G Dattilo1, E Imbalzano2, A Lamari3, M Casale2, N Paunovic4, P Busacca3, G Di Bella2. 1. Department of Clinical and Experimental Medicine, University of Messina, Italy; U.O. of UTIC and Cardiology, Hospital of Urbino, Asur Marche, Italy. Electronic address: giu.dattilo@libero.it. 2. Department of Clinical and Experimental Medicine, University of Messina, Italy. 3. U.O. of UTIC and Cardiology, Hospital of Urbino, Asur Marche, Italy. 4. Railway Health Care Institute, Belgrade, Serbia.
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]×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.
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]×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.