PRECLINICAL RESEARCH: EDITORIAL COMMENT
Strain echocardiography tracks dobutamine-induced decrease in regional myocardial perfusion in nonocclusive coronary stenosis
Gabriel Yip, MRCP,
Bijoy Khandheria, MD, FACC,
Marek Belohlavek, MD, FACC,
Cristina Pislaru, MD,
James Seward, MD, FACC,
Kent Bailey, PhD,
A. Jamil Tajik, MD, FACC,
Patricia Pellikka, MD, FACC and
Theodore Abraham, MD, FACC*
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MinnesotaUSA
Manuscript received July 8, 2003;
revised manuscript received February 6, 2004,
accepted February 10, 2004.
* Reprint requests and correspondence: Dr. Theodore P. Abraham, Johns Hopkins University, 600 North Wolfe StreetCarnegie 568BaltimoreMaryland21287 (Email: Tabraha3{at}jhmi.edu).
OBJECTIVES: This study was designed to determine whether strain echocardiography parameters reflect changes in regional myocardial perfusion during dobutamine stress.
BACKGROUND: Strain echocardiography depicts regional myocardial mechanical activity. Ischemia has been shown to reduce systolic strain rate (sSR) and prolong the time to regional lengthening (TRL). In an experimental model, we tested whether sSR and TRL tracked dobutamine-induced changes in regional myocardial perfusion (regional myocardial blood flow [RMBF]), as measured by colored microspheres.
METHODS: We used a closed-chest pig model of nonocclusive coronary stenosis (n = 14) created by inflating an angioplasty balloon in the proximal left anterior descending artery. Invasive hemodynamics, RMBF, and strain parameters were measured at baseline and peak dobutamine stimulation before and during the coronary stenosis. We compared segments with reduced RMBF versus those with preserved RMBF at peak dobutamine stimulation.
RESULTS: Peak sSR correlated with RMBF (r = 0.70). In the absence of coronary stenosis, dobutamine stimulation caused a significant increase in RMBF and sSR and a decrease in TRL. This response was blunted during coronary stenosis. Using the "best cutoff" method, the sensitivity and specificity for prediction of reduced RMBF (ischemia) was 81% and 91% for sSR and 65% and 91% for TRL, respectively. These changes occurred in the absence of any change in global systolic and diastolic function (dP/dTmax, dP/dTmin, and tau).
CONCLUSIONS: Novel strain parameters that depict regional myocardial mechanics are able to predict changes in RMBF during dobutamine stress. Quantitative strain parameters may complement current echocardiographic techniques for ischemia detection and potentially improve the accuracy and reproducibility of stress echocardiography.
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Abbreviations and Acronyms
| | LAD = left anterior descending artery | | LV = left ventricle/ventricular | | RMBF = regional myocardial blood flow | | SE = strain echocardiography | | sSR = systolic strain rate | | TRL = time to regional lengthening |
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