2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left ventricular function

A case-control study

Ryan T. Hubbard, Maria C. Arciniegas Calle, Sergio Barros-Gomes, Joyce A. Kukuzke, Patricia Pellikka, Rajiv Gulati, Hector R Vilarraga

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Women who have coronary artery disease (CAD) often present with atypical symptoms that may lead to misdiagnosis. We assessed strain, systolic strain rate and left ventricular dyssynchrony with 2- dimensional- speckle tracking echocardiography to evaluate its use as a non-invasive method for detecting CAD in women with normal ejection fraction compared with healthy women controls with a normal angiogram. Methods: We included 35 women with CAD confirmed by coronary angiography and a positive exercise stress echocardiography and 35 women in a control group with a low pretest probability of CAD, normal angiogram and a normal stress echocardiography with normal EF. Results: Statistically significant 2D-STE findings for the CAD vs control groups were as follows for the mean of: global circumferential strain (CS) (-19.4% vs -22.4%, P = .02); global radial S (49% vs 34%, P = .03); global radial SR (2.4 s-1 vs 1.9 s-1, P = .05); global longitudinal LV S (GLS) (-14.3% vs -17.2%, P < .001). For mechanical dyssynchrony, SD of the GLS time-to-peak (TTP) was computed (99 vs 33 ms, P < .001). The receiver operating characteristic and area under the curve (AUC) were calculated. A cutoff value of 45 ms for 1 SD of the longitudinal S TTP had 97% sensitivity and 89% specificity (AUC, 0.96). GLS cutoff value of -15.87% had 71% sensitivity and 74% specificity; AUC, 0.74 in differentiating CAD and control groups. The combined GLS, CS, and SD of the longitudinal S TTP had an AUC of 0.96 (sensitivity 97%, specificity 86%). Interclass correlations of the GLS segment and GLS TTP measurements were 0.49 (95% CI, 0.227-0.868) and 0.74 (95% CI, 0.277-0.926), respectively. Conclusion: In women with a normal echocardiogram and LVEF, CAD can be identified by dyssynchrony and abnormal strain values, as evidenced by 2D-STE.

Original languageEnglish (US)
Article number231
JournalBMC Cardiovascular Disorders
Volume17
Issue number1
DOIs
StatePublished - Aug 24 2017

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Left Ventricular Function
Echocardiography
Case-Control Studies
Coronary Artery Disease
Area Under Curve
Stress Echocardiography
Sensitivity and Specificity
Control Groups
Angiography
Diagnostic Errors
Coronary Angiography
ROC Curve
Exercise

Keywords

  • 2D-STE
  • Coronary artery disease in women
  • Dyssynchrony
  • Normal ejection fraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left ventricular function : A case-control study. / Hubbard, Ryan T.; Arciniegas Calle, Maria C.; Barros-Gomes, Sergio; Kukuzke, Joyce A.; Pellikka, Patricia; Gulati, Rajiv; Vilarraga, Hector R.

In: BMC Cardiovascular Disorders, Vol. 17, No. 1, 231, 24.08.2017.

Research output: Contribution to journalArticle

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abstract = "Background: Women who have coronary artery disease (CAD) often present with atypical symptoms that may lead to misdiagnosis. We assessed strain, systolic strain rate and left ventricular dyssynchrony with 2- dimensional- speckle tracking echocardiography to evaluate its use as a non-invasive method for detecting CAD in women with normal ejection fraction compared with healthy women controls with a normal angiogram. Methods: We included 35 women with CAD confirmed by coronary angiography and a positive exercise stress echocardiography and 35 women in a control group with a low pretest probability of CAD, normal angiogram and a normal stress echocardiography with normal EF. Results: Statistically significant 2D-STE findings for the CAD vs control groups were as follows for the mean of: global circumferential strain (CS) (-19.4{\%} vs -22.4{\%}, P = .02); global radial S (49{\%} vs 34{\%}, P = .03); global radial SR (2.4 s-1 vs 1.9 s-1, P = .05); global longitudinal LV S (GLS) (-14.3{\%} vs -17.2{\%}, P < .001). For mechanical dyssynchrony, SD of the GLS time-to-peak (TTP) was computed (99 vs 33 ms, P < .001). The receiver operating characteristic and area under the curve (AUC) were calculated. A cutoff value of 45 ms for 1 SD of the longitudinal S TTP had 97{\%} sensitivity and 89{\%} specificity (AUC, 0.96). GLS cutoff value of -15.87{\%} had 71{\%} sensitivity and 74{\%} specificity; AUC, 0.74 in differentiating CAD and control groups. The combined GLS, CS, and SD of the longitudinal S TTP had an AUC of 0.96 (sensitivity 97{\%}, specificity 86{\%}). Interclass correlations of the GLS segment and GLS TTP measurements were 0.49 (95{\%} CI, 0.227-0.868) and 0.74 (95{\%} CI, 0.277-0.926), respectively. Conclusion: In women with a normal echocardiogram and LVEF, CAD can be identified by dyssynchrony and abnormal strain values, as evidenced by 2D-STE.",
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T1 - 2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left ventricular function

T2 - A case-control study

AU - Hubbard, Ryan T.

