Clinical InvestigationCoronary Artery DiseaseAssessment of Temporal Heterogeneity and Regional Motion to Identify Wall Motion Abnormalities Using Treadmill Exercise Stress Three-Dimensional Echocardiography
Section snippets
Study Design
We prospectively recruited 110 patients (78 men, aged 60 ± 11 years) who were referred for clinical treadmill exercise echocardiography (using the standard Bruce protocol) and had a coronary angiography within 6 months. All patients had conventional 2DEand 3DE at rest and peak stress, and CFM of 3DE images (Tomtec, Unterschlessheim, Germany) was performed offline. Contrast agents were not used in this study.
Coronary Angiography
Selective coronary angiography was performed in a standard fashion. Quantitative
Patient Characteristics
The results were analyzed in 90 patients (63 men, aged 60 ± 10 years); patients with poor 3DE image quality (n = 8) and submaximal stress (<80% of their maximal heart rate with exercise; n = 12) were excluded. Table 1 summarizes the clinical characteristics, presence, and cause of CAD and resting and peak wall motion scores. Time from cessation of exercise until the end of 2DE acquisition was 58 ± 25 seconds, and time from cessation of exercise until the end of 3DE (taken immediately after 2DE)
Discussion
In this assessment of new exercise echocardiography technologies, angiographic correlation remained best with 2DE followed by CFM and 3DE. The greater specificity of 3DE than 2DE, which may be due to the avoidance of off-axis imaging, was at the cost of an unacceptably low sensitivity of noncontrast stress 3DE.
Limitations
This study has several limitations. First, 3DE was acquired after 2DE at peak exercise in this study, which may have allowed time for wall motion abnormalities to resolve, contributing to the lower sensitivity than 2DE. Because the early post-exercise period is the most valuable diagnostically, there is reluctance to use this time for acquisition of lower-resolution 3DE images. The only means of avoiding compromising clinical data would be to re-stress the patients, which we considered
Conclusions
The current image quality of 3DE does not seem to be sufficient to add incremental value to exercise noncontrast 2DE, although the specificity of 3DE exceeds that of noncontrast 2DE, probably by ensuring that pre- and post-exercise images are matched. Although there are theoretic attractions to analyzing the temporal distribution of contraction, and 3D is an attractive means of summarizing this for the entire LV, 3D wall motion assessment is currently insufficiently accurate for the
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