. The segmental area strain > -25% yielded the best sensitivity and specificity for detecting the ischemic and infracted segments among all four strain parameters. CONCLUSION:3DSTE provides a swift and accurate assessment of regional myocardial motion. The novel area strain derived by 3DSTE is an accurate and reproducible index for regional wall motion abnormality.
Left atrial strain assessed by speckle tracking imaging is related to new-onset atrial fibrillation after coronary artery bypass grafting.
Her Ae-Young,Kim Jong-Youn,Kim Yong Hoon,Choi Eui-Young,Min Pil-Ki,Yoon Young Won,Lee Byoung-Kwon,Hong Bum-Kee,Rim Se-Joong,Kwon Hyuck Moon
The Canadian journal of cardiology
BACKGROUND:Left atrial (LA) dysfunction was recently proposed as an important factor in the development of postoperative atrial fibrillation (POAF). LA strain analysis by 2-dimensional (2D) speckle tracking imaging is emerging as a new tool to evaluate LA function. We aimed to evaluate the correlation of LA dysfunction assessed by 2D speckle tracking imaging with the occurrence of POAF after coronary artery bypass grafting (CABG). METHODS:In this study, 53 patients (mean age 66 ± 9 years) undergoing elective isolated CABG were enrolled. Conventional transthoracic echocardiography and 2D speckle tracking strain analysis were performed before surgery. POAF was detected with continuous electrocardiography monitoring throughout hospitalization (mean duration 17 ± 10 days). RESULTS:POAF occurred in 13 of 53 patients (24%). Patients with POAF were significantly older than patients with normal sinus rhythm after surgery (71 ± 5 vs 64 ± 10 years, P = 0.026). Compared with patients with normal sinus rhythm, patients with POAF had a significantly larger LA volume index (32.6 ± 5.1 vs 27.3 ± 7.2 mL/m(2), P = 0.018), lower value of LA global strain (25.4 ± 10.4 vs 36.8 ± 7.6%, P = 0.001), and strain rate (1.2 ± 0.6 vs 1.6 ± 0.8 seconds, P = 0.024). By multivariate logistic regression analysis, only LA global strain (odds ratio, 1.12; 95% confidence interval, 1.00-1.24; P = 0.040) was an independent predictor of POAF after CABG. CONCLUSIONS:Preoperative LA global strain measured by 2D speckle tracking strain analysis is associated with the development of POAF after CABG.
10.1016/j.cjca.2012.06.006
Evaluation of left ventricular function after percutaneous recanalization of chronic coronary occlusions : The role of two-dimensional speckle tracking echocardiography.
Wang P,Liu Y,Ren L
Herz
BACKGROUND:This study evaluated the feasibility of using two-dimensional speckle tracking echocardiography (2D-STE) to monitor left ventricular (LV) and overall function after percutaneous recanalization. METHODS:LV function after percutaneous recanalization was monitored by 2D-STE and conventional echocardiography in 43 patients with coronary chronic total occlusion (CTO) who underwent primary percutaneous coronary intervention (PCI). Follow-ups were carried out 1 day as well as 3 and 6 months after CTO-PCI. At each time point, LV ejection fraction (LVEF) was examined by echocardiography, and LV global longitudinal strain (GLS) was measured by 2D-STE. RESULTS:It was found that the global longitudinal strain assessed with 2D-STE was improved as early as 1 day after CTO-PCI, whereas LVEF tended to improve up to 3 and 6 months after CTO-PCI. CONCLUSION:PCI can effectively improve LV function in patients with CTO. 2D-STE is a superior technique for objectively quantifying the functional change earlier.
10.1007/s00059-017-4663-1
Evaluation of left atrial function via two-dimensional speckle-tracking echocardiography in patients with coronary artery ectasia.
Aghajani Hasan,Faal Mohsen,Hosseinsabet Ali,Mohseni-Badalabadi Reza
Journal of clinical ultrasound : JCU
BACKGROUND:Coronary artery ectasia (CAE) is a segmental dilation of an epicardial coronary artery. Our aim was to evaluate the left atrial (LA) function in patients with CAE. METHODS:Twenty-seven consecutive patients with CAE and 33 subjects without significant coronary artery disease were included in our study. LA function was evaluated with two-dimensional speckle-tracking echocardiography (2DSTE). RESULTS:The systolic, early diastolic and late diastolic strains and strain rates were not statistically significantly different between the two groups. CONCLUSIONS:Our findings demonstrated that LA function may not be affected by CAE when assessed with 2DSTE. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:231-237, 2017.
10.1002/jcu.22435
Four-dimensional speckle tracking for assessing improvement in left ventricular contractility after coronary angioplasty.
Arbeille Philippe,Angoulvant Denis,Zuj Kathreen,Patier Jeanne,Desveaux Bernard,Quilliet Laurent,Charbonnier Bernard
Ultrasound in medicine & biology
The objective of the study was to identify and quantify the potential improvement of left ventricular contractility after percutaneous transluminal coronary angioplasty (PTCA) using 4-dimensional (4D) speckle tracking echocardiography (4D STE). We investigated 41 patients with coronary disease by 4D STE pre- and 24 hours postcoronarography with (n = 18) or without (n = 23) PTCA. The 4D STE visualizes in real time the myocardium strain on 2- and 4-chamber apical views and on 3 transverse views of the left ventricle. Average and total strain of the left ventricle were measured. Of the 18 PTCA patients, 15 showed significant increase in left ventricle mean (+15 ± 6) and total strain (240 ± 100), which corresponded to an increase of 93% ± 55% from precoronarography, whereas the remainder showed no change. The total strain corresponded to 33% ± 10% (before PTCA) and 59% ± 11% (post PTCA) of the estimated normal strain for each patient. Strain improved in 70% of the segment downstream from the stent, and there was a negative correlation between the amplitude of the mean and total strain improvements after 24 hours and the mean and total strain values before PTCA. In the non-PTCA group, 21 of the 23 patients showed no changes in strain, whereas 2 showed improvement. The 4D STE showed significant improvements in left ventricular contractility in more than 70% of the areas downstream from the PTCA segment. This corresponded to an increase in the initial contractility by approximately 93% ± 55%; however, the myocardium contractility remained approximately 59% of normal level. No changes were seen in patients without PTCA.
10.1016/j.ultrasmedbio.2012.08.021
Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon: A Study of Speckle Tracking Echocardiography.
Gulel Okan,Akcay Murat,Soylu Korhan,Aksan Gokhan,Yuksel Serkan,Zengin Halit,Meric Murat,Sahin Mahmut
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND:The coronary slow flow phenomenon (CSFP) is defined as a delayed distal vessel contrast opacification in the absence of obstructive epicardial coronary artery disease during coronary angiography. There is conflicting data in medical literature regarding the effects of CSFP on the left ventricular functions assessed by conventional echocardiography or tissue Doppler imaging. Therefore, we aimed to evaluate whether there is any abnormality in the myocardial deformation parameters (strain, strain rate (SR), rotation, twist) of the left ventricle obtained by speckle tracking echocardiography (STE) in patients with CSFP. METHODS:Twenty patients with CSFP were included prospectively in the study. Another 20 patients with similar demographics and cardiovascular risk factors as well as normal coronary angiography were used as the control group. Two-dimensional echocardiographic images of the left ventricle from the apical long-axis, two-chamber, four-chamber, and parasternal short-axis views were used for STE analysis. RESULTS:The analysis of left ventricular circumferential deformation parameters showed that the averaged peak systolic strain, systolic SR, and early diastolic SR values were significantly lower in patients with CSFP (P = 0.009, P = 0.02, and P = 0.02, respectively). Among the left ventricular rotation and twist values, apical rotation was significantly lower in patients with CSFP (P = 0.02). Further, the mean thrombolysis in myocardial infarction frame count value was found to be negatively correlated with the averaged peak circumferential early diastolic SR (r = -0.35, P = 0.03). It was positively correlated with the averaged peak circumferential systolic strain (r = 0.47, P = 0.003) and circumferential systolic SR (r = 0.46, P = 0.005). CONCLUSION:Coronary slow flow phenomenon leads to significant alterations in the myocardial deformation parameters of the left ventricle as assessed by STE. Specifically, circumferential deformation parameters are affected in CSFP patients.
10.1111/echo.13146
2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left ventricular function: a case-control study.
Hubbard Ryan T,Arciniegas Calle Maria C,Barros-Gomes Sergio,Kukuzke Joyce A,Pellikka Patricia A,Gulati Rajiv,Villarraga Hector R
BMC cardiovascular disorders
BACKGROUND:Women who have coronary artery disease (CAD) often present with atypical symptoms that may lead to misdiagnosis. We assessed strain, systolic strain rate and left ventricular dyssynchrony with 2- dimensional- speckle tracking echocardiography to evaluate its use as a non-invasive method for detecting CAD in women with normal ejection fraction compared with healthy women controls with a normal angiogram. METHODS:We included 35 women with CAD confirmed by coronary angiography and a positive exercise stress echocardiography and 35 women in a control group with a low pretest probability of CAD, normal angiogram and a normal stress echocardiography with normal EF. RESULTS:Statistically significant 2D-STE findings for the CAD vs control groups were as follows for the mean of: global circumferential strain (CS) (-19.4% vs -22.4%, P = .02); global radial S (49% vs 34%, P = .03); global radial SR (2.4 s vs 1.9 s, P = .05); global longitudinal LV S (GLS) (-14.3% vs -17.2%, P < .001). For mechanical dyssynchrony, SD of the GLS time-to-peak (TTP) was computed (99 vs 33 ms, P < .001). The receiver operating characteristic and area under the curve (AUC) were calculated. A cutoff value of 45 ms for 1 SD of the longitudinal S TTP had 97% sensitivity and 89% specificity (AUC, 0.96). GLS cutoff value of -15.87% had 71% sensitivity and 74% specificity; AUC, 0.74 in differentiating CAD and control groups. The combined GLS, CS, and SD of the longitudinal S TTP had an AUC of 0.96 (sensitivity 97%, specificity 86%). Interclass correlations of the GLS segment and GLS TTP measurements were 0.49 (95% CI, 0.227-0.868) and 0.74 (95% CI, 0.277-0.926), respectively. CONCLUSION:In women with a normal echocardiogram and LVEF, CAD can be identified by dyssynchrony and abnormal strain values, as evidenced by 2D-STE.
10.1186/s12872-017-0656-5
Myocardial strain analysis by 2-dimensional speckle tracking echocardiography improves diagnostics of coronary artery stenosis in stable angina pectoris.
Biering-Sørensen Tor,Hoffmann Soren,Mogelvang Rasmus,Zeeberg Iversen Allan,Galatius Søren,Fritz-Hansen Thomas,Bech Jan,Jensen Jan Skov
Circulation. Cardiovascular imaging
BACKGROUND:Two-dimensional strain echocardiography detects early signs of left ventricular dysfunction; however, it is unknown whether myocardial strain analysis at rest in patients with suspected stable angina pectoris predicts the presence of coronary artery disease (CAD). METHODS AND RESULTS:In total, 296 consecutive patients with clinically suspected stable angina pectoris, no previous cardiac history, and normal left ventricular ejection fraction were included. All patients were examined by 2-dimensional strain echocardiography, exercise ECG, and coronary angiography. Two-dimensional strain echocardiography was performed in the 3 apical projections. Peak regional longitudinal systolic strain was measured in 18 myocardial sites and averaged to provide global longitudinal peak systolic strain. Duke score, including ST-segment depression, chest pain, and exercise capacity, was used as the outcome of the exercise test. Patients with an area stenosis≥70% in ≥1 epicardial coronary artery were categorized as having significant CAD (n=107). Global longitudinal peak systolic strain was significantly lower in patients with CAD compared with patients without (17.1±2.5% versus 18.8±2.6%; P<0.001) and remained an independent predictor of CAD after multivariable adjustment for baseline data, exercise test, and conventional echocardiography (odds ratio, 1.25 [P=0.016] per 1% decrease). Area under receiver operating characteristic curve for exercise test and global longitudinal peak systolic strain in combination was significantly higher than that for exercise test alone (0.84 versus 0.78; P=0.007). Furthermore, impaired regional longitudinal systolic strain identifies which coronary artery is stenotic. CONCLUSIONS:In patients with suspected stable angina pectoris, global longitudinal peak systolic strain assessed at rest is an independent predictor of significant CAD and significantly improves the diagnostic performance of exercise test. Furthermore, 2-dimensional strain echocardiography seems capable of identifying high-risk patients.
10.1161/CIRCIMAGING.113.000989
Assessment of the impact of isolated coronary artery ectasia on left ventricular functions with 3D speckle-tracking echocardiography.
Dogdus Mustafa,Kucukosmanoglu Mehmet,Kilic Salih
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND:Coronary artery ectasia (CAE) is an angiographic definition of coronary artery pathology in which the diameter of the ectatic segment measures more than 1.5 times the diameter of an adjacent healthy reference segment. No previous study has reported on the use of 3D-STE for assessing the left ventricular (LV) functions in patients with isolated CAE. As a result of this, we aimed to evaluate the effects of isolated CAE on LV functions using 3D-STE in the present study. METHODS:Ninety-one patients with isolated CAE and 90 controls who proved to have normal coronary angiograms were enrolled to the study. 3D-STE was performed and GLS, GCS, GAS, and GRS were obtained for every subject after coronary angiography. RESULTS:The mean age of the patients was 61.75 ± 10.02 years, and 71.8% were male. GLS, GCS, GAS, and GRS were significantly depressed in the isolated CAE group than in the control group (P < .001; P < .001; P = .001; and P = .001, respectively). ROC analyses were performed to find out the ideal strain cut off values to predict the presence of isolated CAE. A GLS value of >-16 has 92.1 % sensitivity, 88.5 % specificity; and a GCS value of >-20 has 86.7 % sensitivity, 89.2 % specificity to detect the presence of isolated CAE. CONCLUSION:Isolated CAE has a considerable negative effect on LV functions as evaluated by 3D-strain parameters, and 3D-STE could be an effective method to detect early stage myocardial impairment in patients with isolated CAE.
10.1111/echo.14533
Can ischemia and dyssynchrony be detected during early stages of dobutamine stress echocardiography by 2-dimensional speckle tracking echocardiography?
Yu Yang,Villarraga Hector R,Saleh Haydar K,Cha Stephen S,Pellikka Patricia A
The international journal of cardiovascular imaging
Strain and strain rate (SR) measured with 2-dimensional speckle tracking echocardiography (2-D STE) can quantitatively assess myocardial function. Our aim was to evaluate whether we could detect abnormalities in strain, strain rate, and dyssynchrony by applying 2-D STE in patients with severe coronary artery disease during early stages of dobutamine stress echocardiography. Thirty-four patients with angiographically documented severe 3-vessel coronary artery disease and preserved left ventricular ejection fraction were compared with 42 control patients without evidence of coronary artery disease. Circumferential and longitudinal strain, SR, and left ventricular synchrony using standard deviation (SD) of time to systolic peak strain and SR were analyzed with 2-D STE at rest and at intermediate doses of dobutamine stress echocardiography. Compared with control subjects, patients with coronary artery disease showed lower circumferential SR [-1.42 (0.34) s(-1) vs -1.64 (0.34) s(-1); P < .02] and significantly lower longitudinal strain [-15.41% (3.52%) vs -19.37% (3.21%); P < .001] and SR [-0.91 (0.18) s(-1) vs -1.19 (0.24) s(-1); P < .001] at intermediate doses; these values were also compromised at peak dose. The SD of longitudinal time to systolic peak strain at intermediate dose was significantly greater in patients with coronary artery disease than in control patients [37.89 (12.32) vs 27.21 (10.86); P < .001]. The 2-D STE-derived strain and SR detected myocardial dysfunction and asynchrony in patients with coronary artery disease during intermediate doses of dobutamine stress, with minimal changes in regional wall motion abnormalities at this stage.
10.1007/s10554-012-0074-9
Feasibility and correlation of standard 2D speckle tracking echocardiography and automated function imaging derived parameters of left ventricular function during dobutamine stress test.
