Key result
Resting wall motion scores and peak longitudinal strain identified segments without transmural scarring (AUC 94.0 and 85.7), but severe akinesia did not reliably predict transmural scarring.
Why the study?
Detection and correct localization of transmural lesions is important for optimal treatment of chronic CAD patients, but the ability of PLS to detect scar tissue compared to CMR was unclear.
Does echocardiography at rest and dobutamine stress accurately detect transmural scarring compared to LGE-CMR in patients with chronic CAD?
Observational (n=57)
Does echocardiography at rest and dobutamine stress accurately detect transmural scarring compared to LGE-CMR in patients with chronic CAD?
Effect estimate: AUC 94.0 for WMS and AUC 85.7 for PLS (95% CI 90.6-97.3 for WMS and 79.0-92.3 for PLS)
While normal resting wall motion and strain reliably exclude transmural scars, severe dysfunction (akinesia) on stress echocardiography does not reliably predict transmural scarring in chronic CAD, warranting LGE-CMR for confirmation.
AIMS: Detection and correct localization of transmural lesions can be important for optimal treatment of patients with chronic coronary artery disease (CAD). The aim of the study was to investigate the ability of peak longitudinal ejection strain (PLS) to detect the presence and extent of scar-tissue in CAD patients with normal or near normal ejection fraction, in comparison to cardiac magnetic resonance (CMR). METHODS AND RESULTS: Before coronary artery bypass grafting, 57 patients underwent late gadolinium enhancement (LGE) CMR and echocardiography at rest and dobutamine stress (DS). According to the degree of LGE, segments were allocated to groups of none, subendocardial (1-50%), subtotal (51-75%), and total transmural scars (>75%). Dysfunctional segments were identified by PLS or wall motion scores (WMS). The finding of normal/near normal resting WMS and PLS, excellently identified segments without transmural LGE (AUC 94.0 CI 90.6-97.3 and AUC 85.7 CI 79.0-92.3, respectively). However, the finding of akinesia did not necessarily indicate transmural scarring. The negative predictive value was high (99%, CI 98-100%) while the positive predictive value was low. Detection-rates for subendocardial LGE were low. CONCLUSION: Normo- and slightly hypokinetic myocardium by resting WMS or strain detects the absence of transmural scars. However, the finding of severe hypo- and akinesia does not reliably predict transmural scarring, with no improvement by the addition of DS. Detection of predominant akinesia with less than two normo- or hypokinetic segments in the territory of a high-grade coronary stenosis or occlusion, warrants further examination by LGE-CMR.
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Rösner et al. (2015) conducted an observational in Chronic coronary artery disease (CAD) (n=57). Echocardiography at rest and dobutamine stress (peak longitudinal ejection strain and wall motion scores) vs. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) was evaluated on Identification of segments without transmural LGE (AUC 94.0 for WMS and AUC 85.7 for PLS, 95% CI 90.6-97.3 for WMS and 79.0-92.3 for PLS). Resting wall motion scores and peak longitudinal strain identified segments without transmural scarring (AUC 94.0 and 85.7), but severe akinesia did not reliably predict transmural scarring.
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