Clinical Research
Cardiac Imaging
Automated Analysis of Myocardial Deformation at Dobutamine Stress Echocardiography: An Angiographic Validation

https://doi.org/10.1016/j.jacc.2007.01.059Get rights and content
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Objectives

We investigated the accuracy of automated analysis of myocardial deformation during dobutamine stress echocardiography (DSE).

Background

The time required for segmental measurement of strain rate imaging (SRI) limits its feasibility for quantification of DSE.

Methods

Myocardial deformation was assessed at DSE in 197 patients, 76 with and 61 without coronary artery disease (CAD) at angiography, and 60 at low risk of CAD. Automated deformation analysis was based on velocity gradient and segment length methods of measuring longitudinal motion within a region of interest tracked through the cardiac cycle. Results were compared with independent wall motion scoring (WMS). Patients were randomly divided; group A (n = 69) established optimal cutoffs for the parameters and group B (n = 68) tested their accuracy.

Results

The feasibility of WMS exceeded that of both SRI methods at rest and at peak stress. In group A, the area under the receiver-operating characteristics curve of the peak systolic strain rate was 0.90 by both methods, and the optimal cutoffs for detection of CAD were −1.3 (velocity gradient) and −1.2 s−1(segment length). The areas under the receiver-operating characteristics curves for end-systolic strain were less (0.87) by both methods, with respective cutoffs of 9% and 8%. In group B, the velocity and segment length methods had respective sensitivities of 87% and 84% for SR, and 87% and 88% for end-systolic strain. Both significantly exceeded that of WMS in the same group (75%).

Conclusions

Automated analysis of myocardial deformation at DSE is feasible and accurate, and may increase the sensitivity of expert conventional reading.

Abbreviations and Acronyms

AUC
area under the curve
CAD
coronary artery disease
CX
circumflex artery
DSE
dobutamine stress echocardiography
LAD
left anterior descending artery
PSI
post-systolic strain index
ROC
receiver-operating characteristic
S
strain
Ses
end-systolic strain
Sps
peak post-systolic strain
SR
strain rate
SRs
peak systolic strain rate
SRI
strain rate imaging
tSRs
time to peak systolic strain rate
WMS
wall motion score
WMSI
wall motion score index

Cited by (0)

This study was supported by grants from the Norwegian University of Science and Technology, Trondheim, Norway, and the National Health and Medical Research Council (project grant 210218), Canberra, Australia.

1

Dr. Stoylen has received honoraria from GE Vingmed for lecturing, and both centers involved in this study have joint research studies with General Electric Medical Systems.