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J Am Soc Echocardiogr. 2019 Jan;32(1):65-73. doi: 10.1016/j.echo.2018.09.007. Epub 2018 Oct 17.

Adding Speckle-Tracking Echocardiography to Visual Assessment of Systolic Wall Motion Abnormalities Improves the Detection of Myocardial Infarction.

Author information

1
Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands. Electronic address: manouk.van.mourik@mumc.nl.
2
Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
3
Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands.
4
CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
5
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.
6
Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands.
7
TOMTEC Imaging Systems, Unterschleissheim, Germany.
8
Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway.

Abstract

BACKGROUND:

The aim of this study was to investigate whether speckle-tracking echocardiography (STE) improves the detection of myocardial infarction (MI) over visual assessment of systolic wall motion abnormalities (SWMAs) using delayed enhancement cardiac magnetic resonance imaging as a reference.

METHODS:

Transthoracic echocardiography was performed in 95 patients with first ST segment elevation MI 110 days (interquartile range, 97-171 days) after MI and in 48 healthy control subjects. Two experienced observers independently assessed SWMAs. Separately, longitudinal peak negative, peak systolic, end-systolic, global strain, and strain rate were measured and averaged for the American Heart Association-recommended coronary artery perfusion territories. Receiver operating characteristic analysis was used to determine a single optimal cutoff value for each strain parameter. The diagnostic accuracy of an algorithm combining visual assessment and STE was evaluated.

RESULTS:

Median infarct size and transmurality were 15% (interquartile range, 7%-24%) and 64% (interquartile range, 46%-78%), respectively. Sensitivity, specificity, and accuracy of visual assessment to detect MI were 74% (95% CI, 63%-82%), 85% (95% CI, 72%-93%), and 78% (95% CI, 70%-84%), respectively. Among the strain parameters, SR had the highest diagnostic accuracy (area under the curve, 0.88; 95% CI, 0.83-0.94; cutoff value, -0.97 sec-1). The combination with STE improved sensitivity compared with visual assessment alone (94%; 95% CI, 86%-97%; P < .001), minimally affecting specificity (79%; 95% CI, 65%-89%; P = .607). Overall accuracy improved to 89% (95% CI, 82%-93%; P = .011). Multivariate analysis accounting for age and sex demonstrated that SR was independently associated with MI (odds ratio, 2.0; 95% CI, 1.6-2.7).

CONCLUSIONS:

The sensitivity and diagnostic accuracy of visually detecting chronic MI by assessing SWMAs are moderate but substantially improve when adding STE.

KEYWORDS:

Cardiac magnetic resonance imaging; Deformation analysis; Myocardial infarction; Speckle-tracking echocardiography; Strain; Transthoracic echocardiography

PMID:
30340888
DOI:
10.1016/j.echo.2018.09.007

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