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Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography

BACKGROUND: A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultraso...

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Autores principales: Celutkiene, Jelena, Zakarkaite, Diana, Skorniakov, Viktor, Zvironaite, Vida, Grabauskiene, Virginija, Burca, Jelizaveta, Ciparyte, Laura, Laucevicius, Aleksandras
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495225/
https://www.ncbi.nlm.nih.gov/pubmed/22846395
http://dx.doi.org/10.1186/1476-7120-10-31
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author Celutkiene, Jelena
Zakarkaite, Diana
Skorniakov, Viktor
Zvironaite, Vida
Grabauskiene, Virginija
Burca, Jelizaveta
Ciparyte, Laura
Laucevicius, Aleksandras
author_facet Celutkiene, Jelena
Zakarkaite, Diana
Skorniakov, Viktor
Zvironaite, Vida
Grabauskiene, Virginija
Burca, Jelizaveta
Ciparyte, Laura
Laucevicius, Aleksandras
author_sort Celutkiene, Jelena
collection PubMed
description BACKGROUND: A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE). METHODS: Prospective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis. RESULTS: The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52. CONCLUSIONS: Multiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD.
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spelling pubmed-34952252012-11-12 Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography Celutkiene, Jelena Zakarkaite, Diana Skorniakov, Viktor Zvironaite, Vida Grabauskiene, Virginija Burca, Jelizaveta Ciparyte, Laura Laucevicius, Aleksandras Cardiovasc Ultrasound Research BACKGROUND: A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE). METHODS: Prospective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis. RESULTS: The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52. CONCLUSIONS: Multiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD. BioMed Central 2012-07-30 /pmc/articles/PMC3495225/ /pubmed/22846395 http://dx.doi.org/10.1186/1476-7120-10-31 Text en Copyright ©2012 Celutkiene et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Celutkiene, Jelena
Zakarkaite, Diana
Skorniakov, Viktor
Zvironaite, Vida
Grabauskiene, Virginija
Burca, Jelizaveta
Ciparyte, Laura
Laucevicius, Aleksandras
Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography
title Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography
title_full Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography
title_fullStr Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography
title_full_unstemmed Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography
title_short Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography
title_sort quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495225/
https://www.ncbi.nlm.nih.gov/pubmed/22846395
http://dx.doi.org/10.1186/1476-7120-10-31
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