title: Strain Imaging with a Bull's-Eye Map for Detecting Significant Coronary Stenosis during Dobutamine Stress Echocardiography.
abstract: Accurate visual assessment of wall motion during dobutamine stress echocardiography (DSE) requires expertise; strain stress echocardiography thus has potential for the objective and reliable evaluation of stress-induced wall motion abnormalities. The aim of this study was to test the hypothesis that strain imaging also requires expertise. Diagnostic accuracy for significant coronary artery disease was compared between visual and strain analysis with a bull's-eye map, and the effect of expertise on readers' accuracy during DSE was determined.
  
  
  
  Thirty-seven patients who underwent both DSE and coronary angiography within 6 months were retrospectively selected. Three experts and two fellows performed visual and two-dimensional speckle-tracking analysis using vendor-dependent (GE) software in three apical views. A bull's-eye map of longitudinal strain and a postsystolic shortening map were generated at baseline and peak stress. Significant coronary stenosis was defined as a >1% reduction in longitudinal strain with an increase in postsystolic shortening of at least two contiguous segments in the specific coronary artery territory at peak stress compared with baseline.
  
  
  
  Twenty-five patients had significant coronary artery disease (>70% stenosis on coronary angiography), including 17 with left anterior descending coronary artery stenosis and 19 with non-left anterior descending coronary artery stenosis. Overall, strain imaging provided no additional benefit over visual analysis in detecting significant stenosis per patient and per vessel among experts and fellows. Strain analysis by the fellows had significantly lower specificity and accuracy compared with the experts.
  
  
  
  Expertise affects strain evaluation for detecting significant coronary artery disease during DSE.
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan; Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Li-Tan
authors.initials: LT
authors.lastname: Yang
authors.affiliation: Department of Cardiac Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kado
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Nagata
authors.affiliation: Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Otani
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
authors.affiliation: Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. Electronic address: takeuchi@med.uoeh-u.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
mesh_terms: D000368:Aged; D002983:Clinical Competence; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000187:drug effects / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004280:Dobutamine
keywords: Dobutamine stress echocardiography; Expertise; Strain