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CLINICAL RESEARCH: CARDIAC IMAGING

Automated Analysis of Myocardial Deformation at Dobutamine Stress Echocardiography

An Angiographic Validation

Charlotte Bjork Ingul, MD^_*,, Asbjorn Stoylen, MD, PhD^_*,1, Stig A. Slordahl, MD, PhD^_*, Rune Wiseth, MD, PhD^_*, Malcolm Burgess, MD and Thomas H. Marwick, MD, PhD^,_*

^_* Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
University of Queensland, Brisbane, Australia.

Manuscript received May 12, 2006; revised manuscript received December 12, 2006, accepted January 1, 2007.

^_* Reprint requests and correspondence: Dr. Thomas H. Marwick, University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia. (Email: tmarwick{at}uq.edu.au).

Objectives: We investigated the accuracy of automated analysis of myocardial deformation during dobutamine stress echocardiography (DSE).

Background: The time required for segmental measurement of strain rate imaging (SRI) limits its feasibility for quantification of DSE.

Methods: Myocardial deformation was assessed at DSE in 197 patients, 76 with and 61 without coronary artery disease (CAD) at angiography, and 60 at low risk of CAD. Automated deformation analysis was based on velocity gradient and segment length methods of measuring longitudinal motion within a region of interest tracked through the cardiac cycle. Results were compared with independent wall motion scoring (WMS). Patients were randomly divided; group A (n = 69) established optimal cutoffs for the parameters and group B (n = 68) tested their accuracy.

Results: The feasibility of WMS exceeded that of both SRI methods at rest and at peak stress. In group A, the area under the receiver-operating characteristics curve of the peak systolic strain rate was 0.90 by both methods, and the optimal cutoffs for detection of CAD were –1.3 (velocity gradient) and –1.2 s^–1 (segment length). The areas under the receiver-operating characteristics curves for end-systolic strain were less (0.87) by both methods, with respective cutoffs of 9% and 8%. In group B, the velocity and segment length methods had respective sensitivities of 87% and 84% for SR, and 87% and 88% for end-systolic strain. Both significantly exceeded that of WMS in the same group (75%).

Conclusions: Automated analysis of myocardial deformation at DSE is feasible and accurate, and may increase the sensitivity of expert conventional reading.

Abbreviations and Acronyms   AUC = area under the curve   CAD = coronary artery disease   CX = circumflex artery   DSE = dobutamine stress echocardiography   LAD = left anterior descending artery   PSI = post-systolic strain index   ROC = receiver-operating characteristic   S = strain   Ses = end-systolic strain   Sps = peak post-systolic strain   SR = strain rate   SRs = peak systolic strain rate   SRI = strain rate imaging   tSRs = time to peak systolic strain rate   WMS = wall motion score   WMSI = wall motion score index

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