AU - Arciniegas Calle, Maria C.

AU - Barros-Gomes, Sergio

AU - Kukuzke, Joyce A.

AU - Pellikka, Patricia

AU - Gulati, Rajiv

AU - Vilarraga, Hector R

PY - 2017/8/24

Y1 - 2017/8/24

N2 - Background: Women who have coronary artery disease (CAD) often present with atypical symptoms that may lead to misdiagnosis. We assessed strain, systolic strain rate and left ventricular dyssynchrony with 2- dimensional- speckle tracking echocardiography to evaluate its use as a non-invasive method for detecting CAD in women with normal ejection fraction compared with healthy women controls with a normal angiogram. Methods: We included 35 women with CAD confirmed by coronary angiography and a positive exercise stress echocardiography and 35 women in a control group with a low pretest probability of CAD, normal angiogram and a normal stress echocardiography with normal EF. Results: Statistically significant 2D-STE findings for the CAD vs control groups were as follows for the mean of: global circumferential strain (CS) (-19.4% vs -22.4%, P = .02); global radial S (49% vs 34%, P = .03); global radial SR (2.4 s-1 vs 1.9 s-1, P = .05); global longitudinal LV S (GLS) (-14.3% vs -17.2%, P < .001). For mechanical dyssynchrony, SD of the GLS time-to-peak (TTP) was computed (99 vs 33 ms, P < .001). The receiver operating characteristic and area under the curve (AUC) were calculated. A cutoff value of 45 ms for 1 SD of the longitudinal S TTP had 97% sensitivity and 89% specificity (AUC, 0.96). GLS cutoff value of -15.87% had 71% sensitivity and 74% specificity; AUC, 0.74 in differentiating CAD and control groups. The combined GLS, CS, and SD of the longitudinal S TTP had an AUC of 0.96 (sensitivity 97%, specificity 86%). Interclass correlations of the GLS segment and GLS TTP measurements were 0.49 (95% CI, 0.227-0.868) and 0.74 (95% CI, 0.277-0.926), respectively. Conclusion: In women with a normal echocardiogram and LVEF, CAD can be identified by dyssynchrony and abnormal strain values, as evidenced by 2D-STE.

AB - Background: Women who have coronary artery disease (CAD) often present with atypical symptoms that may lead to misdiagnosis. We assessed strain, systolic strain rate and left ventricular dyssynchrony with 2- dimensional- speckle tracking echocardiography to evaluate its use as a non-invasive method for detecting CAD in women with normal ejection fraction compared with healthy women controls with a normal angiogram. Methods: We included 35 women with CAD confirmed by coronary angiography and a positive exercise stress echocardiography and 35 women in a control group with a low pretest probability of CAD, normal angiogram and a normal stress echocardiography with normal EF. Results: Statistically significant 2D-STE findings for the CAD vs control groups were as follows for the mean of: global circumferential strain (CS) (-19.4% vs -22.4%, P = .02); global radial S (49% vs 34%, P = .03); global radial SR (2.4 s-1 vs 1.9 s-1, P = .05); global longitudinal LV S (GLS) (-14.3% vs -17.2%, P < .001). For mechanical dyssynchrony, SD of the GLS time-to-peak (TTP) was computed (99 vs 33 ms, P < .001). The receiver operating characteristic and area under the curve (AUC) were calculated. A cutoff value of 45 ms for 1 SD of the longitudinal S TTP had 97% sensitivity and 89% specificity (AUC, 0.96). GLS cutoff value of -15.87% had 71% sensitivity and 74% specificity; AUC, 0.74 in differentiating CAD and control groups. The combined GLS, CS, and SD of the longitudinal S TTP had an AUC of 0.96 (sensitivity 97%, specificity 86%). Interclass correlations of the GLS segment and GLS TTP measurements were 0.49 (95% CI, 0.227-0.868) and 0.74 (95% CI, 0.277-0.926), respectively. Conclusion: In women with a normal echocardiogram and LVEF, CAD can be identified by dyssynchrony and abnormal strain values, as evidenced by 2D-STE.

KW - 2D-STE

KW - Coronary artery disease in women

KW - Dyssynchrony

KW - Normal ejection fraction

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