The international journal of cardiovascular imaging
Speckle tracking echocardiography (STE) is a method of quantitative assessment of myocardial function complementary to ejection fraction and visual evaluation. Standard STE analysis, demands manual tracing of the myocardium whereas automated function imaging (AFI) offers more convenient (based on selection of three points) assessment of longitudinal strain. Nevertheless, feasibility and correlation between both methods were not thoroughly examined, especially during tachycardia at peak stage of dobutamine stress echocardiography (DSE). We performed DSE in 238 patients (pts) with recording of apical views during baseline (0) and peak (1) DSE and analyzed them by STE and AFI. According to angiography, 127/238 pts had significant (≥70%) lesions in coronary arteries. We assessed correlations between STE and AFI derived peak systolic longitudinal strain values for global and regional parameters, feasibility, time of analysis and interobserver agreement. Global systolic longitudinal strain measured during baseline and peak stage of DSE by AFI showed very good correlation with standard STE parameters, with correlation coefficients r = 0.90 and r = 0.86 respectively (p < 0.0001). For regional parameters correlation coefficients ranged from 0.83 to 0.85 for baseline and from 0.70 to 0.79 for peak DSE. Both methods provided good and similar feasibility with only 1% segments excluded from analysis at peak stage of DSE with shorter time and lower coefficient of variance offered by AFI. Global and regional longitudinal strain achieved by faster and less operator-dependent AFI method correlate well with standard more time-consuming STE analysis during baseline and peak stage of DSE.
10.1007/s10554-014-0386-z
Detection of abnormal myocardial deformation during acute myocardial ischemia using three-dimensional speckle tracking echocardiography.
Hioki Ayana,Asanuma Toshihiko,Masuda Kasumi,Sakurai Daisuke,Nakatani Satoshi
Journal of echocardiography
BACKGROUND:Three-dimensional (3D) speckle tracking echocardiography can simultaneously evaluate circumferential, longitudinal, and radial strain without being affected by through-plane motion. Moreover, the assessment of area change ratio may allow measuring regional myocardial deformation more accurately. We investigated the changes in each deformation parameter during acute coronary flow reduction, and evaluated whether the spatial extent of the abnormal values in each deformation parameter corresponded to that of the perfusion abnormality. METHODS:In 10 dogs, myocardial strains of three directions and area change ratio were analyzed at baseline and during three different ischemic conditions. The peak systolic value and the post-systolic index (PSI) were measured in both the ischemic and normal segments. The function abnormality, derived from the deformation parameter, and the perfusion abnormality, derived from Evans blue staining, were evaluated in each segment during complete occlusion and the concordance rate between both abnormalities was calculated. RESULTS:In all deformation parameters, the peak systolic value tended to gradually decrease and the PSI tended to gradually increase with the severity of flow reduction in the ischemic segment. Especially in area change ratio, significant changes were observed in both the peak systolic value and the PSI during occlusion compared to baseline. The concordance rate was the highest in the PSI assessed by area change ratio. CONCLUSIONS:Among 3D myocardial deformation parameters, area change ratio demonstrated better detectability of acute coronary flow reduction than conventional strain components. Area change ratio may be a useful parameter for detecting acute ischemia by 3D speckle tracking echocardiography.
10.1007/s12574-019-00449-6
Echo-tracking technology assessment of carotid artery stiffness in patients with coronary slow flow.
Yang Song,Wang De-Zhao,Zhang Hong-Xia,He Wen,Chen Bu-Xing
Ultrasound in medicine & biology
Coronary slow flow (CSF) in coronary angiography (CAG) is a well-recognized clinical entity. Previous studies have suggested that microvascular abnormalities and endothelial dysfunction are responsible for CSF. Accordingly, we hypothesized that the CSF phenomenon is a form of atherosclerosis including both small vessels and epicardial coronary arteries. The echo-tracking (ET) technique is a non-invasive detection method for early prediction of arterial atherosclerosis. Therefore, we investigated carotid elasticity with the ET technique in patients with CSF. Fifty patients with CSF and 50 patients with normal coronary artery blood flow, as determined by CAG, with a similar distribution of risk factors were recruited. The stiffness parameter (β), pressure-strain elastic modulus (Ep), arterial compliance (AC), augmentation index (AIx) and local pulse-wave velocity (PWV) were determined at the level of the bilateral common carotid artery (CCA) with using the ET technique. Levels of serum high-sensitivity C-reactive protein (hs-HSCRP) were determined for the two groups. β, Ep and PWV were significantly higher in the CSF group than in the control group (β: 11.4 ± 3.76 vs. 9.22 ± 3.28, p < 0.01; Ep: 153.44 ± 47.85 vs. 126.40 ± 43.32, p < 0.01; PWV: 7.26 ± 1.10 vs. 6.55 ± 1.02, p < 0.01), but AC was lower in the CSF group than in the control group (0.62 ± 0.20 vs. 0.74 ± 0.24, p < 0.01). The elasticity parameters of the bilateral common carotid artery did not significantly differ. The level of hs-HSCRP was correlated positively with β (r = 0.306, p = 0.015), Ep (r = 0.358, p = 0.005) and PWV (r = 0.306, p = 0.015), but negatively with AC (r = -0.236, p = 0.049). In conclusion, the ET technique is a simple practical method for evaluating carotid artery elasticity, and there is a significant correlation between carotid artery stiffness and level of hs-HSCRP in patients with CSF.
10.1016/j.ultrasmedbio.2014.08.015
Evaluation of left ventricular systolic function in patients with different types of ischemic heart disease by two-dimensional speckle tracking imaging.
Journal of cardiothoracic surgery
BACKGROUND:The purpose of this study was to evaluate left ventricular systolic function in patients with different types of ischemic heart disease using two-dimensional speckle tracking imaging (2D-STI). METHODS:We retrospectively studied patients who were admitted to Peking University Third Hospital from January 2011 to December 2017 due to chest tightness and chest pain. Two hundred forty-two patients were divided into control group, CMD group and obstructive CAD group. The main coronary artery stenosis was confirmed by coronary angiography or coronary computed tomography and coronary flow reserve (CFR) in patients was measured by transthoracic Doppler echocardiography. Left ventricular strain and strain rate (SR) measured by 2D-STI. Cardiac structure and function were measured by conventional echocardiography. RESULTS:Conventional echocardiography showed that there was no significant difference in cardiac structure and function among the three groups (P > 0.05). Moreover, the longitudinal strain (LS) of each ventricular wall in CMD group was notably lower than that in control group (P < 0.01). In addition, global longitudinal SR and longitudinal SR in CMD group and obstructive CAD group were obviously lower than those in control group (P < 0.01). GLS, endocardial LS and epicardial LS were negatively correlated with CFR (P < 0.01). CONCLUSIONS:Early left ventricular systolic dysfunction was found in patients with CMD and patients with obstructive CAD, with similar degree. CFR is an independent influencing factor of GLS. GLS and stratified LS have certain diagnostic value for CMD.
10.1186/s13019-020-01345-2
Effect of Coronary Slow Flow on the Longitudinal Left Ventricular Function Assessed by 2-Dimensional Speckle-Tracking Echocardiography.
Narimani Sima,Hosseinsabet Ali,Pourhosseini Hamidreza
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
OBJECTIVES:The coronary slow flow phenomenon is defined as the slow progression of an angiographic contrast agent to the distal part of the coronary arteries on selective coronary angiography in the absence of stenosis. There are some studies with different results about the effect of this phenomenon on left ventricular (LV) function. The aim of our study was to evaluate the longitudinal LV function in the coronary slow flow phenomenon using 2-dimensional (2D) speckle-tracking echocardiography. METHODS:In a study with a patient-to-patient matched design, 36 patients with the coronary slow flow phenomenon and 36 individuals with normal coronary flow matched for age (±5 years), sex, hypertension, and diabetes mellitus were compared in terms of the longitudinal LV systolic and diastolic functions by pulsed wave tissue Doppler echocardiography and 2D speckle-tracking echocardiography-derived indices. RESULTS:Lateral s' and e' waves were lower in the patients with the coronary slow flow phenomenon, but there were no statistically significant differences between the groups regarding the other tissue Doppler echocardiographic indices and longitudinal systolic strain and systolic and diastolic strain rates derived by 2D speckle-tracking echocardiography. CONCLUSIONS:Our results showed that the coronary slow flow phenomenon could not impair the longitudinal LV systolic and diastolic functions.
10.7863/ultra.15.05075
Evaluation of Left and Right Atrial Function in Patients with Coronary Slow-Flow Phenomenon Using Two-Dimensional Speckle Tracking Echocardiography.
Wang Yonghuai,Zhang Yan,Ma Chunyan,Guan Zhengyu,Liu Shuang,Zhang Weixin,Li Yuling,Yang Jun
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND:Coronary slow-flow phenomenon (CSFP) is an angiographic diagnosis characterized by delayed coronary opacification in the absence of obstructive coronary artery disease. Currently, several investigators are focusing on ventricular function assessment in patients with CSFP; however, there is a paucity of data on their atrial function. This study was performed to evaluate left atrial (LA) and right atrial (RA) function in patients with CSFP. MATERIALS AND METHODS:Eighty-two patients with CSFP and 55 controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by thrombolysis in myocardial infarction frame count (TFC). The LA and RA global longitudinal strain and strain rate during systole (Ss, SRs), during early diastole (Se, SRe), and during late diastole (Sa, SRa) were measured using two-dimensional speckle tracking echocardiography. RESULTS:In the CSFP group, LA Se and SRe decreased, while LA Sa and SRa increased, compared with the control group. RA Se and SRe were lower in patients with CSFP than in the controls. CONCLUSIONS:LA conduit function decreased in patients with CSFP, while contractile function increased. RA conduit function also decreased in patients with CSFP.
10.1111/echo.13197
Prognostic implications of left ventricular strain by speckle-tracking echocardiography in the general population: a meta-analysis.
Vascular health and risk management
PURPOSE:Left ventricular (LV) mechanics by speckle-tracking echocardiography (STE) is prognostic in patients with cardiovascular diseases, but evidence related to community-dwelling individuals is uncertain. We therefore performed a systematic review and meta-analysis of STE as a predictor of adverse outcomes in the general population. METHODS:PRISMA guidelines were followed and MEDLINE and EMBASE were searched to identify eligible studies. Primary outcome was all-cause mortality and secondary outcomes were composite cardiac and cardiovascular end-point. Random effects meta-analysis was performed, and a modified Newcastle-Ottawa Assessment Scale was used for quality assessment. RESULTS:Eight papers matched the predefined criteria (total number of individuals studied=11,744). All publications assessed global longitudinal strain (GLS) by two-dimensional speckle-tracking echocardiography (2D-STE), one assessed circumferential, radial and transverse strains, and one assessed GLS-derived post-systolic shortening. None assessed LV rotational measures in association with outcomes. Two studies reported associations between GLS and all-cause mortality and composite cardiovascular end-point. Six papers reported an association between GLS and composite cardiac end-point, three of which were from the same study. Four papers were suitable for meta-analysis. GLS predicted all-cause mortality (pooled minimally adjusted HR per unit strain (%)=1.07 [95% CI 1.03-1.11], =0.001), and composite cardiovascular (pooled maximally adjusted HR=1.18 [1.09-1.28], <0.0001) and cardiac (HR=1.08 [1.02-1.14], =0.006) end-points. GLS also predicted coronary heart disease (HR=1.15 [1.03-1.29], =0.017) and heart failure (HR=1.07 [1.02-1.13], =0.012). The quality of all studies was good. CONCLUSIONS:This study provides some evidence that STE may have utility as a measure of cardiac function and risk in the general population. 2D-STE-based GLS predicts total mortality, major adverse cardiac and cardiovascular end-points in community-dwelling individuals in a limited number of studies. Despite this, this systematic review also highlights important knowledge gaps in the current literature and further evidence is needed regarding the prognostic value of LV mechanics in unselected older populations. CRD42018090302.
10.2147/VHRM.S206747
Speckle-tracking imaging to monitor myocardial function after coronary artery bypass graft surgery.
Yin Zhe-Yu,Li Xiao-Feng,Tu Ying-Feng,Dong Dan-Dan,Zhao Dong-Liang,Shen Baozhong
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
OBJECTIVES:The purpose of this study was to investigate the changes in myocardial function in patients after coronary artery bypass graft (CABG) surgery using longitudinal and circumferential strain on speckle-tracking imaging. METHODS:A total of 145 patients who successfully underwent CABG surgery with a left ventricular ejection fraction (LVEF) of 50% or greater were enrolled in this study. Patients were classified into 4 groups based on age: group 1 (33-59 years), group 2 (60-64 years), group 3 (65-69 years), and group 4 (70-79 years). Routine echocardiography and longitudinal and circumferential strain measurements on speckle-tracking imaging were performed 1 week before and 1, 3, and 6 months after the CABG. RESULTS:In all groups, longitudinal strain increased significantly at 3 and 6 months after CABG therapy compared to baseline (P < .05). A significant increase in circumferential strain was found 1 month after the CABG in groups 1, 2, and 3, and a continuous increase in the parameter was observed in all groups 3 months after therapy (P < .05). However, the LVEF, left ventricular end-diastolic dimension, and stroke volume measured by routine echocardiography were not significantly changed after successful CABG treatment in all groups during 6 months of follow-up. CONCLUSIONS:Based on the results of our study in all age groups, speckle-tracking imaging parameters are more effective than the LVEF, left ventricular end-diastolic dimension, and stroke volume for monitoring improvement in myocardial function after CABG surgery.
10.7863/ultra.32.11.1951
Two-Dimensional Speckle Tracking Echocardiography Identifies Coronary Artery Disease in 690 Patients: A Retrospective Study from a Single Center.
Zhu Huolan,Yang Chenguang,Li Yi,Guo Ying,Meng Xuyang,Ren Yirong,Tan Long,Zhang Ruisheng,Wang Fang
Medical science monitor : international medical journal of experimental and clinical research
BACKGROUND Two-dimensional speckle tracking echocardiography (2D-STE) is a novel and non-invasive technique for the diagnosis of coronary artery disease (CAD). This retrospective study from a single center aimed to identify myocardial ischemia using 2D-STE in CAD patients identified by angiography. MATERIAL AND METHODS From March 1 to November 30, 2019, 690 patients in Beijing Hospital were enrolled. After angiography, 346 patients were diagnosed with CAD. Reduction in vessel diameter of ≥50% by stenosis in at least 1 major coronary artery or its main branch was considered CAD. Analysis of 2D-STE was performed using EchoPAC version 201. RESULTS The global strain was significantly impaired in CAD patients (P<0.01). Global longitudinal peak strain (GLPS) was analyzed in layers. For GLPS of the epicardium, the odds ratio (OR) was 1.297 (1.217-1.382; P=0.002), the area under the curve (AUC) was 0.727, and the cut-off value was -16.95; sensitivity and specificity were 73.7% and 63.0%, respectively. For GLPS of the middle layer, the OR was 1.260 (1.192-1.333; P<0.001), the AUC was 0.732, and the cut-off value was -20.95; sensitivity and specificity were 82.4% and 56.2%, respectively. For GLPS of the endocardium, the OR was 1.193 (1.137-1.251; P<0.001), the AUC was 0.708, and the cut-off value was -22.95; sensitivity and specificity were 82.9% and 52.9%, respectively. CONCLUSIONS The findings from this study support the clinical application of 2D-STE in patient populations with suspected myocardial ischemia due to CAD. Therefore, 2D-STE combined with ECG monitoring may have a future role for early screening of CAD patients.
10.12659/MSM.929476
Evaluation of right-ventricular function by two-dimensional echocardiography and two-dimensional speckle-tracking echocardiography in patients with successful RCA CTO recanalization.
Clinical research in cardiology : official journal of the German Cardiac Society
OBJECTIVES:Chronic total occlusion (CTO) of the right coronary artery (RCA) is common in patients with coronary artery disease. Although revascularization techniques and success rates have improved significantly in recent years, there are still no studies investigating possible effects of successful recanalization of RCA CTO on the right-ventricular (RV) function. With this study, we aimed to evaluate RV function after recanalization of the RCA by two-dimensional transthoracic echocardiography (2DE) and additional two-dimensional speckle-tracking echocardiography (2DSTE). METHODS AND RESULTS:Our analysis included 102 patients undergoing successful RCA CTO recanalization at the University Medical Center of Mainz. All patients underwent 2DE and 2DSTE to assess RV function before PCI procedure and 6 months after successful revascularization. We found an altered RV function in our collective at baseline assessed by 2DSTE with a significant improvement at 6 month follow-up (baseline RV free wall strain: - 20.7 [- 6.3 to - 32.0] % vs. - 23.4 [- 8.3 to - 39.3] % at follow-up, p < 0.001 and baseline RV global strain - 15.9 [- 6.0 to - 25.7] % vs. - 17.9 [- 7.0 to - 29.5] % at follow-up, p < 0.001). CONCLUSION:RV function was altered in patients with RCA CTO and showed significant improvement after successful recanalization. We also noticed an improvement in patient-reported clinical symptoms. Our study suggests that CTO procedure is a beneficial treatment option in symptomatic patients with RCA CTO.
