title: Longitudinal Strain by Automated Function Imaging Detects Single-Vessel Coronary Artery Disease in Patients Undergoing Dipyridamole Stress Echocardiography.
abstract: BACKGROUND
  The aim of this study was to investigate the incremental value of global longitudinal strain (GLS) by automated function imaging in respect to wall motion (WM) for the detection of coronary artery disease (CAD) during dipyridamole stress echocardiography.
  
  
  METHODS
  Fifty-two patients (mean age, 65.3 ± 8.7 years; 22 men) underwent dipyridamole stress echocardiography followed by coronary angiography within 1 week. Diagnostic accuracy for the identification of single-vessel CAD was evaluated for WM and GLS. The study population was divided into two groups according to coronary angiographic findings: those with CAD (n = 38; mean age, 67.2 ± 5.9 years; 19 men) and those without CAD (n = 14; mean age, 63.3 ± 6.4 years; three men).
  
  
  RESULTS
  A trend toward lower resting GLS values was found in patients with CAD than in those without (-18.7 ± 2.2% vs -20 ± 2.8%, P = .061). In patients without CAD, GLS progressively increased up to peak dose (from -20 ± 2.8% at rest to -20.7 ± 1.9% at low dose, P = .045; from -20.7 ± 1.9% at low dose to -21.5 ± 3.1% at peak dose, P = .032), whereas in patients with CAD, an increase of GLS from rest to low dose (from -18.7 ± 2.2% to -19.2 ± 3.9%, P = .046) followed by a decrease from low to peak dose (from -19.2 ± 3.9% to -17.5 ± 2.4%, P = .007) was observed. In addition, with regard to diagnostic accuracy in detecting CAD, WM yielded sensitivity of 44%, specificity of 55%, positive predictive value of 73%, and negative predictive value of 26%, whereas GLS, alternatively evaluated as the difference between peak dose and resting values or between peak and low-dose values, provided sensitivity of 61%, specificity of 90%, positive predictive value of 94%, and negative predictive value of 47% (respectively, P = .020, P = .001, P = .023, and P = .031, all vs WM) and sensitivity of 84%, specificity of 92%, positive predictive value of 96%, and negative predictive value of 68% (respectively, P < .001, P < .001, P = .001, P < .001, all vs WM).
  
  
  CONCLUSIONS
  GLS analysis, particularly performed by comparing peak-dose with low-dose values, improves the accuracy of dipyridamole stress echocardiography in the detection of single-vessel CAD compared with the sole assessment of WM changes.
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cusmà-Piccione
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Lilia
authors.initials: L
authors.lastname: Oreto
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Myriam
authors.initials: M
authors.lastname: D'Angelo
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Tripepi
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Todaro
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin. Electronic address: publishing22@aurora.org.
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Khandheria
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
mesh_terms: D000368:Aged; D001331:Automation; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004176:Dipyridamole / Q000494:pharmacology*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole
keywords: Coronary artery disease; Dipyridamole; Longitudinal strain; Stress echocardiography