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Regional layer-specific longitudinal peak systolic strain using exercise stress two-dimensional speckle-tracking echocardiography for the detection of functionally significant coronary artery disease

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Abstract

The present study aimed to investigate whether layer-specific regional peak-systolic longitudinal strain (LS) measurement on transthoracic echocardiogram (TTE) with exercise stress can be useful for the detection of functionally significant coronary artery disease as confirmed by invasive fractional flow reserve (FFR) in stable patients. This is a prospective analysis of 88 coronary arteries in 30 stable patients undergoing invasive FFR measurement and ergometer exercise stress TTE. Regional LS in the mid, endocardial and epicardial layers was calculated at rest, peak stress and early and late recovery phases after the exercise stress test. The endocardial-to-epicardial LS ratio was calculated as an indicator of endocardial-layer dependency of the left ventricular myocardium. Ischemic FFR defined as FFR ≤ 0.80 was observed in 33 of 88 coronary arteries. The mid-, endocardial- and epicardial-layer LS at early recovery (− 15.4 ± 5.2 vs. −  13.0 ± 4.4%, P = 0.040;  − 15.7 ± 5.1 vs.  − 13.2 ± 4.5%, P = 0.029;  − 14.6 ± 5.1 vs.  − 12.4 ± 4.0%, P = 0.038, respectively) and the percent change in the endocardial-to-epicardial LS ratio from baseline to peak stress, early recovery, and late recovery phases (1.5 ± 11.2% vs. 6.6 ± 10.5%, P = 0.009; 2.8 ± 8.9% vs. 7.1 ± 12.6%, P = 0.002; 5.2 ± 8.8% vs. 8.5 ± 13.7%, P = 0.026; respectively) were significantly more impaired in the ischemic territories (FFR ≤ 0.80) compared with the non-ischemic territories (FFR > 0.80). According to the receiver operating characteristic curve analysis, a combination of endocardial LS and percent change in the endocardial-to-epicardial LS ratio at early recovery phase plus visual evaluation of LV wall motion had incremental diagnostic value for the detection of the ischemic territory compared with visual evaluation alone (area under the curve = 0.752 and 0.618, P = 0.006). The results of this study suggested that assessing layer-specific LS and the endocardial-to-epicardial LS ratio after exercise stress on speckle-tracking TTE may have potential for objective and quantitative evaluation in the assessment of myocardial ischemia. Further studies in a larger population are needed to confirm these findings.

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Acknowledgements

We thank Drs. Saito Y, Ohno Y, Shoji S, Takahara M, Wakabayashi S, Tokimasa S and the team of our cardiac catheterization laboratory for performing coronary angiography and fractional flow reserve measurement.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Chiba, Japan

    Takeshi Nishi, Nobusada Funabashi, Koya Ozawa, Tomoko Nishi, Tomoko Kamata, Yoshihide Fujimoto & Yoshio Kobayashi

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  1. Takeshi Nishi
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  2. Nobusada Funabashi
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  3. Koya Ozawa
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  4. Tomoko Nishi
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Correspondence to Nobusada Funabashi.

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Nishi, T., Funabashi, N., Ozawa, K. et al. Regional layer-specific longitudinal peak systolic strain using exercise stress two-dimensional speckle-tracking echocardiography for the detection of functionally significant coronary artery disease. Heart Vessels 34, 1394–1403 (2019). https://doi.org/10.1007/s00380-019-01361-w

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