10.1007/s00392-023-02259-4
Incremental value of early systolic lengthening and postsystolic shortening in detecting left anterior descending artery stenosis using nonstress speckle-tracking echocardiography.
Ishigaki Takako,Asanuma Toshihiko,Yagi Noriaki,Izumi Hiromi,Shimizu Shoko,Fujisawa Yoshihisa,Ikemoto Toshiyuki,Kushima Ryoji,Masuda Kasumi,Nakatani Satoshi
Scientific reports
The diagnosis of coronary artery disease (CAD) with nonstress echocardiography remains challenging. Although the assessment of either early systolic lengthening (ESL) or postsystolic shortening (PSS) allows the sensitive detection of CAD, it is unclear whether the integrated analysis of ESL and PSS in addition to the peak systolic strain can improve the diagnostic accuracy. We investigated the incremental value of ESL and PSS in detecting left anterior descending artery (LAD) stenosis using nonstress speckle-tracking echocardiography. Fifty-nine patients with significant LAD stenosis but without visual wall motion abnormalities on echocardiography at rest (30 single-vessel stenosis, 29 multivessel stenosis) and 43 patients without significant stenosis of any vessel were enrolled. The peak systolic strain, the time to ESL (T), and the time to PSS (T) were analyzed in all LAD segments, and the incremental values of the T and T in detecting LAD stenosis and the diagnostic accuracy were evaluated. In the apical anterior segment, the peak systolic strain was significantly lower and T and T were significantly longer in the single-vessel group than in the no stenosis group. In the single-vessel group, the addition of T and T to the peak systolic strain significantly increased the model power in detecting stenosis, and the integrated analysis improved diagnostic accuracy compared with the peak systolic strain alone. In contrast, this incremental value was not demonstrated in the multivessel group. The integrated analysis of the peak systolic strain, ESL, and PSS may allow better screening of single-vessel LAD stenosis using nonstress speckle-tracking echocardiography.
10.1038/s41598-021-98900-1
Myocardial layer-specific analysis of ischemic memory using speckle tracking echocardiography.
Sakurai Daisuke,Asanuma Toshihiko,Masuda Kasumi,Hioki Ayana,Nakatani Satoshi
The international journal of cardiovascular imaging
The assessment of post-systolic shortening (PSS) by speckle tracking echocardiography allows myocardial ischemic memory imaging. Because the endocardial layer is more vulnerable to ischemia, the assessment of this layer might be useful for detecting ischemic memory. Serial echocardiographic data were acquired from nine dogs with 2 min of coronary occlusion followed by reperfusion. Regional deformation parameters were measured in the risk and normal areas. Using speckle tracking echocardiography, circumferential strain was analyzed in the endocardial, mid-wall, and epicardial layers; and radial strain was analyzed in the inner half, outer half and entire (transmural) layers. In the risk area, peak systolic and end-systolic strain in the circumferential and radial directions significantly decreased during occlusion, but recovered to the baseline levels immediately after reperfusion in all layers. However, circumferential post-systolic strain index (PSI), a parameter of PSS, significantly increased during occlusion, and the significant increases persisted until 20 min after reperfusion in the endocardial and mid-wall layers. Radial PSI tended to increase after reperfusion in the inner half and entire layers but these increases were not significant compared with baseline. In the normal area, systolic strains and PSI in the radial and circumferential directions hardly changed before and after occlusion/reperfusion in all layers. In layer-specific analysis with speckle tracking echocardiography, circumferential PSS in the endocardial and mid-wall layers may be useful for detecting ischemic memory.
10.1007/s10554-014-0388-x
The evaluation of coronary microvascular obstruction in patients with STEMI by cardiac magnetic resonance T2-STIR image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography.
Heart and vessels
This study was designed to assess coronary microvascular obstruction (MVO) in patients with acute ST-segment elevation myocardial infarction (STEMI) by cardiac magnetic resonance T2-weighted short tau inversion recovery (T2-STIR) image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography (LDDSE-LS2D-STE). 32 patients were enrolled to perform cardiac magnetic resonance and echocardiography 5-7 days after primary percutaneous coronary intervention. Infarcted myocardium was categorized into MVO group and MVO group by late gadolinium enhancement as gold standard. At T2-weighted image, the area of hyper-intense region and hypo-intense core inside were marked as A1, A2 and A2/A1 > 0 represented MVO. Strain parameters were composed of longitudinal strain (LS), circumferential strain and radial strain at rest and dobutamine stress. There were 94 MVO segments, 136 MVO segments according to gold standard. 96 segments had hypo-intense core at T2-STIR image. The sensitivity and specificity of T2-STIR in detecting MVO were 91.49 and 92.65%. Endocardial LS was superior to other parameters, and stress endocardial LS was higher than that of resting endocardial LS (sensitivity: 77.11% vs 72.29%, specificity: 93.28% vs 83.19%, AUC: 0.87 vs 0.82, P < 0.05). The combination of T2-STIR and stress endocardial LS in parallel test could improve sensitivity significantly (98.05% vs 91.49%). T2-STIR has higher diagnostic value in detecting MVO with some limitations. However, LDDSE-LS2D-STE with cost-effective and handling may be a good alternative to T2-STIR. It provides additional and reliable diagnostic tools to identify MVO in STEMI patients after reperfusion.
10.1007/s00380-022-02131-x
Diagnostic utility of two-dimensional speckle tracking echocardiography to identify ischemic etiology of left ventricular systolic dysfunction.
Kowalczyk Ewelina,Kasprzak Jarosław D,Wejner-Mik Paulina,Wdowiak-Okrojek Katarzyna,Lipiec Piotr
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND:The differentiation between dilated cardiomyopathy (DCM) and systolic dysfunction caused by coronary artery disease (CAD) based on clinical and echocardiographic presentation can be difficult in some cases. AIM:Our study aimed to define differences in myocardial function between patients with ischemic and nonischemic etiology of reduced left ventricular ejection fraction using 2D speckle tracking echocardiography (STE). MATERIAL AND METHODS:We retrospectively analyzed 90 patients (mean age 65 ± 11 years, 70% male) with de novo diagnosed reduced left ventricular ejection fraction (≤45% as determined by the transthoracic echocardiography), who were referred for coronary angiography to determine the presence of significant CAD. On the basis of coronary angiography results, patients were divided into two subgroups as follows: 45 subjects with significant CAD (group A) and 45 subjects without CAD (group B). Acquired transthoracic echocardiographic images were assessed off-line using 2DSTE. In each patient, we calculated arithmetic mean, median value, and standard deviation of regional longitudinal strain and strain rate of 18 left ventricular segments. RESULTS:Standard deviation of the regional peak early diastolic strain rate was significantly higher in group A than in group B (P = 0.01). The cutoff value with the highest diagnostic value was >0.37/s-its sensitivity and specificity for the diagnosis of CAD were 73% and 53%, respectively. The remaining parameters did not differ significantly between the study groups. CONCLUSIONS:Patients with systolic dysfunction resulting from CAD have significantly more heterogeneous regional longitudinal early diastolic strain rate assessed by 2DSTE than patients with DCM.
10.1111/echo.14312
Assessment of the ability of the CHADS-VASc scoring system to grade left atrial function by 2D speckle-tracking echocardiography.
Hadadi Marjan,Mohseni-Badalabadi Reza,Hosseinsabet Ali
BMC cardiovascular disorders
BACKGROUND:The CHADS-VASc scoring system is correlated with left atrial (LA) reservoir function in patients with atrial fibrillation (AF) rhythm or paroxysmal AF. We assessed the ability of CHADS-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG). METHODS:This cross-sectional study recruited 340 consecutive candidates for CABG and categorized them according to their CHADS-VASc scores as mild-, moderate-, and high-risk score groups with 34 (10%), 83 (24%), and 223 (66%) patients, respectively. LA function was evaluated via 2D speckle-tracking echocardiography in terms of global longitudinal strain and strain rate during the reservoir, conduit, and contraction phases. In-hospital mortality, postoperative AF, prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation were assessed. RESULTS:LA strain and strain rate during the reservoir phase was statistically significantly lower in the high-risk score group than the low- and moderate-risk score groups (27.8 ± 6.9% vs 31.0 ± 5.0% vs 29.8 ± 6.1%, respectively; P = 0.004 and 2.6 ± 0.7 s vs 2.9 ± 0.6 s vs 2.9 ± 0.6 s, correspondingly; P = 0.009) and regarding LA strain and strain rate during the conduit phase (9.7 [7.1-12.5]% vs 12.9 [9.4-15.1]% vs 11.5 [9.1-13.8]%, correspondingly; P < 0.001 and 2.1 [1.6-2.7] s vs 2.8 [2.4-3.6] s vs 2.6 [2.2-3.0] s, respectively; P < 0.001). In addition, LA strain rate during the conduit phase was lower in the moderate-risk score group than the low-risk score group. After adjustments for possible confounders, these differences remained statistically significant. The risk of postoperative AF and prolonged ICU stay was highest in the high-risk score group (relative risk = 9.67 (1.31-71.43) and 8.05 (1.08-60.16), respectively; P = 0.026 and P = 0.042, respectively). CONCLUSIONS:LA reservoir and conduit functions decreased in the high-risk score group, which was accompanied by an increased risk of postoperative AF and prolonged ICU stay.
10.1186/s12872-021-01908-8
Dobutamine-stress echocardiography speckle-tracking imaging in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of coronary artery disease.
Rumbinaitė Eglė,Žaliaduonytė-Pekšienė Diana,Vieželis Mindaugas,Čeponienė Indrė,Lapinskas Tomas,Žvirblytė Rūta,Venclovienė Jonė,Morkūnaitė Kristina,Bielinis Augustinas,Šlapikas Rimvydas,Vaškelytė Jolanta Justina
Medicina (Kaunas, Lithuania)
BACKGROUND AND OBJECTIVE:Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckle-tracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD. MATERIALS AND METHODS:In 81 patients (mean age, 64±8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n=41) and pathologic (n=40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI). RESULTS:In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters. CONCLUSIONS:Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD.
10.1016/j.medici.2016.11.005
The predictive value of speckle tracking during dobutamine stress echocardiography in patients with chronic stable angina.
Farag Shereen Ibrahim,El-Rabbat Khaled Emad El-Din,Ahmed Mostafa Shaimaa,Abd Alnaby Mahmoud Said,Sabry Al-Shimaa Mohamed
Indian heart journal
OBJECTIVE:Evaluation of the diagnostic value of speckle tracking echocardiography (STE) at rest and during dobutamine stress in predicting the presence and severity of coronary artery disease (CAD) in patients with chronic stable angina. METHODS:A total of 100 patients with chronic stable angina were evaluated using STE at rest and during dobutamine stress to detect the presence, severity, and number of affected coronary arteries. Then, the correlation with the SYNTAX score (SS) was analyzed. RESULTS:STE at stress showed better agreement with coronary angiography (CA) than dobutamine stress echocardiography (DSE) in detecting the presence of coronary artery stenosis (Kappa = 0.819, p < 0.001). STE at stress suggested involvement of the left anterior descending artery (LAD) with excellent agreement with CA (Kappa = 0.816, p < 0.001). For right coronary artery, STE at rest and stress showed good agreement with the CA results (Kappa = 0.775 and 0.858, respectively, p < 0.001), whereas for left circumflex artery, STE at rest and stress showed a fair agreement with the CA results (Kappa = 0.556 and 0.583, respectively, p < 0.001). Resting global longitudinal peak systolic strain (GLPSS) ≥ -15.2% had the best diagnostic accuracy (sensitivity = 61.8%; specificity = 93.5%) in predicting SS > 22. Stress GLPSS ≥ -12.5% had the best diagnostic accuracy (sensitivity = 82.4%; specificity = 78.3%) in predicting SS > 22. CONCLUSION:Speckle tracking during DSE has high sensitivity and specificity for predicting the presence of CAD. It provides quantitative diagnostic information that decreases the false positive and false negative results of DSE.
10.1016/j.ihj.2020.03.001
Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography.
Xing Yumeng,Shi Jing,Yan Yan,Liu Yu,Chen Yongle,Kong Dehong,Shu Xianhong,Pan Cuizhen
Microcirculation (New York, N.Y. : 1994)
OBJECTIVE:This study aimed to determine whether STE could help detect subclinical myocardial dysfunction in patients with CSFP. METHODS:Sixty patients with CSFP confirmed by CAG and 51 controls with normal coronary flow were prospectively enrolled. Coronary angiographic data and conventional and speckle tracking echocardiographic parameters of the LV and RV were obtained for every subject. RESULTS:Compared with controls, CSFP patients presented with higher BMI and TG levels, but lower HDL-C levels. Conventional echocardiographic parameters of biventricular systolic and diastolic function did not differ between the two groups (all P > 0.05). The GLS of the LV and RV was significantly impaired in CSFP patients compared with that in controls (-19.03% vs -21.42%, P < 0.001 and -19.72% vs -22.96%, P = 0.001, respectively). The myocardial impairment pattern of CSFP patients was homogenous in the RV and heterogeneous in the LV, where only endo- and mid-myocardial layers were affected. LV-GLS and RV-GLS were found to be well correlated with mTFC and HDL-C in CSFP groups (r = 0.463 vs r = 0.439; r = -0.569 vs r = -0.552, all P < 0.05). ROC curve analysis demonstrated that LV-GLS-endo had the highest AUC (0.867, P < 0.001) for predicting subclinical myocardial impairment in CSFP patients. CONCLUSIONS:Subclinical myocardial systolic dysfunction occurs in both ventricles, and GLS could be an effective method to detect early-stage myocardial impairment in patients with CSFP.
10.1111/micc.12509
Rest 2D speckle tracking echocardiography may be a sensitive but nonspecific test for detection of significant coronary artery disease.
Mahjoob Mohammad Parsa,Alipour Parsa Saeed,Mazarei Asghar,Safi Morteza,Khaheshi Isa,Esmaeeli Shooka
Acta bio-medica : Atenei Parmensis
AIMS:To detect the significance of coronary artery disease in the patients, who are suspected, was assumed to be one of the advantages of 2D STE, as a novel non-invasive imaging modality with acceptable accuracy. METHODS:In this study, 216 patients who were suspected to have coronary artery disease and candidate for coronary angiography, underwent rest two-dimensional speckle tracking echocardiography (2D STE) and negative global systolic longitudinal strain was evaluated. RESULTS:Negative global systolic left ventricular longitudinal strain under 18% in rest 2D-STE was significantly prevalent in patients with significant CAD in coronary angiography (P value<0.0001).Our results revealed sensitivity of 91.1%, specificity of 63.0%, positive predictive value of 80.4%, negative predictive value of 81.0% and accuracy of 80.5% for rest 2D-STE in detection of significant CAD. CONCLUSION:Here in we showed that rest Two-dimensional speckle tracking echocardiography could be a sensitive but nonspecific imaging modality to determine significant coronary artery disease. Future studies with large size will reveal more detailed findings.
10.23750/abm.v88i4.5445
Quantitative Dobutamine Stress Echocardiography Using Speckle-Tracking Analysis versus Conventional Visual Analysis for Detection of Significant Coronary Artery Disease after ST-Segment Elevation Myocardial Infarction.
Joyce Emer,Hoogslag Georgette E,Al Amri Ibithal,Debonnaire Philippe,Katsanos Spyridon,Bax Jeroen J,Delgado Victoria,Marsan Nina Ajmone
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
BACKGROUND:Residual ischemia detection after ST-segment elevation myocardial infarction (STEMI) during dobutamine stress echocardiography (DSE) using visual analysis is challenging. The aim of the present study was to investigate the feasibility and accuracy of two-dimensional speckle-tracking strain DSE to detect significant coronary artery disease (CAD) after STEMI. METHODS:First STEMI patients (n = 105; mean age, 60 ± 11 years; 86% men) treated with primary percutaneous coronary intervention undergoing full-protocol DSE at 3 months and repeat coronary angiography within 1 year were retrospectively included. Using two-dimensional speckle-tracking echocardiography, segmental and global left ventricular peak longitudinal systolic strain (PLSS) at rest and peak stress and change (Δ) in PLSS were measured. Significant CAD was defined as detection of >70% diameter stenosis at coronary angiography. RESULTS:In total, 1,653 (93%) and 1,645 (92%) segments were analyzable at rest and peak stress, respectively. At follow-up, 38 patients (36%) showed significant angiographic CAD. These patients demonstrated greater worsening in global PLSS from rest to peak (-16.8 ± 0.5% to -12.6 ± 0.5%) compared with patients without significant CAD (-16.6 ± 0.4% to -14.3 ± 0.3%; group-stage interaction P < .001). The optimal cutoff of ΔPLSS for the detection of significant CAD on receiver operating characteristic curve analysis was ≥1.9% (area under the curve, 0.70; sensitivity, 87%; specificity, 46%; accuracy, 60%). Using a sentinel segment approach (apex, midposterior, and midinferior for the left anterior descending, left circumflex, and right coronary artery territories, respectively), larger segmental ΔPLSS was also independently associated with significant CAD (odds ratio, 1.1; 95% CI, 1.1-1.2). CONCLUSIONS:Two-dimensional speckle-tracking echocardiographic strain analysis is feasible on DSE after STEMI and represents a promising new technique to detect significant angiographic CAD at follow-up.
