Two-dimensional speckle-tracking echocardiography (STE) may help detect coronary artery disease (CAD) when combined with dobutamine stress echocardiography. However, few studies have explored STE with exercise stress echocardiography (ESE). We aimed to evaluate the feasibility, reliability, and incremental value of STE combined with treadmill ESE compared to treadmill ESE alone to detect CAD. We conducted a case–control study of all consecutive patients with abnormal ESE in 2018–2020 who subsequently underwent coronary angiography within a six-month interval. We 1:1 propensity score-matched these patients to those with a normal ESE. Two blinded operators generated a 17-segment bull's-eye map of longitudinal strain (LS). We utilized the mean differences between stress and baseline LS values in segments 13–17, segment 17, and segments 15–16 to create receiver operator curves for the overall examination, the left anterior descending artery (LAD), and the non-LAD territories, respectively. We excluded 61 STEs from 201 (30.3%) eligible ESEs; 47 (23.4%) because of suboptimal image quality and 14 (7.0%) because of excessive heart rate variability precluding the calculation of a bull's-eye map. After matching, a total of 102 patients were included (51 patients in each group). In the group with abnormal ESE patients (mean age 66.4 years, 39.2% female), 64.7% had significant CAD (> 70% stenosis) at coronary angiogram. In the group with normal ESE patients (mean age 65.1 years, 35.3% female), 3.9% were diagnosed with a new significant coronary stenosis within one year. The intra-class correlation for global LS was 0.87 at rest and 0.92 at stress, and 0.84 at rest, and 0.89 at stress for the apical segments. The diagnostic accuracy of combining ESE and STE was superior to visual assessment alone for the overall examination (area under the curve (AUC) = 0.89 vs. 0.84, p = 0.025), the non-LAD territory (AUC = 0.83 vs. 0.70, p = 0.006), but not the LAD territory (AUC = 0.79 vs. 0.73, p = 0.11). Two-dimensional speckle-tracking combined with treadmill ESE is relatively feasible, reliable, and may provide incremental diagnostic value for the detection and localization of significant CAD.

中文翻译：

---

二维散斑追踪检测跑步机负荷超声心动图显着冠状动脉狭窄的可行性、可靠性和增量值

二维斑点跟踪超声心动图 (STE) 与多巴酚丁胺负荷超声心动图结合使用可能有助于检测冠状动脉疾病 (CAD)。然而，很少有研究通过运动负荷超声心动图 (ESE) 来探索 STE。我们旨在评估 STE 结合跑步机 ESE 与单独跑步机 ESE 检测 CAD 的可行性、可靠性和增量值。我们对 2018-2020 年所有 ESE 异常患者进行了病例对照研究，这些患者随后在 6 个月的时间间隔内接受了冠状动脉造影。我们以 1:1 的倾向评分将这些患者与 ESE 正常的患者相匹配。两个盲操作员生成了纵向应变 (LS) 的 17 段牛眼图。我们利用了第 13-17 段、第 17 段、和第 15-16 段，分别为整体检查、左前降支 (LAD) 和非 LAD 区域创建接收器操作曲线。我们从 201 (30.3%) 个符合条件的 ESE 中排除了 61 个 STE；47 (23.4%) 是因为图像质量欠佳，14 (7.0%) 是因为心率变异性过大，无法计算牛眼图。匹配后共纳入102例患者（每组51例）。在 ESE 异常患者组（平均年龄 66.4 岁，39.2% 女性）中，64.7% 的冠状动脉造影显示有明显的 CAD（> 70% 狭窄）。在ESE正常组（平均年龄65.1岁，女性35.3%）中，3.9%在一年内被诊断为新的显着冠状动脉狭窄。全局 LS 的类内相关性在休息时为 0.87，在压力时为 0.92，在休息时为 0.84，和 0.89 的心尖段应力。对于整体检查（曲线下面积 (AUC) = 0.89 对 0.84，p = 0.025）、非 LAD 区域（AUC = 0.83 对 0.70， p = 0.006），但不是 LAD 区域（AUC = 0.79 对 0.73，p = 0.11）。二维散斑追踪结合跑步机ESE相对可行、可靠，可为重要CAD的检测和定位提供增量诊断价值。