J Cardiovasc Ultrasound.  2013 Dec;21(4):177-182. 10.4250/jcu.2013.21.4.177.

Accuracy of Two-Dimensional Speckle Tracking Echocardiography for the Detection of Significant Coronary Stenosis

• Anwar AM

• KMID: 2135416
• DOI: http://doi.org/10.4250/jcu.2013.21.4.177

Abstract

BACKGROUND
Visual assessment of wall motion abnormalities (WMA) by 2-dimensional echocardiography (2DE) is the most semi-quantitative method used to detect coronary artery disease (CAD), but it carries many limitations. Speckle tracking echocardiography (STE) overcomes these limitations and allows an objective quantification of myocardial deformation. The aim of the study to examine the accuracy of global and segmental longitudinal strain (LS) for the detection of CAD compared with visual assessment of WMA using coronary angiography as a golden standard.
METHODS
The study enrolled 25 patients (mean age 51.0 +/- 8.7, 64% are male) referred to coronary angiography with clinical suspicion of CAD. 2DE assessment of WMA and evaluation of LS using STE were performed using left ventricular 17-segments models. Significant CAD was defined as > or = 50% stenosis in one or more major coronary arteries by angiography.
RESULTS
Patients were classified into 2 groups: group I included 15 patients with significant CAD and group II included 10 patients with insignificant and/or absence of CAD. WM score was strongly correlated with the global LS in group I and II (R = 0.80, p < 0.0001 and R = 0.88, p < 0.0001 respectively). In all patients, 425 segments were analyzed. WMA was detected in 163 segments of 425 (38.3%) while abnormal LS was detected in 214 segments (50.3%). Compared with coronary angiography, the total sensitivity, specificity and accuracy for visual analysis and STE were (56%, 88.2%, and 60% vs. 68.6%, 77%, and 81.8% respectively).
CONCLUSION
Segmental LS is more accurate for the detection of ischemic myocardial segment corresponding to functionally relevant coronary anatomy than visual assessment of WM.

Keyword

Speckle tracking; Longitudinal strain; Wall motion abnormalities

MeSH Terms

Angiography
Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis*
Coronary Vessels
Echocardiography*
Humans
Methods
Sensitivity and Specificity
Track and Field*

Figure

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  Fig. 1 Segmental longitudinal strain displayed in 3 image planes: (A) apical 4-chamber, (B) apical 2-chamber and (C) apical long axis views

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  Fig. 2 Example of display of all left ventricular segments in bulle's eye view with the corresponding curves in normal subject

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  Fig. 3 Nomenclature of left ventricular myocardial segments with their distribution according to coronary artery territories. LAD: left anterior descending, RCA: right coronary artery, LCx: left circumflex.

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