10.1016/j.echo.2015.07.023
Identification of significant coronary artery disease in patients with non-ST segment elevation acute coronary syndrome by myocardial strain analyses using three dimensional speckle tracking echocardiography.
Biswas Asim Kumar,Haque Tuhin,Banik Dhiman,Choudhury Sohel Reza,Khan Sayeedur Rahman,Malik Fazila-Tun-Nesa
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND:Speckle-tracking imaging is a novel method for assessing left ventricular function and ischemic changes. This study aimed to predict the presence of significant coronary artery stenosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by 3D strain analysis using speckle tracking echocardiography (3DSTE) at rest. METHODS:This cross-sectional study included a total 60 patients with NSTE-ACS who underwent 3DSTE immediately prior to coronary angiography. Subsequently, patients undergone coronary angiogram (CAG) and divided into two groups; group- I: significant stenosis (n = 36), group-II: non-significant stenosis (n = 24). RESULTS:Global peak systolic longitudinal strain (GPSLS), circumferential strain (CS), area strain (AS), and radial strain (RS) were obtained successfully in 60 patients. All strain parameters were significantly reduced in patient group of significant stenosis. Receiver operating characteristic (ROC) curve analysis demonstrated that GPSLS could effectively detect patients with significant stenosis (area under ROC curve = 0.840, 95% CI = 0.735-0.945). GPSLS with a cutoff value of -13.50% showed good sensitivity and specificity for predicting significant stenosis (sensitivity 88.9% and specificity 70.8%). CONCLUSION:Global peak systolic longitudinal strain using 3D speckle tracking echocardiography at rest was significantly lower in patients with significant stenosis and might be useful for identifying patients with a significant stenosis with good degree of sensitivity and specificity.
10.1111/echo.14181
Early ischemia identification employing 2D speckle tracking selective layers analysis during dobutamine stress echocardiography.
Cadeddu Dessalvi Christian,Deidda Martino,Farci Salvatore,Longu Giorgio,Mercuro Giuseppe
Echocardiography (Mount Kisco, N.Y.)
PURPOSE:Two-dimensional (2D) strain derived from speckle tracking proved to be feasible and accurate in the quantitative evaluation of myocardial ischemia during stress echocardiography. We compared the accuracy in detecting myocardial ischemia of the transmural segmental analysis with an endocardial specific evaluation in 20 patients undergoing dobutamine stress echocardiography (DSE) and coronary angiography. METHODS:Peak systolic global strain (G-ε) and at the subendocardial level (Endo-ε) were measured off-line at rest, a low dose, and peak stress; then, we compared the results with wall-motion analysis and significant coronary artery disease (CAD > 70% diameter stenosis). Endocardial strain variation from basal to low and peak dose was computed both for global or subendocardial analysis. The utilization of the ROC curve allowed us to derive optimal cutoffs, sensibility and specificity for ischemic segments. RESULTS:The subendocardial analysis at high dose showed to be able to increase significantly the accuracy of the test to detect the ischemic segments (sens 90.2% vs 85.4%; spec 93.1% vs 92.2%). Moreover, at the low dose, the subendocardial analysis showed to be able to increase significantly, mostly the specificity of the test (sens 69.6% vs 68.3%; spec 92.2% vs 86.2%). Notably, the strain subendocardial analysis at low dose showed to reach a high specificity, similar to the peak dose transmural analysis. CONCLUSIONS:Measurement of subendocardial strain during DSE is feasible and can increase the accuracy of the test. Moreover, the subendocardial strain during DSE can reach a high specificity, even limiting the test at a low dose infusion.
10.1111/echo.14535
Evaluation of the right atrial phasic functions in patients with anterior ST-elevation myocardial infarction: a 2D speckle-tracking echocardiography study.
BMC cardiovascular disorders
BACKGROUND:Evidence suggests that changes in left ventricular systolic and diastolic functions may affect right atrial (RA) phasic functions. We aimed to evaluate RA phasic functions in the presence of anterior ST-elevation myocardial infarction (ASTEMI) as an acute event and to compare the findings with those in a control group. METHODS:We recruited 92 consecutive ASTEMI patients without accompanying significant stenosis in the proximal and middle parts of the right coronary artery and 31 control subjects, matched for age, sex, diabetes, and hypertension. RA phasic functions were evaluated concerning their longitudinal 2D speckle-tracking echocardiography-derived markers. The ASTEMI group was followed up for all-cause mortality or reinfarction. RESULTS:In the ASTEMI group, RA strain was reduced during the reservoir (33.2% ± 4.3% vs 30.5% ± 8.1%; P = 0.021) and conduit (16% [12-18%] vs 14% [9-17%]; P = 0.048) phases. The other longitudinal 2D speckle-tracking echocardiography-derived markers of RA phasic functions were not different between the 2 groups. RA strain and strain rate during the contraction phase were predictive of all-cause mortality or reinfarction (hazard ratio = 0.80; P = 0.024 and hazard ratio = 0.39; P = 0.026, respectively). CONCLUSIONS:Based on 2D speckle-tracking echocardiography, in the ASTEMI group, compared with the control group, RA reservoir and conduit functions were reduced, while RA contraction function was preserved. RA contraction function was predictive of all-cause mortality or reinfarction during the follow-up period.
10.1186/s12872-022-02546-4
Layer-specific global longitudinal strain reveals impaired cardiac function in patients with reversible ischemia.
Hagemann Christoffer E,Hoffmann Søren,Olsen Flemming J,Jørgensen Peter G,Fritz-Hansen Thomas,Jensen Jan S,Biering-Sørensen Tor
Echocardiography (Mount Kisco, N.Y.)
AIMS:Two-dimensional speckle tracking echocardiography (2DSTE) detects early signs of left ventricular dysfunction; however, it is unknown whether layer-specific global longitudinal strain (GLS) has incremental value in diagnosis of patients with reversible ischemia assessed by single photon emission computed tomography (SPECT). METHODS AND RESULTS:Eighty patients with stable angina pectoris (SAP), normal left ventricular ejection fraction (LVEF), and no history of ischemic heart disease were retrospectively identified to have been examined by 2DSTE, SPECT, and coronary angiography (CAG). Patients with a normal SPECT constituted the control group, and patients with a positive SPECT were divided into patients with or without (true- or false- positive SPECT) significant stenosis assessed by CAG. GLS was measured for two myocardial layers (endocardial and epicardial) and as well as mid-myocardial GLS. Patients with reversible ischemia had significantly lower GLS compared to the control group (GLS : -19.0 ± 4.4% vs -21.4 ± 3.7%, P = .011; GLS : -14.3 ± 2.9% vs -16.3 ± 2.9%, P = .004); GLS : -16.5 ± 3.6% vs -18.6 ± 3.2%, P = .006. This difference was even more evident in patients with a true-positive SPECT (GLS : -18.0 ± 4.4% vs -21.4 ± 3.7%, P < .001; GLS : -13.6 ± 3.0% vs -16.3 ± 2.9%, P < .001); GLS : -15.6 ± 3.6% vs -18.6 ± 3.2%, P < .001. Notably, no significant differences existed in patients with a false-positive SPECT. GLS was the only independent predictor of coronary artery disease. IN CONCLUSION:In patients with SAP and preserved LVEF, layer-specific GLS at rest identifies patients with reversible ischemia. This seems to be evident only in patients with a true-positive SPECT, thus, 2DSTE at rest might improve the diagnostic accuracy of a positive SPECT.
10.1111/echo.13830
Diagnostic accuracy of left ventricular longitudinal function by speckle tracking echocardiography to predict significant coronary artery stenosis. A systematic review.
Norum Ingvild Billehaug,Ruddox Vidar,Edvardsen Thor,Otterstad Jan Erik
BMC medical imaging
BACKGROUND:Patients evaluated for acute and chronic chest pain comprise a large, heterogeneous group that often provides diagnostic challenges. Although speckle tracking echocardiography (STE) has proved to have diagnostic value in acute coronary syndrome it is not commonly incorporated in everyday practice. The purpose of the present systematic review was to assess the diagnostic accuracy of left ventricular (LV) longitudinal function by STE to predict significant coronary artery stenosis (CAD+) or not (CAD-) verified by coronary angiography in patients with chest pain suspected to be of cardiac ischemic origin. METHODS:4 electronic databases; Embase, Medline, Cochrane and PubMed ahead-of print were searched for per 19.05.14. Only full-sized articles including >40 patients were selected. RESULTS:A total of 166 citations were identified, 16 full-size articles were assessed of which 6 were found eligible for this review. Of 781 patients included 397 (60%) had CAD+. The overall weighted mean global longitudinal strain (GLS) was -17.2% (SD=2.6) among CAD+ vs. -19.2% (SD=2.8) in CAD- patients. Mean area under curve in 4 studies for predicting CAD+ ranged from 0.68 to 0.80. The study cut-off levels for prediction of CAD+ in the ROC analysis varied between -17.4% and -19.7% with sensitivity from 51% to 81% and specificity between 58% and 81%. In 1 study GLS obtained during dobutamine stress echocardiography (DSE) had the best accuracy. Regional strain measurements were not uniform, but may have potential in detecting CAD. CONCLUSIONS:GLS measurements at rest only have modest diagnostic accuracy in predicting CAD+ among patients presenting with acute or chronic chest pain. The results from regional strain, layer specific strain and DSE need to be verified in larger studies.
10.1186/s12880-015-0067-y
Clinical study of two-dimensional speckle tracking to evaluate abnormal myocardial motion due to coronary lesions.
Echocardiography (Mount Kisco, N.Y.)
OBJECTIVE:To investigate the predictive ability of global longitudinal strain (GLS) and mechanical dispersion for coronary stenosis and provide a more reliable noninvasive method for diagnosis of obstructive coronary artery disease(OCAD). METHODS:Sixty-seven patients diagnosed with suspected CAD were included in the study. Patients with coronary stenosis greater than 50% were assigned as OCAD, while the others were assigned as non obstructive coronary artery disease(NOCAD). General information was collected and patients underwent speckle tracking echocardiogram(STE). RESULTS:Spearman's correlation analysis showed that GLS and mechanical dispersion were positively correlated with the degree of coronary stenosis (r = 0.383, 0.342, p < 0.05), and there was also a positive correlation between GLS and mechanical dispersion (r = 0.327, p < 0.05). GLS, longitudinal strain (LS) of each chamber, and mechanical dispersion were higher in the OCAD group than in the NOCAD group (p < 0.05). Univariate regression analysis showed that GLS, each lumen LS and mechanical dispersion were statistically significant (p < 0.05). Multifactorial regression analysis showed that elevated GLS (p = 0.007) and elevated mechanical dispersion (p = 0.030) were independent risk factors for OCAD. The ROC curves showed that GLS predicted OCAD (AUC area 0.745, 95% CI 0.624 to 0.865) versus mechanical discrete prediction of OCAD (AUC area 0.702, 95% CI 0.569 to 0.834) were more diagnostic than conventional cardiac ultrasound observations of ventricular wall motion abnormalities (AUC area 0.566, 95% CI 0.463 to 0.669). CONCLUSIONS:Combining GLS with mechanical dispersion can rapidly assess OCAD in a very short period, which has strong promotion value and in-depth research value.
10.1111/echo.15744
Two-dimensional speckle tracking for the assessment of coronary artery disease during dobutamine stress echo: clinical tool or merely research method.
Aggeli Constantina,Lagoudakou Stauroula,Felekos Ioannis,Panagopoulou Vasiliki,Kastellanos Stellios,Toutouzas Konstantinos,Roussakis George,Tousoulis Dimitris
Cardiovascular ultrasound
BACKGROUND:Two-dimensional speckle tracking provides valuable information for regional wall motion abnormalities. The purpose of this study was to determine the diagnostic value of left ventricular longitudinal strain and torsion to diagnose coronary artery disease during dobutamine stress echocardiography. METHODS:We studied 100 patients (mean age 60.8 ± 10.7 years, 72 male) with known or suspected coronary artery disease, excluding those with prior history of transmural infraction. All of them underwent dobutamine stress echo and coronary angiography within one month. Wall-motion score index, left ventricular global longitudinal strain and torsion were measured at rest and peak stress. Additionally, the respective differences between rest and stress were also calculated. Optimal cut-offs were derived from receiver operating characteristic curves for strain and torsion values. RESULTS:Mean left ventricular ejection fraction was 55 ± 5.4 %. Coronary angiography revealed significant lesions in 67 patients. Values regarding sensitivity, and specificity for wall motion score index difference were 78 % and 88 % respectively (area under curve 0.84). Global longitudinal strain difference (median 0.5 %) illustrated 81 % sensitivity and 72 % specificity for disease detection (area under curve 0.80, cut-off value ≤0 %). The respective values for torsion difference (median 4.7°) were 81 % and 82 % (area under curve 0.76, cut-off value ≤6.5°). Combination of wall motion score index difference and torsion difference for disease detection showed 91 % sensitivity and 79 % specificity (area under curve 0.85). CONCLUSIONS:The implementation of speckle tracking during dobutamine stress echo could serve as an adjunct method for coronary artery disease assessment, providing quantitative diagnostic information.
10.1186/s12947-015-0038-z
Use of two-dimensional speckle tracking echocardiography to predict cardiac events: Comparison of patients with acute myocardial infarction and chronic coronary artery disease.
Scharrenbroich Jörg,Hamada Sandra,Keszei Andras,Schröder Jörg,Napp Andreas,Almalla Mohammad,Becker Michael,Altiok Ertunc
Clinical cardiology
BACKGROUND:Two-dimensional speckle strain (2D STE) echocardiography can aid in the prognosis of acute myocardial infarction (AMI) and chronic coronary artery disease (CAD). HYPOTHESIS:Differences occur in the prediction of cardiac events using 2D STE in AMI vs CAD patients. METHODS:In this prospective study, 94 patients with a first AMI and successful revascularization, and 137 patients with stable CAD after complete revascularization were included. In all patients, we performed echocardiography and myocardial deformation analysis for layer-specific global circumferential strain (GCS) and longitudinal strain. Receiver operating characteristic (ROC) curve analysis was used to predict the presence of a cardiac event using strain values and baseline characteristics in different regression models. RESULTS:Patients were followed for 3.6 ± 0.8 years. Strain parameters in AMI and CAD patients were significantly different with respect to the occurrence of a cardiac event. Frequency of diabetes and hypertension was associated with the presence of a cardiac event in CAD patients. Furthermore, in CAD patients, ROC analysis demonstrated that the addition of endocardial GCS to baseline characteristics and ejection fraction to a regression model significantly improved the prediction of cardiac events (area under curve = 0.86, cutoff value: 20%, sensitivity: 79%, specificity: 84%). In contrast, the addition of strain parameters in AMI patients did not increase the prediction power for cardiac events. CONCLUSIONS:Global strain parameters by 2D STE may be useful for the prediction of cardiac events in patients with CAD but add no supplemental information to baseline characteristic and ejection fraction in patients with AMI.
10.1002/clc.22860
Ascending Aortic Strain Analysis Using 2-Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris.
