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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Dobutamine-stress echocardiography speckle-tracking imaging in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of coronary artery disease

1
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
2
Laboratory of Clinical Cardiology, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
3
Faculty of Medicine, Medical Academy, University of Health Sciences, Kaunas, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2016, 52(6), 331-339; https://doi.org/10.1016/j.medici.2016.11.005
Received: 3 April 2015 / Revised: 17 October 2016 / Accepted: 10 November 2016 / Published: 25 November 2016
Background and objective: Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckletracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD.
Materials and methods: In 81 patients (mean age, 64 ± 8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n = 41) and pathologic (n = 40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI).
Results: In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters.
Conclusions: Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD.
Keywords: Probability of coronary artery disease; Speckle-tracking echocardiography; Adenosine stress myocardial perfusion Probability of coronary artery disease; Speckle-tracking echocardiography; Adenosine stress myocardial perfusion
MDPI and ACS Style

Rumbinaitė, E.; Žaliaduonytė-Pekšienė, D.; Vieželis, M.; Čeponienė, I.; Lapinskas, T.; Žvirblytė, R.; Venclovienė, J.; Morkūnaitė, K.; Bielinis, A.; Šlapikas, R.; Vaškelytė, J.J. Dobutamine-stress echocardiography speckle-tracking imaging in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of coronary artery disease. Medicina 2016, 52, 331-339.

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