2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left ventricular function: a case-control study.

BACKGROUND: Women who have coronary artery disease (CAD) often present with atypical symptoms that may lead to misdiagnosis. We assessed strain, systolic strain rate and left ventricular dyssynchrony with 2- dimensional- speckle tracking echocardiography to evaluate its use as a non-invasive method for detecting CAD in women with normal ejection fraction compared with healthy women controls with a normal angiogram. METHODS: We included 35 women with CAD confirmed by coronary angiography and a positive exercise stress echocardiography and 35 women in a control group with a low pretest probability of CAD, normal angiogram and a normal stress echocardiography with normal EF. RESULTS: Statistically significant 2D-STE findings for the CAD vs control groups were as follows for the mean of: global circumferential strain (CS) (-19.4% vs -22.4%, P = .02); global radial S (49% vs 34%, P = .03); global radial SR (2.4 s-1 vs 1.9 s-1, P = .05); global longitudinal LV S (GLS) (-14.3% vs -17.2%, P < .001). For mechanical dyssynchrony, SD of the GLS time-to-peak (TTP) was computed (99 vs 33 ms, P < .001). The receiver operating characteristic and area under the curve (AUC) were calculated. A cutoff value of 45 ms for 1 SD of the longitudinal S TTP had 97% sensitivity and 89% specificity (AUC, 0.96). GLS cutoff value of -15.87% had 71% sensitivity and 74% specificity; AUC, 0.74 in differentiating CAD and control groups. The combined GLS, CS, and SD of the longitudinal S TTP had an AUC of 0.96 (sensitivity 97%, specificity 86%). Interclass correlations of the GLS segment and GLS TTP measurements were 0.49 (95% CI, 0.227-0.868) and 0.74 (95% CI, 0.277-0.926), respectively. CONCLUSION: In women with a normal echocardiogram and LVEF, CAD can be identified by dyssynchrony and abnormal strain values, as evidenced by 2D-STE.

Role of biplane and biplane echocardiographically guided 3-dimensional echocardiography during dobutamine stress echocardiography.

Image acquisition time and wall-motion score of conventional 2-dimensional (2D) dobutamine stress echocardiography (DSE) were compared with those of biplane and 3-dimensional (3D) DSE in 50 patients (age 67 +/- 13 years) with regular rhythms during clinically indicated DSE. Commercially available systems were used for the study. We used a conventional transducer for 2D and a matrix-array transducer (x4 or x3-1) for two biplane (60- and 120-degree) images and one 3D full-volume image. Image quality was scored as 1 = good; 2 = adequate; and 3 = inadequate. Segmental wall-motion scores for each method were analyzed in blinded fashion. Acquisition times of biplane (9.3 +/- 2.8 seconds) and biplane-guided 3D (additional 2.6 +/- 1.0 seconds) echocardiography were significantly shorter than those of conventional 2D DSE (60.0 +/- 26.7 seconds) (P < .001). Image quality was adequate or good in 94% for biplane and 96% for 3D echocardiography. Agreement of segmental wall-motion score was present in 87.6% of segments for 2D versus biplane and 85.9% for 2D versus 3D at baseline and in 88.0% for 2D versus biplane and 87.4% for 2D versus 3D at peak stress. Acquisition of biplane or biplane-guided 3D volumetric data during DSE with use of a new matrix-array transducer was feasible and shortened image acquisition time without affecting the diagnostic yield compared with conventional 2D imaging.