Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiology

Background: Detection of significant coronary artery disease (CAD) in patients with moderate pretest probability is a major challenge. The standard dobutamine stress echocardiography (DSE) has a moderate sensitivity even with expert eyes. 2D speckle tracking echocardiography (STE) provides an objective semi-automated analysis of global and regional myocardial deformation. Aim: Studying the diagnostic accuracy of global and regional longitudinal: systolic strain (LS), systolic strain rate (LSRs), early diastolic strain rate (LSRd) and post systolic index (PSI) both at rest and at peak dobutamine stress in detecting significant CAD as compared to conventional wall motion abnormality (WMA) assessment. Methodology: We prospectively studied 101 symptomatic patients (excluding those with significant structural heart disease). For all patients, DSE was done with off line 2D STE analysis; the regional strain was analysed for the segments representing the anterior and posterior circulation territories separately. Coronary angiography was done within one month. Significant CAD was considered if the luminal diameter stenosis was {u2265}70%. Patients were classified into group 1 having significant CAD [n=49; 21 left anterior descending (Ant-Circ), 11 right coronary or left circumflex (Post-Circ) and 17 (mixed territories)] and group 2 (mild or normal coronaries; n=52). Results: The mean age was 53±8 years, 29 of 44 males. had significant CAD (P=0.002). The sensitivity and specificity of WMA assessment were 79.5% and 92.3% respectively, with corresponding positive predictive value (PPV) 90.6%, negative predictive value (NPV) 82.7% and diagnostic accuracy 86%

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