title: Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography.
abstract: BACKGROUND
  A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE).
  
  
  METHODS
  Prospective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis.
  
  
  RESULTS
  The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52.
  
  
  CONCLUSIONS
  Multiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD.
authors: Centre of Innovative Medicine, Vilnius, Lithuania. jelena.celutkiene@santa.lt
authors: Jelena
authors: J
authors: Celutkiene
authors: Diana
authors: D
authors: Zakarkaite
authors: Viktor
authors: V
authors: Skorniakov
authors: Vida
authors: V
authors: Zvironaite
authors: Virginija
authors: V
authors: Grabauskiene
authors: Jelizaveta
authors: J
authors: Burca
authors: Laura
authors: L
authors: Ciparyte
authors: Aleksandras
authors: A
authors: Laucevicius
mesh_terms: D002316:Cardiotonic Agents; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004280:Dobutamine; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D016276:Ventricular Function / Q000502:physiology*
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine