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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Diagnostic accuracy of left ventricular longitudinal function by speckle tracking echocardiography to predict
Ingvild Billehaug Norum1,2, Vidar Ruddox3,4, Thor Edvardsen5,6
1Department of Cardiology, Vestfold Hospital Trust, Pb 2168, 3103, Tønsberg, Norway. ingvild.billehaug.norum@siv.no.
Insights
Global longitudinal strain (GLS) measured by speckle tracking echocardiography has modest accuracy in diagnosing coronary artery disease (CAD) in chest pain patients. Further research on regional strain and dobutamine stress echocardiography is needed.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Echocardiography
Background:
- Chest pain evaluation presents diagnostic challenges.
- Speckle tracking echocardiography (STE) shows diagnostic value in acute coronary syndrome but is underutilized.
- Coronary artery stenosis (CAD) diagnosis often requires invasive procedures.
Purpose of the Study:
- To assess the diagnostic accuracy of left ventricular (LV) longitudinal function by STE.
- To predict significant coronary artery stenosis (CAD+) versus no stenosis (CAD-) in patients with suspected cardiac ischemic chest pain.
- To compare STE findings with coronary angiography results.
Main Methods:
- Systematic review of 4 electronic databases (Embase, Medline, Cochrane, PubMed ahead-of-print).
- Inclusion criteria: full-sized articles, >40 patients.
- Data extraction on LV longitudinal function using STE and CAD status verified by coronary angiography.
Main Results:
- Six studies with 781 patients (60% with CAD+) were included.
- Mean global longitudinal strain (GLS) was -17.2% (CAD+) vs. -19.2% (CAD-).
- Area under the curve for predicting CAD+ ranged from 0.68 to 0.80; cut-off values varied, with sensitivity 51-81% and specificity 58-81%.
Conclusions:
- Resting GLS measurements offer only modest accuracy for predicting CAD+ in chest pain patients.
- Regional strain and layer-specific strain show potential but require larger studies.
- Dobutamine stress echocardiography (DSE) demonstrated good accuracy in one study, warranting further investigation.
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.
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