title: Comparison of deformation imaging and velocity imaging for detecting regional inducible ischaemia during dobutamine stress echocardiography.
abstract: OBJECTIVE
  To determine whether Doppler based myocardial tissue velocity imaging (TVI) or strain rate imaging (SRI) is more accurate in detecting stress-induced ischaemia during dobutamine stress echocardiography (DSE).
  
  
  RESULTS
  Regional myocardial velocity, displacement, strain rate and strain patterns during DSE were investigated in 44 routine patients with known or suspected coronary artery disease. Simultaneous perfusion scintigraphy defined regional ischaemia. Curves and curved-M-mode patterns were analysed and receiver-operating-characteristics of TVI and SRI parameters were compared by their area under the curve (AUC) in the receiver-operating-characteristics. In non-ischaemic segments, peak systolic velocity and strain rate increased significantly. Unlike SRI, TVI parameters had higher values in basal than in apical segments. In 47 segments of 19 segments DSE-induced ischaemia, which was proven by scintigraphy. In ischaemia, velocity and strain rate increased less. Post-systolic shortening (PSS) was always seen in SRI but not regularly in TVI. Peak systolic velocity and systolic displacement were the best TVI-parameters of stress-induced ischaemia (AUC 0.68 and 0.77, respectively.), in SRI it was the ratio of PSS and maximal segmental deformation (AUC=0.95, p < 0.0001).
  
  
  CONCLUSIONS
  Compared to TVI, SRI parameters showed no major apico-basal gradient and had significantly higher diagnostic accuracy, comparable to conventional reading. SRI thus appears superior to TVI for regional ischaemia detection during DSE and may be preferred to support conventional DSE reading.
authors.affiliation: Medizinische Klinik II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany. jens.uwe.voigt@gmx.net
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
authors.forename: Uwe
authors.initials: U
authors.lastname: Nixdorff
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Bogdan
authors.forename: Bert
authors.initials: B
authors.lastname: Exner
authors.forename: Kristin
authors.initials: K
authors.lastname: Schmiedehausen
authors.forename: Günther
authors.initials: G
authors.lastname: Platsch
authors.forename: Torsten
authors.initials: T
authors.lastname: Kuwert
authors.forename: Werner G
authors.initials: WG
authors.lastname: Daniel
authors.forename: Frank A
authors.initials: FA
authors.lastname: Flachskampf
mesh_terms: D001783:Blood Flow Velocity; D017023:Coronary Angiography; D025401:Echocardiography, Stress / Q000592:standards; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012372:ROC Curve; D012680:Sensitivity and Specificity