Systolic longitudinal strain correlates with visual assessment of regional left ventricular function during dobutamine stress echocardiography and discriminates the segments with induced contractility impairment.

Abstract

The relationship between visual and strain assessment of left ventricular (LV) function during dobutamine stress echocardiography (DSE) remains poorly investigated. We assessed systolic longitudinal strain (SLS) and strain rate (SLSR) in segments visually graded as normokinetic, hypokinetic, or akinetic at baseline (0) and peak stage (1) of DSE and compared deformation changes between segments with and without induced contractility worsening. From 250 patients examined by DSE, 238 patients with diagnostic test were included, mean age of 62±9years (105 females). Regional LV contractility was assessed visually and measured using SLS and SLSR in 4284 segments. The LV segments during baseline and peak stage of DSE revealed gradual decrease in absolute values of SLS (from 17.7±6.4% in normokinetic to 11.7±8.4% in akinetic segments at rest, and from 17.2±8.5% to 14.4±7.8% at peak, P<.001), as measured by automated function imaging (AFI) and SLSR (from 1.1±0.37s-1 in normokinetic to 0.9±0.29s-1 in akinetic at rest, and from 2.32±0.92 to 2.13±0.85s-1 at peak). The decrease in SLS in segments with contractility worsening was higher than in segments without induced impairment (ΔSLS 2% vs 0%, P<.0001 for all LV segments and 2% vs 1%, P=.02 in mid-LV segments). Absolute value of regional SLS <23% at peak DSE and decrease in SLS >2% from baseline showed 90% and 76% sensitivity for the detection of contractility impairment. Strain analysis quantifies segmental LV contractility not only at rest and peak DSE but may be helpful in detection of stress-induced contractility worsening.