Karolina Wella, Soesanto Amiliana Mardiani, Kuncoro B R M Ario Soeryo, Ariani Rina, Rudiktyo Estu, Sukmawan Renan
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar Hospital, Malang, Indonesia.
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
J Cardiovasc Echogr. 2023 Jan-Mar;33(1):17-21. doi: 10.4103/jcecho.jcecho_65_22. Epub 2023 May 29.
The relationship between visual assessment and longitudinal strain during dobutamine stress echocardiography (DSE) remains poorly investigated. This study assessed wall motion segments visually graded as normokinetic, hypokinetic, and akinetic at baseline and the peak of DSE and compared with longitudinal strain between segments with and without induced impaired contractility and improved contractility during DSE.
This study included 112 patients examined by DSE, consisting of 58 patients referred for diagnostic study and 54 patients referred for viability study. Regional left ventricular (LV) contractility was assessed visually and longitudinal strain was measured using echocardiography transthoracic.
At baseline, the strain of LV segments was -16.33 ± 6.26 in visually normokinetic, 13.05 ± 6.44 in visually hypokinetic, and -8.46 ± 5.69 in visually akinetic segments. During peak dose, the strain of LV segments was -15.37 ± 6.89 in visually normokinetic, -11.37 ± 5.11 in visually hypokinetic, and -7.37 ± 3.92 in visually akinetic segments. In segments with visually observed impaired contractility, the median longitudinal strain was significantly lower than in segments without impaired contractility. For segments with visually observed improved contractility, the median longitudinal strain was significantly higher than for segments without improved contractility. In diagnostic study, sensitivity of visual assessment for absolute decrease of >2% longitudinal strain was 77%, respectively. In the viability study, the sensitivity was 82% for an absolute decrease of ≥2% longitudinal strain.
There is good association between strain analysis value and visually assessed wall motion contractility.
多巴酚丁胺负荷超声心动图（DSE）期间视觉评估与纵向应变之间的关系仍未得到充分研究。本研究评估了在基线和DSE峰值时视觉分级为正常运动、运动减弱和无运动的室壁运动节段，并比较了DSE期间有和无收缩功能受损及收缩功能改善节段之间的纵向应变。
本研究纳入了112例行DSE检查的患者，其中58例因诊断性检查就诊，54例因存活心肌检查就诊。采用经胸超声心动图对左心室（LV）局部收缩功能进行视觉评估并测量纵向应变。
基线时，视觉评估为正常运动的LV节段应变值为-16.33±6.26，运动减弱节段为13.05±6.44，无运动节段为-8.46±5.69。峰值剂量时，视觉评估为正常运动的LV节段应变值为-15.37±6.89，运动减弱节段为-11.37±5.11，无运动节段为-7.37±3.92。在视觉观察到收缩功能受损的节段中，纵向应变中位数显著低于无收缩功能受损的节段。对于视觉观察到收缩功能改善的节段，纵向应变中位数显著高于无收缩功能改善的节段。在诊断性检查中，视觉评估对纵向应变绝对降低>2%的敏感性分别为77%。在存活心肌检查中，纵向应变绝对降低≥2%时敏感性为82%。
应变分析值与视觉评估的室壁运动收缩功能之间存在良好的相关性。
