Incremental value of strain rate analysis as an adjunct to wall-motion scoring for assessment of myocardial viability by dobutamine echocardiography: A follow-up study after revascularization

Hanekom, Lizelle, Jenkins, Carly, Jeffriess, Leanne, Case, Colin, Mundy, Julie, Hawley, Carmel and Marwick, Thomas H. (2005) Incremental value of strain rate analysis as an adjunct to wall-motion scoring for assessment of myocardial viability by dobutamine echocardiography: A follow-up study after revascularization. Circulation, 112 25: 3892-3900. doi:10.1161/CIRCULATIONAHA.104.489310


Author Hanekom, Lizelle
Jenkins, Carly
Jeffriess, Leanne
Case, Colin
Mundy, Julie
Hawley, Carmel
Marwick, Thomas H.
Title Incremental value of strain rate analysis as an adjunct to wall-motion scoring for assessment of myocardial viability by dobutamine echocardiography: A follow-up study after revascularization
Journal name Circulation   Check publisher's open access policy
ISSN 0009-7322
Publication date 2005
Sub-type Article (original research)
DOI 10.1161/CIRCULATIONAHA.104.489310
Volume 112
Issue 25
Start page 3892
End page 3900
Total pages 9
Place of publication Philadelphia
Publisher Lippincott Williams & Wilkins
Language eng
Subject 110201 Cardiology (incl. Cardiovascular Diseases)
Formatted abstract
Background -
Assessment of myocardial viability based on wall-motion scoring (WMS) during dobutamine echocardiography (DbE) is difficult and subjective. Strain-rate imaging (SRI) is quantitative, but its incremental value over WMS for prediction of functional recovery after revascularization is unclear.

Methods and Results -

DbE and SRI were performed in 55 stable patients ( mean age, 64 ± 10 years; mean ejection fraction, 36 ± 8%) with previous myocardial infarction. Viability was predicted by WMS if function augmented during low-dose DbE. SR, end-systolic strain (ESS), postsystolic strain (PSS), and timing parameters were analyzed at rest and with low-dose DbE in abnormal segments. Regional and global functional recovery was defined by side-by-side comparison of echocardiographic images before and 9 months after revascularization. Of 369 segments with abnormal resting function, 146 showed regional recovery. Compared with segments showing functional recovery, those that failed to recover had lower low-dose DbE SR, SR increment (ΔSR), ESS, and ESS increment (ΔESS) ( each P < 0.005). After optimal cutoffs for the strain parameters were defined, the sensitivity of low-dose DbE SR (78%, P = 0.3), ΔSR (80%, P = 0.1), ESS (75%, P = 0.6), and ΔESS (74%, P = 0.8) was better though not significantly different from WMS (73%). The specificity of WMS (77%) was similar to the SRI parameters. Combination of WMS and SRI parameters augmented the sensitivity for prediction of functional recovery above WMS alone (82% versus 73%, P = 0.015; area under the curve = 0.88 versus 0.73, P < 0.001), although specificities were comparable ( 80% versus 77%, P = 0.2).

Conclusions -

The measurement of low-dose DbE SR and ΔSR is feasible, and their combination with WMS assessment improves the sensitivity of viability assessment with DbE.
Keyword Cardiac & Cardiovascular Systems
Hematology
Peripheral Vascular Disease
heart failure
echocardiography
imaging
myocardial infarction
stress
Left-ventricular Function
Coronary-artery Disease
Closed-chest Pigs
Stress Echocardiography
Hibernating Myocardium
Doppler-echocardiography
Ischemic-myocardium
Systolic Function
Infarction
Accuracy
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Wed, 17 Oct 2007, 14:19:18 EST