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
View larger version (41K):
[in a new window]
|
Figure 1 Schematic representation of the animal model and study flow (see text for details). LAD = left anterior descending artery; RMBF = regional myocardial blood flow.
|
|
View larger version (17K):
[in a new window]
|
Figure 3 Correlation between peak systolic strain rate (sSR) and regional myocardial blood flow (RMBF).
|
|
View larger version (66K):
[in a new window]
|
Figure 4 Representative color M-mode and strain rate images at baseline (A), dobutamine without stenosis (B), and dobutamine (DOB) with stenosis (C). Despite similar increases in heart rate (HR), regional myocardial blood flow (RMBF) is reduced, and the dobutamine-induced increase in sSR and a decrease in TRL (B) significantly blunted in the presence (C) versus absence (B) of coronary stenosis. Other abbreviations as in Figure 2.
|
|
View larger version (30K):
[in a new window]
|
Figure 5 Change in sSR (A) and TRL (B) from baseline to peak dobutamine stress was significantly lower in ischemic versus normal segments (both p < 0.0001; dashed lines = mean, solid lines = 1 SD). Using a combination of the best cutoff values for change in sSR and TRL significantly increased the specificity compared with sSR and TRL alone (C). Open circles = control segment response; black circles = ischemic segment response. (D) Receiver operating characteristic curves demonstrated that the area under the curve was similar for sSR compared with TRL, and was higher for sSR + TRL compared with TRL alone (p = 0.01) and for sSR alone (p = 0.05). Abbreviations as in Figure 2.
|
|
|
p < 0.01 between baseline and dobutamine; 
p < 0.01 between dobutamine and dobutamine + stenosis. SE = strain echocardiography.