Key result
Low-dose dobutamine stress 2DSTE detects reversible myocardial dysfunction with ~82% sensitivity, outperforming resting strain.
Why the study?
The diagnostic accuracy of 2D-speckle tracking echocardiography strain at rest and during low-dose dobutamine stress for detecting myocardial viability was uncertain.
Does 2DSTE strain during low-dose dobutamine stress improve diagnostic accuracy for detecting reversible myocardial dysfunction compared to resting strain in patients with ischemic heart disease?
Meta-Analysis (n=525)
Does 2DSTE strain during low-dose dobutamine stress improve diagnostic accuracy for detecting reversible myocardial dysfunction compared to resting strain in patients with ischemic heart disease?
Absolute Event Rate: 81.5% vs 67.1%
p-value: p=<0.0001
2D-speckle tracking echocardiography during low-dose dobutamine stress provides significantly higher diagnostic accuracy than resting strain for identifying reversible ischemic myocardial dysfunction.
May improve viability assessment in ischemic heart disease; confirms higher diagnostic accuracy of low-dose dobutamine 2DSTE over resting strain.
Purpose: Some studies have indicated that the use of 2D-Speckle tracking echocardiography (2DSTE) aids in predicting recovery of myocardial contractile function after revascularization in patients with chronic ischemic left ventricular (LV) dysfunction or acute myocardial infarction (MI). The purpose of this meta-analysis was to evaluate the diagnostic accuracy of 2DSTE strain in the detection of myocardial viability at rest and during low-dose dobutamine (LDD) stress. Methods: A systematic review for all prospective trials using 2DSTE to assess myocardial viability until January 2019 was done. Using a standard approach of meta-analysis for diagnostic tests. Results: Overall, 9 studies including 525 patients with either chronic ischemic heart disease or acute MI fulfilled the inclusion criteria. Seven studies used longitudinal strain (LS) at rest, 9 studies used circumferential strain (CS) at rest, 4 studies used LS during LDD stress, and 4 studies used CS during LDD stress. LS and CS during LDD stress showed equally high sensitivity (81.5% and 81.5% respectively) and specificity (81.3% and 81.4% respectively) for detecting reversible dysfunction. At rest, LS and CS showed equally lower sensitivity (67.1%, p<0.0001 vs. LDD stress and 68.7%, p<0.0001, vs. LDD stress, respectively) and specificity (64%, p<0.0001 vs. LDD stress and 65.7%, p=0.0008 vs. LDD stress, respectively) as compared with LDD stress. Conclusions: LS and CS by 2DSTE during LDD stress accurately identify reversible ischemic myocardial dysfunction in patients with chronic ischemic LV dysfunction or after MI. The use of LDD stress can be recommended over resting strain measures in this setting.
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Ballo et al. (2022) conducted a meta-analysis in Chronic ischemic left ventricular dysfunction or acute myocardial infarction (n=525). 2D-Speckle tracking echocardiography (2DSTE) during low-dose dobutamine (LDD) stress vs. 2DSTE at rest was evaluated on Sensitivity for predicting regional functional recovery (Longitudinal Strain) (95% CI 63.7-91.7, p=<0.0001). 2D-speckle tracking echocardiography during low-dose dobutamine stress accurately identified reversible ischemic myocardial dysfunction with 81.5% sensitivity, significantly outperforming resting strain measures.
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