Comparison of Quantitative Wall‐Motion Analysis and Strain for Detection of Coronary Stenosis with Three‐Dimensional Dobutamine Stress Echocardiography

Background Quantitative analysis of wall motion from three‐dimensional (3D) dobutamine stress echocardiography ( DSE ) could provide additional diagnostic information not available from qualitative analysis. In this study, we compare the effectiveness of 3D fractional shortening (3 DFS ), a measure of wall motion computed from 3D echocardiography (3 DE ), to strain and strain rate measured with sonomicrometry for detecting critical stenoses during DSE . Methods Eleven open‐chest dogs underwent DSE both with and without a critical stenosis. 3 DFS was measured from 3 DE images acquired at peak stress. 3 DFS was normalized by subtracting average 3 DFS during control peak stress (∆3 DFS ). Strains in the perfusion defect ( PD ) were measured from sonomicrometry, and PD size and location were measured with microspheres. Results A ∆3 DFS abnormality indicated the presence of a critical stenosis with high sensitivity and specificity (88% and 100%, respectively), and ∆3 DFS abnormality size correlated with PD size (R 2  = 0.54). The sensitivity and specificity for ∆3 DFS were similar to that for area strain (88%, 100%) and circumferential strain and strain rate (88%, 92% and 88%, 86%, respectively), while longitudinal strain and strain rate were less specific. ∆3 DFS correlated significantly with both coronary flow reserve (R 2  = 0.71) and PD size (R 2  = 0.97), while area strain correlated with PD size only (R 2  = 0.67), and other measures were not significantly correlated with flow reserve or PD size. Conclusion Quantitative wall‐motion analysis using ∆3 DFS is effective for detecting critical stenoses during DSE , performing similar to 3D strain, and provides potentially useful information on the size and location of a perfusion defect.