Accuracy of Two-Dimensional Speckle Tracking Echocardiography for the Detection of Significant Coronary Stenosis

BACKGROUND: Visual assessment of wall motion abnormalities (WMA) by 2-dimensional echocardiography (2DE) is the most semi-quantitative method used to detect coronary artery disease (CAD), but it carries many limitations. Speckle tracking echocardiography (STE) overcomes these limitations and allows an objective quantification of myocardial deformation. The aim of the study to examine the accuracy of global and segmental longitudinal strain (LS) for the detection of CAD compared with visual assessment of WMA using coronary angiography as a golden standard. METHODS: The study enrolled 25 patients (mean age 51.0 +/- 8.7, 64% are male) referred to coronary angiography with clinical suspicion of CAD. 2DE assessment of WMA and evaluation of LS using STE were performed using left ventricular 17-segments models. Significant CAD was defined as > or = 50% stenosis in one or more major coronary arteries by angiography. RESULTS: Patients were classified into 2 groups: group I included 15 patients with significant CAD and group II included 10 patients with insignificant and/or absence of CAD. WM score was strongly correlated with the global LS in group I and II (R = 0.80, p < 0.0001 and R = 0.88, p < 0.0001 respectively). In all patients, 425 segments were analyzed. WMA was detected in 163 segments of 425 (38.3%) while abnormal LS was detected in 214 segments (50.3%). Compared with coronary angiography, the total sensitivity, specificity and accuracy for visual analysis and STE were (56%, 88.2%, and 60% vs. 68.6%, 77%, and 81.8% respectively). CONCLUSION: Segmental LS is more accurate for the detection of ischemic myocardial segment corresponding to functionally relevant coronary anatomy than visual assessment of WM.

[Hanging by a thread] left ventricular thrombus in an asymptomatic soldier

A mobile and pedunculated left ventricular mass was incidentally detected on transthoracic echocardiography in a 32-year old asymptomatic soldier. Because of the mobility of the mass and the uncertainty of its nature, the risk of embolization was considered to be high, and hence surgical removal was recommended but the patient opted for anticoagulation therapy. The mass resolved within 6 weeks without any embolic or bleeding complications. No recurrence of the thrombus was observed during a 12-month follow up period

Effect of thrombolytic therapy on QT dispersion in patients with acute myocardial infarction

QT dispersion is an important ECG feature fundamental for initiation of ventricular fibrillation and increased after myocardial infarction. to correlate site of infarction and QT dispersion and assess the effect of thrombolysis on it in patients with acute myocardial infarction [AMI]. The study include 100 patients with AMI were classified into 3 groups: 01: included 30 patients received streptokinase [SK] with successful reperfusion, 02: 30 patients received streptokinase with failed reperfusion and 03: included 40 patients not received SK due to contra-indications. all patients were subjected to resting 12 leads ECG at admission, 2 hours post SK [in G1 and G2] and predischarge. the following parameters were measured [QT interval, QRS interval, JT interval, PR interval, QT dispersion, JT dispersion, QRS dispersion, rate corrected QT, rate corrected JT, QTc dispersion and JTc dispersion]. The study reavles the QTd and JTd values significantly increased in patients < 50 years than pts > 50 years [p < 0.05]; QTd, JTd, QTcd and JTcd were significantly increased with anterior MI than inferior MI [p <0.001]. Among risk factors for coronary artery disease, QTcd and JTcd significantly increased in none obese pts [p < 0.05], QTd, QTcd, JTd, JTcd and QTc significantly increased in diabetics [p < 0.05], while in hypertensives, QTd, QTcd, JTd, JTcd and JTc are significantly increased [p <0.01]. The highest incidence of arrhythmia was in 01 and greater with anterior MI than inferior MI. QTd, JTd, QTcd and JTcd were longer in cases complicating arrhythmia and largest with ventricular fibrillation. In G1, QTd, JTd and QTcd were significantly increased at pre- discharge than at admission [p = 0.001] and than 2 hours after SK [p = 0.001] in G2, QTcd and JTcd significantly decreased 2 hrs after SK [p = 0.05], QTc, JTc, QTcd and JTcd decreased significantly at predischarge than at admission [p < 0.05], in G3, QTc and JTc significantly decreased at pre-discharge than at admission [p 0.001]. Conclusion The study concluded that QT dispersion is increased after myocardial infarction and showed significant rduction with successful thrombolysis. QTd is influenced by hypertension, diabetes mellitus, age and site of myocardial infarction. It could be used equally to QT for analysis