ABSTRACT
OBJECTIVES: Exercise stress echocardiography is a widely used modality for the diagnosis and follow-up of patients with coronary artery disease. During the last decade, speckle tracking imaging has been used increasingly for accurate evaluation of cardiac function. This work aimed to assess speckle-tracking imaging parameters during nonischemic exercise stress echocardiography. METHODS: During 2011 to 2014 we studied 46 patients without history of coronary artery disease, who completed exercise stress echocardiography protocol, had normal left ventricular function, a nonischemic response, and satisfactory image quality. These exams were analyzed with speckle-tracking imaging software at rest and at peak exercise. Peak strain and time-to-peak strain were measured at rest and after exercise. Clinical follow-up included a telephone contact 1 to 3 years after stress echo exam, confirming freedom from coronary events during this time. RESULTS: Global and regional peak strain increased following exercise. Time-to-peak global and regional strain and time-to-peak strain adjusted to the heart rate were significantly shorter in all segments after exercise. Rest-to-stress ratio of time-to-peak strain adjusted to the heart rate was 2.0 to 2.8. CONCLUSIONS: Global and regional peak strain rise during normal exercise echocardiography. Peak global and regional strain occur before or shortly after aortic valve closure at rest and after exercise, and the delay is more apparent at the basal segments. Time-to-peak strain normally shortens significantly during exercise; after adjustment to heart rate it shortens by a ratio of 2.0 to 2.8. These data may be useful for interpretation of future exercise stress speckle-tracking echocardiography studies.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Echocardiography, Stress/methods , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reproducibility of ResultsSubject(s)
Churg-Strauss Syndrome/diagnosis , Adult , Biomarkers/analysis , Biopsy , Churg-Strauss Syndrome/complications , Churg-Strauss Syndrome/therapy , Diagnosis, Differential , Echocardiography , Female , Heart Failure/diagnosis , Heart Failure/etiology , Humans , Magnetic Resonance Imaging , Ventricular Dysfunction, Right/diagnosis , Ventricular Dysfunction, Right/etiology , Ventricular RemodelingABSTRACT
BACKGROUND: Echocardiographic assessment of left ventricular function includes calculation of ejection fraction and regional wall motion analysis. Recently, speckle imaging was introduced for quantification of left ventricular function. OBJECTIVES: To assess LVEF by speckle imaging and compare it with Simpson's method, and to assess the regional LV strain obtained by speckle imaging in relation to conventional echocardiographic scores. METHODS: Thirty consecutive patients, 28 with regional LV dysfunction, underwent standard echocardiographic evaluation. LV end-diastolic volume, LV end-systolic volume and EF were calculated independently by speckle imaging and Simpson's rule. The regional peak systolic strain presented by speckle imaging as a bull's-eye map was compared with the conventional visual estimate of echo score. RESULTS: Average EDV obtained by speckle imaging and by Simpson's method was 85.1 vs. 92.7 ml (P = 0.38), average ESV was 49.4 vs. 48.8 ml (P = 0.94), calculated EF was 43.9 vs. 50.5% (P = 0.08). The correlation rate with Simpson's rule was high: 0.92 for EDV, 0.96 for ESV, and 0.89 for EF. The peak systolic strain in two patients without wall motion abnormality was 17.3 +/- 4.7; in normal segments of patients with regional dysfunction, peak systolic strain (13.4 +/- 4.9) was significantly higher than in hypokinetic segments (10.5 +/- 4.5) (P < 0.000001). The strain in hypokinetic segments was significantly higher than in akinetic segments (6.2 +/- 3.6) (P < 0.000001). CONCLUSIONS: Speckle imaging can be successfully used for the assessment of LV volumes and EF. Bull's-eye strain map, created by speckle imaging, can achieve an accurate real-time segmental wall motion analysis.
