Peak myocardial work assessment to detect coronary ischemia during dobutamine stress echocardiography

Figures

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  Figure 1. Example of GLS and myocardial work parameters at peak stress in two patients undergoing DSE. First is a control patient with normal DSE (A-D), showing increase in GLS [rest −21% to peak −24% (A)], and GWI [rest 2,031 mmHg% to peak 3,044 mmHg% (B)] compared to rest. Pressure strain loop (PSL) shows adequate GWI- area under the curve (C), and the bar graph showing high GCW and minimal GWW(D) at peak. In comparison, patient with significant CAD shows reduced peak GLS [rest −15% to peak −10% (E)], and reduced GWI [rest 1,014 mmHg% to peak 673 mmHg% (F)] compare to rest, due to obstructive lesion in the mid LAD and distal LCX confirmed on coronary angiography, PSL loop also shows reduced GWI- area under the curve (G), compared to normal DSE PSL (C) Bar graph (H) shows reduced GCW and higher GWW in significant CAD compared to (D) control. CAD, coronary artery disease; DSE, dobutamine stress echocardiogram; GLS, global longitudinal strain; GWI, global myocardial work index; GCW, global myocardial constructive work; GWW, global myocardial wasted work; PSL, pressure strain loop.

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  Figure 2. Percent change in GLS, GWE, GWI, GCW, GWW from rest to peak stress undergoing DSE in those with significant and non-significant CAD, as well as controls. CAD, coronary artery disease; GLS, global longitudinal strain; GCW, global myocardial constructive work; GWE, global myocardial work efficiency; GWI, global myocardial work index; GWW, global myocardial wasted work; DSE, dobutamine stress echocardiogram. *p < .05; **p < .01; ns = non-significant.

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  Figure 3. Receiver operating curves (ROC) for rest (A) and peak (B) GLS, GWI, GWE, GCW, and GWW to detect coronary ischemia in patients with abnormal DSE. SE, dobutamine stress echocardiogram; GLS, global longitudinal strain; GWI, global myocardial work index; GWE, global myocardial work efficiency; GCW, global myocardial constructive work; GWW, global myocardial wasted work.

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  Figure 4. Example of two patients with hypertensive response during DSE. First patient was a 56 y/o female that had basal inferior and inferior septum wall motion abnormality at peak stress. Peak SBP was 262/78 mmHg. GLS and regional longitudinal strain were decreased at peak stress in the RCA territory compared to rest (A,B). GWI was increased from rest to peak stress, but regional MW was deceased in the RCA territory (C,D). Peak GWE and regional MW efficiency was also decreased in the RCA territory (E,F). Cardiac catheterization showed total occlusion of the mid RCA with collaterals to the distal RCA. Second patient was a 41 y/o male that showed similar wall motion abnormality (basal inferior and inferior septum). Peak SBP was 250/111 mmHg. However, peak GLS and regionals longitudinal strain were unchanged (G,H). GWI and regional MW in the RCA region were increased at peak stress (I,J). GWE and regional MW was preserved at peak stress (K,L). Subsequent cardiac PET was negative for coronary ischemia. DSE, dobutamine stress echocardiogram; GLS, global longitudinal strain; GWI, global myocardial work index; GWE, global myocardial work efficiency; MW, myocardial work; RCA, right coronary…