Left atrial strain during stress echocardiography for the assessment of myocardial ischaemia
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Eduardo Henrique Bonotto1, Fernanda Arejano Vaucher1, Miguel Morita Fernandes-Silva1
1Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal University of Paraná, Curitiba, Brazil.
Insights
Left atrial strain accurately detects myocardial ischemia during dobutamine stress echocardiography. Lower left atrial reservoir strain (LASr) values predict ischemia, with a cutoff of ⩽29.7% at peak stress showing high diagnostic accuracy.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Ischemia
Background:
- Diastolic dysfunction can precede systolic changes in myocardial ischemia.
- Left ventricular dysfunction impacts left atrial function, detectable via speckle-tracking echocardiography.
Purpose of the Study:
- To evaluate the accuracy of left atrial strain in identifying myocardial ischemia during dobutamine stress echocardiography (DSE).
Main Methods:
- Prospective enrollment of patients undergoing DSE for suspected ischemia.
- Analysis of left atrial strain components (reservoir, conduit, contractile) during DSE.
- Diagnosis of ischemia based on new/worsening wall motion abnormalities.
Main Results:
- Patients with inducible ischemia showed significantly lower left atrial reservoir strain (LASr) at all DSE stages.
- LASr at rest and low-dose DSE predicted ischemia.
- An LASr cutoff of ⩽29.7% at peak stress demonstrated high accuracy (AUC=0.88) for detecting ischemia.
Conclusions:
- Left atrial strain assessment is valuable in DSE for suspected myocardial ischemia.
- Integrating LASr can corroborate positive DSE findings for ischemia.
Introduction:
Diastolic dysfunction precedes ventricular contractility changes in the ischaemic cascade. Both diastolic and systolic left ventricle dysfunctions are known to alter left atrial myocardial deformation by impairing its phasic function, which can be evaluated using speckle-tracking echocardiography.
Objective:
The aim of this study was to assess the accuracy of left atrial strain in detecting myocardial ischaemia in patients undergoing dobutamine stress echocardiography.
Methods:
Patients referred for dobutamine stress echocardiography due to suspected ischaemia were prospectively enrolled. Left atrial strain, including its three components - reservoir, conduit, and contractile - was analysed at each stage of dobutamine stress echocardiography. The diagnosis of myocardial ischaemia was defined as a new or worsening wall motion abnormality in at least two contiguous left ventricle segments during dobutamine stress echocardiography. Patients with a positive dobutamine stress echocardiography for ischaemia were compared with those with a negative dobutamine stress echocardiography for ischaemia.
Results:
A total of 56 patients were included. Patients with inducible ischaemia had significantly lower left atrial reservoir strain (LASr) values at rest and throughout all dobutamine stress echocardiography phases, with the lowest values at peak stress (27.6% (24.0 to 28.4) vs 34% (29.6 to 42.7), p < 0.001). LASr at rest and during low-dose dobutamine predicted ischaemia during dobutamine stress echocardiography (rest: area under the curve = 0.68, p = 0.038; low dose: area under the curve = 0.78, p < 0.001). An LASr cutoff of ⩽29.7% at peak stress yielded high diagnostic accuracy in detecting inducible ischaemia (area under the curve = 0.88, p < 0.001).
Conclusion:
Assessment of left atrial strain in patients undergoing dobutamine stress echocardiography for suspected myocardial ischaemia has diagnostic value and can be integrated into conventional dobutamine stress echocardiography to corroborate the findings of a positive test.
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