Assessment of Postsystolic Shortening and Global Longitudinal Strain Improves the Sensitivity of Dobutamine Stress Echocardiography in End-Stage Liver Disease

Wesley L Anderson; Pantila V Bateman; Susan Ofner; Xiaochun Li; Benjamin Maatman; Deborah Green-Hess; Stephen G Sawada; Harvey Feigenbaum

doi:10.1016/j.echo.2023.02.010

Assessment of Postsystolic Shortening and Global Longitudinal Strain Improves the Sensitivity of Dobutamine Stress Echocardiography in End-Stage Liver Disease

J Am Soc Echocardiogr. 2023 Aug;36(8):832-840. doi: 10.1016/j.echo.2023.02.010. Epub 2023 Feb 23.

Authors

Wesley L Anderson¹, Pantila V Bateman², Susan Ofner³, Xiaochun Li³, Benjamin Maatman⁴, Deborah Green-Hess⁵, Stephen G Sawada⁵, Harvey Feigenbaum⁵

Affiliations

¹ Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana. Electronic address: anderswl@iu.edu.
² Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana; Loyola University Medical Center, Division of Cardiology, Maywood, Illinois.
³ Department of Biostatics, and Health Data Science, Indiana University, Indianapolis, Indiana.
⁴ Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana; Community Physicians Network, Cardiology, Indianapolis, Indiana.
⁵ Indiana University School of Medicine, Division of Cardiovascular Medicine, IU Health, Indianapolis, Indiana.

PMID: 36828259
DOI: 10.1016/j.echo.2023.02.010

Abstract

Background: Dobutamine stress echocardiography (DSE) remains a widely used method for detection of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) despite low sensitivity. Speckle-tracking assessment of strain may enhance the sensitivity of DSE in the general population, but the value of strain analysis in ESLD is unknown.

Methods: Dobutamine stress echocardiography with two-dimensional speckle-tracking and quantitative coronary angiography were performed in 146 patients with ESLD. Thirty-six patients (25%) had CAD (≥50% diameter stenosis of a major vessel). Global longitudinal strain at rest (GLSr) and at peak stress (GLSp) and an index of postsystolic (PSSi) shortening ([maximal extent of shortening - extent of shortening in systole]/[extent of shortening in systole]) were determined. A PSSi of ≥ 0.25 was considered evidence for CAD. Receiver operating characteristic analysis was used to determine the optimal thresholds of GLSr and GLSp for CAD and to assess the diagnostic performance of visual assessment of wall motion (WMA) and strain parameters. The sensitivity and specificity of WMA, GLSr, GLSp, and PSSi were compared.

Results: Thirty-six patients (25%) had significant CAD. The areas under the curve for WMA, GLSr, GLSp, and PSSi were 0.60, 0.72, 0.68, and 0.78, respectively. Visual assessment of wall motion had a sensitivity of 28%. The sensitivity of each of the strain parameters, GLSr (53%, P = .016), GLSp (69%, P = .004), and PSSi (78%, P < .001), exceeded the sensitivity for WMA. Visual assessment of wall motion specificity was 92%, which exceeded the specificity for each of the strain parameters (GLSr = 82%, P = .037; GLSp = 63%, P < .001; and PSSi =78%, P = .009). Of the strain parameters, PSSi had the best balance between sensitivity and specificity (both 78%).

Conclusion: Assessment of GLS and PSSi with DSE yields better sensitivity than WMA in ELSD patients. Index of postsystolic shortening had the best diagnostic performance of all parameters in this population with a low prevalence of CAD.

Keywords: Dobutamine; Echocardiography; Liver disease; Strain; Stress.

Published by Elsevier Inc.

MeSH terms

Coronary Angiography
Coronary Artery Disease* / diagnostic imaging
Dobutamine
Echocardiography, Stress / methods
End Stage Liver Disease*
Global Longitudinal Strain
Humans
Sensitivity and Specificity

Substances

Dobutamine