Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana.
Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana; Loyola University Medical Center, Division of Cardiology, Maywood, Illinois.
J Am Soc Echocardiogr. 2023 Aug;36(8):832-840. doi: 10.1016/j.echo.2023.02.010. Epub 2023 Feb 23.
Dobutamine stress echocardiography (DSE) remains a widely used method for detection of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) despite low sensitivity. Speckle-tracking assessment of strain may enhance the sensitivity of DSE in the general population, but the value of strain analysis in ESLD is unknown.
Dobutamine stress echocardiography with two-dimensional speckle-tracking and quantitative coronary angiography were performed in 146 patients with ESLD. Thirty-six patients (25%) had CAD (≥50% diameter stenosis of a major vessel). Global longitudinal strain at rest (GLSr) and at peak stress (GLSp) and an index of postsystolic (PSSi) shortening ([maximal extent of shortening - extent of shortening in systole]/[extent of shortening in systole]) were determined. A PSSi of ≥ 0.25 was considered evidence for CAD. Receiver operating characteristic analysis was used to determine the optimal thresholds of GLSr and GLSp for CAD and to assess the diagnostic performance of visual assessment of wall motion (WMA) and strain parameters. The sensitivity and specificity of WMA, GLSr, GLSp, and PSSi were compared.
Thirty-six patients (25%) had significant CAD. The areas under the curve for WMA, GLSr, GLSp, and PSSi were 0.60, 0.72, 0.68, and 0.78, respectively. Visual assessment of wall motion had a sensitivity of 28%. The sensitivity of each of the strain parameters, GLSr (53%, P = .016), GLSp (69%, P = .004), and PSSi (78%, P < .001), exceeded the sensitivity for WMA. Visual assessment of wall motion specificity was 92%, which exceeded the specificity for each of the strain parameters (GLSr = 82%, P = .037; GLSp = 63%, P < .001; and PSSi =78%, P = .009). Of the strain parameters, PSSi had the best balance between sensitivity and specificity (both 78%).
Assessment of GLS and PSSi with DSE yields better sensitivity than WMA in ELSD patients. Index of postsystolic shortening had the best diagnostic performance of all parameters in this population with a low prevalence of CAD.
尽管多巴酚丁胺负荷超声心动图（DSE）的敏感性较低，但它仍然是一种广泛用于检测终末期肝病（ESLD）患者冠心病（CAD）的方法。应变的斑点追踪评估可能会提高一般人群中 DSE 的敏感性，但应变分析在 ESLD 中的价值尚不清楚。
对 146 例 ESLD 患者进行 DSE 二维斑点追踪和定量冠状动脉造影检查。36 例患者（25%）患有 CAD（≥50%主要血管狭窄）。静息时（GLSr）和峰值负荷时（GLSp）的整体纵向应变以及收缩后（PSSi）缩短指数（[最大缩短程度-收缩期缩短程度]/[收缩期缩短程度]）。PSSi ≥ 0.25 被认为有 CAD 的证据。使用接收者操作特征分析确定 GLSr 和 GLSp 对 CAD 的最佳阈值，并评估壁运动（WMA）和应变参数的视觉评估的诊断性能。比较了 WMA、GLSr、GLSp 和 PSSi 的敏感性和特异性。
36 例患者（25%）患有显著 CAD。WMA、GLSr、GLSp 和 PSSi 的曲线下面积分别为 0.60、0.72、0.68 和 0.78。壁运动的视觉评估敏感性为 28%。每个应变参数的敏感性，GLSr（53%，P=0.016）、GLSp（69%，P=0.004）和 PSSi（78%，P<0.001），均高于 WMA 的敏感性。壁运动的视觉评估特异性为 92%，超过了每个应变参数的特异性（GLSr=82%，P=0.037；GLSp=63%，P<0.001；PSSi=78%，P=0.009）。在应变参数中，PSSi 的敏感性和特异性之间具有最佳的平衡（均为 78%）。
在 ESLD 患者中，与 WMA 相比，DSE 评估 GLS 和 PSSi 可提高敏感性。在 CAD 患病率较低的人群中，收缩后缩短指数是所有参数中诊断性能最佳的参数。
