The role of post-systolic strain and electrocardiographic changes during dobutamine stress echocardiography in enhancing detection of symptomatic coronary artery disease

TL;DR

This study investigates whether post-systolic strain and ECG changes during dobutamine stress echocardiography improve detection of coronary artery disease in patients with chest pain.

Contribution

The study evaluates the role of post-systolic strain index during recovery in detecting coronary artery disease alongside traditional methods.

Findings

LV wall motion abnormalities were strongly associated with obstructive CAD.

ECG changes during DSE correlated with obstructive CAD.

PSI during recovery was not linked to CAD but was associated with ECG changes.

Abstract

To enhance the diagnosis of coronary artery disease (CAD) during dobutamine stress echocardiography (DSE), subjective visual evaluation of left ventricular (LV) wall motion abnormalities may be complemented by analyzing myocardial deformation and electrocardiographic (ECG) changes.

This study evaluates the post-systolic strain index (PSI) measured during the recovery phase of DSE for detecting obstructive CAD and explores its relationship with wall motion abnormalities and ECG changes during DSE in patients with anginal symptoms.

We retrospectively analyzed data from 72 patients who underwent both DSE and coronary angiography. We compared visual interpretation of DSE at peak stress, ECG abnormalities during DSE, and PSI during the recovery phase with obstructive CAD.

LV wall motion abnormalities induced by dobutamine were independently associated with obstructive CAD [odds ratio (OR) 8.58, 95% confidence interval (CI) 2.67–27.50, p < 0.011], diagnosed in 44% of patients. Significant ECG changes during DSE correlated with obstructive CAD (OR 4.41, 95% CI 1.41–13.81, p = 0.011). PSI during recovery did not correlate with DSE-induced wall motion abnormalities (OR 1.45, 95% CI 0.49–4.24, p = 0.497) or obstructive CAD (OR 1.00, 95% CI 0.342–2.926, p = 1.00), but was associated with pathological ECG changes (OR 5.51, 95% CI 1.05–28.99, p = 0.044).

PSI measured during the recovery phase of DSE is not associated with DSE-induced wall motion abnormalities and obstructive CAD in patients with anginal symptoms. However, PSI may be related to ECG changes and could potentially reflect subtle, stress-induced myocardial dysfunction, possibly involving coronary microvascular impairment.

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