Speckle tracking during stress echocardiography using high frame rate imaging

Abstract

Abstract Background As many cardiac diseases do not lead to symptoms under resting conditions, subjecting the patient to a stress (e.g. exercise) test is clinical routine to reveal disease. Quantification of cardiac function using speckle tracking echocardiography (STE) during such stress test remains a challenge not only as overall image quality typically drops but also as the heart rate increases which results in an unfavourable heart-rate-to-frame-rate ratio as required for robust tracking. Moreover, conventional STE runs at relatively low frame rate thereby under-resolving peak strain rate (SR) values – which is particularly true at high heart rates – while this biomarker has been shown to better disclose stress-induced disease than strain using Tissue Doppler Imaging (TDI)-based strain methodologies. Purpose The aim of this study was therefore to test whether HFR STE could reveal the strain / SR response described previously in the TDI literature. Methods Stress echocardiography was performed in 25 healthy volunteers at four different stress levels (baseline, 25%, 50% and 66% of maximum workload) using a supine bike. Apical 4-chamber views were recorded using the ULA-OP 256 experimental scanner running a HFR sequence based on the compounding of 6 diverging wave transmits to achieve a frame rate of 833Hz. A myocardial contour was manually drawn on the reconstructed images and tracked during the cardiac cycle by a custom-made 2D HFR STE algorithm (DOI: 10.1109/TUFFC.2020.2985451). Then, strain and strain rate curves were computed from which systolic (S) and diastolic (early (E) and late (A)) peak values, as well as the short-lived isovolumic relaxation peak (IVR) were extracted. Finally, these values were compared amongst the different stress levels using a single factor ANOVA. Results Some datasets had to be discarded as the contour was not properly tracked at a visual assessment of an expert cardiologist. Tracking was feasible in 92%, 98%, 80% and 64% of cases, for baseline, 25%, 50% and 66% of maximum workload, respectively. The decreasing feasibility with exercise level is in line with what is seen clinically, as volunteers' breathing is faster and heavier with increasing exercise level making the imaging more challenging. The extracted strain and SR curves showed a physiological pattern (Fig. 1a). As shown in Fig. 1b, the global systolic strain response was biphasic, showing a significant increase at low stress level but then reaching a plateau. In contrast, all SR indices linearly increased at each stress level. Conclusion Strain rate clinical markers extracted with HFR STE are concordant with what was reported in TDI literature. These findings show that HFR STE allows to assess cardiac function adequately during stress echocardiography. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): FWO - Research Foundation Flanders