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(Circulation. 2007;115:1252-1259.)
© 2007 American Heart Association, Inc.

Imaging

Incremental Value of Strain Rate Imaging to Wall Motion Analysis for Prediction of Outcome in Patients Undergoing Dobutamine Stress Echocardiography

Charlotte Bjork Ingul, MD; Ellen Rozis, MD; Stig A. Slordahl, PhD; Thomas H. Marwick, MD, PhD

From the University of Queensland, Brisbane, Australia (C.B.I., E.R., T.H.M.), and the Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway (S.A.S.).

Correspondence to Thomas H. Marwick, MD, PhD, University of Queensland, Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia. E-mail tmarwick{at}soms.uq.edu.au

Received May 24, 2006; accepted November 10, 2006.

Background— Wall motion score at dobutamine stress echocardiography is an independent predictor of mortality. We sought to determine whether quantification of DSE by strain rate imaging was incremental to wall motion score for predicting outcome.

Methods and Results— In 646 patients undergoing dobutamine stress echocardiography for the evaluation of known or suspected coronary disease, customized software was used to automatically measure peak systolic strain rate (SR_s) and end-systolic strain (S_es) in 18 segments. Results were expressed as the number of abnormal segments and the mean SR_s and S_es per patient. All-cause mortality was identified over 7 years of follow-up (mean, 5.2±1.5 years). Contributions of clinical, wall motion, and SR_s and S_es data to outcome were analyzed with Cox models, which also were used to define cut points for SR_s and S_es. Ischemia (new or worsening wall motion abnormalities) was detected in 45%, and 39% had a previous myocardial infarction. In patients with no ischemia, annualized mortality without and with previous myocardial infarction were 2% and 3% compared with 5% in patients with ischemia. Peak wall motion score index, mean SR_s, segmental S_es, and segmental SR_s were all predictors of mortality, but only segmental SR_s (hazard ratio, 3.6; 95% CI, 1.7 to 7.2) was independently predictive. In sequential Cox models, the model based on clinical data (overall ², 12.7) was improved by peak wall motion score index (18.4, P=0.002) and further increased by either segmental SR_s (31.8, P<0.001) or mean SR_s (25.7, P=0.009).

Conclusions— Segmental analysis by SR_s, derived from automated strain rate imaging analysis of dobutamine stress echocardiography response, offers prognostic information that is independent and incremental to standard wall motion score index.

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