Speckle Tracking Imaging in Normal Stress Echocardiography

Objectives Exercise stress echocardiography is a widely used modality for the diagnosis and follow‐up of patients with coronary artery disease. During the last decade, speckle tracking imaging has been used increasingly for accurate evaluation of cardiac function. This work aimed to assess speckle‐tracking imaging parameters during nonischemic exercise stress echocardiography. Methods During 2011 to 2014 we studied 46 patients without history of coronary artery disease, who completed exercise stress echocardiography protocol, had normal left ventricular function, a nonischemic response, and satisfactory image quality. These exams were analyzed with speckle‐tracking imaging software at rest and at peak exercise. Peak strain and time‐to‐peak strain were measured at rest and after exercise. Clinical follow‐up included a telephone contact 1 to 3 years after stress echo exam, confirming freedom from coronary events during this time. Results Global and regional peak strain increased following exercise. Time‐to‐peak global and regional strain and time‐to‐peak strain adjusted to the heart rate were significantly shorter in all segments after exercise. Rest‐to‐stress ratio of time‐to‐peak strain adjusted to the heart rate was 2.0 to 2.8. Conclusions Global and regional peak strain rise during normal exercise echocardiography. Peak global and regional strain occur before or shortly after aortic valve closure at rest and after exercise, and the delay is more apparent at the basal segments. Time‐to‐peak strain normally shortens significantly during exercise; after adjustment to heart rate it shortens by a ratio of 2.0 to 2.8. These data may be useful for interpretation of future exercise stress speckle‐tracking echocardiography studies.