Key result
Abnormal apical longitudinal strain during dipyridamole stress echocardiography predicted worse event-free survival compared to normal strain (P<0.01).
Why the study?
Regional apical longitudinal strain can corroborate regional wall motion abnormalities quantitatively, but data on its long-term prognostic value are lacking.
Does apical longitudinal strain assessment during dipyridamole stress echocardiography improve prediction of major cardiac events compared to visual wall motility analysis in patients referred for stress echocardiography?
Cohort (n=150)
Does apical longitudinal strain assessment during dipyridamole stress echocardiography improve prediction of major cardiac events compared to visual wall motility analysis in patients referred for stress echocardiography?
p-value: p=<0.01
Abnormal apical longitudinal strain during dipyridamole stress echocardiography correlates with coronary flow velocity reserve and is a better independent predictor of long-term major cardiac events than visual wall motion analysis.
Apical strain during dipyridamole stress echo may aid risk stratification; leaves open incremental prognostic value over wall motion in prospective cohorts.
Background: Regional apical longitudinal strain can corroborate the diagnosis of regional wall motion abnormalities on a quantitative basis, but data on long-term prognostic value are lacking. Objectives: To evaluate the physiological correlate and the prognostic value of apical longitudinal strain versus wall motility during dipyridamole stress echocardiography. Methods: Retrospective study, which included 150 patients referred for dipyridamole stress echocardiography. Apical longitudinal strain, anterior descending artery coronary reserve, and visual analysis of wall motility were evaluated. Patients were divided into two groups. Group 1: patients with normal apical longitudinal strain, and Group 2: abnormal strain. Follow-up was carried out for 36 9.3 months. Major event was defined as: death, myocardial infarction, revascularization and hospitalization for cardiac causes. Results: Eighty-seven patients (61.3%) in Group 1 and 55 (38.7%) patients in Group 2 were included (8 patients were excluded due to a suboptimal ultrasound window). There were no differences in apical longitudinal strain at rest between the groups. During the stress, Group 1 patients showed better visual wall motility and a higher coronary reserve (p < 0.001). The coronary reserve showed a linear correlation with the changes in the apical longitudinal strain (Pearson's correlation coefficient 0.89, p < 0.0001). At follow-up, there were 24 major events. Group 1 patients had better event-free survival (p < 0.01) and apical longitudinal strain proved to be a better independent event predictor than wall motion analysis (p = 0.002 vs p = 0.1) in logistic regression analysis. Conclusions: Apical longitudinal strain has a very good correlation with physiological standards -coronary flow velocity reserve-and its association with long-term prognosis is better. Abnormal apical longitudinal strain during dipyridamole stress echocardiography predicted a worse outcome, regardless of visual wall motion analysis.
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Haber et al. (2022) conducted a cohort in Referred for dipyridamole stress echocardiography (n=150). Abnormal apical longitudinal strain vs. Normal apical longitudinal strain was evaluated on Major event (death, myocardial infarction, revascularization and hospitalization for cardiac causes) (p=<0.01). Abnormal apical longitudinal strain during dipyridamole stress echocardiography predicted worse event-free survival compared to normal strain (P<0.01).
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