title: Combination of single quantitative parameters into multiparametric model for ischemia detection is not superior to visual assessment during dobutamine stress echocardiography.
abstract: BACKGROUND
  To evaluate if the combination of several quantitative parameters into a mathematical model would enhance the detection of myocardial ischemia during dobutamine stress echocardiography (DSE) when compared to conventional wall motion analysis.
  
  
  METHODS
  In a prospective study design 151 patients (age 61.8 ± 9.2) in test group and 105 patients (age 64.0 ± 10.6) in validation group were selected and underwent DSE between January 2008 and December 2012. In all patients coronary angiography was performed within 6-8 weeks from DSE, considering at least one stenosis ≥50% per patient as significant coronary artery disease (CAD). Results of DSE visual assessment and myocardial velocity, strain and strain rate parameters derived from speckle tracking imaging were imported automatically to an originally created software. A mathematical model calculating prognosis of at least one stenosis per patient and stenosis in separate arteries was constructed.
  
  
  RESULTS
  Myocardial ischemia was visually detected in 60 (39.7 %) and in 58 (54.2 %) patients of the test and validation group, respectively. A total of 76 (50.3 %) patients in the test group and 69 patients (65.7 %) in the validation group had ≥50% coronary stenosis. Sensitivity and specificity of the mathematical model per patient in the test group were 91.6 % and 86.3 % compared to 76.8 % and 89.0 % of the visual assessment, respectively. However, in the validation group the sensitivity, specificity, positive predictive value and negative predictive value dropped down significantly becoming lower to visual assessment.
  
  
  CONCLUSIONS
  Myocardial deformation imaging may potentially replace visual assessment with an automated predictive model for stress-induced ischemia detection. However, a multiparametric mathematical model based on quantitative deformation markers did not demonstrate incremental value to visual assessment of wall motion.
authors.affiliation: Clinic of Cardiovascular diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. jelena.celutkiene@santa.lt.|Centre of Cardiology and Angiology, Vilnius University Hospital, Santariskiu 2, 08661, Vilnius, Lithuania. jelena.celutkiene@santa.lt.
authors.forename: Jelena
authors.initials: J
authors.lastname: Čelutkienė
authors.affiliation: Clinic of Cardiovascular diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.|Centre of Cardiology and Angiology, Vilnius University Hospital, Santariskiu 2, 08661, Vilnius, Lithuania.
authors.forename: Greta
authors.initials: G
authors.lastname: Burneikaitė
authors.affiliation: Faculty of Mathematics and Informatics, Vilnius University, Naugarduko 24, 03225, Vilnius, Lithuania.
authors.forename: Linas
authors.initials: L
authors.lastname: Petkevičius
authors.affiliation: Clinic of Cardiovascular diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Laura
authors.initials: L
authors.lastname: Balkevičienė
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University Hospital, Santariskiu 2, 08661, Vilnius, Lithuania.|Centre for Innovative Medicine, Zygimantu 9, 01102, Vilnius, Lithuania.
authors.forename: Aleksandras
authors.initials: A
authors.lastname: Laucevičius
mesh_terms: D003198:Computer Simulation; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D000069550:Machine Learning; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013566:Sympathomimetics
chemical_list: D013566:Sympathomimetics; D004280:Dobutamine
keywords: Coronary artery disease; Dobutamine stress echocardiography; Machine learning; Myocardial deformation imaging; Speckle tracking