529Assessment of myocardial viability during low-dose dobutamine stress echocardiography by 2D speckle tracking in patients after acute myocardial infarction


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Abstract

Introduction: Low-dose dobutamine stress echocardiography(LDDSE) is useful in assessment of myocardial viability, but involves subjective interpretation of wall motion changes requiring experience. The aim of this study was to assess if use of 2D speckle tracking at rest and during LDDSE may facilitate the prediction of myocardial viability in patients after acute myocardial infarction (AMI).Material and methods: The study group comprised 96patients (65 male, mean age 58±10 years) with first AMI treated with successful primary percutaneous coronary intervention. 7-10 days after AMI, all patients underwent LDDSE with visual assessment of contractile reserve by expert echocardiographer. Subsequently, acquired images were analyzed off-line by echocardiographer in training using 2D speckle tracking. Measurements at baseline and peak of stress protocol included systolic longitudinal strain (SLS), peak longitudinal strain (PLS) and systolic longitudinal strain rate (SLSR). After twelve months each patient underwent control resting transthoracic echocardiography with visual assessment of functional recovery in akinetic/dyskinetic segments at baseline, which was defined as improvement from dyskinesis and akinesis to hypokinesis or normokinesis.Results: At baseline there were 224 segments with akinesis or dyskinesis. 91 (41%) of those segments showed functional recovery after 12months. There were significant differences in mean values of strain between segments with and without functional recovery (P=0.0002 to 0.003). The highest prognostic value for prediction of functional recovery was provided by peak longitudinal strain both at rest (sensitivityof 76%, specificity of 44%, diagnostic accuracy of 61%) and stress (sensitivityof 62%, specificity of 66%, diagnostic accuracy of 64%). However, the diagnostic value of 2D strain analysis was significantly lower than of expert's visual assessment of wall motion abnormalities during LDDSE (sensitivity of 67.12%, specificity of 88.71%, diagnostic accuracy of 77.00%).Conclusions: 2D speckle tracking analysis at rest and during LDDSE canbe helpful in prediction of functional recovery in patients after AMI for inexperienced echocardiographers.The most useful parameter is peak longitudinal strain.

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