PMID- 19168323
OWN - NLM
STAT- MEDLINE
DCOM- 20090610
LR  - 20191210
IS  - 1097-6795 (Electronic)
IS  - 0894-7317 (Linking)
VI  - 22
IP  - 3
DP  - 2009 Mar
TI  - Assessment of temporal heterogeneity and regional motion to identify wall motion 
      abnormalities using treadmill exercise stress three-dimensional echocardiography.
PG  - 268-75
LID - 10.1016/j.echo.2008.11.030 [doi]
AB  - BACKGROUND: Exercise 3-dimensional echocardiography (3DE) may avoid the problem 
      of poorly matched pre- and post-exercise 2-dimensional echocardiograms (2DE), and 
      contraction front mapping (CFM) may be used to quantify the temporal homogeneity 
      of contraction. We compared 3DE with 2DE for identification of angiographically 
      significant disease. METHODS: Conventional 2DE and 3DE at rest and peak stress 
      were performed in 110 patients (78 men, aged 60 +/- 11 years) who underwent 
      angiography within 6 months. Offline assessment of CFM was performed 
      qualitatively (delayed regional relaxation in a coronary territory) and 
      quantitatively (difference in regional and global contraction delays from rest to 
      peak in individual segments). The accuracy of each test was calculated for 
      identification of 70% or more diameter angiographic stenoses. RESULTS: Patients 
      were excluded for nondiagnostic stress (n = 12) or poor-quality 3DE (n = 8). Time 
      until end of 2DE acquisition was 58 +/- 25 seconds, and time until end of 3DE 
      (taken after 2DE) was 109 +/- 55 seconds. Receiver operating characteristic 
      analyses were used to define normal cutoff ranges of contraction delays for the 
      following coronary territories: left anterior descending (<or=10%), left coronary 
      artery (<or=10%), right coronary artery (<or=11%), and overall (<or=10%). The 
      concordance between angiography and qualitative CFM (63%) was similar to 
      quantitative CFM (70%). The sensitivity of wall motion assessment at 3DE (40%) 
      was lower than CFM (55%, P = .04) and 2DE (83%, P < .01) at comparable levels of 
      specificity (65%, 84%, and 78%). CONCLUSION: Although the higher specificity of 
      3DE may represent avoidance of false-positives from off-axis imaging, the 
      sensitivity of 3DE is insufficient for clinical use. Analysis of the temporal 
      distribution of contraction may be more sensitive than 3D wall motion assessment 
      for identification of ischemia at exercise 3DE.
FAU - Jenkins, Carly
AU  - Jenkins C
AD  - University of Queensland, Brisbane, Australia.
FAU - Haluska, Brian
AU  - Haluska B
FAU - Marwick, Thomas H
AU  - Marwick TH
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20090124
PL  - United States
TA  - J Am Soc Echocardiogr
JT  - Journal of the American Society of Echocardiography : official publication of the 
      American Society of Echocardiography
JID - 8801388
SB  - IM
MH  - *Algorithms
MH  - Echocardiography, Three-Dimensional/*methods
MH  - *Exercise Test
MH  - Female
MH  - Humans
MH  - Image Enhancement/methods
MH  - Image Interpretation, Computer-Assisted/*methods
MH  - Male
MH  - Middle Aged
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Ventricular Dysfunction, Left/*diagnostic imaging
EDAT- 2009/01/27 09:00
MHDA- 2009/06/11 09:00
CRDT- 2009/01/27 09:00
PHST- 2008/06/27 00:00 [received]
PHST- 2009/01/27 09:00 [entrez]
PHST- 2009/01/27 09:00 [pubmed]
PHST- 2009/06/11 09:00 [medline]
AID - S0894-7317(08)00778-5 [pii]
AID - 10.1016/j.echo.2008.11.030 [doi]
PST - ppublish
SO  - J Am Soc Echocardiogr. 2009 Mar;22(3):268-75. doi: 10.1016/j.echo.2008.11.030. 
      Epub 2009 Jan 24.