Key result
Two-dimensional strain imaging during stress testing is a feasible technique for detecting inducible ischemia and contractile reserve, though it does not yet provide incremental diagnostic accuracy over expert visual interpretation.
Why the study?
Stress echocardiography interpretation is subjective and requires experience; the clinical value and reliability of 2D strain imaging during stress testing need further specification.
Does 2D strain imaging during stress testing improve diagnostic accuracy compared to visual interpretation?
Does 2D strain imaging during stress testing improve diagnostic accuracy compared to visual interpretation?
While 2D strain imaging during stress testing shows promise for evaluating myocardial deformation, it does not yet offer incremental diagnostic accuracy over expert visual interpretation for coronary artery disease.
Answers are grounded in this paper and cite their sources.
Does not support routine adoption of 2D strain over expert visual assessment; leaves open need for prospective validation studies.
Stress echocardiography is increasingly used but its major limitation is the subjective interpretation of wall motion changes requiring experience. Speckle tracking enables simultaneous evaluation of radial, longitudinal, and circumferential myocardial deformation. Recently, two-dimensional (2D) strain has been found to be as reliable as sonomicrometry for the assessment of left ventricular (LV) regional function. In the presence of inducible ischemia, longitudinal and circumferential abnormalities preceed the decrease in radial deformation. Optimal cutoffs have been obtained from 2D strain rate (SR) at peak dobutamine stress to predict coronary artery disease. However, 2D strain rate does not yet provide incremental accuracy to visual interpretation by experts. Speckle tracking strain could be useful to better identify contractile reverse and biphasic response of viable myocardium but there are not yet clinical studies published in this setting. Preliminary results suggest that 2D strain obtained during exercise could be useful in asymptomatic patients with severe aortic stenosis or organic mitral regurgitation (MR). In conclusion, the reliability and clinical importance of 2D strain during stress will be specified by further investigations.
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Moonen et al. (2009) conducted a review in Ischemic heart disease, valvular heart disease, and heart failure. 2D strain imaging (speckle tracking) during stress testing vs. Visual interpretation or tissue Doppler imaging was evaluated. Two-dimensional strain imaging during stress testing is a feasible technique for detecting inducible ischemia and contractile reserve, though it does not yet provide incremental diagnostic accuracy over expert visual interpretation.
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