Usefulness of the addition of two-dimensional speckle tracking during dobutamine stress echocardiography for the detection of coronary artery disease.

Background: Coronary artery disease (CAD) is the most frequent type of cardiac disorder. Initial evaluation for ischaemia using dobutamine stress echocardiography (DSE) is based on a visual interpretation of the regional wall motion abnormality.

Aims: To assess the usefulness of speckle tracking during DSE and evaluate the diagnostic accuracy of 2D global longitudinal strain (GLS) along with its additive role over wall motion abnormalities interpretation for the diagnosis of CAD.

Materials and methods: One hundred and twenty-five patients are included in the study. Full history, physical examination, ECG, echocardiography, DSE, speckle tracking echocardiography (STE) with global and regional post-systolic strain index (PSI) during rest, peak dobutamine stress and recovery phase, and coronary angiography are done.

Results: In the rest study, there is a statistically significant difference in the global and regional PSIs, both are higher in patients with CAD (group 1) than in patients without CAD (group 2) (PSI 5.1 ± 3 in group 1 and 2.7 ± 2.4 in group 2, p value .02) (regional PSI 5.4 ± 4.1 in group 1 and 3 ± 3.3 in group 2, p value .02). At peak stress, the global PSI is higher in group 1 (7 ± 4.2, p value .01) and regional PSI is higher in group 1 (7.9 ± 8.5, p value .03). In recovery period, the global PSI is higher in group 1 (8 ± 6.1, p value .01), the regional PSI is higher in group 1 (9.8 ± 8.5, p value .001) and the GLS is lower in group 1 than in group 2 (-15.5 ± 4 vs. -19.1 ± 3.1, p value .03). The most sensitive and specific parameters are the global and regional PSI in the recovery period, where both showed sensitivities of 95% and 98%, respectively, and specificities of 93% and 95%, respectively.

Conclusions: Speckle tracking during rest and DSE seems feasible in detecting the stenosis of the coronary arteries in patients with chronic CADs through the evaluation of GLS, and global and regional PSIs. The combination of DSE and STE increases accuracy, sensitivity, and specificity of diagnosing CADs.