Diagnostic Value of Ultrasound-Based Strain Imaging in Patients With Suspected Coronary Artery Disease

다국어 초록 (Multilingual Abstract)

Background and Objectives: Strain imaging has already been shown to quantify regional myocardial function in
both acute ischemic myocardium and infarcted myocardium. We proposed that strain imaging could differentiate
deformation of normal and ischemic myocardium that are without regional wall motion abnormality, as assessed
by conventional echocardiography. The aim of this study is to determine the diagnostic value of strain imaging for
the detection and localization of coronary lesions in patients with chest pain, but they are without apparent wall
motion abnormalities. Subjects and Methods: Strain imaging for advanced wall motion analysis was performed
in 179 patients with suspicious stable angina (SA) and in 94 patients with suspicious acute coronary syndrome
(ACS) prior to coronary angiography. All the patients had normal conventional wall motion scoring based on the
standards of the American Society of Echocardiography. Longitudinal strain was measured in 3 apical views, and
assessments of the strain value for individual segments with using an 18-segment division of the left ventricle were
performed to determine the average strain value. Marked heterogeneity of strain was considered abnormal, and
significant coronary artery disease was considered present if stenosis above 70% was noted on the quantitative angiography.
Results: Eighty (78%) of the 103 patients with SA and 18 (56%) of the 32 patients with ACS and who
showed constant systolic strain throughout the left ventricular wall had normal or minimal coronary lesions. Fiftyone
(67%) of the 76 patients with SA and 53 (85%) of the 62 patients with ACS and marked heterogeneity of strain
had angiographically significant coronary stenosis. The receiver-operating characteristic (ROC) analysis of the peak
systolic strain yielded that the ROC-area of peak systolic strain for the left anterior descending artery territory
was 0.79 (95% CI 0.72-0.84), this was 0.87 (95% CI 0.79-0.91) for the left circumflex artery territory and 0.89
(95% CI 0.79-0.93) for the right coronary artery territory. Conclusion: Ultrasound-based strain imaging demonstrates
a strong correlation with coronary angiography and it has potential as a noninvasive diagnostic tool for detecting
coronary artery stenosis in patients with chest pain, but who are without apparent wall motion abnormalities
on conventional echocardiography.

다국어 초록 (Multilingual Abstract)

Background and Objectives: Strain imaging has already been shown to quantify regional myocardial function in
both acute ischemic myocardium and infarcted myocardium. We proposed that strain imaging could differentiate
deformation of normal and ischemic myocardium that are without regional wall motion abnormality, as assessed
by conventional echocardiography. The aim of this study is to determine the diagnostic value of strain imaging for
the detection and localization of coronary lesions in patients with chest pain, but they are without apparent wall
motion abnormalities. Subjects and Methods: Strain imaging for advanced wall motion analysis was performed
in 179 patients with suspicious stable angina (SA) and in 94 patients with suspicious acute coronary syndrome
(ACS) prior to coronary angiography. All the patients had normal conventional wall motion scoring based on the
standards of the American Society of Echocardiography. Longitudinal strain was measured in 3 apical views, and
assessments of the strain value for individual segments with using an 18-segment division of the left ventricle were
performed to determine the average strain value. Marked heterogeneity of strain was considered abnormal, and
significant coronary artery disease was considered present if stenosis above 70% was noted on the quantitative angiography.
Results: Eighty (78%) of the 103 patients with SA and 18 (56%) of the 32 patients with ACS and who
showed constant systolic strain throughout the left ventricular wall had normal or minimal coronary lesions. Fiftyone
(67%) of the 76 patients with SA and 53 (85%) of the 62 patients with ACS and marked heterogeneity of strain
had angiographically significant coronary stenosis. The receiver-operating characteristic (ROC) analysis of the peak
systolic strain yielded that the ROC-area of peak systolic strain for the left anterior descending artery territory
was 0.79 (95% CI 0.72-0.84), this was 0.87 (95% CI 0.79-0.91) for the left circumflex artery territory and 0.89
(95% CI 0.79-0.93) for the right coronary artery territory. Conclusion: Ultrasound-based strain imaging demonstrates
a strong correlation with coronary angiography and it has potential as a noninvasive diagnostic tool for detecting
coronary artery stenosis in patients with chest pain, but who are without apparent wall motion abnormalities
on conventional echocardiography.

참고문헌 (Reference)

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