Accuracy of Two-Dimensional Speckle Tracking Echocardiography for the Detection of Significant Coronary Stenosis
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Background: Visual assessment of wall motion abnormalities (WMA) by 2-dimensional echocardiography (2DE) is the most semi-quantitative method used to detect coronary artery disease (CAD), but it carries many limitations. Speckle tracking echocardiography (STE) overcomes these limitations and allows an objective quantification of myocardial deformation. The aim of the study to examine the accuracy of global and segmental longitudinal strain (LS) for the detection of CAD compared with visual assessment of WMA using coronary angiography as a golden standard. Methods: The study enrolled 25 patients (mean age 51.0 ± 8.7, 64% are male) referred to coronary angiography with clinical suspicion of CAD. 2DE assessment of WMA and evaluation of LS using STE were performed using left ventricular 17-segments models. Significant CAD was defined as ≥ 50% stenosis in one or more major coronary arteries by angiography. Results: Patients were classified into 2 groups: group I included 15 patients with significant CAD and group II included 10 patients with insignificant and/or absence of CAD. WM score was strongly correlated with the global LS in group I and II (R = 0.80, p < 0.0001 and R = 0.88, p < 0.0001 respectively). In all patients, 425 segments were analyzed. WMA was detected in 163 segments of 425 (38.3%) while abnormal LS was detected in 214 segments (50.3%). Compared with coronary angiography, the total sensitivity, specificity and accuracy for visual analysis and STE were (56%, 88.2%, and 60% vs. 68.6%, 77%, and 81.8% respectively). Conclusion: Segmental LS is more accurate for the detection of ischemic myocardial segment corresponding to functionally relevant coronary anatomy than visual assessment of WM.
Abstract
Background: Visual assessment of wall motion abnormalities (WMA) by 2-dimensional echocardiography (2DE) is the most semi-quantitative method used to detect coronary artery disease (CAD), but it carries many limitations. Speckle tracking echocardiography (STE) overcomes these limitations and allows an objective quantification of myocardial deformation. The aim of the study to examine the accuracy of global and segmental longitudinal strain (LS) for the detection of CAD compared with visual assessment of WMA using coronary angiography as a golden standard. Methods: The study enrolled 25 patients (mean age 51.0 ± 8.7, 64% are male) referred to coronary angiography with clinical suspicion of CAD. 2DE assessment of WMA and evaluation of LS using STE were performed using left ventricular 17-segments models. Significant CAD was defined as ≥ 50% stenosis in one or more major coronary arteries by angiography. Results: Patients were classified into 2 groups: group I included 15 patients with significant CAD and group II included 10 patients with insignificant and/or absence of CAD. WM score was strongly correlated with the global LS in group I and II (R = 0.80, p < 0.0001 and R = 0.88, p < 0.0001 respectively). In all patients, 425 segments were analyzed. WMA was detected in 163 segments of 425 (38.3%) while abnormal LS was detected in 214 segments (50.3%). Compared with coronary angiography, the total sensitivity, specificity and accuracy for visual analysis and STE were (56%, 88.2%, and 60% vs. 68.6%, 77%, and 81.8% respectively). Conclusion: Segmental LS is more accurate for the detection of ischemic myocardial segment corresponding to functionally relevant coronary anatomy than visual assessment of WM.
참고문헌 (22)
- Lang RM, "Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology", J Am Soc Echocardiogr, 18, pp.1440~1463 (2005)
- Cerqueira MD, "American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association", Int J Cardiovasc Imaging, 18, pp.539~542 (2002)
- Lang RM, "American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification", Eur J Echocardiogr, 7, pp.79~108 (2006)
- Geyer H, "Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications", J Am Soc Echocardiogr, 23, pp.351~369 (2010)
- Belghitia H, "Automated function imaging: a new operator-independent strain method for assessing left ventricular function", Arch Cardiovasc Dis, 101, pp.163~169 (2008)
- Choi JO, "Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality", Eur J Echocardiogr, 10, pp.695~701 (2009)
- Nucifora G, "ncremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease", Am Heart J, 159, pp.148~157 (2010)
- Scanlon PJ, "ACC", AHA guidelines for coronary angiography: executive summary and recommendations. A report of the American College of Cardiology, Circulation, pp.1999, 99[DOI]
- Leitman M, "Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function", J Am Soc Echocardiogr, 17, pp.1021~1029 (2004)
- Kusunose K, "Validation of longitudinal peak systolic strain by speckle tracking echocardiography with visual assessment and myocardial perfusion SPECT in patients with regional asynergy", Circ J, 75, pp.141~147 (2011)
- Bamberg F, "Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging", Radiology, 260, pp.689~698 (2011)
- Hawass NE, "Comparing the sensitivities and specificities of two diagnostic procedures performed on the same group of patients", Br J Radiol, 70, pp.360~366 (1997)
- Zhou XH, "Statistical methods in diagnostic medicine" (2002), John Wiley and Sons
- Hoit BD, "Strain and strain rate echocardiography and coronary artery disease", Circ Cardiovasc Imaging, 4, pp.179~179 (2011)
- Lorch SM, "Maturational and growth-related changes in left ventricular longitudinal strain and strain rate measured by two-dimensional speckle tracking echocardiography in healthy pediatric population", J Am Soc Echocardiogr, 21, pp.1207~1215 (2008)
- Pakkal M, "Non-invasive imaging in coronary artery disease including anatomical and functional evaluation of ischaemia and viability assessment", Br J Radiol, 84(Spec No 3), pp.280~295 (2011)
- Tonino PA, "Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation", J Am Coll Cardiol, 55, pp.2816~2821 (2010)
- Dalen H, "Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway", Eur J Echocardiogr, 11, pp.176~183 (2010)
- Kumar SP, "Importance of wall motion analysis in the diagnosis of left main disease using stress nuclear myocardial perfusion imaging", Int J Cardiovasc Imaging, 19, pp.219~224 (2003)
- Huang WC, "Early assessment of left ventricular viability of dyskinesia and akinesia myocardium in patients with acute myocardial infarction: real-time contrast echocardiography versus low-dose dobutamine echocardiography", Acta Cardiol Sin, 20, pp.160~170 (2004)
- Munk K, "Global longitudinal strain by speckle tracking for infarct size estimation", Eur J Echocardiogr, 12, pp.156~165 (2011)
- Nakai H, "Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration", Eur J Echocardiogr, 10, pp.926~932 (2009)