Journal of the American Heart Association
BACKGROUND:Arterial stiffening and atherosclerosis tend to coexist. Strain imaging, using a 2-dimensional speckle tracking (2D-ST) method, has been used for arterial stiffness assessment and early identification of atherosclerosis. We investigated whether the ascending aortic strain assessed by 2D-ST echocardiography at rest can predict the presence of coronary artery disease (CAD). METHODS AND RESULTS:Two hundred seventy-one consecutive patients with suspected stable angina pectoris sequentially underwent exercise treadmill testing, 2-dimensional echocardiography, M-mode echocardiography, 2D-ST echocardiography, and coronary angiography. Circumferential ascending aortic strain (CAAS) and radial ascending aortic strain were assessed by 2D-ST echocardiography. Ninety-two patients with coronary lumen area stenosis ≥70% were categorized as having significant CAD. Global CAAS was significantly lower in patients with significant CAD (7.41±2.30% versus 11.54±4.03%; <0.001) and remained an independent predictor of significant CAD (odds ratio, 0.64 [0.54-0.75]; <0.001) after multivariate regression. Based on the receiver operating characteristic curve for diagnosing significant CAD, the optimal cut-off value of global CAAS was ≤9.22% (sensitivity, 86%; specificity, 70%; area under curve=0.82; <0.001). Global CAAS decreased with increasing severity of CAD and was significantly associated with 3-vessel disease (odds ratio, 0.58 [0.42-0.79]; <0.001). Diagnostics for significant CAD were remarkably better for global CAAS combined with exercise treadmill testing than for exercise treadmill testing alone (area under curve=0.88 versus 0.78; <0.001). CONCLUSIONS:Global CAAS assessed by 2D-ST echocardiography at rest was able to predict the presence of significant CAD and identify multivessel disease. In addition, global CAAS combined with exercise treadmill testing remarkably improved the diagnostics for significant CAD.
10.1161/JAHA.118.008802
Intraoperative Assessment of Coronary Artery Stenosis by 2D Speckle-Tracking Echocardiography: The Correlation Between Peak Strain Rate During Early Diastole and the Severity of Coronary Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting.
Ebrahimi Farzad,Gharedaghi Mohammad Hadi,Petrossian Vaheh,Kohanchi David
Journal of cardiothoracic and vascular anesthesia
OBJECTIVES:The effects of inhalation anesthetics on cardiac function and the low correlation between transthoracic and transesophageal echocardiographic measurements may alter the ability of transesophageal echocardiography-derived strain rate during early diastole to detect coronary artery stenosis in anesthetized patients. The authors assessed the correlation between coronary artery stenosis and strain-based parameters during early diastole in heart failure patients with preserved ejection fraction undergoing coronary artery bypass grafting. DESIGN:Retrospective clinical study. SETTING:Single university hospital. PARTICIPANTS:Thirty-two adult patients with preserved ejection fraction undergoing coronary artery bypass grafting between December 2016 and December 2018. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Transesophageal echocardiography images and coronary artery angiographies of the participants were studied. The correlation between the severity of coronary artery stenosis and strain-based indices measured in the corresponding left ventricular segments were assessed. Receiver operating characteristic curve analysis of strain rate during early diastole was used to predict the presence of coronary artery stenosis ≥70%. Regarding the severity of coronary artery stenosis, it demonstrated a strong and inverse correlation with strain rate during early diastole (r = -0.71, p < 0.001), but showed no significant correlation with time to peak strain rate during early diastole (r = 0.19, p = 0.18). Strain rate during early diastole ≤1.5 s had a sensitivity of 77% and a specificity of 87% for predicting coronary artery stenosis ≥70% (area under the curve, 0.88). CONCLUSIONS:Strain rate during early diastole significantly correlates with the severity of coronary artery stenosis in anesthetized patients suffering from heart failure with preserved ejection fraction.
10.1053/j.jvca.2019.05.016
Speckle-Tracking Echocardiography for Detecting Subclinical Left Ventricular Dysfunction in Patients With Familial Hypercholesterolemia.
Li Rongjuan,Xie Jinjie,Jiang Bo,Sun Zhonghua,Wang Lvya,Leng Zhaoting,Wang Yueli,Yang Ya
Texas Heart Institute journal
Myocardial ischemia and left ventricular dysfunction have been documented in young adults with familial hypercholesterolemia. We investigated whether speckle-tracking echocardiography can be used to detect subclinically impaired global and regional myocardial function in patients with this lipid disorder. This single-center study included 47 patients with familial hypercholesterolemia and 37 healthy control subjects who underwent transthoracic Doppler echocardiography and speckle-tracking echocardiography from January 2003 through December 2016. Conventional echocardiographic and strain parameters in the 2 groups were analyzed and compared. Left ventricular dimensions were significantly larger at end-diastole (P=0.02) and end-systole (P=0.013), left ventricular walls were significantly thicker (P <0.0001), and the early transmitral/early diastolic mitral annular velocity ratio was significantly higher (P=0.006) in the patient group than in the control group. In the patient group, global longitudinal and circumferential strain values were significantly lower (P <0.0001) and global radial strain values significantly higher (P=0.006); all segmental longitudinal strain (P <0.04) and most segmental circumferential strain values (P ≤0.01) were significantly lower; and some segmental radial strains, especially at the apex, were significantly higher (P ≤0.04). However, average longitudinal, circumferential, and radial strains in the different segments of the 3 main coronary artery territories were significantly lower in the patient group (P <0.01). Global longitudinal strain (r=0.561; P=0.001) and global circumferential strain (r=0.565; P <0.0001) were inversely correlated with low-density-lipoprotein cholesterol levels. We conclude that speckle-tracking echocardiography can be used to detect subclinical global and regional systolic abnormalities in patients with familial hypercholesterolemia.
10.14503/THIJ-18-6720
Speckle Tracking Imaging in Normal Stress Echocardiography.
Leitman Marina,Tyomkin Vladimir,Peleg Eli,Zyssman Izhak,Rosenblatt Simcha,Sucher Edgar,Gercenshtein Vered,Vered Zvi
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
OBJECTIVES:Exercise stress echocardiography is a widely used modality for the diagnosis and follow-up of patients with coronary artery disease. During the last decade, speckle tracking imaging has been used increasingly for accurate evaluation of cardiac function. This work aimed to assess speckle-tracking imaging parameters during nonischemic exercise stress echocardiography. METHODS:During 2011 to 2014 we studied 46 patients without history of coronary artery disease, who completed exercise stress echocardiography protocol, had normal left ventricular function, a nonischemic response, and satisfactory image quality. These exams were analyzed with speckle-tracking imaging software at rest and at peak exercise. Peak strain and time-to-peak strain were measured at rest and after exercise. Clinical follow-up included a telephone contact 1 to 3 years after stress echo exam, confirming freedom from coronary events during this time. RESULTS:Global and regional peak strain increased following exercise. Time-to-peak global and regional strain and time-to-peak strain adjusted to the heart rate were significantly shorter in all segments after exercise. Rest-to-stress ratio of time-to-peak strain adjusted to the heart rate was 2.0 to 2.8. CONCLUSIONS:Global and regional peak strain rise during normal exercise echocardiography. Peak global and regional strain occur before or shortly after aortic valve closure at rest and after exercise, and the delay is more apparent at the basal segments. Time-to-peak strain normally shortens significantly during exercise; after adjustment to heart rate it shortens by a ratio of 2.0 to 2.8. These data may be useful for interpretation of future exercise stress speckle-tracking echocardiography studies.
10.7863/ultra.16.04010
Regional myocardial strain analysis via 2D speckle tracking echocardiography: validation with sonomicrometry and correlation with regional blood flow in the presence of graded coronary stenoses and dobutamine stress.
Cardiovascular ultrasound
BACKGROUND:Quantitative regional strain analysis by speckle tracking echocardiography (STE) may be particularly useful in the assessment of myocardial ischemia and viability, although reliable measurement of regional strain remains challenging, especially in the circumferential and radial directions. We present an acute canine model that integrates a complex sonomicrometer array with microsphere blood flow measurements to evaluate regional myocardial strain and flow in the setting of graded coronary stenoses and dobutamine stress. We apply this unique model to rigorously evaluate a commercial 2D STE software package and explore fundamental regional myocardial flow-function relationships. METHODS:Sonomicrometers (16 crystals) were implanted in epicardial and endocardial pairs across the anterior myocardium of anesthetized open chest dogs (n = 7) to form three adjacent cubes representing the ischemic, border, and remote regions, as defined by their relative locations to a hydraulic occluder on the mid-left anterior descending coronary artery (LAD). Additional cardiac (n = 3) and extra-cardiac (n = 3) reference crystals were placed to define the cardiac axes and aid image registration. 2D short axis echocardiograms, sonometric data, and microsphere blood flow data were acquired at baseline and in the presence of mild and moderate LAD stenoses, both before and during low-dose dobutamine stress (5 μg/kg/min). Regional end-systolic 2D STE radial and circumferential strains were calculated with commercial software (EchoInsight) and compared to those determined by sonomicrometry and to microsphere blood flow measurements. Post-systolic indices (PSIs) were also calculated for radial and circumferential strains. RESULTS:Low-dose dobutamine augmented both strain and flow in the presence of mild and moderate stenoses. Regional 2D STE strains correlated moderately with strains assessed by sonomicrometry (R = 0.56, p < 0.0001; R = 0.55, p < 0.0001) and with regional flow quantities (R = 0.61, R = 0.63). Overall, correspondence between 2D STE and sonomicrometry was better in the circumferential direction (Bias ± 1.96 SD: - 1.0 ± 8.2% strain, p = 0.06) than the radial direction (5.7 ± 18.3%, p < 0.0001). Mean PSI values were greatest in low flow conditions and normalized with low-dose dobutamine. CONCLUSIONS:2D STE identifies changes in regional end-systolic circumferential and radial strain produced by mild and moderate coronary stenoses and low-dose dobutamine stress. Regional 2D STE end-systolic strain measurements correlate modestly with regional sonomicrometer strain and microsphere flow measurements.
10.1186/s12947-019-0183-x
Correlation Between Glycated Hemoglobin (HbA1c) and Post-Systolic Index Measured by Speckle-Tracking Echocardiography in Patients with Non-apparent Coronary Artery Disease.
Cardiovascular toxicology
Glycated hemoglobin (HbA1c) is a useful biomarker for the diagnosis of diabetes and also for determination of individuals with an increased risk of a severe disease. Some subtle changes in myocardial contractile function is measurable by post-systolic index (PSI) which is defined as late systolic shortening after aortic valve closure. The aim of our study was to determine the relationship between HbA1c and PSI in patients with non-apparent coronary artery disease (CAD) on angiograms. This study was a historical cohort study on 85 consecutive patients with a left ventricular ejection fraction ≥ 50% and non-apparent CAD on angiogram. Patients were divided into two groups based on their HbA1c levels, regardless of the diagnosis of diabetes in these patients, to patients with an HbA1c level of equal or higher than 5.7% and those with an HbA1c of less than 5.7%. A speckle-tracking echocardiography was performed for all patients and global longitudinal strain, PSI, left ventricular diameters, left atrial volume, pulsed-Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. PSI, E/e' ratio, and A wave were higher and e' velocity was lower in patients with HbA1c ≥ 5.7% than those with a level of < 5.7% (P value = 0.04, 0.001, 0.014, and 0.004, respectively). Other echocardiographic variables were not different between two groups. Multiple linear regression analysis showed the association between HbA1c and PSI was independent of other demographic, biochemical, and echocardiographic variables (B = 35.674, 95% CI 10.741-60.606, P value = 0.006). Our study showed PSI is more pronounced in individuals with an HbA1c > 5.7% than those with a lower value in the absence of CAD. Because PSI is an important indicator of adverse outcome and increased mortality, these data can underline the importance of an abnormal HbA1c level and its association with subtle cardiac dysfunction, irrespective of the diagnosis of diabetes in patients with non-apparent CAD.
10.1007/s12012-022-09732-y
Early diastolic strain rate by two-dimensional speckle tracking echocardiography is a predictor of coronary artery disease and cardiovascular events in stable angina pectoris.
Hagemann Rikke A,Hoffmann Søren,Brainin Philip,Hagemann Christoffer A,Fritz-Hansen Thomas,Olsen Flemming J,Møgelvang Rasmus,Biering-Sørensen Tor
The international journal of cardiovascular imaging
This study aimed to clarify the diagnostic and prognostic potential of strain rate in patients with suspected stable angina pectoris (SAP). Strain rate by 2-dimensional speckle tracking echocardiography (2DSTE) has been suggested to be able to diagnose coronary artery disease (CAD) and predict cardiovascular events in various patient groups. Prospectively enrolled patients (n = 296) with suspected SAP, no previous cardiac disease, and normal left ventricular ejection fraction were examined by 2DSTE, exercise ECG, and coronary angiography. Obstructive CAD was defined as stenosis ≥ 70% in ≥ 1 coronary artery on coronary angiography (n = 107). Major adverse cardiac events (MACE) included myocardial infarction, heart failure, atrial fibrillation, and stroke. In multivariable analysis adjusted for baseline data, conventional echocardiography, and Duke score, early diastolic strain rate (SRe) was independently associated with significant CAD with a 1.35 increased risk of having CAD per 0.1 decrease in SRe (OR = 1.35, 95% CI 1.03-1.76, P = 0.027). Peak velocity of early diastolic filling (E)/SRe was not associated with significant CAD (OR = 1.14, 95% CI 0.81-1.62, P = 0.445). MACE occurred in 34 patients (12%) during follow-up (median 3.5 years) and both SRe (HR 1.26, 95% CI (1.07-1.49), P = 0.006) and E/SRe (HR 1.24, 95% CI (1.04-1.47), P = 0.017) were independent predictors after multivariable adjustment. In patients with suspected SAP, SRe by 2DSTE was independently associated with presence of CAD. In addition, SRe and E/SRe provided independent and incremental prognostic value for predicting future MACE.
10.1007/s10554-020-01822-8
Resting segmental speckle tracking strain and strain rate in stable coronary artery disease and revascularized myocardial infarction.
The international journal of cardiovascular imaging
Patients with acute coronary artery disease (CAD) exhibit reduced global and regional strain and strain rate (S/SR). However, knowledge about segmental S/SR in stable CAD patients is still limited. This study aimed to investigate whether resting segmental S/SR measurements differ in patients with chronic chest pain who have normal coronary arteries or stenotic coronary arteries, and to compare these measurements to those in patients with revascularized myocardial infarction (MI). We prospectively enrolled 510 patients with chronic chest pain referred for coronary computed tomography angiography (CCTA) and 102 patients revascularized after MI. All participants underwent transthoracic echocardiography featuring S/SR analysis. In addition to the patients with MI, patients with suspected CAD based on CCTA findings subsequently underwent invasive coronary angiography (CAG). We assessed global longitudinal strain (GLS) and averaged segmental peak longitudinal strain during systole (PLS), peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), and post systolic shortening (PSS). We also determined functionally reduced segment percentages using differing S/SR cut-off values. There were significant disparities in all average segmental S/SR metrics between the No-CAD and MI groups. SRe was the only S/SR metric that differed significantly between the No-CAD and PCI groups. Differences in SRe, PLS and GLS measurements were observed between the No-CAD and CABG groups. The proportion of diminished segmental S/SR mirrored these findings. For the percentage of pathological segments with varying cut-off values, segmental SRe below 1.5 s displayed the most marked difference among the four groups (p < 0.001). Revascularized MI patients or those referred to CABG present with diminished segmental S/SR values. However, among patients with chronic chest pain, only segmental SRe discerns subtle disparities between the No-CAD and the PCI group. The diagnostic accuracy of SRe warrants further exploration in subsequent studies.
10.1007/s10554-024-03200-0
Two-dimensional speckle tracking imaging cardiac motion-based quantitative evaluation of global longitudinal strain among patients with coronary Heart Disease and functions of left ventricular ischemic myocardial segment.
The international journal of cardiovascular imaging
To investigate two-dimensional speckle tracking imaging (2D-STI)-based quantitative evaluation of the influences of different levels of coronary artery stenosis on left ventricular functions and its clinical diagnostic values, 120 patients with coronary heart disease (CHD) were divided into control group (30 cases), mild stenosis group (30 cases), moderate stenosis group (30 cases), and severe stenosis group (30 cases) according to coronary angiography (CAG) results. They underwent routine ultrasound examination and 2D-STI examination. Receiver operating characteristic (ROC) curves were drawn to evaluate the sensitivity and specificity of different levels of coronary artery stenosis. Global longitudinal strain (GLS) of left ventricular myocardium among patients in moderate and severe stenosis groups remarkably declined (P < 0.05). Global radial strain (GRS) and global circular strain (GCS) among patients in severe stenosis group dramatically reduced (P < 0.05). ROC curves revealed that available GLS=-17.2 was the cut-off value for screening moderate coronary stenosis. The sensitivity, specificity, and area under the curve (AUC) amounted to 57.3%, 58.4%, and 0.573, respectively. GLS, GRS, and GCS could be used to screen severe coronary stenosis. When GLS=-16.5 was the cut-off value for screening severe coronary stenosis, sensitivity, specificity, and AUC amounted to 84.3%, 82.5%, and 0.893, respectively. With the aggravation of stenosis, left ventricular systolic function of CHD patients was impaired more significantly. 2D-STI technique could be adopted for the quantitative evaluation of left ventricular strain of patients with coronary stenosis and provided a new method for early clinical diagnosis of CHD.
