Ischemic heart disease and early diagnosis. Study on the predictive value of 2D strain

• Published in: International journal of cardiology 2016-07, Vol.215, p.150-156
• Main Authors: Dattilo, G, Imbalzano, E, Lamari, A, Casale, M, Paunovic, N, Busacca, P, Di Bella, G
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular; Circumferential strain; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Dipyridamole stress echocardiography; Early Diagnosis; Echocardiography - methods; Exercise Test - methods; Female; Humans; Longitudinal strain; Male; Middle Aged; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - physiopathology; Predictive Value of Tests; Two-dimensional strain echocardiography
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.04.035

Abstract Introduction Two-dimensional strain echocardiography (2D-SE) quantifies left ventricular global longitudinal strain (GLS) and global circumferential strain (GCS). Our aim was to test 2D-SE during Dipyridamole Stress Echocardiography (Dipy-Stress) in patients with non-diagnostic result, checking by way of coronary CT angiography (CCTA) the possible presence of coronary artery disease (CAD). Methods Over twenty-four months 65 consecutive patients with non-diagnostic Dipy-Stress were studied by 2D-SE and by CCTA. GCS and GLS at rest and after stress were compared according to data derived from CCTA. CAD was graded as significant (stenosis ≥ 50%), mild (stenosis between 15 and 50%) or absent (stenosis < 15%). CCTA was defined as “positive” in presence of mild CAD and “negative” in absence of stenoses. Furthermore, Δ strain was defined as follows: [(stressS - restS)/restS] X 100. Results GCS at rest and after stress was similar in CCTA-positive (26 ± 5% and 27 ± 5% respectively) and CCTA-negative groups (27 ± 3% and 28 ± 3% respectively). GLS at rest was significantly reduced (P < 0.0001) in CCTA-positive (23 ± 3%) compared to CCTA-negative group (25 ± 2%). GLS after stress was lower (P < 0.0001) in CCTA-positive group (20 ± 3%) than CCTA-negative one (26 ± 2%). A significant reduction (P < 0.0001) of GLS at rest versus after stress was found in positive-CCTA group. ΔGLS showed a significant decrease (P < 0.0001) in CCTA-positive (− 10 ± 8%) compared to CCTA-negative (4.4 ± 5.8%) group. ROC analysis of ΔGLS showed high accuracy (area under the ROC curve 0.916, 95%CI: 0.820–0.970) in distinguishing positive and negative CCTA groups. Conclusions 2D-SE during Dipy-Stress allows, in case of non-diagnostic test, identification of mild-CAD with high sensitivity and specificity.