Key result
Visual assessment of dobutamine stress echocardiography (AUC 0.88) was significantly more accurate than any single quantitative velocity or strain/strain rate parameter (AUC 0.63-0.72) for diagnosing significant coronary artery disease.
Why the study?
Does the use of single ultrasound quantitative parameters improve the prediction of significant coronary stenosis compared to visual assessment during dobutamine stress echocardiography in patients with known or suspected CAD?
Case-Control (n=151)
Blinded analysis
No
Does the use of single ultrasound quantitative parameters improve the prediction of significant coronary stenosis compared to visual assessment during dobutamine stress echocardiography in patients with known or suspected CAD?
Visual assessment during dobutamine stress echocardiography remains more accurate than single quantitative velocity or strain parameters for predicting significant coronary artery stenosis.
Visual assessment remains superior to single quantitative parameters in dobutamine stress echocardiography; leaves open whether multiparametric models enhance CAD detection.
BACKGROUND: A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE). METHODS: Prospective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis. RESULTS: The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52. CONCLUSIONS: Multiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD.
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Čelutkienė et al. (2012) conducted a case-control in Coronary artery disease (n=151). Single ultrasound quantitative parameters (velocity, strain, strain rate) vs. Visual assessment (wall motion score index) was evaluated on Prediction of significant coronary stenosis (≥70% narrowing) measured by Area Under the Curve (AUC) (AUC 0.63 to 0.72 vs 0.88, p=<0.05). Visual assessment of dobutamine stress echocardiography (AUC 0.88) was significantly more accurate than any single quantitative velocity or strain/strain rate parameter (AUC 0.63-0.72) for diagnosing significant coronary artery disease.
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