10.1007/s10554-023-02993-w
Regional layer-specific longitudinal peak systolic strain using exercise stress two-dimensional speckle-tracking echocardiography for the detection of functionally significant coronary artery disease.
Nishi Takeshi,Funabashi Nobusada,Ozawa Koya,Nishi Tomoko,Kamata Tomoko,Fujimoto Yoshihide,Kobayashi Yoshio
Heart and vessels
The present study aimed to investigate whether layer-specific regional peak-systolic longitudinal strain (LS) measurement on transthoracic echocardiogram (TTE) with exercise stress can be useful for the detection of functionally significant coronary artery disease as confirmed by invasive fractional flow reserve (FFR) in stable patients. This is a prospective analysis of 88 coronary arteries in 30 stable patients undergoing invasive FFR measurement and ergometer exercise stress TTE. Regional LS in the mid, endocardial and epicardial layers was calculated at rest, peak stress and early and late recovery phases after the exercise stress test. The endocardial-to-epicardial LS ratio was calculated as an indicator of endocardial-layer dependency of the left ventricular myocardium. Ischemic FFR defined as FFR ≤ 0.80 was observed in 33 of 88 coronary arteries. The mid-, endocardial- and epicardial-layer LS at early recovery (- 15.4 ± 5.2 vs. - 13.0 ± 4.4%, P = 0.040; - 15.7 ± 5.1 vs. - 13.2 ± 4.5%, P = 0.029; - 14.6 ± 5.1 vs. - 12.4 ± 4.0%, P = 0.038, respectively) and the percent change in the endocardial-to-epicardial LS ratio from baseline to peak stress, early recovery, and late recovery phases (1.5 ± 11.2% vs. 6.6 ± 10.5%, P = 0.009; 2.8 ± 8.9% vs. 7.1 ± 12.6%, P = 0.002; 5.2 ± 8.8% vs. 8.5 ± 13.7%, P = 0.026; respectively) were significantly more impaired in the ischemic territories (FFR ≤ 0.80) compared with the non-ischemic territories (FFR > 0.80). According to the receiver operating characteristic curve analysis, a combination of endocardial LS and percent change in the endocardial-to-epicardial LS ratio at early recovery phase plus visual evaluation of LV wall motion had incremental diagnostic value for the detection of the ischemic territory compared with visual evaluation alone (area under the curve = 0.752 and 0.618, P = 0.006). The results of this study suggested that assessing layer-specific LS and the endocardial-to-epicardial LS ratio after exercise stress on speckle-tracking TTE may have potential for objective and quantitative evaluation in the assessment of myocardial ischemia. Further studies in a larger population are needed to confirm these findings.
10.1007/s00380-019-01361-w
The feasibility, reliability, and incremental value of two-dimensional speckle-tracking for the detection of significant coronary stenosis after treadmill stress echocardiography.
d'Entremont Marc-André,Fortin Gabriel,Huynh Thao,Croteau Étienne,Farand Paul,Lemaire-Paquette Samuel,Brochu Marie-Claude,Do Doan Hoa,Lepage Serge,Mampuya Warner Mbuila,Couture Étienne L,Nguyen Michel,Essadiqi Btissama
Cardiovascular ultrasound
BACKGROUND:Two-dimensional speckle-tracking echocardiography (STE) may help detect coronary artery disease (CAD) when combined with dobutamine stress echocardiography. However, few studies have explored STE with exercise stress echocardiography (ESE). We aimed to evaluate the feasibility, reliability, and incremental value of STE combined with treadmill ESE compared to treadmill ESE alone to detect CAD. METHODS:We conducted a case-control study of all consecutive patients with abnormal ESE in 2018-2020 who subsequently underwent coronary angiography within a six-month interval. We 1:1 propensity score-matched these patients to those with a normal ESE. Two blinded operators generated a 17-segment bull's-eye map of longitudinal strain (LS). We utilized the mean differences between stress and baseline LS values in segments 13-17, segment 17, and segments 15-16 to create receiver operator curves for the overall examination, the left anterior descending artery (LAD), and the non-LAD territories, respectively. RESULTS:We excluded 61 STEs from 201 (30.3%) eligible ESEs; 47 (23.4%) because of suboptimal image quality and 14 (7.0%) because of excessive heart rate variability precluding the calculation of a bull's-eye map. After matching, a total of 102 patients were included (51 patients in each group). In the group with abnormal ESE patients (mean age 66.4 years, 39.2% female), 64.7% had significant CAD (> 70% stenosis) at coronary angiogram. In the group with normal ESE patients (mean age 65.1 years, 35.3% female), 3.9% were diagnosed with a new significant coronary stenosis within one year. The intra-class correlation for global LS was 0.87 at rest and 0.92 at stress, and 0.84 at rest, and 0.89 at stress for the apical segments. The diagnostic accuracy of combining ESE and STE was superior to visual assessment alone for the overall examination (area under the curve (AUC) = 0.89 vs. 0.84, p = 0.025), the non-LAD territory (AUC = 0.83 vs. 0.70, p = 0.006), but not the LAD territory (AUC = 0.79 vs. 0.73, p = 0.11). CONCLUSIONS:Two-dimensional speckle-tracking combined with treadmill ESE is relatively feasible, reliable, and may provide incremental diagnostic value for the detection and localization of significant CAD.
10.1186/s12947-021-00259-w
SPECKLE TRACKING DOBUTAMINE STRESS ECHOCARDIOGRAPHY DIAGNOSTIC ACCURACY IN PRIMARY CORONARY ARTERIES DISEASE DIAGNOSIS.
Smiianov Vladyslav A,Rudenko Serhii A,Potashev Serhii V,Salo Serhii V,Gavrylyshin Andrii Y,Levchyshina Elena V,Hrubyak Liliana M,Nosovets Elena K,Nastenko Evgenii A,Rudenko Anatolii V,Lazoryshynets Vasilii V
Wiadomosci lekarskie (Warsaw, Poland : 1960)
OBJECTIVE:The aim of the work was to evaluate STE feasibility as DSE visualization method and its accuracy compared to coronary angiography (CAG) in the patients with moderate-tohigh coronary arteries disease (CAD) risk. PATIENTS AND METHODS:Materials and methods: We prospectively examined 140 pts (84 (60.0%) men) with suspected CAD in order to verify diagnosis and evaluate myocardial viability and coronary reserve. RESULTS:Results: Mean LV EF was 54.4±15.8%. All pts had normal BP and HR during the test. There were no significant hemodynamics alterations during the test. There were no significant complications during DSE - 15 (12.9%) cases of different relatively low-grade supraventricular and ventricular arrhythmia, mainly transitory without interventions. There were 116 (82.9%) positive DSE results, of which 2 (1.72%) were false-positive. In 2 (8.3%) pts with negative DSE results CAG revealed 1-vessel insignificant (50 - 70%) lesions with developed collaterals (false-negative results). According to DSE and CAG results, 96 (82.3%) pts underwent revascularization interventions - 86 (89.6%) PCI's and (10.4%) CABG surgeries. Sensitivity and specificity of DSE with STE for primary CAD diagnosis according to "golden standard" CAG results were 98.3% and 91.7%, respectively, with identical positive and negative predictive value and very high method overall accuracy (AUC = 0.98) and OR = 627.0 (p<0.0001). Sensitivity and specificity of DSE with STE for defining indications for intervention and revascularization were 97.9% and 91.7%, respectively, with high overall accuracy (AUC = 0.95; OR = 564.0, p<0.0001). Combined quantification of ΔGLS and ΔWMSI for primary CAD diagnosis showed significantly lower sensitivity 86.2% (р=0.0002) and specificity 80.4% (р=0.0064) with significantly lower integral method accuracy (AUC 0.83, р<0.0001). CONCLUSION:Conclusions: DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis and myocardial viability and coronary reserve evaluation in the pts with CAD suspicion. Given the lower ΔGLS and ΔWMSI accuracy compared to integral DSE with STE result evaluation, as well as frequent GLS growth in significant amount of patients with definite positive test result, authors recommend evaluating integral test result rather than strain value.
Detection of Obstructive Coronary Artery Disease Using Peak Systolic Global Longitudinal Strain Derived by Two-Dimensional Speckle-Tracking: A Systematic Review and Meta-Analysis.
Liou Kevin,Negishi Kazuaki,Ho Suyen,Russell Elizabeth A,Cranney Greg,Ooi Sze-Yuan
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
BACKGROUND:Global longitudinal strain (GLS) is well validated and has important applications in contemporary clinical practice. The aim of this analysis was to evaluate the accuracy of resting peak GLS in the diagnosis of obstructive coronary artery disease (CAD). METHODS:A systematic literature search was performed through July 2015 using four databases. Data were extracted independently by two authors and correlated before analyses. Using a random-effect model, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and summary area under the curve for GLS were estimated with their respective 95% CIs. RESULTS:Screening of 1,669 articles yielded 10 studies with 1,385 patients appropriate for inclusion in the analysis. The mean age and left ventricular ejection fraction were 59.9 years and 61.1%. On the whole, 54.9% and 20.9% of the patients had hypertension and diabetes, respectively. Overall, abnormal GLS detected moderate to severe CAD with a pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 74.4%, 72.1%, 2.9, and 0.35 respectively. The area under the curve and diagnostic odds ratio were 0.81 and 8.5. The mean values of GLS for those with and without CAD were -16.5% (95% CI, -15.8% to -17.3%) and -19.7% (95% CI, -18.8% to -20.7%), respectively. Subgroup analyses for patients with severe CAD and normal left ventricular ejection fractions yielded similar results. CONCLUSION:Current evidence supports the use of GLS in the detection of moderate to severe obstructive CAD in symptomatic patients. GLS may complement existing diagnostic algorithms and act as an early adjunctive marker of cardiac ischemia.
10.1016/j.echo.2016.03.002
Speckle tracking stress echocardiography: A valuable diagnostic technique or a burden for everyday practice?
Mandoli Giulia Elena,Pastore Maria Concetta,Vasilijevaite Kristina,Cameli Paolo,D'Ascenzi Flavio,Focardi Marta,Mondillo Sergio,Cameli Matteo
Echocardiography (Mount Kisco, N.Y.)
Non-invasive screening for early diagnosis of coronary artery disease (CAD) represents a key element in the never-ending challenge to reduce cardiac death. Stress/rest electrocardiogram often lacks diagnostic accuracy, especially in asymptomatic patients, in fact the latest guidelines for the diagnosis and management of chronic coronary syndromes (CCS) stated the superiority of functional imaging techniques for the detection of subtle myocardial ischemia and the evaluation of myocardial viability (MV). Stress echocardiography is the most accessible and inexpensive imaging method for the study of CAD, either with pharmacological or with exercise provocative stress, based on visual wall-motion assessment. However, in some cases, such as small coronary lesions or microvascular angina, it loses its diagnostic power, therefore requiring a more sensitive approach. Accordingly, in the last years many authors investigated the possible additive value provided by the integration of an advanced but easy-to-obtain technique, that is speckle tracking imaging, to stress echocardiography, reaching promising results; nevertheless, its use is not included in the latest recommendations for CCS. The present review discusses the potential benefits from using a combination of speckle tracking and stress echocardiography for the early detection of myocardial ischemia and the assessment of MV and its suitability in different clinical scenarios, basing on the available evidence.
10.1111/echo.14894
Detection of left atrial dysfunction with speckle tracking echocardiography.
Bayramoğlu A,Bektaş O,Yaman M
Herz
BACKGROUND:The aim of this study was to evaluate the relationship between the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score and left ventricular end-diastolic pressure (LVEDP) measured with an invasive method and with speckle-tracking echocardiography (STE). METHODS:The study included 124 patients who underwent cardiac catheterization. LVEDP values and coronary images were obtained for all patients. SYNTAX scores were calculated and separated into three tertiles (SYNTAX = 0, SYNTAX < 22, and SYNTAX > 22). Standard echocardiography and STE were performed on all the patients. Peak LA strain (LAs strain) in ventricular end-systole and LA strain during LA contraction (LAa strain) values were obtained with STE. RESULTS:In univariate analysis, a strong correlation was observed between the SYNTAX score and LAs strain and a moderate correlation with LAa strain. A moderate correlation was also found between both LAs strain and LAa strain and LVEDP. In multiple regression analysis, LAs strain and LVEDP were observed to be independent predictors of SYNTAX score. CONCLUSION:LAs strain and LVEDP were observed to be independent predictors of SYNTAX scores. The relationship between LAs strain, LVEDP, and SYNTAX score could be useful in clinical practice.
10.1007/s00059-016-4485-6
Evaluation of coronary steal in myocardium supplied by coronary collaterals: the role of speckle tracking analysis in resting and stress echocardiography.
Liu Kan,Krone Ronald
Echocardiography (Mount Kisco, N.Y.)
Coronary steal could develop in patients with chronic coronary artery disease (CAD) with collateral circulation, and adversely affect ventricular function and long-term clinical outcome. Poorly developed collaterals are more prone than well-developed collaterals to withdrawing their blood support to the collateralized myocardium due to higher collateral pathway resistance and lower vasodilatory reserve of the collateral bed. Even with well-developed coronary collaterals, coronary steal could still occur when perfusion pressure in the donor artery becomes low, or the recipient microvasculature is maximally dilated with exhaustion of vasodilatory reserve. The evaluation of distinctive coronary collateral function with or without steal provides important therapeutic and prognostic information in patients with chronic CAD. However, due to lack of reliable assessment methods, the detection and quantitative measurement of coronary steal remains a challenge. In this article, we present typical clinical scenarios to illustrate the major mechanisms underlying coronary steal in patients with chronic CAD and coronary collateral circulation, and review invasive and noninvasive methods currently available to assess coronary steal in myocardium supplied by coronary collaterals. We specifically focus on recent advances in the resting and stress echocardiography with speckle tracking techniques.
10.1111/echo.12311
Which is the best Myocardial Work index for the prediction of coronary artery disease? A data meta-analysis.
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND:Early diagnosis of Coronary Artery Disease (CAD) plays a key role to prevent adverse cardiac events such as myocardial infarction and Left Ventricular (LV) dysfunction. Myocardial Work (MW) indices derived from echocardiographic speckle tracking data in combination with non-invasive blood pressure recordings seems promising to predict CAD even in the absence of impairments of standard echocardiographic parameters. Our aim was to compare the diagnostic accuracy of MW indices to predict CAD and to assess intra- and inter-observer variability of MW through a meta-analysis. METHODS:Electronic databases were searched for observational studies evaluating the MW indices diagnostic accuracy for predicting CAD and intra- and inter-observer variability of MW indices. Pooled sensitivity, specificity, and Summary Receiver Operating Characteristic (SROC) curves were assessed. RESULTS:Five studies enrolling 501 patients met inclusion criteria. Global Constructive Work (GCW) had the best pooled sensitivity (89%) followed by GLS (84%), Global Work Index (GWI) (82%), Global Work Efficiency (GWE) (80%), and Global Wasted Work (GWW) (75%). GWE had the best pooled specificity (78%) followed by GWI (75%), GCW (70%), GLS (68%), and GWW (61%). GCW had the best accuracy according to SROC curves, with an area under the curve of 0.86 compared to 0.84 for GWI, 0.83 for GWE, 0.79 for GLS, and 0.74 for GWW. All MW indices had an excellent intra- and inter-observer variability. CONCLUSIONS:GCW is the best MW index proving best diagnostic accuracy in the prediction of CAD with an excellent reproducibility.
10.1111/echo.15537
Implication of coronary CT angiography combined with four-dimensional speckle tracking echocardiography for predicting major adverse cardiac events.
Yin Xiaohua,Xu Rong,Wang Yingchun,Cheng Tao,Zhou Hui
The international journal of cardiovascular imaging
Coronary computed tomography angiography (CCTA) can provide abundant information about the anatomy of the coronary artery. However, this modality is limited in evaluation of myocardial function. Four-dimensional speckle tracking echocardiography (4DSTE) is a novel and sensitive technique for quantitative evaluation of myocardial deformation. We estimated the value of these imaging modalities to predict the risk of MACE in 209 patients with suspected coronary artery disease(CAD) after a median follow-up of 727 days. Three models were established: (1) CCTA alone, (2) CCTA combined with 4DSTE, and (3) CCTA combined with 4DSTE and clinical risk factors. Forty-six (22.0%) patients developed MACE. The hazard ratio (HR) of CCTA classification to predict the risk of MACE was greater (HR = 4.86) than for other parameters, including B-type natriuretic peptide (BNP) (HR = 2.44) and left ventricular ejection fraction (LVEF) (HR = 0.40). The area under the curve of models 2 and 3 to predict MACE was significantly greater than that of model 1 (0.92 and 0.93 vs. 0.84, respectively, p < 0.001). We conclude that there is direct relationship between CCTA classification and MACE risk. CCTA combined with 4DSTE can improve the ability of CCTA to predict the risk of MACE. This approach provides cardiologists a noninvasive, objective, and efficient method to predict MACE.
