Adding Speckle-Tracking Echocardiography to Visual Assessment of Systolic Wall Motion Abnormalities Improves the Detection of Myocardial Infarction

Background The aim of this study was to investigate whether speckle-tracking echocardiography (STE) improves the detection of myocardial infarction (MI) over visual assessment of systolic wall motion abnormalities (SWMAs) using delayed enhancement cardiac magnetic resonance imaging as a reference. Methods Transthoracic echocardiography was performed in 95 patients with first ST segment elevation MI 110 days (interquartile range, 97–171 days) after MI and in 48 healthy control subjects. Two experienced observers independently assessed SWMAs. Separately, longitudinal peak negative, peak systolic, end-systolic, global strain, and strain rate were measured and averaged for the American Heart Association–recommended coronary artery perfusion territories. Receiver operating characteristic analysis was used to determine a single optimal cutoff value for each strain parameter. The diagnostic accuracy of an algorithm combining visual assessment and STE was evaluated. Results Median infarct size and transmurality were 15% (interquartile range, 7%–24%) and 64% (interquartile range, 46%–78%), respectively. Sensitivity, specificity, and accuracy of visual assessment to detect MI were 74% (95% CI, 63%–82%), 85% (95% CI, 72%–93%), and 78% (95% CI, 70%–84%), respectively. Among the strain parameters, SR had the highest diagnostic accuracy (area under the curve, 0.88; 95% CI, 0.83–0.94; cutoff value, −0.97 sec −1 ). The combination with STE improved sensitivity compared with visual assessment alone (94%; 95% CI, 86%–97%; P P  = .607). Overall accuracy improved to 89% (95% CI, 82%–93%; P  = .011). Multivariate analysis accounting for age and sex demonstrated that SR was independently associated with MI (odds ratio, 2.0; 95% CI, 1.6–2.7). Conclusions The sensitivity and diagnostic accuracy of visually detecting chronic MI by assessing SWMAs are moderate but substantially improve when adding STE.