title: Layer-specific analysis of dobutamine stress echocardiography for the evaluation of coronary artery disease.
abstract: Although dobutamine stress echocardiography (DSE) is a well-defined tool for the diagnosis of coronary artery disease (CAD), false-negative and false-positive results still occur. This study investigated the diagnostic role of layer-specific analysis using 2-dimensional speckle-tracking echocardiography (STE) during DSE.A total of 121 patients who underwent DSE and showed normal wall motion and ejection fraction during baseline echocardiography were enrolled. All patients underwent coronary angiography after DSE within 2 weeks. The patients were divided into the following 4 groups according to DSE results and CAD status: negative DSE with no significant CAD (n = 73), positive DSE with significant CAD (n = 16), negative DSE with significant CAD (n = 17), and positive DSE with no significant CAD (n = 15). Layer-specific global longitudinal strain (GLS) was assessed in the endocardium, mid-myocardium, and epicardium by STE techniques.Patients with significant CAD were older, more male and showed higher glucose level compared to patients without CAD. But coronary risk factors and previous medications were not different between patients with and without CAD. There were no significant differences in whole myocardium or layer-specific GLS found in the baseline echocardiography. During recovery echocardiography, endocardial GLS was significantly different between patients with and without CAD, regardless of the DSE results. A receiver-operating characteristic curve analysis showed that endocardial GLS (>-16%) was superior for identifying significant CAD during the DSE recovery stage. Diagnostic accuracy was improved by applying the results of endocardial GLS compared with visual estimation of DSE.The assessment of layer-specific strain by STE during DSE was feasible, and the evaluation of poststress endocardial function is a more sensitive tool for the detection of CAD.
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul Department of Laboratory Medicine, College of Medicine, Kangwon National University, Kangwon, Republic of Korea.
authors: Jae Hun
authors: JH
authors: Park
authors: Jong Shin
authors: JS
authors: Woo
authors: Shin
authors: S
authors: Ju
authors: Su Woong
authors: SW
authors: Jung
authors: Insoo
authors: I
authors: Lee
authors: Jin Bae
authors: JB
authors: Kim
authors: Soo Joong
authors: SJ
authors: Kim
authors: Weon
authors: W
authors: Kim
authors: Woo-Shik
authors: WS
authors: Kim
authors: Kwon Sam
authors: KS
authors: Kim
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D025401:Echocardiography, Stress / Q000379:methods; D004699:Endocardium / Q000000981:diagnostic imaging; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging