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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left
Ryan T Hubbard1, Maria C Arciniegas Calle2, Sergio Barros-Gomes2
1Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
Insights
2D speckle tracking echocardiography can detect coronary artery disease (CAD) in women with normal ejection fraction by identifying abnormal strain and dyssynchrony. This non-invasive method aids in diagnosing CAD in women presenting with atypical symptoms.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Coronary artery disease (CAD) in women often presents with atypical symptoms, increasing the risk of misdiagnosis.
- Standard diagnostic methods may not always capture subtle signs of CAD in women with preserved ejection fraction.
Purpose of the Study:
- To evaluate the utility of 2-dimensional speckle tracking echocardiography (2D-STE) for detecting CAD in women with normal ejection fraction.
- To compare strain, strain rate, and left ventricular dyssynchrony parameters between women with CAD and healthy controls.
Main Methods:
- Inclusion of 35 women with confirmed CAD and 35 healthy controls with normal angiograms and ejection fraction.
- Assessment of global circumferential strain (CS), global radial strain (S), global radial strain rate (SR), and global longitudinal LV strain (GLS) using 2D-STE.
- Measurement of standard deviation of GLS time-to-peak (TTP) to quantify mechanical dyssynchrony.
Main Results:
- Significant differences in CS, global radial S, global radial SR, and GLS between CAD and control groups (P < .05).
- Mechanical dyssynchrony (SD of GLS TTP) was significantly higher in the CAD group (99 ms vs 33 ms, P < .001).
- A cutoff of 45 ms for SD of longitudinal S TTP demonstrated 97% sensitivity and 89% specificity (AUC, 0.96) for CAD detection. Combined parameters showed an AUC of 0.96.
Conclusions:
- 2D-STE can identify CAD in women with normal echocardiograms and ejection fraction by detecting abnormal strain and dyssynchrony.
- The study highlights the potential of 2D-STE as a non-invasive tool for diagnosing CAD in women, particularly those with atypical presentations.
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-1 vs 1.9 s-1, 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.
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