Abstract 12513: Assessment of Coronary Artery Disease With Real Time Three-Dimensional Speckle Tracking Stress Echocardiography With Adenosine: A Comparative Study With Thallium Scintigraphy and Coronary Angiography
Background: Stress echocardiography with adenosine is not routinely used for assessment of coronary artery disease (CAD) because of insufficient accuracy. Visual estimation of dyssynchrony with 2 dimensional echocardiography is often difficult because delays ≤ 70 ms cannot be detected with human eyes. Left ventricular (LV) time-strain curves from 3-dimensional speckle tracking echocardiography (3D-STE) (Siemens Medical Solutions) have a major advantage as LV dyssynchrony can be obtained from one heart cycle at volumes rates of 40-70vps. We evaluated the usefulness of stress 3D-STE for detection of CAD by comparison with scintigraphy and angiography.
Methods: We performed 3D-STE and scintigraphy at rest and stress with adenosine before angiography in 62 patients with suspected CAD. 3D-STE from apical view can automatically divide LV into 16 segments and provide time-radial, circumferential and longitudinal strain curves for all 16 segments and detect post systolic shortening. CAD assessed by 3D-STE was defined by the quantitative analysis based on the dispersion of time from the average of peak strain to peak strain> 70ms (dispersion 70) in more than at least 1 segment of any direction on time-strain curve during stress. Coronary angiography was the reference standard and stenosis ≥75% was considered significant. Vasospastic angina was excluded from analysis.
Results: 60 images suitable for analysis (feasibility; 97%). The prevalence of CAD was 72%. Time dispersion of strain in CAD during stress was increased over 70ms compared to normal. The sensitivity (76% for echo vs. 66% for Scintigraphy), specificity (95% vs. 84%), PPV (97% vs. 90%) and NPV (64% vs. 53%) for detection of CAD were better in stress 3D-STE than scintigraphy. The ability to detect single-vessel disease by 3DSTE was high and similar to scintigraphy, but that of multi-vessel disease was low.
Conclusion: Evaluation of CAD using dispersion 70 of LV strain by stress 3D-STE as a novel technique to quantify LV dyssynchrony with high volume rate volume imaging confers favorable diagnostic accuracy in detection of CAD compared to scintigraphy and may be useful in the routine clinical setting for evaluation of patients with suspected CAD.
- © 2013 by American Heart Association, Inc.