title: New concept of myocardial longitudinal strain reserve assessed by a dipyridamole infusion using 2D-strain echocardiography: the impact of diabetes and age, and the prognostic value.
abstract: OBJECTIVE
  Although dipyridamole is a widely used pharmacological stress agent, the direct effects on myocardium are not entirely known. Diabetic cardiomyopathy can be investigated by 2D-strain echocardiography. The aim of this study was to assess myocardial functional reserve after dipyridamole infusion using speckle-tracking echocardiography.
  
  
  METHODS
  Seventy-five patients referred for dipyridamole stress myocardial perfusion gated SPECT (MPGS) were examined by echocardiography to assess a new concept of longitudinal strain reserve (LSR) and longitudinal strain rate reserve (LSRR) respectively defined by the differences of global longitudinal strain (GLS) and longitudinal strain rate between peak stress after dipyridamole and rest. Twelve patients with myocardial ischemia were excluded on the basis of MPGS as gold standard.
  
  
  RESULTS
  Mean LSR was -2.28±2.19% and was more important in the 28 (44%) diabetic patients (-3.27±1.93%; p=0.001). After multivariate analyses, only diabetes improved LSR (p=0.011) after dipyridamole infusion and was not associated with glycaemic control (p=0.21), insulin therapy (p=0.46) or duration of the disease (p=0.80). Conversely, age (p=0.002) remained associated with a decrease in LSR. LSSR was also correlated to age (p=0.005). Patients with a LSR<0% have a better survival after 15 months (log-rank p=0.0012).
  
  
  CONCLUSIONS
  LSR explored by 2D speckle-tracking echocardiography after dipyridamole infusion is a simple and new concept that provides new insights into the impact of diabetes and age on the myocardium with a potential prognostic value.
authors.affiliation: Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France. thomascognet31@gmail.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Cognet
authors.forename: Paul-Louis
authors.initials: PL
authors.lastname: Vervueren
authors.forename: Laurent
authors.initials: L
authors.lastname: Dercle
authors.forename: Delphine
authors.initials: D
authors.lastname: Bastié
authors.forename: Rainui
authors.initials: R
authors.lastname: Richaud
authors.forename: Matthieu
authors.initials: M
authors.lastname: Berry
authors.forename: Pauline
authors.initials: P
authors.lastname: Marchal
authors.forename: Matthieu
authors.initials: M
authors.lastname: Gautier
authors.forename: Audrey
authors.initials: A
authors.lastname: Fouilloux
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Pierre
authors.initials: P
authors.lastname: Massabuau
authors.forename: Isabelle
authors.initials: I
authors.lastname: Berry
authors.forename: Olivier
authors.initials: O
authors.lastname: Lairez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D003920:Diabetes Mellitus; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging*; D004176:Dipyridamole / Q000494:pharmacology*; D025401:Echocardiography, Stress; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D014665:Vasodilator Agents / Q000494:pharmacology*
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole