Severe regional myocardial dysfunction by stress echocardiography does not predict the presence of transmural scarring in chronic coronary artery disease.
OBJECTIVE
Detection and correct localization of transmural lesions can be important for optimal treatment of patients with chronic coronary artery disease (CAD). The aim of the study was to investigate the ability of peak longitudinal ejection strain (PLS) to detect the presence and extent of scar-tissue in CAD patients with normal or near normal ejection fraction, in comparison to cardiac magnetic resonance (CMR).


RESULTS
Before coronary artery bypass grafting, 57 patients underwent late gadolinium enhancement (LGE) CMR and echocardiography at rest and dobutamine stress (DS). According to the degree of LGE, segments were allocated to groups of none, subendocardial (1-50%), subtotal (51-75%), and total transmural scars (>75%). Dysfunctional segments were identified by PLS or wall motion scores (WMS). The finding of normal/near normal resting WMS and PLS, excellently identified segments without transmural LGE (AUC 94.0 CI 90.6-97.3 and AUC 85.7 CI 79.0-92.3, respectively). However, the finding of akinesia did not necessarily indicate transmural scarring. The negative predictive value was high (99%, CI 98-100%) while the positive predictive value was low. Detection-rates for subendocardial LGE were low.


CONCLUSIONS
Normo- and slightly hypokinetic myocardium by resting WMS or strain detects the absence of transmural scars. However, the finding of severe hypo- and akinesia does not reliably predict transmural scarring, with no improvement by the addition of DS. Detection of predominant akinesia with less than two normo- or hypokinetic segments in the territory of a high-grade coronary stenosis or occlusion, warrants further examination by LGE-CMR.
Cardiological Department, Division of Cardiothoracic and Respiratory Medicine, University Hospital North Norway, Tromsø 9038, Norway assami.rosner@unn.no.
Assami
A
Rösner
Cardiological Department, Division of Cardiothoracic and Respiratory Medicine, University Hospital North Norway, Tromsø 9038, Norway.
Derk
D
Avenarius
University Hospital North Norway, Harstad, Norway Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
Siri
S
Malm
Cardiological Department, Division of Cardiothoracic and Respiratory Medicine, University Hospital North Norway, Tromsø 9038, Norway.
Amjid
A
Iqbal
Department of Clinical Medicine, University of Tromsø, Tromsø, Norway ICREA-Universitat Pompeu Fabra, Barcelona, Spain ICREA-Universitat Pompeu Fabra, K.U. Leuven, Belgium.
Bart
B
Bijnens
Cardiological Department, Division of Cardiothoracic and Respiratory Medicine, University Hospital North Norway, Tromsø 9038, Norway Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
Henrik
H
Schirmer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D002921:Cicatrix / Q000473:pathology*; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D025401:Echocardiography, Stress; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume
D003287:Contrast Media; D019786:Gadolinium DTPA
Coronary artery disease; Detection of scar-tissue; Dobutamine-stress echocardiography; Strain-echocardiography