Mental Stress-Induced Myocardial Ischemia Detected by Global Longitudinal Strain and Quantitative Myocardial Contrast Echocardiography in Women With Nonobstructive Coronary Artery Disease - 09/07/24
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Abstract |
Background |
The utility of radionuclide myocardial perfusion imaging including positron emission tomography (PET) for diagnosing mental stress-induced myocardial ischemia (MSIMI) is clinically restricted. This study aims to assess the diagnostic performance of novel echocardiographic techniques, including automated strain and quantitative myocardial contrast echocardiography (MCE) with dedicated software and deep neural network model, for MSIMI detection. The secondary objective was to explore the correlation between changes in myocardial blood flow and MSIMI.
Methods |
Seventy-two female patients ages 18 to 75 with angina and nonobstructive coronary artery disease (ANOCA) and 23 healthy controls were prospectively recruited. Both echocardiography with contrast agent and PET imaging were performed during structured mental stress testing. Mental stress-induced myocardial ischemia was defined as a summed difference score ≥3 on PET. Echocardiographic parameters including left ventricular global longitudinal strain, β, and A × β were obtained, and their trends during mental stress testing were observed. ΔGLS was defined as the ratio of difference between global longitudinal strain values at stress and rest to the rest data. β reserve and A×β reserve were respectively calculated.
Results |
Thirty-two ANOCA patients (44%) and 1 control (4%) were diagnosed with MSIMI (P < .01). For ANOCA patients with MSIMI, left ventricular GLS, β, and A × β declined to varied extents during mental stress testing compared with those without MSIMI and the controls (P < .05). Bland-Altman plots demonstrated good consistency between β reserve and A × β reserve output by the deep neural network model and iMCE software. Receiver operating characteristic curve analyses showed that ΔGLS, β reserve, and A × β reserve demonstrated favorable ability to predict MSIMI, especially the combination of A × β reserve using iMCE analysis and ΔGLS (area under the curve, 0.94; sensitivity, 83%; specificity, 97%).
Conclusions |
Novel technologies in echocardiography exhibit the potential to be a clinical alternative to cardiac PET for effectively detecting MSIMI. Attenuated myocardial blood flow response during structured mental stress testing was correlated with MSIMI, providing a reasonable explanation for the chest discomfort persisting in ANOCA women.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Mental stress-induced myocardial ischemia detected by global longitudinal strain and quantitative myocardial contrast echocardiography in women with nonobstructive coronary artery disease. 2D ΔGLS and A×β reserve on quantitative MCE could effectively predict MSIMI diagnosed by cardiac PET among a cohort of female patients with angina and nonobstructive coronary artery disease. Attenuated MBF response during structured mental stress testing was correlated with MSIMI.
Central illustrationMental stress-induced myocardial ischemia detected by global longitudinal strain and quantitative myocardial contrast echocardiography in women with nonobstructive coronary artery disease. 2D ΔGLS and A×β reserve on quantitative MCE could effectively predict MSIMI diagnosed by cardiac PET among a cohort of female patients with angina and nonobstructive coronary artery disease. Attenuated MBF response during structured mental stress testing was correlated with MSIMI.Le texte complet de cet article est disponible en PDF.
Highlights |
• | The diagnosis of MSIMI is challenging. |
• | ΔGLS and flow reserve on quantitative MCE could effectively detect MSIMI. |
• | Attenuated flow response during mental stress was correlated with MSIMI. |
Keywords : Mental stress-induced myocardial ischemia, Global longitudinal strain, Myocardial contrast echocardiography, Myocardial blood flow, Deep neural network
Abbreviations : 2D, ANOCA, AUC, CAD, CAG, CMD, ConvLSTM, CSIMI, DNN, GLS, HADS, ICC, IQR, LVEF, LVGLS, MBF, MCE, MI, MSIMI, PET, PSS, ROC, ROI, RPP
Plan
Drs. Kong, Fei, Cheng and Ma contributed equally to this work. |
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This work was supported by Basic and Applied Basic Research Foundation of Guangdong Province (2021A1515012232) and the National Natural Science Foundation of China launching fund of Guangdong Provincial People's Hospital (8,227,070,211). |
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