The Role of left ventricle myocardial regional deformation parameters during dobutamine stress to detect hemodynamically significant coronary artery stenoses

Abstract

Introduction The role of global longitudinal strain is well validated and has important application in detecting significant coronary artery disease (CAD). While the diagnostic value of regional deformation parameters ((regional strain, strain rate (SR) and postsystolic strain index (PSI)) to detect hemodynamically significant coronary artery stenoses still is unclear. Purpose To determine and compare the diagnostic value of regional deformation parameters at early recovery phase after dobutamine stress echocardiography (DSE) to predict significant coronary artery stenosis in patients with moderate pretest probability of CAD. Methods DSE and adenosine stress magnetic resonance imaging (AMRI) were perfomed to 83 patients with moderate pretest probability of CAD. CAD was defined as >70% diameter coronary artery stenosis on invasive angiography or in the presence of intermediate stenosis (50-69%) validated as hemodynamically significant by AMRI. Regional longitudinal strain, SR and PSI were analysed using 2D speckle tracking echocardiography during early recovery phase after DSE. Patients were divided into two groups: no significant CAD (-) n=38 (45.8%) vs significant CAD (+) n=45 (54.2%). Results There were no significant differences of clinical characteristics, conventional echocardiography and regional longitudinal deformation parameters between the groups at rest. The vessel-bassed analysis showed that regional PSI was significantly increased in areas of stenotic vessel as compared to non-stenotic vessel areas (PSI 10.64±6.32% vs. 5.56±3.56%, p=0.01. The same tendency of significant difference between groups was found in strain and SR evaluation - parameters were lower in patients with CAD than without (strain: -25.9±3.0% vs. -18.2±3.5%, p=0.02, SR: -2.0±0.6 s-1 vs. -1.6±0.3 s-1, p=0.04). According to ROC analysis, regional PSI at early recovery phase had the greatest sensitivity and specificity for ass[...].