Eduardo Henrique Bonotto, Fernanda Arejano Vaucher, Miguel Morita Fernandes-Silva, Marco Stephan Lofrano-Alves
{"title":"在应激超声心动图左心房应变评估心肌缺血。","authors":"Eduardo Henrique Bonotto, Fernanda Arejano Vaucher, Miguel Morita Fernandes-Silva, Marco Stephan Lofrano-Alves","doi":"10.1177/1742271X251371417","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Diastolic dysfunction precedes ventricular contractility changes in the ischaemic cascade. Both diastolic and systolic left ventricle dysfunctions are known to alter left atrial myocardial deformation by impairing its phasic function, which can be evaluated using speckle-tracking echocardiography.</p><p><strong>Objective: </strong>The aim of this study was to assess the accuracy of left atrial strain in detecting myocardial ischaemia in patients undergoing dobutamine stress echocardiography.</p><p><strong>Methods: </strong>Patients referred for dobutamine stress echocardiography due to suspected ischaemia were prospectively enrolled. Left atrial strain, including its three components - reservoir, conduit, and contractile - was analysed at each stage of dobutamine stress echocardiography. The diagnosis of myocardial ischaemia was defined as a new or worsening wall motion abnormality in at least two contiguous left ventricle segments during dobutamine stress echocardiography. Patients with a positive dobutamine stress echocardiography for ischaemia were compared with those with a negative dobutamine stress echocardiography for ischaemia.</p><p><strong>Results: </strong>A total of 56 patients were included. Patients with inducible ischaemia had significantly lower left atrial reservoir strain (LASr) values at rest and throughout all dobutamine stress echocardiography phases, with the lowest values at peak stress (27.6% (24.0 to 28.4) vs 34% (29.6 to 42.7), <i>p</i> < 0.001). LASr at rest and during low-dose dobutamine predicted ischaemia during dobutamine stress echocardiography (rest: area under the curve = 0.68, <i>p</i> = 0.038; low dose: area under the curve = 0.78, <i>p</i> < 0.001). An LASr cutoff of ⩽29.7% at peak stress yielded high diagnostic accuracy in detecting inducible ischaemia (area under the curve = 0.88, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Assessment of left atrial strain in patients undergoing dobutamine stress echocardiography for suspected myocardial ischaemia has diagnostic value and can be integrated into conventional dobutamine stress echocardiography to corroborate the findings of a positive test.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":" ","pages":"1742271X251371417"},"PeriodicalIF":0.7000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476370/pdf/","citationCount":"0","resultStr":"{\"title\":\"Left atrial strain during stress echocardiography for the assessment of myocardial ischaemia.\",\"authors\":\"Eduardo Henrique Bonotto, Fernanda Arejano Vaucher, Miguel Morita Fernandes-Silva, Marco Stephan Lofrano-Alves\",\"doi\":\"10.1177/1742271X251371417\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Diastolic dysfunction precedes ventricular contractility changes in the ischaemic cascade. Both diastolic and systolic left ventricle dysfunctions are known to alter left atrial myocardial deformation by impairing its phasic function, which can be evaluated using speckle-tracking echocardiography.</p><p><strong>Objective: </strong>The aim of this study was to assess the accuracy of left atrial strain in detecting myocardial ischaemia in patients undergoing dobutamine stress echocardiography.</p><p><strong>Methods: </strong>Patients referred for dobutamine stress echocardiography due to suspected ischaemia were prospectively enrolled. Left atrial strain, including its three components - reservoir, conduit, and contractile - was analysed at each stage of dobutamine stress echocardiography. The diagnosis of myocardial ischaemia was defined as a new or worsening wall motion abnormality in at least two contiguous left ventricle segments during dobutamine stress echocardiography. Patients with a positive dobutamine stress echocardiography for ischaemia were compared with those with a negative dobutamine stress echocardiography for ischaemia.</p><p><strong>Results: </strong>A total of 56 patients were included. Patients with inducible ischaemia had significantly lower left atrial reservoir strain (LASr) values at rest and throughout all dobutamine stress echocardiography phases, with the lowest values at peak stress (27.6% (24.0 to 28.4) vs 34% (29.6 to 42.7), <i>p</i> < 0.001). LASr at rest and during low-dose dobutamine predicted ischaemia during dobutamine stress echocardiography (rest: area under the curve = 0.68, <i>p</i> = 0.038; low dose: area under the curve = 0.78, <i>p</i> < 0.001). An LASr cutoff of ⩽29.7% at peak stress yielded high diagnostic accuracy in detecting inducible ischaemia (area under the curve = 0.88, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Assessment of left atrial strain in patients undergoing dobutamine stress echocardiography for suspected myocardial ischaemia has diagnostic value and can be integrated into conventional dobutamine stress echocardiography to corroborate the findings of a positive test.</p>\",\"PeriodicalId\":23440,\"journal\":{\"name\":\"Ultrasound\",\"volume\":\" \",\"pages\":\"1742271X251371417\"},\"PeriodicalIF\":0.7000,\"publicationDate\":\"2025-09-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476370/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ultrasound\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/1742271X251371417\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ultrasound","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/1742271X251371417","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Left atrial strain during stress echocardiography for the assessment of myocardial ischaemia.
Introduction: Diastolic dysfunction precedes ventricular contractility changes in the ischaemic cascade. Both diastolic and systolic left ventricle dysfunctions are known to alter left atrial myocardial deformation by impairing its phasic function, which can be evaluated using speckle-tracking echocardiography.
Objective: The aim of this study was to assess the accuracy of left atrial strain in detecting myocardial ischaemia in patients undergoing dobutamine stress echocardiography.
Methods: Patients referred for dobutamine stress echocardiography due to suspected ischaemia were prospectively enrolled. Left atrial strain, including its three components - reservoir, conduit, and contractile - was analysed at each stage of dobutamine stress echocardiography. The diagnosis of myocardial ischaemia was defined as a new or worsening wall motion abnormality in at least two contiguous left ventricle segments during dobutamine stress echocardiography. Patients with a positive dobutamine stress echocardiography for ischaemia were compared with those with a negative dobutamine stress echocardiography for ischaemia.
Results: A total of 56 patients were included. Patients with inducible ischaemia had significantly lower left atrial reservoir strain (LASr) values at rest and throughout all dobutamine stress echocardiography phases, with the lowest values at peak stress (27.6% (24.0 to 28.4) vs 34% (29.6 to 42.7), p < 0.001). LASr at rest and during low-dose dobutamine predicted ischaemia during dobutamine stress echocardiography (rest: area under the curve = 0.68, p = 0.038; low dose: area under the curve = 0.78, p < 0.001). An LASr cutoff of ⩽29.7% at peak stress yielded high diagnostic accuracy in detecting inducible ischaemia (area under the curve = 0.88, p < 0.001).
Conclusion: Assessment of left atrial strain in patients undergoing dobutamine stress echocardiography for suspected myocardial ischaemia has diagnostic value and can be integrated into conventional dobutamine stress echocardiography to corroborate the findings of a positive test.
UltrasoundRADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
1.70
自引率
0.00%
发文量
55
期刊介绍:
Ultrasound is the official journal of the British Medical Ultrasound Society (BMUS), a multidisciplinary, charitable society comprising radiologists, obstetricians, sonographers, physicists and veterinarians amongst others.