Comparison of Diagnostic Value Between STE+LDDSE and CMR-FT for Evaluating Coronary Microvascular Obstruction in Post-PCI Patients for STEMI

Tao Liu; Chaofan Wang; Jie Yin; Lili Wang; Haochen Xuan; Yan Yan; Junhong Chen; Jieli Bao; Dongye Li; Tongda Xu

doi:10.2147/TCRM.S374866

Comparison of Diagnostic Value Between STE+LDDSE and CMR-FT for Evaluating Coronary Microvascular Obstruction in Post-PCI Patients for STEMI

Ther Clin Risk Manag. 2022 Aug 15:18:813-823. doi: 10.2147/TCRM.S374866. eCollection 2022.

Authors

Tao Liu^#¹, Chaofan Wang^#¹, Jie Yin¹, Lili Wang¹, Haochen Xuan¹, Yan Yan¹, Junhong Chen¹, Jieli Bao¹, Dongye Li¹, Tongda Xu¹

Affiliation

¹ Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.

^# Contributed equally.

Abstract

Background: Coronary microvascular obstruction (CMVO) is closely associated with poor prognosis of ST-segment elevation myocardial infarction (STEMI) patients. However, data showing the comparison between cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) combined with low-dose dobutamine stress echocardiography (LDDSE) in evaluating CMVO was scarcely available. We aimed to explore and compare the predictive value between CMR-FT and STE+LDDSE in detecting CMVO.

Methods: Sixty-one STEMI patients were executed cardiac magnetic resonance and echocardiography within the first 5-7 days after primary percutaneous coronary intervention (PCI). The myocardial strain analysis was performed in STE, STE+LDDSE, and CMR-FT, and strain parameters included radial strain (RS), circumferential strain (CS), and longitudinal strain (LS). ROC curves were performed to predict infarcted myocardium segments with CMVO.

Results: Finally, 324 infarcted myocardium segments were analyzed, including 100 infarcted segments with CMVO and 224 segments without CMVO by the gold standard assessment of late gadolinium-enhancement cardiac magnetic resonance imaging (LGE-CMR). The results showed that CS was generally superior to RS and LS in identifying CMVO. CS in CMR-FT facilitated the detection of CMVO, with a sensitivity, specificity, and accuracy of 78.00%, 81.25%, and 80.25%, respectively. The sensitivity, specificity, and accuracy of CS in STE combined with LDDSE were better than STE alone (76.00% vs 60.00%, 79.91% vs 64.29%, and 78.70% vs 62.96%, P < 0.05). In addition, CMR-FT is not superior to STE+LDDSE for detection of CMVO (P > 0.05).

Conclusion: Low-dose dobutamine can improve the clinical value of STE for evaluating CMVO in STEMI patients. Compared with CMR-FT, STE+LDDSE might be a better choice for STEMI patients because of its safety, convenience, and low-cost.

Keywords: ST-segment elevation myocardial infarction; coronary microvascular obstruction; low-dose dobutamine; magnetic resonance feature tracking; speckle tracking echocardiography.

Grants and funding

This study was supported by the Jiangsu Provincial Science and Technology Department Social Development Fund (Grant number: BE2019639), Jiangsu Provincial Health Commission Project Fund (Grant number: M2020015), Research and Practice Innovation Plan for Postgraduates in General Colleges and Universities in Jiangsu Province (Grant number: SJCX22_1267) and Jiangsu Traditional Chinese Medicine Science and Technology Development Plan Project (Grant number: YB201988).