New Three-dimensional Methods of Analysis for the Detection of Coronary Artery Disease by Dobutamine Stress Echocardiography

Study Overview
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Brief Summary
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The investigators are going to recruit patients who have a scheduled elective coronary angiography and going to do a dobutamin stress echography (DSE) before the coronary examination. Next to a regular 2D-DSE, the investigators will perform an 3-dimensional DSE, incl ventriculography. In the interventional part (coronary angiography), they will measure each stenosis with fractional flow-reserve (FFR)and herewith graduate its stenosis severity.

Detailed Description
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Background Coronary heart disease is the leading cause of death worldwide. Non-invasive, radiation-free diagnostic needs further improvement. In this study, the investigators test the hypothesis that their method, which measures the myocardial deformation using 3D echocardiography is superior to previous ultrasound technologies with regard to diagnosis of stable coronary artery disease. The aim is establish an improved, non-invasive method to diagnose stable coronary artery disease. Objective The investigators want to investigate if a 3D-speckle-tracking is superior and more accurate in predicting hemodynamically significant coronary artery stenosis than predicted by 2D echocardiography? The reference variable for the hemodynamic significance of coronary artery stenosis is invasively measured by coronary flow reserve (CFR) in consideration of collateral flow (CFI). Methods This is a prospective observational study. The investigators will include 100 persons who are scheduled for an elective coronary angiography. A regular 2D-stress echocardiography according to the international guidelines will be performed (incl. PLAX, SAX, 2CV, 4CV). The classification of regional wall motion abnormality is carried out according to the internationally recognized standards in 16 myocardial segments of the LV, with a grading of wall thickening (0 = dyskinetic, akinetic = 1, 2 = hypokinetic, 3 = normal). In addition, a 3D speckle tracking is performed after data transfer. To determine the functional relevance of any stenosis (reference method) a flow reserve in a maximum of two coronary arteries will be performed. Test accuracy of 2D stress echocardiography and the new 3D method for detecting a significant stenosis (CFI <2) are then compared.

Official Title
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New Three-dimensional Methods of Analysis for the Detection of Coronary Artery Disease by Dobutamine Stress Echocardiography

Conditions
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Coronary Artery Disease, Echocardiography, Stress

Intervention / Treatment
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* Other: Stress-echocardiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Scheduled elective coronary angiography Age >/= 18 years Written informed consent Exclusion Criteria Age < 18 years Acute coronary syndrome Unstable angina pectoris Coronary 3-vessel disease Left-main artery affected Situation after myocardial infarction Coronary anomaly Situation after coronary bypass Congenital heart disease Pacemaker Any contraindication concerning stress-echo

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| All patients<br>Patients with a suspicion of coronary heart disease | Other: Stress-echocardiography<br>* Stress-echocardiography (incl dobutamin and atropin)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Area Strain in the affected coronary artery stenosis myocardial segments (Reference: Coronary flow reserve CFR) | Area Strain (%) by Echocardiography | After dobutamin-stress-echocardiography, PTCA will be performed within aprox.1-3hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Area at Risk: Surface Area of site with reduced strain relative to the total LV-surface | Size of infarcted area according to the Area Strain (in % of total LV-surface) | After dobutamin-stress-echocardiography, PTCA will be performed within aprox.1-3hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Echocardiography, Stress, Echocardiography, Three-Dimensional, Coronary Artery Disease, Fractional Flow Reserve, Myocardial, Coronary Circulation