TY - JOUR
T1 - Adding Speckle-Tracking Echocardiography to Visual Assessment of Systolic Wall Motion Abnormalities Improves the Detection of Myocardial Infarction
AU - van Mourik, Manouk J. W.
AU - Zaar, Danielle V. J.
AU - Smulders, Martijn W.
AU - Heijman, Jordi
AU - Lumens, Joost
AU - Dokter, Jeffrey E.
AU - Passos, Valeria Lima
AU - Schalla, Simon
AU - Knackstedt, Christian
AU - Schummers, Georg
AU - Gjesdal, Ola
AU - Edvardsen, Thor
AU - Bekkers, Sebastiaan C. A. M.
N1 - Funding Information:
Dr. Lumens has received support from the Dr. Dekker Program of the Dutch Heart Foundation (grant 2015T082) and the Netherlands Organization for Scientific Research (VIDI grant 016.176.340). Commercially available research software was kindly provided by TomTec Imaging Systems (Unterschleissheim, Germany). The vendor was not involved in the study design.
Publisher Copyright:
© 2018 American Society of Echocardiography
PY - 2019/1
Y1 - 2019/1
N2 - 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.
AB - 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.
KW - Myocardial infarction
KW - Transthoracic echocardiography
KW - Deformation analysis
KW - Strain
KW - Speckle-tracking echocardiography
KW - Cardiac magnetic resonance imaging
KW - ULTRASONIC STRAIN-RATE
KW - MAGNETIC-RESONANCE
KW - DOPPLER
KW - DEFORMATION
KW - ENHANCEMENT
KW - VALIDATION
KW - SIZE
KW - TRANSMURALITY
KW - PREVALENCE
KW - MRI
U2 - 10.1016/j.echo.2018.09.007
DO - 10.1016/j.echo.2018.09.007
M3 - Article
C2 - 30340888
SN - 0894-7317
VL - 32
SP - 65
EP - 73
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 1
ER -