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European Heart Journal Advance Access originally published online on May 15, 2007
European Heart Journal 2007 28(12):1425-1432; doi:10.1093/eurheartj/ehm082
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Assessment of the contractile reserve in patients with intermediate coronary lesions: a strain rate imaging study validated by invasive myocardial fractional flow reserve

Frank Weidemann*,{dagger}, Philip Jung, Caroline Hoyer, Jens Broscheit, Wolfram Voelker, Georg Ertl, Stefan Störk, Christiane E. Angermann and Joerg M. Strotmann

Medical Clinic I/Center of Cardiovascular Disease, University of Würzburg, Josef-Schneider Str. 2, D 20, 97080 Würzburg, Germany

Received 22 August 2006; revised 1 March 2007; accepted 8 March 2007; online publish-ahead-of-print 15 May 2007.

* Corresponding author. Tel: +49 931 2010; fax: +49 931 20136291. E-mail address: weidemann_f{at}medizin.uni-wuerzburg.de

See page 1407 for the editorial comment on this article (doi:10.1093/eurheartj/ehm166)

Aims: The present study aims to compare the change of left ventricular deformation during dobutamine stress echocardiography (DSE) with the reference standard of invasive myocardial fractional flow reserve (FFR) to assess the haemodynamic significance of intermediate coronary lesions.

Methods and results: In 30 patients with an intermediate coronary artery stenosis in one epicardial coronary artery, FFR measurements were performed during coronary catheterization. In case of an FFR < 0.75 after intracoronary adenosine administration, the stenosis was considered significant, indicating ischaemia. In addition, during DSE, peak systolic strain rate and systolic strain of the region of interest (supplied by the stenotic vessel) and of a non-ischaemic remote region were assessed at baseline and at peak stress. Thirteen patients had an FFR ≥ 0.75, indicating normal flow reserve (non-ischaemic group). The remaining 17 patients with an FFR < 0.75 comprised the ischaemic group. At baseline DSE, mean values of strain rate (–1.2 ± 0.3 s–1) and strain (–17 ± 8%) were not significantly different between both groups. In the ischaemic group, in the target region, strain at peak stress decreased to – 10 ± 8%, whereas strain rate remained unchanged. In contrast, in the non-ischaemic group, strain at peak stress remained unchanged (–18 ± 7%), whereas strain rate increased to – 2.5 ± 1.1 s–1. The receiver operating characteristic curve analysis revealed the change in strain rate as the best parameter to detect ischaemia, with a sensitivity of 89% and a specificity of 86%. In the remote region, in both groups, strain rate (–1.4 ± 0.4 s–1) and strain values (–20 ± 7%) were not significantly different at baseline, and strain rate doubled and strain remained unchanged at DSE peak stress.

Conclusion: Non-invasive evaluation of regional deformation, using strain rate imaging during DSE, predicted the relevance of intermediate coronary stenosis. In this context, strain rate is superior to strain measurements for the quantification of the contractile reserve.

Key Words: Intermediate stenosis • Strain rate imaging • Fractional flow reserve

{dagger} The first two authors contributed equally to this study.


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