الفهرس 
DOBUTAMINE STRESS ECHOCARDIOGRAPHYOnly 14 pages are availabe for public view
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Abstract
D
obutamine stress echocardiography (DSE) is an accurate non-invasive technique for detecting coronary artery disease and is a test which has significant prognostic value in clinical practice, both in detecting viability and in risk stratification. However, this approach is subjective and relies on operator experience and doesn’t attempt to define the distal ischemic substrate.
Therefore, it was necessary to develop a more quantitative method to overcome the above mentioned limitations.
Several new ultrasound techniques have been developed to quantify dobutamine stress but translation and tethering effects between normal and hypocontractile segments may limit the applicability of these techniques.
Measuring deformation derived from tissue Doppler velocity (TVI)or speckle tracking in 2D gray scale images, strain imaging has largely overcome these limitations.
The aim of the present study To compare the feasibility and accuracy of two-dimensional strain derived from speckle –tracking and tissue velocity imaging (TVI) derived strain during dobutamine stress echocardiography in patient with ischemic heart disease.
This study was conducted on 30 patients, who were referred to Ain Shams University hospital and Ain Shams Specialized hospital in Cairo for clinical evaluation of myocardial ischemia in the period between April 2009 and January 2010, excluding from them patients with severe depressed left ventricular function, with ECG evidence of left bundle branch block (LBBB), with Significant valvular heart disease, with ventricular arrhythmia OR with pace maker rhythm.
All patients were complaining of chest pain and were subjected to: Thorough history taking, Full clinical examination, 12 leads surface ECG, Full 2D, M-mode & Doppler echocardiographic study, Dobutamine stress echocardiography, Tissue velocity imaging strain at basal and peak DSE, Two-dimensional speckle tracking strain at basal and peak DSE and coronary angiography.
In this study, peak TVI derived strain had a significant relationship to significant coronary arteries lesion. While, peak speckle tracking derived strain had a highly significant relationship to significant coronary arteries lesion
In this study, peak TVI derived strain sensitivity and specificity were 63%, 65% respectively at a cut off value of -15.3 while peak speckle tracking derived strain sensitivity and specificity were 74%, 62% respectively at a cut off value of -14.4.
Both methods are better in anterior circulation with less sensitivity and specificity in postero-lateral circulation.
Both peak TVI strain and peak speckle strain are a feasible and accurate methods for quantification of DSE, peak speckle strain is more sensitive while peak TVI strain is more specific.