Two-dimensional speckle tracking echocardiography derived post systolic shortening in patients with unstable angina and normal left ventricular systolic function.

OBJECTIVES: Post systolic shortening (PSS) had been shown to be sensitive in detecting ischemia on stress echocardiography. This work aims to study the diagnostic potential of resting PSS and post systolic index (PSI) in patients with suspected unstable angina (UA). METHODS: Total of 159 participants with suspected UA without any wall motion abnormalities were recruited. They all underwent speckle tracking echocardiography (STE) and coronary angiogram (CAG). Global longitudinal strain (GLS), presence or absence of pathological PSS, PSI17 and PSI12, PSI in left anterior descending, left circumflex and right coronary artery territories were assessed. Based on CAG those who had more than 70% stenosis were labelled to have obstructive CAD. RESULTS: Obstructive disease was noted in 54.7% patients. The prevalence of PSS (62.1% Vs 13.9%), mean PSI17 (5.4 Vs 3.3) and PSI12 (6.2 Vs 3.7) were significantly higher in those with CAD compared to patients without obstructive disease. Both PSS (Odds ratio-10.145; 95% CI, 4.577-22.489; p=0.001) and PSI17 (odds ratio-1.217;95 CI, 1.064-1.393; p=0.004) were predictors of CAD by multivariate regression analysis. PSS had a sensitivity of 62.1% and specificity of 86.1% with a positive predictive value of 84.4%. PSI17 (area under curve- 0.637; p=0.003) and PSI12 (AUC- 0.661; p=0.001) have moderate accuracy in identifying obstructive CAD. CONCLUSION: In patients presenting with suspected UA, STE derived PSS has reasonable sensitivity and good specificity in diagnosis of obstructive CAD. Patients identified to have PSS can be subjected to CAG without further stress testing because of its high positive predictive value.

Assessment of Pulmonary Artery Pressures by Various Doppler Echocardiographic Parameters and its Correlation with Cardiac Catheterization in Patients with Pulmonary Hypertension.

BACKGROUND: Measuring pulmonary artery pressures is a routine index in Doppler echocardiography to diagnose, risk stratify, and prognosticate patients with pulmonary hypertension (PH). There are numerous methods in use to measure it in routine clinical practice. OBJECTIVE: The objective of this study was to assess the correlation between the commonly used Doppler-derived parameters such as tricuspid regurgitation (TR)-derived systolic pulmonary artery pressure (SPAP), pulmonary regurgitation (PR)-derived mean pulmonary artery pressure (MPAP), and right ventricular outflow tract acceleration time (RVOT AcT) with right heart catheterization (RHC) data which are the gold standard. MATERIALS AND METHODS: In this analytical study, we prospectively measured echo and angiogram parameters such as TR-derived SPAP, PR-derived MPAP, and RVOT AcT and studied its association with RHC data of thirty patients for a span of 2 years. Right ventricular AcT was also included in the study. Their relationship was displayed using Bland-Altman scatter plots. P < 0.05 was considered as statistically significant. RESULTS: Although both TR-derived SPAP and PR-derived MPAP had a moderate correlation with RHC-acquired data, the agreement between them was poor. RVOT AcT showed a strong inverse correlation with invasive MPAP. CONCLUSION: Among the three Doppler methods that were assessed to measure pulmonary pressures, RVOT AcT had a strong correlation with MPAP. RVOT AcT of <80 ms had a high sensitivity to detect severe PH (defined as MPAP >45 mmHg). Hence, it is recommended to include AcT as a routine measure in the armamentarium of echocardiographic parameters used in patients with PH.