Combining strain-rate imaging with wall-motion scoring during dobutamine echocardiography improved sensitivity for predicting functional recovery compared to WMS alone (82% vs 73%, P=0.015).
Observational (n=55)
Does strain-rate imaging combined with wall-motion scoring during dobutamine echocardiography improve the prediction of functional recovery after revascularization in stable patients with previous myocardial infarction?
Combining strain-rate imaging with wall-motion scoring during dobutamine echocardiography significantly improves the sensitivity and overall accuracy for predicting myocardial functional recovery after revascularization.
Effect estimate: AUC 0.88 vs 0.73
Absolute Event Rate: 82% vs 73%
p-value: p=0.015
Background— Assessment of myocardial viability based on wall-motion scoring (WMS) during dobutamine echocardiography (DbE) is difficult and subjective. Strain-rate imaging (SRI) is quantitative, but its incremental value over WMS for prediction of functional recovery after revascularization is unclear. Methods and Results— DbE and SRI were performed in 55 stable patients (mean age, 64±10 years; mean ejection fraction, 36±8%) with previous myocardial infarction. Viability was predicted by WMS if function augmented during low-dose DbE. SR, end-systolic strain (ESS), postsystolic strain (PSS), and timing parameters were analyzed at rest and with low-dose DbE in abnormal segments. Regional and global functional recovery was defined by side-by-side comparison of echocardiographic images before and 9 months after revascularization. Of 369 segments with abnormal resting function, 146 showed regional recovery. Compared with segments showing functional recovery, those that failed to recover had lower low-dose DbE SR, SR increment (ΔSR), ESS, and ESS increment (ΔESS) (each P <0.005). After optimal cutoffs for the strain parameters were defined, the sensitivity of low-dose DbE SR (78%, P =0.3), ΔSR (80%, P =0.1), ESS (75%, P =0.6), and ΔESS (74%, P =0.8) was better though not significantly different from WMS (73%). The specificity of WMS (77%) was similar to the SRI parameters. Combination of WMS and SRI parameters augmented the sensitivity for prediction of functional recovery above WMS alone (82% versus 73%, P =0.015; area under the curve=0.88 versus 0.73, P <0.001), although specificities were comparable (80% versus 77%, P =0.2). Conclusions— The measurement of low-dose DbE SR and ΔSR is feasible, and their combination with WMS assessment improves the sensitivity of viability assessment with DbE.
Hanekom et al. (Mon,) conducted a observational in Previous myocardial infarction (n=55). Strain-rate imaging (SRI) combined with wall-motion scoring (WMS) vs. Wall-motion scoring (WMS) alone was evaluated on Sensitivity for prediction of functional recovery (AUC 0.88 vs 0.73, p=0.015). Combining strain-rate imaging with wall-motion scoring during dobutamine echocardiography improved sensitivity for predicting functional recovery compared to WMS alone (82% vs 73%, P=0.015).
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