I'm interested to know if you can add strain to stress echocardiography to improve the accuracy of the method for the diagnosis of coronary artery disease and the best strategy (longitudinal strain, radial, circumferential, or combination of two or all of them)?
There are several studies demonstrating the additional value of longitudinal strain over WMSI on during stress echo. However, in my opinion because of the relative low frame rate (50-90 fps) the best way is to use speckle tracking derived strain on during dipiridamole stress echo (less increase in HR). Keep in mind that with this approach you can detect abnormalities that you could miss just relying on your eyes. We are trained to assess radial function by eye, but the early abnormalities are on the longitudinal plane (subendocardial ischemia). Finally, you need good image quality to perform the speckle tracking analysis. In my opinion 4D strain at the moment is not ready for the clinical use (very low frame rate, reduced spatial resolution).
I agree with Giovanni in that speckle tracking with non-HR increasing protocols make the most sense. Like many techniques, they are designed for subtle, pre-clinical detection (or obtaining higher sensitivity), but in the end, these techniques seem to best correlate to 'severe disease' and 'normal hearts'. In my opinion, despite being closer than ever, we are still not at the point of offering this as a robust complementary ischemia tool during stress testing.
Yes, segmental strain along with stress echo can give a answer in intermediate lesions and correlates well with FFR on cath.
Despite the good reliability and relatively easy assessment from standard echo images (apical windows), I would like to add a word of caution when considering longitudinal strain as a parameter. Longitudinal strain is a global measurement that is extremely oversimplified and its great reliability is likely caused by an extreme averaging of many myocardial segments. In my opinion, the exact opposite is required for the detection of coronary artery disease, where segmental analysis may help to detect which area of the myocardium is potentially ischemic. In that case, short-axis images may be a better approach as the velocities / strain rates in these views is equally represented in all segments (which is not the case with longitudinal strain, where apical segments are largely underrepresented).
- Badges
- Science topic
- Similar topics
- Biological Science
- Immunology
- Antibodies