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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Clinical Utility of Mechanical Echocardiographic Dispersion to Assess Left Ventricular Function and Ischemia or
Adrian Espejel-Guzman1, Alfonso Gonzalez-Trejo2, Neftali Eduardo Antonio-Villa3
1National Medical Center Siglo XXI, Mexican Institute of Social Security, Cardiology Hospital, Mexico City, Mexico.
Insights
Systolic and diastolic mechanical dispersion (MD) measured by 3D-echocardiography are simple parameters that effectively assess left ventricular (LV) function and detect ischemia or infarction in patients with coronary artery disease (CAD). These findings offer valuable insights for improving cardiac diagnostics.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Coronary artery disease (CAD) is a leading global cause of death.
- Echocardiographic assessment of left ventricular (LV) asynchrony may aid in detecting ischemia or infarction.
Purpose of the Study:
- To evaluate systolic and diastolic mechanical dispersion (MD) using 3D-echocardiography.
- To correlate MD with left ventricular ejection fraction (LVEF) and myocardial perfusion study (MPS) findings for ischemia or infarction detection.
Main Methods:
- Cross-sectional study involving 205 angina patients.
- Systolic and diastolic MD calculated as standard deviation of time to minimum ventricular volume, R-R interval corrected.
- Correlation with LVEF, ROC curve analysis for ischemia/infarction detection compared to diastolic function parameters.
Main Results:
- A negative correlation was found between MD (systolic and diastolic) and MPS-LVEF.
- Both systolic and diastolic MD showed significant accuracy (AUC > 0.6) in detecting ischemia/infarction.
- Systolic MD demonstrated improved accuracy (AUC 0.691) in patients with transmural infarction.
Conclusions:
- Systolic and diastolic mechanical dispersion are practical and effective parameters for assessing LV function.
- MD parameters aid in the detection of ischemia or infarction in patients with suspected or known CAD.
Background:
Coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide. Echocardiographic assessment of left ventricular (LV) asynchrony may provide additional value for detecting ischemia or infarction.
Objectives:
To assess the systolic and diastolic mechanical dispersion (MD) by 3D-echocardiography and its correlation with left ventricular ejection fraction (LVEF) and ischemia or infarction by myocardial perfusion study (MPS) gated 99m-Tc Sestamibi-SPECT.
Methods:
Cross-sectional study of patients with angina. Systolic and diastolic MD were defined as the standard deviation (SD) of the time to reach minimum ventricular volume, corrected for the R-R interval. Association with LVEF was assessed with correlation and linear regression. ROC curves identified ischemia or infarction and compared with E/A ratio, TRIVI, and E/e' ratio.
Results:
205 patients were studied with median age 62 (IQR: 54-69) years. 51% (n = 104) presented ischemia or infarction. We observed a negative correlation with systolic (r = -0.343, 95% -0.459 to -0.215; p < 0.001) and diastolic (r = -0.184, 95% -0.314 to -0.047; p < 0.01) MD and MPS-LVEF, which contributes to 8.9% and 11.8% of variance, respectively. Both parameters displayed an area under the curve (AUC) of 0.634 (95% 0.559-0.709, p < 0.001) and 0.604 (95% CI 0.527-0.679, p < 0.001) are shown to detect ischemia/infarction. In patients with transmural infarction the AUC for systolic MD improved to 0.691 (95% 0.582-0.801, p < 0.05).
Conclusions:
Systolic and diastolic MD are useful and simple parameters for assessment of LV function and ischemia or infarction.
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