Quantitative Assessment of Strain and Strain Rate by Velocity Vector Imaging During Dobutamine Stress Echocardiography to Predict Outcome in Patients With Left Bundle Branch Block

Ying Shan, Hector R Vilarraga, Cristina D Pislaru, Aijaz A. Shah, Stephen S. Cha, Patricia Pellikka

Research output: Contribution to journalArticle

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Abstract

Background: Abnormal septal motion in left bundle branch block (LBBB) may compromise the interpretation of regional wall motion. Velocity vector imaging (VVI) has been proposed as an objective method to quantify regional myocardial deformation. The aim of this study was to determine whether VVI during dobutamine stress echocardiography (DSE) has prognostic value in patients with LBBB. Methods: In 84 patients with (mean age, 75 ± 9 years) undergoing DSE, longitudinal peak systolic strain (ε{lunate}sys) and strain rate (SRsys) were measured in 16 segments using VVI. Results were expressed as average SRsys and ε{lunate}sys per patient. Follow-up was obtained for the combined endpoint of mortality, myocardial infarction, and coronary revascularization. Contributions of clinical, conventional dobutamine stress echocardiographic, and ε{lunate}sys and SRsys variables to outcome were assessed using Cox models. Results: During a mean follow-up period of 18.3 ± 13.8 months, 23 patients had endpoints. Wall motion score index at rest was the only independent predictor in a model combining clinical and conventional dobutamine stress echocardiographic variables. However, when ε{lunate}sys and SRsys variables were considered, average SRsys at peak stress (hazard ratio, 2.38 per 0.2/s increment; 95% confidence interval, 1.53-3.88; P < .0001) became the only independent predictor of outcome. Using average SRsys at peak of -0.5/s as the cut point maximized the model χ2 value for the prediction of outcomes (model χ2 = 18.71, P = .002). The annualized event-free survival in patients with average SRsys at peak stress lower and higher than -0.5/s were 89.9% and 45.9%, respectively (P < .0001). Conclusion: Average SRsys at peak stress during DSE offers prognostic information incremental to wall motion analysis in patients with LBBB.

Original languageEnglish (US)
Pages (from-to)1212-1219
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume22
Issue number11
DOIs
StatePublished - Nov 2009

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Stress Echocardiography
Bundle-Branch Block
Dobutamine
Proportional Hazards Models
Disease-Free Survival
Myocardial Infarction
Confidence Intervals
Mortality

Keywords

  • Dobutamine
  • Left bundle branch block
  • Strain rate imaging
  • Stress echocardiography
  • Velocity vector imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

@article{12fec510001943d29a455dcd3d71bc6e,
title = "Quantitative Assessment of Strain and Strain Rate by Velocity Vector Imaging During Dobutamine Stress Echocardiography to Predict Outcome in Patients With Left Bundle Branch Block",
abstract = "Background: Abnormal septal motion in left bundle branch block (LBBB) may compromise the interpretation of regional wall motion. Velocity vector imaging (VVI) has been proposed as an objective method to quantify regional myocardial deformation. The aim of this study was to determine whether VVI during dobutamine stress echocardiography (DSE) has prognostic value in patients with LBBB. Methods: In 84 patients with (mean age, 75 ± 9 years) undergoing DSE, longitudinal peak systolic strain (ε{lunate}sys) and strain rate (SRsys) were measured in 16 segments using VVI. Results were expressed as average SRsys and ε{lunate}sys per patient. Follow-up was obtained for the combined endpoint of mortality, myocardial infarction, and coronary revascularization. Contributions of clinical, conventional dobutamine stress echocardiographic, and ε{lunate}sys and SRsys variables to outcome were assessed using Cox models. Results: During a mean follow-up period of 18.3 ± 13.8 months, 23 patients had endpoints. Wall motion score index at rest was the only independent predictor in a model combining clinical and conventional dobutamine stress echocardiographic variables. However, when ε{lunate}sys and SRsys variables were considered, average SRsys at peak stress (hazard ratio, 2.38 per 0.2/s increment; 95{\%} confidence interval, 1.53-3.88; P < .0001) became the only independent predictor of outcome. Using average SRsys at peak of -0.5/s as the cut point maximized the model χ2 value for the prediction of outcomes (model χ2 = 18.71, P = .002). The annualized event-free survival in patients with average SRsys at peak stress lower and higher than -0.5/s were 89.9{\%} and 45.9{\%}, respectively (P < .0001). Conclusion: Average SRsys at peak stress during DSE offers prognostic information incremental to wall motion analysis in patients with LBBB.",
keywords = "Dobutamine, Left bundle branch block, Strain rate imaging, Stress echocardiography, Velocity vector imaging",
author = "Ying Shan and Vilarraga, {Hector R} and Pislaru, {Cristina D} and Shah, {Aijaz A.} and Cha, {Stephen S.} and Patricia Pellikka",
year = "2009",
month = "11",
doi = "10.1016/j.echo.2009.07.011",
language = "English (US)",
volume = "22",
pages = "1212--1219",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
publisher = "Mosby Inc.",
number = "11",