10.1007/s10554-018-1337-x
[Value of 3-dimensional speckle tracking imaging to quantify regional left ventricular function in patients with coronary artery disease].
Liu Fang,Lin Qing,Ding Lei,Sun Yan-shu,Fan Yan,Liu Qian-zhu,Liu Mei-lin
Zhonghua xin xue guan bing za zhi
OBJECTIVE:To assess left ventricular (LV) strain by 3-dimensional speckle tracking imaging (3D-STI) in patients with coronary heart disease (CHD). METHODS:All subjects underwent invasive coronary angiography.2-dimensional and 3-dimensional echocardiography were performed in 52 subjects with suspected CHD. Longitudinal strain (LS) , circumferential strain (CS) , radial strain (RS) and area strain (AS) in 17 LV segments were acquired by 3D-STI respectively. RESULTS:According to coronary angiography results, 35 (76.1%)subjects were diagnosed as CHD, and 138 coronary branches were divided into the control group(25 branches, 18.1%), the mild stenosis group (31 branches, 22.5%), the moderate stenosis group (43 branches, 31.2%) and the severe stenosis group (39 branches, 28.2%).3D-STI was performed with reliable tracking quality in 46(88.5%) out of the 52 subjects initially enrolled in this study. 3D-STI showed:(1)LS was similar between mild stenosis group and the control group (P > 0.05) and significantly reduced in the moderate stenosis group compared with the control group(P < 0.05), and LS in some segments (MAS, AA, A, BAL, MAL, AL, BIS, MIS and AI) of moderate stenosis group were significantly decreased compared with the mild stenosis group (P < 0.05). LS of all segments in the severe stenosis group decreased significantly compared with the control group, the mild stenosis group and the moderate stenosis (P < 0.05). (2)RS was similar between mild stenosis group and the control group (P > 0.05) . RS in some segments (BAS,MA and BI) was significantly decreased in the moderate stenosis group compared with the control group(P < 0.05). RS was significantly decreased in the severe stenosis group compared with the control group and the mild stenosis group (except for AS,AL,MIS,MI and AI) (P < 0.05). (3) CS was similar between mild stenosis group and the control group (P > 0.05) and was significantly reduced in some segments (BAS,AS,BIL and BI) of the moderate stenosis group compared with the control group(P < 0.05). CS was significantly decreased in the severe stenosis group compared with the control group, the mild stenosis group and the moderate stenosis(P < 0.05). (4) AS was significantly decreased in the mild stenosis group compared with the control group(P < 0.05, except for BIL,MAL and BIS) and in all segments of the moderate stenosis group compared with the control group and the mild stenosis group(P < 0.05). AS was significantly decreased in the severe stenosis group compared with the control group, the mild stenosis group and the moderate stenosis(P < 0.05). The progressive decrease in AS was observed from the control group to the mild stenosis group, the moderate stenosis group and the severe stenosis group (P < 0.05). In addition, AS was negatively correlated with coronary artery Gensini score (r = -0.71, P < 0.01) . CONCLUSION:LV strain can be reliably quantified by 3D-STI. AS is a more sensitive parameter to detect coronary artery disease at early phase.
Assessment of the left ventricular systolic function in multi-vessel coronary artery disease with normal wall motion by two-dimensional speckle tracking echocardiography.
Xie M-Y,Yin J-B,Lv Q,Wang J
European review for medical and pharmacological sciences
OBJECTIVE:To evaluate the clinical value of two-dimensional speckle tracking echocardiography for analyzing the left ventricular systolic function in patients with multi-vessel coronary artery disease with normal wall motion (NWM-MVD). PATIENTS AND METHODS:Forty-five NWM-MVD patients and thirty-six subjects with low risk of coronary artery disease (control group) were enrolled in this study. Echocardiogram images of the short axis of the left ventricle and apical long axis were obtained. The Q-analysis software was used to analyze the peak systolic strain of the left ventricular segments and the global longitudinal strain (GLS). We calculated the left ventricular global circumferential strain (GCS) and the radial strain (GRS), as well as the longitudinal, radial and circumferential strain of the basal (Bas-GLS, Bas-GCS, Bas-GRS), middle (Mid-GLS, Mid-GCS, Mid-GRS) and apical segments (Ap-GLS, Ap-GCS, Ap-GRS). RESULTS:(1) The coronary occlusion or subtotal occlusion were visible in 85.71% of the NWM-MVD patients. (2) The heart rate of the NWM-MVD patients was lower than that of the control group [(61.78 ± 6.76) beats/min vs. (66.13 ± 6.24) beats/min, p < 0.05]. The conventional ultrasonic measurement indices are similar between the NWM-MVD group and the control group (p > 0.05). (3) Compared with the control group, the GLS, Bas-GLS, Mid-GLS, Bas-GCS, Mid-GCS, GRS and Bas-GRS were lower in the NWM-MVD group (p < 0.05). CONCLUSIONS:The longitudinal, circumferential and radial systolic functions of the NWM-MVD patients were impaired at different degrees.
Assessment of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery by myocardial contrast echocardiography and two-dimensional strain echocardiography.
Liu Rong,Deng Youbin,Bi Xiaojun,Liu Yani,Xiong Li,Chen Liuping
Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban
The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography (RT-MCE) combined with two-dimensional strain echocardiography was assessed. Twenty patients underwent intravenous RT-MCE by intravenous injections of SonoVue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months after coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitudinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78+/-5.91)% vs (-10.45+/-8.31)%, P<0.05]. However, the parameters did not change in the group without myocardial perfusion improvement [(-10.33+/-6.53)% vs (-9.41+/-6.09)%, P>0.05]. It was concluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of regional systolic function. The combination of myocardial perfusion with two-dimensional strain echocardiography can more accurately assess the curative effectiveness of coronary artery bypass surgery.
10.1007/s11596-009-0526-1
Myocardial strain analysis by 4D-speckle tracking echocardiography for prediction of coronary artery disease severity in patients with stable angina pectoris.
Indian heart journal
OBJECTIVE:We sought to evaluate the myocardial strain by four-dimensional speckle-tracking echocardiography (4D-STE) in patients with stable angina pectoris (SAP) to determine the severity of coronary artery disease (CAD) based on the Gensini score. METHODS:The present study comprised of 150 patients with SAP. Patients with history of SAP, normal left ventricular ejection fraction, and without regional wall motion abnormalities (RWMA) were scheduled for elective coronary angiography. Based on Gensini score, there were two groups: non-critical stenosis group [Gensini score (0-19), n = 117] and critical stenosis group [Gensini score ≥20, n = 33]. Correlation between Gensini score and 4D-STE strain parameters were investigated. RESULTS:Out of 150 patients, critical stenosis group had significantly depressed values of all 4D-STE strain parameters than non-critical stenosis group (p < 0.001), except global radial strain (GRS) parameter. Significant positive correlation was found between Gensini score and 4D global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) with Spearman's correlation coefficient (ρ) as 0.626, 0.548, and 0.631, respectively (p < 0.001), whereas significant negative correlation was found between Gensini score and GRS (ρ = -0.433, p < 0.001). A 4D GLS value of ≥ -17 had 84.9% sensitivity and 97.4% specificity, GAS ≥ -31 (90.9% sensitivity, 78.6% specificity), GCS ≥ -17 (69.7% sensitivity, 92.3% specificity), and GRS <47 (sensitivity 72.7%, specificity 76.1%) to detect critical CAD described by Gensini score ≥20. CONCLUSION:The 4D-STE can aid in the assessment of severe CAD stenosis with good sensitivity and specificity in the patients with SAP without RWMA on traditional echocardiography.
10.1016/j.ihj.2023.03.002
The correlation between speckle tracking echocardiography and coronary artery disease in patients with suspected stable angina pectoris.
Moustafa Shaimaa,Elrabat Khalid,Swailem Fathy,Galal Alaa
Indian heart journal
BACKGROUND:To examine the value of speckle tracking echocardiography to detect the presence, extent and severity of coronary artery affection in patients with suspected stable angina pectoris. METHODS:Two hundred candidates with suspected stable angina pectoris and normal resting conventional echocardiography were subjected to speckle tracking echocardiography and coronary angiography. Global and segmental longitudinal peak systolic strain were assessed and were correlated to the results of coronary angiography for each patient. RESULTS:There was a statistically significant difference in the mean of global longitudinal peak systolic strain between normal coronaries and different degrees of coronary artery disease (CAD) (-20.11±0.8 for normal, -18.34±2.52 for single vessel, -16.14±2.85 for two vessels, -14.81±2.12 for three vessels, -13.01±2.92 for left main disease). GLPSS showed high sensitivity for the diagnosis of single vessel CAD (90%, specificity 95.1%, cutoff value: -18.44, AUC: 0.954); two vessels disease (90%, sensitivity 88.9%, cutoff value -17.35, AUC: 0.906) and for three vessels CAD (cutoff value -15.33, sensitivity 63% and specificity 72.2% AUC 0.681) segmental LPSS also showed statistical significance for localization of the affected vessel for left anterior descending, left circumflex and right coronary artery (ρ=0.001) and inverse correlation with syntax score that was significant with high and intermediate score (ρ=0.001) and insignificant for low syntax score (ρ value 0.05). CONCLUSION:Two-dimensional speckle tracking echocardiography has good sensitivity and specificity to predict the presence, extent and severity of CAD.
10.1016/j.ihj.2017.09.220
[Clinical application of the 3-dimensional speckle tracking imaging in coronary artery disease].
Zhu Wenhui,Meng Qin,Xiao Jidong,Wang Yan,Zhao Yongfeng
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences
OBJECTIVE:To observe the 3-dimensional speckle tracking imaging (3D-STI) in clinical diagnosis of coronary artery disease by quantitatively evaluating left ventricular segmental and global systolic function. METHODS:According to the selective coronary artery angiography, 150 inpatients suspected of coronary artery disease were divided into 5 groups according to the distribution of the affected coronary arteries: a left anterior descending coronary artery group (LAD, n=46), a left circumflex coronary artery group (LCX, n=25), a right coronary artery group (RCA, n=23), a multivessel group (n=26), and a normal group (n=30). Gensini score was calculated according to coronary artery angiography. Conventional echocardiography was applied in each patient and wall motion score index (WMSI) was calculated. 3D-STI was applied in each patient to evaluate the segmental and global systolic function in the left ventricle. RESULTS:Compared with the normal group, ejection fraction was decreased in the multi-vessel group alone (P<0.05). Peak systolic 3D strains in all segments were decreased in the multi-vessel group (P<0.01), while peak systolic 3D strains in the main blood-supply segments were decreased significantly in the rest of the groups (P<0.05). Global 3-dimensional strain (G3DS) was negatively correlated with Gensini score in patients with coronary artery disease (r= -0.76, P<0.01). Receiver operating characteristic curve analysis demonstrated that G3DS was more sensitive and accurate in clinical diagnosis of coronary artery disease. CONCLUSION:3D-STI can quantitatively evaluate the segmental and global systolic function of the left ventricle, and reflect the extent of coronary artery stenosis in patients with coronary artery disease.
10.3969/j.issn.1672-7347.2012.10.016
3D-speckle tracking echocardiography for assessment of coronary artery disease severity in stable angina pectoris.
Dogdus Mustafa,Simsek Evrim,Cinar Cahide Soydas
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND AND AIM:Stable angina pectoris is a common disease that may cause disability. Some noninvasive new methods can be useful for the detection of early-stage coronary artery disease. The relationship between coronary artery disease (CAD) severity and resting 3-dimensional-speckle tracking echocardiography (3D-STE) in stable angina pectoris patients was evaluated in this study. METHODS:One hundred and twenty consecutive patients between 18-80 years of age and without a history of CAD to whom elective coronary angiography was planned after positive stress test or myocardial perfusion scintigraphy were enrolled in the study. 3D-STE was performed and global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were measured before coronary angiography. A Gensini score of ≥20 was accepted as critical CAD. Correlation between Gensini scores and 3D-STE results were evaluated. RESULTS:Mean age was 60.7 ± 10.01 years, and 55% of the patient population were male. There were not any significant differences between critical CAD and noncritical CAD groups for age, gender, history of hypertension, diabetes mellitus, hyperlipidemia, and Left Ventricular Ejection Fraction. Mean GLS was -12, GCS was -18.8, GRS was 33.4, GAS was -28.9, and mean Gensini score was 18.8. GLS and all other strain parameters were significantly worse in patients with critical CAD group compared with noncritical CAD group and also positive linear correlation was observed between Gensini score and all measured strain parameters (r = 0.568, P < 0.001 for Gensini score and GLS; r = 0.617, P < 0.001 for Gensini score and GAS). A GLS value of >-10 has 88.9% sensitivity and 92.9% specificity; A GAS value of >-21 has 97.2% sensitivity and 88.1% specificity to detect critical CAD. CONCLUSIONS:3D-STE is a noninvasive and handy parameter to detect subclinical left ventricular dysfunction and global strain values were significantly correlated with CAD severity. GAS has the sensitivity of 97.2% and specificity of 88.1% to detect critical CAD. Adding 3D strain echocardiography to exercise test or myocardial perfusion scintigraphy might increase sensitivity to detect critical CAD in clinical practice.
10.1111/echo.14214
Value of 2D speckle tracking technique combined with real-time 3-dimensional echocardiography in the evaluation of the right atrial function in patients with 3-branch coronary artery disease without myocardial infarction.
Medicine
To evaluate the right atrial function in patients with 3-branch coronary artery disease (TBCAD) without myocardial infarction by 2D speckle tracking echocardiography (2D-STE) combined with real-time 3-dimensional echocardiography (RT-3DE). Fifty-six patients admitted to our hospital without myocardial infarction with TBCAD were selected. We divided them into 2 groups according to the coronary angiography results: 28 patients in group B (the rate of stenosis is 50% ~< 75%); 28 patients in group C (the rate of stenosis is ≥75%); in addition, 30 healthy volunteers were screened as group A. All subjects underwent RT-3DE to obtain the right atrial volume (RAVmax, RAVmin, and RAVp), and then we calculated the right atrial passive and active ejection fraction (RAPEF, RAAEF), and maximum volume index (RAVImax). In addition, to measure the strain rates (RASRs, RASRe, RASRa) of the right atrium during systole, early diastole, and late diastole, 2D-STE was applied. Correlations between the 2D-STE parameters and the results of N-terminal pro-brain natriuretic peptide (NT-proBNP) and Gensini scores were analyzed by Pearson linear analysis. Compared with group A, RAPEF and RASRe were reduced, while RAAEF and RASRa were elevated in group B (P < .05). RAPEF, RASRs, RASRe, and RASRa were decreased compared with groups A and B, while RAVmax, RAVmin, RAVp, RAVImax, and RAAEF were increased in group C (P < .05). There was a significant correlation between 2D-STE parameters and the results of NT-proBNP and Gensini scores (P < .05). The storage, conduit, and pump functions of the right atrium are reduced in patients with 3-branch coronary artery disease without myocardial infarction; 2D-STE combined with RT-3DE is valuable in the evaluation of the right atrium in patients with coronary artery disease.
10.1097/MD.0000000000038058
Rapidly and Accurately Detecting Significant Coronary Artery Stenosis in Patients with Suspected Stable Coronary Artery Disease and Normal Segmental Wall Motion by Speckle Tracking Automated Functional Imaging.
Weng Yahui,Liu Yani,Deng Youbin,Lu Shirui,Zhu Ying
Ultrasound in medicine & biology
This study was performed to explore the value of a machine with built-in speckle tracking automated functional imaging (AFI) in predicting the severity of coronary artery lesions in patients with suspected stable coronary artery disease (SCAD) with normal wall motion. One hundred forty-three consecutive patients with clinically suspected SCAD with normal wall motion were included. Multiple parameters, including global longitudinal peak strain, post-systolic index (PSI) and peak strain dispersion, were automatically analyzed with AFI. Territorial longitudinal strain (TLS) and territorial PSI (TPSI) were also calculated. Receiver operating characteristic curve analyses revealed that global longitudinal peak strain and PSI were superior to other parameters in detecting left main or three-vessel SCAD. A combination of TLS and TPSI could improve diagnostic performance in identifying significant stenotic left anterior descending and right coronary arteries. In conclusion, 2-dimensional speckle tracking AFI can rapidly provide multiple parameters for detecting significant coronary artery stenosis with high accuracy in patients suspected of having SCAD with normal wall motion.
