title: Prediction of left ventricular contractile recovery using tissue Doppler strain and strain rate measurements at rest in patients undergoing percutaneous coronary intervention.
abstract: The aim of the study was to assess the ability of tissue Doppler (TD) deformation analysis at rest to predict left ventricular contractile recovery in patients undergoing percutaneous coronary intervention (PCI). This prospective cohort enrolled 67 patients with segmental wall motion abnormality. Assessment of each segment was performed at rest and during low dose Dobutamine stress echocardiography (DSE) using a 4 point scoring system, TD peak systolic strain (PSS) and peak systolic strain rate (PSSR). The study followed up the patients for contractile improvement after 6 months of successful PCI by echocardiography. Of a 319 dysfunctional segments, 155 (49%) showed contractile recovery and 164 (51%) did not. PSS and PSSR at rest were significantly higher in recovered segments compared to segments without recovery (PSS: -7.27 ± 0.8 Vs. -6.14 ± 0.7%, PSSR: -0.34 ± 0.13 Vs. -0.24 ± 0.1/s. p < 0.0001 both). Similarly, both parameters were significantly higher in the contractile recovery group at follow up (p 0.001). Resting PSSR as well as PSS and PSSR during DSE were significant independent predictors of contractile recovery (p < 0.001 each). For predicting segmental contractile recovery, resting PSSR with a -0.31/s cut-off point had 76% sensitivity and 59% specificity (AUC 0.74), DSE qualitative viability assessment had a sensitivity of 75% and specificity of 77%, DSE PSS with a cut-off point of -9.1% had 74% sensitivity and 63% specificity (AUC 0.77) and DSE PSSR with a cut-off point of -0.72/s had 78% sensitivity and 77% specificity (AUC 0.81). Resting PSSR is a modest predictor of segmental contractile recovery after PCI while PSSR during DSE has a comparable diagnostic performance to subjective wall motion scoring. Recovered segments show improvement of deformation parameters after PCI.
authors.affiliation: Department of Cardiovascular Medicine, Suez Canal University, Ismailia, Egypt. Ihab.M.Mohamed@hotmail.com.
authors.forename: Ihab M
authors.initials: IM
authors.lastname: Abdelgawwad
authors.affiliation: Department of Cardiovascular Medicine, Suez Canal University, Ismailia, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Al Hawary
authors.affiliation: Department of Cardiovascular Medicine, Suez Canal University, Ismailia, Egypt.
authors.forename: Hanan M
authors.initials: HM
authors.lastname: Kamal
authors.affiliation: Department of Cardiovascular Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Layla M
authors.initials: LM
authors.lastname: Al Maghawry
mesh_terms: D019540:Area Under Curve; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D013314:Stress, Mechanical; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Contractile recovery; Deformation; Strain; Strain rate; Tissue Doppler; Viability