title: Comparison of quantitative wall-motion analysis and strain for detection of coronary stenosis with three-dimensional dobutamine stress echocardiography.
abstract: BACKGROUND
  Quantitative analysis of wall motion from three-dimensional (3D) dobutamine stress echocardiography (DSE) could provide additional diagnostic information not available from qualitative analysis. In this study, we compare the effectiveness of 3D fractional shortening (3DFS), a measure of wall motion computed from 3D echocardiography (3DE), to strain and strain rate measured with sonomicrometry for detecting critical stenoses during DSE.
  
  
  METHODS
  Eleven open-chest dogs underwent DSE both with and without a critical stenosis. 3DFS was measured from 3DE images acquired at peak stress. 3DFS was normalized by subtracting average 3DFS during control peak stress (∆3DFS). Strains in the perfusion defect (PD) were measured from sonomicrometry, and PD size and location were measured with microspheres.
  
  
  RESULTS
  A ∆3DFS abnormality indicated the presence of a critical stenosis with high sensitivity and specificity (88% and 100%, respectively), and ∆3DFS abnormality size correlated with PD size (R(2) = 0.54). The sensitivity and specificity for ∆3DFS were similar to that for area strain (88%, 100%) and circumferential strain and strain rate (88%, 92% and 88%, 86%, respectively), while longitudinal strain and strain rate were less specific. ∆3DFS correlated significantly with both coronary flow reserve (R(2) = 0.71) and PD size (R(2) = 0.97), while area strain correlated with PD size only (R(2) = 0.67), and other measures were not significantly correlated with flow reserve or PD size.
  
  
  CONCLUSIONS
  Quantitative wall-motion analysis using ∆3DFS is effective for detecting critical stenoses during DSE, performing similar to 3D strain, and provides potentially useful information on the size and location of a perfusion defect.
authors.affiliation: Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Parker
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Clark
authors.forename: Norman C
authors.initials: NC
authors.lastname: Goodman
authors.forename: David K
authors.initials: DK
authors.lastname: Glover
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Holmes
mesh_terms: D000818:Animals; D002316:Cardiotonic Agents; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004195:Disease Models, Animal; D004280:Dobutamine; D004285:Dogs; D025401:Echocardiography, Stress; D019560:Echocardiography, Three-Dimensional; D012680:Sensitivity and Specificity
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine
keywords: cardiac mechanics; coronary artery disease; demand ischemia; perfusion