P1029Detection of viable myocardium using global longitudinal two dimensional strain during dobutamine stress echocardiography


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Abstract

Purpose: The purpose of the present study was to assess the ability of deformation analysis using 2D speckle tracking echocardiography (STE) during low dose dobutamine echocardiography (DSE) to detect the presence of myocardial viability. Automated Function Imaging technique (AFI), a new method based on STE, was used, which calculates the global longitudinal peak strain (GLPS).Methods :Thirty –one patients with moderate to severe ischemic LV dysfunction(LVEF<35%) after transmural myocardial infarction (> 1 month) and established coronary artery disease in coronary angiography (1,2 or 3 vessels disease) were included.Patients underwent a low DSE protocol in order to determine the presence of myocardial viability before reperfusion therapy and were reassessed 9 months after revascularization. Global (GLPS) and segmental (regional) longitudinal LV strain obtained by AFI was determined at rest and at each stage of DSE. Functional recovery was defined by improvement in wall motion score and global LV function comparing side by side the echocardiographic images obtained before and 9 months after revascularization.Results : Twenty-one patients showed viable myocardium in more than 5 segments (mostly in the territory of LAD). There were no significant differences between the 2 groups concerning LVEF (33.4 ±4.1 vs 27.6 ±13.1 %, p=0.38) or average GLPS (-11.7±1.5 vs -9±3.4 %, p=0.14).A strong correlation was found between improvement of average GLPS values during dobutamine stimulation and functional recovery 9 months after revascularization (r=0.74, p=0.02) as determined by WMSI and LVEF improvement at follow-up. ROC analysis showed that change of average GPLS > 6 % during dobutamine could discriminate the patients with viable myocardium with a sensitivity of 80% and specificity of 80 %.Conclusions: In conclusion, integration of AFI derived GLPS of LV into low dose DSE could be helpful to objectively quantify the extent of contractility impairment and the potential of myocardial recovery after revascularization therapy in ischemic cardiomyopathy.

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