Speckle tracking echocardiography derived systolic longitudinal strain is better than rest single photon emission tomography perfusion imaging for nonviable myocardium identification

The detection of viable myocardium by low-dose dobutamine stress speckle tracking echocardiography in patients with old myocardial infarction

PURPOSE

To explore the significance and value of speckle-tracking echocardiography (STE) associated with low-dose dobutamine stress echocardiography (LDDSE) for the detection of viable myocardium (VM) in patients with old myocardial infarction (OMI).

METHODS

We performed STE with LDDSE in 33 hospitalized patients with OMI and left ventricular systolic dysfunction. QLAB software was used to analyze strain (S) and strain rate (Sr). Percutaneous coronary intervention (PCI) was subsequently performed. The movement of each wall segment was observed by routine echocardiography before and after 1, 3, and 6 months of PCI, and improvement was regarded as the gold standard for diagnosing VM.

RESULTS

Compared with semi-quantitative wall-motion analysis combined with LDDSE, the sensitivity, specificity, and accuracy of c-STE (combining the three directions of S and Sr) at LDDSE were 91.6%, 79.5%, and 87.5%, respectively (p < 0.02). Among the deformation parameters, longitudinal strain (LS) and longitudinal strain rate (LSr) had the highest sensitivity, specificity, and accuracy. Upon combining LS and LSr at LDDSE to parallel tests, the sensitivity, specificity, and accuracy were 91.7%, 90%, and 90.6%, respectively. Compared with baseline, LVEF after PCI increased from 43.3% ± 2.6% to 47.3% ± 2.9% (p < 0.001).

CONCLUSIONS

Global strain at LDDSE is superior to semi-quantitative wall-motion analysis with LDDSE for the assessment of VM. When the multivariable analysis and the parallel tests are combined, LS combined with LSr can be considered an independent predictor of VM. LVEF is improved after PCI in patients with VM and OMI. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:545-554, 2016.