Speckle Tracking Imaging And Strain Stress Analysis For The Diagnosis Of Stable Angina Pectoris

Objective:In this study, two-dimensional speckle tracking imaging(2DSTI)and strain stress analysis were used to evaluate the changes of regional myocardial systolic function before and after dobutamin stress test, which was very useful for the clinical application of dobutamin stress speckle tracking imaging and strain analysis for the diagnosis of stable angina pectoris.Methods:30 suspected stable angina pectoris patients, who are suffering from chest pain or chest tightness, are chosen for dobutamine stress echocardiography(DSE) analysis,following coronary arteriography(CAG) and coronary computed tomography angiography(CTA) analysis. According to CAG and CTA results, patients were divided into(coronary heart disease) CHD group(n=20) and control group(n=10).In the stage of baseline, peak stress and after DSE 10 min, 30 min,60min,120 min,240min,echocardiography was performed to obtain the two-dimensional images from LV short-axis views at the levels of mitral annulus, papillary muscle and apex, and LV apical four-chamber view, two-chamber view and long-axis view in 5 continuous cardiac cycles.QLab8.1 software was used to analyze the peak circumferential strain rate of early and late diastole(CSRe, CSRa) in myocardial segments of left ventricular, the peak systolic longitudinal strain(LS) and strain rate(LSR), the peak systolic circumferential strain(CS)and strain rate(CSR) and the peak longitudinal strain rate of early and late diastole(LSRe,LSRa), and further compare the time-dependent regional myocardial systolic and diastolic function before and after DSE between CHD and control group.Results:In resting state or maximum drug utilization stage, no regional wall motion abnormality was found by conventional ultrasound analysis. In resting state, there were no significant difference in the values of LS, LSr, CS, CSr, LSRe, LSRa,CSRe and CSRa between control and CHD group(P>0.05). But in maximum drug utilization state, the values of LS and CS for CHD ischemic segments were much smaller than the values of control and CHD non-ischemic segments groups. And the values of LSr and CSr significantly decreased both in control and CHD group in maximum drug utilization state, which were reversed by the discontinuation of dobutamine treatment. The values of LSRe, LSRa, CSRe and CSRa for control and CHD group all significantly increased in maximum drug utilization state. After the discontinuation of dobutamine treatment, the values of LSRe would dramatically decrease to a level below the baseline,which would be reversed to the baseline in 30 min. The values of CSRe would slowly decrease to a level below the baseline, which would also be reversed to the baseline in 60 min. And the values of LSRa and CSRa would decrease slowly to the baseline in 30 min.Conclusion:Our results demonstrated that two-dimensional speckle tracking imaging based dobutamine stress analysis found the regional myocardial systolic and diastolic dysfunction in CHD patients, which couldn’t be obtained by conventional two-dimensional dobutamine stress ultrasound analysis, showing the potential use of two-dimensional speckle tracking imaging based dobutamine stress analysis for the diagnosis of stable angina pectoris.