COMPARATIVE VALUE OF DIASTOLIC AND SYSTOLIC RESPONSES DURING PHARMACOLOGIC STRESS ECHOCARDIOGRAPHY FOR THE DETECTION OF OBSTRUCTIVE CORONARY ARTERY DISEASE
Keywords:
Stress echocardiography, diastolic function, coronary artery disease, wall motion score index, global longitudinal strain, pharmacologic stressAbstract
Introduction: Stress echocardiography (SE) is primarily based on systolic parameters. Although diastolic dysfunction may occur early during ischemia, the diagnostic value of diastolic assessment during pharmacologic SE remains uncertain.
Aim: To evaluate the frequency of diastolic dysfunction during pharmacologic SE and its association with angiographically confirmed obstructive CAD, in comparison with conventional systolic parameters.
Matrial and methods: We prospectively evaluated 61 patients who underwent dipyridamole or dobutamine SE followed by coronary angiography. Systolic parameters included wall motion score index (WMSI), left ventricular ejection fraction, systolic tissue Doppler velocity (s′TDI), and global longitudinal strain (GLS%). Diastolic assessment included transmitral inflow velocities, deceleration time (DT), isovolumic relaxation time (IVRT), tissue Doppler e′ velocities, E/e′ ratio, and left atrial volume. Parameters were measured at rest and peak stress, and delta values were calculated.
Results: Obstructive CAD was present in 20 patients (32.8%). Systolic parameters, particularly WMSI, significantly differentiated patients with and without CAD. ΔWMSI and Δs′TDI were significantly greater in patients with CAD, whereas GLS% showed non-significant, opposite trends between groups. Diastolic parameters demonstrated expected physiological stress responses, including shortening of DT and IVRT and increased e′ velocities, but neither peak values nor stress-induced changes differed significantly between patients with and without CAD. No diastolic delta parameter provided incremental diagnostic value for CAD detection.
Conclusion: During pharmacologic SE, conventional systolic parameters remain superior for identifying obstructive CAD. Diastolic indices appear largely influenced by heart rate and loading conditions and do not improve diagnostic discrimination beyond standard systolic assessment.
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