title: Dobutamine-stress echocardiography speckle-tracking imaging in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of coronary artery disease.
abstract: OBJECTIVE
  Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckle-tracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD.
  
  
  METHODS
  In 81 patients (mean age, 64±8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n=41) and pathologic (n=40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI).
  
  
  RESULTS
  In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters.
  
  
  CONCLUSIONS
  Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD.
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: Egle.Rumbinaite@lsmuni.lt.
authors.forename: Eglė
authors.initials: E
authors.lastname: Rumbinaitė
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Diana
authors.initials: D
authors.lastname: Žaliaduonytė-Pekšienė
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Vieželis
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Indrė
authors.initials: I
authors.lastname: Čeponienė
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Tomas
authors.initials: T
authors.lastname: Lapinskas
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Rūta
authors.initials: R
authors.lastname: Žvirblytė
authors.affiliation: Laboratory of Clinical Cardiology, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Jonė
authors.initials: J
authors.lastname: Venclovienė
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Kristina
authors.initials: K
authors.lastname: Morkūnaitė
authors.affiliation: Faculty of Medicine, Medical Academy, University of Health Sciences, Kaunas, Lithuania.
authors.forename: Augustinas
authors.initials: A
authors.lastname: Bielinis
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Rimvydas
authors.initials: R
authors.lastname: Šlapikas
authors.affiliation: Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Jolanta Justina
authors.initials: JJ
authors.lastname: Vaškelytė
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004280:Dobutamine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011336:Probability; D011446:Prospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D004280:Dobutamine; D000241:Adenosine
keywords: Adenosine stress myocardial perfusion; Probability of coronary artery disease; Speckle-tracking echocardiography