10.1016/j.ultrasmedbio.2020.10.024
Real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging in the evaluation of left atrial function in patients with triple-vessel coronary artery disease without myocardial infarction.
Journal of clinical ultrasound : JCU
OBJECTIVE:To evaluate left atrial function in patients with triple-vessel disease (TVD) without myocardial infarction by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STE). METHODS:Sixty patients with coronary artery disease (CAD) without myocardial infarction were classified into two groups in accordance with the coronary angiography results: group B (all triple-vessel stenosis ≥ 50% and < 75%) and group C (all triple-vessel stenosis ≥ 75%). Thirty healthy individuals were selected as group A. LA volume related parameters including left atrial maximum volume index (LAVImax), LA passive and active ejection fraction (LAPEF, LAAEF) and LA total ejection fraction (LATEF) were measured by RT-3DE. The global peak atrial longitudinal systolic strain (LASRs), early and late diastolic LA strain (LASRe and LASRa) rates were measured by 2D-STE. RESULTS:We found statistically significant differences between 2D-STE and RT-3DE related parameters of these three groups. Furthermore, in groups B and C, N-terminal fragment brain natriuretic peptides (NT-pro-BNP) and left ventricular end-diastolic pressure (LVEDP) were found to be significantly correlated with LASRs and LASRa. And NT-pro-BNP had a moderate correlation with LVEDP. CONCLUSIONS:2D-STE and RT-3DE can assess the LA function in patients with TVD without myocardial infarction. And LA strain values may provide additional information for predicting increased LVEDP and NT-pro-BNP.
10.1002/jcu.23188
Echocardiographic evaluation of coronary artery disease.
Chatzizisis Yiannis S,Murthy Venkatesh L,Solomon Scott D
Coronary artery disease
Although the availability and utilization of other noninvasive imaging modalities for the evaluation of coronary artery disease have expanded over the last decade, echocardiography remains the most accessible, cost-effective, and lowest risk imaging choice for many indications. The clinical utility of mature echocardiographic methods (i.e. two-dimensional echocardiography, stress echocardiography, contrast echocardiography) across the spectrum of coronary artery disease has been well established by numerous clinical studies. With continuing advancements in ultrasound technology, emerging ultrasound technologies such as three-dimensional echocardiography, tissue Doppler imaging, and speckle tracking methods hold significant promise to further widen the scope of clinical applications and improve diagnostic accuracy. In this review, we provide an update on the role of echocardiography in the diagnosis, management, and prognosis of coronary artery disease and introduce emerging technologies that are anticipated to further increase the clinical utility of echocardiography in the evaluation of patients with coronary artery disease.
10.1097/MCA.0000000000000028
Values of three-dimensional speckle tracking imaging for the diagnosis of coronary artery disease.
Scandinavian cardiovascular journal : SCJ
Coronary artery disease (CAD) is a top life-threatening disease and early and sensitive detection of CAD remains a challenge. This study aimed to assess the value of three-dimensional speckle tracking imaging (3D-STI) in diagnosing CAD patients and investigate the parameters of 3D-STI associated with disease severity. A total of 260 suspected CAD patients who met the study criteria underwent coronary angiography within one week after the ultrasound examination. Based on the examination results, 142 patients were confirmed to have CAD (CAD group), while 118 patients were classified as non-CAD (NCAD group). Age, gender, family history, smoking status, diabetes, hypertension, dyslipidemia, electrocardiogram, BMI, heart rate, and left ventricular ejection fraction were compared between the two groups. Additionally, 3D-STI parameters including left ventricular global radial strain (GRS), left ventricular global longitudinal strain (GLS), left ventricular global area strain (GAS), and left ventricular global circumferential strain (GCS) were analyzed. No significant differences were found between the CAD and NCAD groups in terms of demographics, smoking history, physiological measurements, and common comorbidities such as diabetes mellitus and dyslipidemia. However, when comparing the 3D-STI parameters, all four parameters, including GLS, GRS, GCS, and GAS, were significantly different in the CAD group compared to the NCAD group. The results suggest that 3D-STI parameters have diagnostic value for CAD, and their changes are associated with CAD severity. Combined detection of these parameters enhances diagnostic accuracy compared to individual detection.
10.1080/14017431.2024.2373091
Association between atrial function assessed by 2D-speckle tracking echocardiography and albuminuria in patients with type 2 diabetes and coronary artery disease.
Moinfar Ali,Hosseinsabet Ali,Sotudeh-Anvary Maryam
Journal of clinical ultrasound : JCU
PURPOSE:We compared left atrial function as assessed by two-dimensional speckle-tracking echocardiography (2DSTE) between patients with type 2 diabetes and coronary artery disease (CAD) with or without albuminuria, nondiabetic patients without CAD, and CAD patients without type 2 diabetes. METHODS:This cross-sectional study was performed on 112 consecutive patients with CAD (28 nonalbuminuric patients without diabetes, 40 nonalbuminuric patients with type 2 diabetes, and 44 albuminuric patients with type 2 diabetes) and 30 consecutive patients with no CAD, no diabetes, and no albuminuria. Spot urine analysis was performed to measure the urine level of creatinine and albumin. Atrial mechanical variables were measured by 2DSTE. RESULTS:Although systolic strain and the absolute value of early diastolic strain rate were lower in the CAD groups than in the non-CAD group, there were no significant differences between the CAD groups. Early diastolic strain was lower in the diabetic patients with CAD than in the nondiabetic non-CAD group. There were, however, no significant differences between the CAD groups. CONCLUSIONS:In our CAD patients, there was no significant association between the presence of type 2 diabetes mellitus and albuminuria and left atrial function, but the reservoir and conduit function of the left atrium were lower in the CAD patients. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:561-570, 2016.
10.1002/jcu.22377
Application value of real-time 3D speckle tracking imaging in left atrial function evaluation of patients with paroxysmal atrial fibrillation.
Medicine
OBJECTIVE:To evaluate left atrial volume and function in patients with paroxysmal atrial fibrillation (AF) combined with left atrial appendage thrombosis and patients with paroxysmal AF without left atrial appendage thrombosis by 3-dimensional speckle tracking imaging (3D-STI), and to explore the application value of this set of parameters in the evaluation of left atrial function in patients with paroxysmal AF. MATERIALS AND METHODS:A total of 40 patients with paroxysmal AF admitted from December 2018 to December 2020 were selected as the observation group. All patients with paroxysmal AF in the observation group underwent transesophageal echocardiography. According to the presence of left atrial appendage thrombosis, the patients were divided into the AF without thrombosis group (24 cases) and the AF with thrombosis group (16 cases). Thirty normal people were selected as control group who were chosen as having no heart-related disease. The left atrial volume parameters (Left atrial maximum volume LAVmax, Left atrial minimum volume LAVmin, Left atrial volume before atrial contraction LAVpre-A, Left atrial stroke volume LAEV), left atrial ejection fraction (LAEF) and left atrial strain parameters (Left atrial reservoir longitudinal strain LASr, Left atrial conduit longitudinal strain LAScd, Left atrial contraction longitudinal strain LASct, Left atrial reservoir circumferential strain LASr-c, Left atrial conduit circumferential strain LAScd-c, Left atrial contraction circumferential strain LASct-c) of the 3 groups were measured by 3D-STI. RESULTS:With the progression of paroxysmal AF, the left atrial volume increased, and the reservoir, conduit and contractile function were damaged. The left atrial volume continued to increase, and the reservoir, conduit and contractile function further decreased significantly in patients with AF combined with left atrial appendage thrombosis. LAEF was positively correlated with LASr and LASr_c. CONCLUSION:Real-time 3-dimensional spot tracking imaging (3D-STI) can evaluate the changes in left atrial volume and function in patients with paroxysmal AF, and has a certain reference value for clinical judgment of disease progression and prognosis.
10.1097/MD.0000000000038206
Changes in left ventricular function induced by carboplatin combined with paclitaxel in patients with ovarian cancer identified using three-dimensional spot tracking imaging technology.
Journal of clinical ultrasound : JCU
OBJECTIVE:To investigate the clinical value of three-dimensional speckle tracking imaging (3D-STI) in evaluating left ventricular (LV) systolic function in patients with ovarian cancer (OC) treated with paclitaxel and carboplatin. METHOD:We studied 30 patients with OC treated with paclitaxel combined with carboplatin chemotherapy. Two-dimensional echocardiography and 3D-STI were performed in the patients before they underwent 2- and 6-cycle chemotherapies, and in 30 normal control subjects. Were measured LV end-diastolic volume (EDV), end-systolic volume (ESV), three-dimensional LV ejection fraction (3D-LVEF), stroke volume (SV), spherical index (SPI), LV end-diastolic mass (LV EDmass), LV end-systolic mass (LV ESmass), LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS) and cardiac troponin T(cTnT). At the end of chemotherapy, magnetic resonance imaging (MRI) was also performed. RESULT:The 3D conventional strain values (3D-LVEF, SV, LV EDV) after the 2- and 6-cycle chemotherapy were lower than before chemotherapy. LV Edmass, LV ESmass and cTnT were higher while LV GLS, GCS, GRS, GAS were lower after 2- and after 6-cycle chemotherapy than before chemotherapy. There was no significant difference in ESV and EDV between the 3D-STI and MRI parameters. GAS showed a significant negative correlation with cTnT. MRI and 3D-STI variables were significantly correlated, and the receiver operating characteristic curves showed the greater area under the curve for GAS after 2- and after 6-cycle chemotherapy. After 2-cycle chemotherapy, the highest specificity for GAS was 93.3%, and the highest sensitivity for GLS was 70.0%. After 6-cycle chemotherapy, the highest specificity for GAS was 96.7%, and the highest sensitivity for GLS was 96.7%. CONCLUSION:The LV systolic function decreased in OC patients treated with paclitaxel and carboplatin, showing that 3D-STI may detect early LV systolic dysfunction.
10.1002/jcu.22941
[Assessment of heart's changes of elite Chinese male weightlifter by speckle tracking echocardiography].
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
OBJECTIVE:To evaluate the changes of heart structure and function in elite Chinese weightlifters by spot tracking technique. METHODS:Chinese elite male weightlifters (weightlifter group, =16) and age-matched healthy men (control group, =16) were included as subjects. Transthoracic echocardiography and speckle-tracking automatic functional imaging were used for two-dimensional myocardial strain measurements. RESULTS:The thickness of septum and left ventricular (LV) posterior wall and the myocardial mass index of LV were all higher than those of the control group [(9.3±1.3) mm (8.0±0.4) mm, (9.2±0.8) mm (8.0±0.8) mm, (77.8±12.8) g/m (67.8±11.2) g/m, all < 0.05]. Although the LV ejection fraction (LVEF) and global long axis strain value (LVGLS) were not significantly different from those in the control group, the LV mean Sm and Em reflecting the systolic and diastolic functions of the LV were lower than those in the control group ( < 0.05). Further myocardial strain analysis showed that the absolute value of the long axial strain of the basal anteroseptal and mid-inferoseptal segments of the weightlifters were significantly lower than those of the control group [|(-15.1±4.2)%||(-18.7±3.0)%|, |(-18.8±2.6)%||(-21.3±2.8)%|, all < 0.05]. There was no significant difference in other segments. The athletes were divided into two groups according to their best performance in the National Youth Games. The athletes were divided into two sub-groups according to their performance in the National Youth Games. The thickness of the septum in the sub-group with better performance (who ranked the 1 to 8) was larger [(10.2±1.1) mm (8.5±1.0) mm, < 0.05], and the absolute value of the long-axis strain in the mid-inferoseptal segment was lower [|(-17.1±2.1)%||(-20.4±2.1)%|, < 0.05]. CONCLUSION:The thickening of septum is more obvious in the excellent weightlifters, accompanied by the decrease of myocardial systolic function. The speckle-tracking technique of echocardiography can identify the changes of the heart structure and function of elite athletes at an early stage, which may provide a basis for sports medicine supervision and the selection of excellent talents.
Diagnosing vasculitis with ultrasound: findings and pitfalls.
Therapeutic advances in musculoskeletal disease
Rheumatologists are increasingly utilizing ultrasound for suspected giant cell arteritis (GCA) or Takayasu arteritis (TAK). This enables direct confirmation of a suspected diagnosis within the examination room without further referrals. Rheumatologists can ask additional questions and explain findings to their patients while performing ultrasound, preferably in fast-track clinics to prevent vision loss. Vascular ultrasound for suspected vasculitis was recently integrated into rheumatology training in Germany. New European Alliance of Associations for Rheumatology recommendations prioritize ultrasound as the first imaging tool for suspected GCA and recommend it as an imaging option for suspected TAK alongside magnetic resonance imaging, positron emission tomography and computed tomography. Ultrasound is integral to the new classification criteria for GCA and TAK. Diagnosis is based on consistent clinical and ultrasound findings. Inconclusive cases require histology or additional imaging tests. Robust evidence establishes high sensitivities and specificities for ultrasound. Reliability is good among experts. Ultrasound reveals a characteristic non-compressible 'halo sign' indicating intima-media thickening (IMT) and, in acute disease, artery wall oedema. Ultrasound can further identify stenoses, occlusions and aneurysms, and IMT can be measured. In suspected GCA, ultrasound should include at least the temporal and axillary arteries bilaterally. Nearly all other arteries are accessible except the descending thoracic aorta. TAK mostly involves the common carotid and subclavian arteries. Ultrasound detects subclinical GCA in over 20% of polymyalgia rheumatica (PMR) patients without GCA symptoms. Patients with silent GCA should be treated as GCA because they experience more relapses and require higher glucocorticoid doses than PMR patients without GCA. Scores based on intima-thickness (IMT) of temporal and axillary arteries aid follow-up of GCA, particularly in trials. The IMT decreases more rapidly in temporal than in axillary arteries. Ascending aorta ultrasound helps monitor patients with extracranial GCA for the development of aneurysms. Experienced sonologists can easily identify pitfalls, which will be addressed in this article.
10.1177/1759720X241251742
Prevention of non-response to cardiac resynchronization therapy: points to remember.
Zhu Huolan,Zou Tong,Zhong You,Yang Chenguang,Ren Yirong,Wang Fang
Heart failure reviews
Cardiac resynchronization therapy (CRT) is an important and effective therapy for end-stage heart failure. Non-response to CRT is one of the main obstacles to its application in clinical practice. There is no uniform consensus or definition of CRT "response." Clinical symptoms, ventricular remodeling indices, and cardiovascular events have been reported to be associated with non-responders. To prevent non-response to CRT, three aspects should be thoroughly considered: preoperative patient selection, electrode implantation, and postoperative management. Preoperative selection of appropriate patients for CRT treatment is an important step in preventing non-response. Currently, the CRT inclusion criteria are mainly based on the morphology of QRS waves in deciding ventricular dyssynchrony. Echocardiography and cardiac magnetic resonance are being explored to predict nonresponse to CRT. The location of left ventricular electrode implantation is a current hot spot of research; it is important to identify the location of the latest exciting ventricular segment and avoid scars. Cardiac magnetic resonance and ultrasonic spot tracking are being progressively developed in this field. Some new techniques such as His Bundle pacing, endocardial electrodes, and novel sensors are also being investigated. Postoperative management of patients is another essential step towards preventing non-response; it mainly focuses on the treatment of the disease itself and CRT program control optimization. CRT treatment is just one part of the overall treatment of heart failure, and multidisciplinary efforts are needed to improve the overall outcome.
10.1007/s10741-019-09834-w
Heart Infection Prognosis Analysis by Two-dimensional Spot Tracking Imaging.
Qian Jie,Xie Jing,Lakshmipriya Thangavel,Gopinath Subash C B,Xu Huaigang
Current medical imaging
Cardiovascular death is one of the leading causes worldwide; an accurate identification followed by diagnosing the cardiovascular disease increases the chance of a better recovery. Among different demonstrated strategies, imaging on cardiac infections yields a visible result and highly reliable compared to other analytical methods. Two-dimensional spot tracking imaging is the emerging new technology that has been used to study the function and structure of the heart and test the deformation and movement of the myocardium. Particularly, it helps to capture the images of each segment in different directions of myocardial strain values, such as valves of radial strain, longitudinal strain, and circumferential strain. In this overview, we discussed the imaging of infections in the heart by using the two-dimensional spot tracking.
10.2174/1573405615666190130164037