Document Detail


Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia.
MedLine Citation:
PMID:  12682001     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Interpretation of dobutamine stress echocardiography (DSE) is subjective and strongly dependent on the skills of the reader. Strain-rate imaging (SRI) by tissue Doppler may objectively analyze regional myocardial function. This study investigated SRI markers of stress-induced ischemia and analyzed their applicability in a clinical setting. METHODS AND RESULTS: DSE was performed in 44 patients with known or suspected coronary artery disease. Simultaneous perfusion scintigraphy served as a "gold standard" to define regional ischemia. All patients underwent coronary angiography. Segmental strain and strain rate were analyzed at all stress levels by measuring amplitude and timing of deformation and visual curved M-mode analysis. Results were compared with conventional stress echo reading. In nonischemic segments, peak systolic strain rate increased significantly with dobutamine stress (-1.6+/-0.6 s-1 versus -3.4+/-1.4 s-1, P<0.01), whereas strain during ejection time changed only minimally (-17+/-6% versus -16+/-9%, P<0.05). During DSE, 47 myocardial segments in 19 patients developed scintigraphy-proven ischemia. Strain-rate increase (-1.6+/-0.8 s-1 versus -2.0+/-1.1 s-1, P<0.05) and strain (-16+/-7% versus -10+/-8%, P<0.05) were significantly reduced (both P<0.01 compared with nonischemic). Postsystolic shortening (PSS) was found in all ischemic segments. The ratio of PSS to maximal segmental deformation was the best quantitative parameter to identify stress-induced ischemia. Compared with conventional readings, SRI curved M-mode assessment improved sensitivity/specificity from 81%/82% to 86%/90%. CONCLUSIONS: During DSE, SRI quantitatively and qualitatively differentiates ischemic and nonischemic regional myocardial response to dobutamine stress. The ratio of PSS to maximal strain may be used as an objective marker of ischemia during DSE.
Authors:
Jens-Uwe Voigt; Bert Exner; Kristin Schmiedehausen; Cord Huchzermeyer; Udo Reulbach; Uwe Nixdorff; Günther Platsch; Torsten Kuwert; Werner G Daniel; Frank A Flachskampf
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-04-07
Journal Detail:
Title:  Circulation     Volume:  107     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-29     Completed Date:  2003-05-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2120-6     Citation Subset:  AIM; IM    
Affiliation:
Medizinische Klinik II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany. jens.uwe.voigt@gmx.net
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MeSH Terms
Descriptor/Qualifier:
Coronary Angiography
Coronary Artery Disease / diagnosis,  ultrasonography*
Echocardiography, Doppler*
Echocardiography, Stress*
Humans
Middle Aged
Myocardial Ischemia / etiology,  radiography,  radionuclide imaging,  ultrasonography*
ROC Curve
Sensitivity and Specificity
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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