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TY - JOUR

T1 - Quantitative Assessment of Strain and Strain Rate by Velocity Vector Imaging During Dobutamine Stress Echocardiography to Predict Outcome in Patients With Left Bundle Branch Block

AU - Shan, Ying

AU - Vilarraga, Hector R

AU - Pislaru, Cristina D

AU - Shah, Aijaz A.

AU - Cha, Stephen S.

AU - Pellikka, Patricia

PY - 2009/11

Y1 - 2009/11

N2 - Background: Abnormal septal motion in left bundle branch block (LBBB) may compromise the interpretation of regional wall motion. Velocity vector imaging (VVI) has been proposed as an objective method to quantify regional myocardial deformation. The aim of this study was to determine whether VVI during dobutamine stress echocardiography (DSE) has prognostic value in patients with LBBB. Methods: In 84 patients with (mean age, 75 ± 9 years) undergoing DSE, longitudinal peak systolic strain (ε{lunate}sys) and strain rate (SRsys) were measured in 16 segments using VVI. Results were expressed as average SRsys and ε{lunate}sys per patient. Follow-up was obtained for the combined endpoint of mortality, myocardial infarction, and coronary revascularization. Contributions of clinical, conventional dobutamine stress echocardiographic, and ε{lunate}sys and SRsys variables to outcome were assessed using Cox models. Results: During a mean follow-up period of 18.3 ± 13.8 months, 23 patients had endpoints. Wall motion score index at rest was the only independent predictor in a model combining clinical and conventional dobutamine stress echocardiographic variables. However, when ε{lunate}sys and SRsys variables were considered, average SRsys at peak stress (hazard ratio, 2.38 per 0.2/s increment; 95% confidence interval, 1.53-3.88; P < .0001) became the only independent predictor of outcome. Using average SRsys at peak of -0.5/s as the cut point maximized the model χ2 value for the prediction of outcomes (model χ2 = 18.71, P = .002). The annualized event-free survival in patients with average SRsys at peak stress lower and higher than -0.5/s were 89.9% and 45.9%, respectively (P < .0001). Conclusion: Average SRsys at peak stress during DSE offers prognostic information incremental to wall motion analysis in patients with LBBB.

AB - Background: Abnormal septal motion in left bundle branch block (LBBB) may compromise the interpretation of regional wall motion. Velocity vector imaging (VVI) has been proposed as an objective method to quantify regional myocardial deformation. The aim of this study was to determine whether VVI during dobutamine stress echocardiography (DSE) has prognostic value in patients with LBBB. Methods: In 84 patients with (mean age, 75 ± 9 years) undergoing DSE, longitudinal peak systolic strain (ε{lunate}sys) and strain rate (SRsys) were measured in 16 segments using VVI. Results were expressed as average SRsys and ε{lunate}sys per patient. Follow-up was obtained for the combined endpoint of mortality, myocardial infarction, and coronary revascularization. Contributions of clinical, conventional dobutamine stress echocardiographic, and ε{lunate}sys and SRsys variables to outcome were assessed using Cox models. Results: During a mean follow-up period of 18.3 ± 13.8 months, 23 patients had endpoints. Wall motion score index at rest was the only independent predictor in a model combining clinical and conventional dobutamine stress echocardiographic variables. However, when ε{lunate}sys and SRsys variables were considered, average SRsys at peak stress (hazard ratio, 2.38 per 0.2/s increment; 95% confidence interval, 1.53-3.88; P < .0001) became the only independent predictor of outcome. Using average SRsys at peak of -0.5/s as the cut point maximized the model χ2 value for the prediction of outcomes (model χ2 = 18.71, P = .002). The annualized event-free survival in patients with average SRsys at peak stress lower and higher than -0.5/s were 89.9% and 45.9%, respectively (P < .0001). Conclusion: Average SRsys at peak stress during DSE offers prognostic information incremental to wall motion analysis in patients with LBBB.

KW - Dobutamine

KW - Left bundle branch block

KW - Strain rate imaging

KW - Stress echocardiography

KW - Velocity vector imaging

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