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Updated: Apr 5, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Quantitative Dobutamine Stress Echocardiography Using Speckle-Tracking Analysis versus Conventional Visual Analysis
Emer Joyce1, Georgette E Hoogslag1, Ibithal Al Amri1
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Two-dimensional speckle-tracking strain echocardiography effectively detects significant coronary artery disease after ST-segment elevation myocardial infarction. This method offers a feasible and promising approach for post-STEMI patient assessment.
Area of Science:
- Cardiology
- Echocardiography
- Medical Imaging
Background:
- Detecting residual ischemia after ST-segment elevation myocardial infarction (STEMI) using visual analysis during dobutamine stress echocardiography (DSE) is difficult.
- Assessing significant coronary artery disease (CAD) post-STEMI requires accurate diagnostic tools.
Purpose of the Study:
- To evaluate the feasibility and accuracy of 2D speckle-tracking strain DSE for detecting significant CAD in STEMI patients.
- To compare strain analysis with traditional visual assessment in the post-STEMI setting.
Main Methods:
- Retrospective analysis of 105 STEMI patients treated with primary PCI.
- Measurement of left ventricular peak longitudinal systolic strain (PLSS) at rest and peak stress using 2D speckle-tracking echocardiography.
- Correlation of strain changes (ΔPLSS) with coronary angiography findings (significant CAD defined as >70% diameter stenosis).
Main Results:
- High analyzability of myocardial segments at rest (93%) and peak stress (92%).
- Significant CAD was identified in 36% of patients.
- Greater worsening in global PLSS (ΔPLSS) was observed in patients with significant CAD compared to those without (P < .001).
- Optimal ΔPLSS cutoff (≥1.9%) showed 87% sensitivity and 60% accuracy for detecting significant CAD.
Conclusions:
- 2D speckle-tracking strain analysis is feasible during DSE in post-STEMI patients.
- This technique shows promise for accurately detecting significant angiographic CAD at follow-up.
- Strain analysis offers a valuable, objective tool for risk stratification after STEMI.
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.
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