The value of STE-LDDSE to detect viable myocardium

The value of STE-LDDSE to detect viable myocardium | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report The value of STE-LDDSE to detect viable myocardium Wei Qian, Ran Zhou, Tao Chen, Xueshan Zhang, Yanfeng Ma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4061629/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract To explore the value of speckle tracking echocardiography (STE) with low dose dobutamine stress echocardiography (LDDSE) for evaluation of viable myocardium (VM) in the acute ST-elevation myocardial infarction (STEMI) patients with or without type 2 diabetes mellitus (DM). Here, we show that a total of 183 regional wall motion abnormalities (RWMA) were detected in the DM group, of which 117 (63.93%) segments were viable myocardium; 357 RWMA were detected in non DM patients, of which 248 (69.47%) segments of viable myocardium were detected by echocardiography. The sensitivity, accuracy, and specificity of STE-LDDSE in detecting viable myocardium in DM group were 70.94%、77.45%、87.88% ; 92.31%、72.73% and 85.25% for LS and LSr. In the non DM group, the sensitivity, specificity, and accuracy of LS and LSr were 68.95%、92.66%、76.19% ; 77.42%、88.07% and 80.67%, respectively. Further parallel diagnostic tests were conducted on LS and LSr parameters. The sensitivity, specificity, and accuracy of detecting viable myocardium in the DM and non DM groups were 84.62%、45.45%、70.49%, 66.53%、63.30% and 65.55%, respectively, at rest; They were 84.62%、45.45%、70.49%, 66.53%、63.30% and 65.55%, respectively, during low dose dobutamine stress. In summary, Parallel diagnostic test for LS and LSr is the best choice in detecting VM in the patients with STEMI and is more sensitive for the patients with type 2 DM. speckle tracking echocardiography low dose dobutamine stress echocardiography ST-elevation myocardial infarction diabetes mellitus viable myocardium Figures Figure 1 Figure 2 Introduction DM is a systemic metabolic disorder, and more than 70% of diabetic patients develop coronary heart disease (CHD), which exhibits a wider range and faster progression of coronary artery disease compared to non-diabetic individuals. The main lesions in CHD occur in the epicardium, whereas in DM, the primary lesions involve the myocardium and microvasculature. When both conditions coexist, the aforementioned lesions may be more extensive and severe. Clinical observations have shown that DM patients with concomitant CHD have a higher prevalence and severity of multi-vessel and diffuse coronary lesions compared to non-diabetic patients( 1 , 2 ). Studies have confirmed that after acute myocardial infarction (AMI), the region of RWMA comprises not only necrotic myocardium but also viable myocardium, including stunned myocardium and hibernating myocardium( 3 , 4 ). So far, there are three main approaches used to identify viable myocardium( 4 ): ( 1 ) Assessment of myocardial cellular metabolism, including oxidative metabolism, glucose metabolism, and fatty acid metabolism; ( 2 ) Evaluation of myocardial perfusion; ( 3 ) Monitoring of myocardial contractile reserve. Among these, dobutamine stress echocardiography (DSE) is internationally recognized as the standard method for monitoring myocardial contractile reserve and is widely employed. At present, STE-LDDSE offers significant advantages over traditional methods for assessing viable myocardium( 5 – 8 ). It mainly tracks the speckles of high-frame-rate two-dimensional images frame by frame, allowing for the calculation and delineation of myocardial motion velocity and deformation. By observing myocardial motion trajectories, it accurately measures myocardial fiber motion strain, strain rate, and rotation angles. Due to its angle-independent nature, STE can provide more accurate assessments of local and global myocardial function, making it highly valuable for detecting viable myocardium. The combination of STE and LDDSE further enhances the sensitivity and specificity, maximizing the detection of viable myocardium( 9 – 12 ). Results Basic Clinical Characteristics of Patients A total of 85 patients were included in the study, including 30 patients in the DM group and 55 patients in the non-DM group （Dataset 1）. All patients successfully completed the examinations, and satisfactory cardiac ultrasound images were obtained (Fig. 1A and B). No malignant arrhythmias or cardiovascular events occurred during the entire examination process. Changes in Hemodynamic Parameters pre/post LDDSE The comparison of heart rate and blood pressure pre/post LDDSE in the 85 patients (Table S1). The results showed an increase in heart rate after medication, while blood pressure did not show significant changes. Analysis of Echocardiographic Wall Motion A total of 1,445 segments from the 85 patients were included in the study, including 540 segments with RWMA. After LDDSE in the DM group, 119 segments were classified as viable myocardium, and 64 segments were classified as non-viable myocardium. In the non-DM group, 189 segments were classified as viable myocardium, and 168 segments were classified as non-viable myocardium (Table S2). Follow-up echocardiography was performed at 1, 3, and 6 months after PCI. The improvement of RWMA systolic function after PCI is recognized as the "gold standard" for judging viable myocardium.Based on the "gold standard", 540 segments were followed up, which 365 segments classified as viable myocardium and 175 segments classified as non-viable myocardium(13-16). Among the 183 segments followed up in the DM group, which 117 segments were classified as viable myocardium and 66 segments were classified as non-viable myocardium. In the non-DM group, 357 segments were followed up, which 248 segments classified as viable myocardium and 109 segments classified as non-viable myocardium (Table S3). Comparison with the "gold standard" showed that the sensitivity, specificity, and accuracy of LDDSE semi-quantitative visual assessment for evaluating viable myocardium in the DM group were 70.09%, 43.94%, and 60.66%, respectively. In the non-DM group, the sensitivity, specificity, and accuracy were 55.65%, 53.21%, and 54.90%, respectively. The DM group had higher sensitivity and accuracy compared to the non-DM group, with statistically significant differences ( P < 0.05). However, the specificity was lower in the DM group compared to the non-DM group, with statistically significant differences ( P < 0.05). The Value of STE-LDDSE in Evaluating Viable Myocardium It involves quantitative analysis of S and Sr parameters in 540 segments with RWMA by QLAB 8.1 software. Binary logistic regression analysis was performed to evaluate the value of different S and Sr parameters at rest for detecting viable myocardium. The results showed that CS, LS, and LSr had significant value ( P < 0.05) in detecting viable myocardium (Table 1). Table 1: The value of using binary logistic stepwise regression analysis to detect viable myocardium using different S and Sr parameters in the resting state. factor B P value RSr rest CS rest LS rest LSr rest -1.310 0.223 0.155 0.941 ＜0.001 ＜0.001 0.009 0.022 Subsequently, LS, LSr and ROC curves were plotted to determine the optimal cutoff points for detecting viable myocardium using STE. Accordingly, sensitivity, specificity, and accuracy were calculated (Fig. 2A-D, Table 2 and 3). In the DM group, the cutoff point for LS rest was determined to be -13.27, with 46 out of 117 segments classified as viable myocardium (LS rest ≤ -13.27) and 71 segments as non-viable myocardium (LS rest > -13.27) according to the gold standard. Similarly, for LS LDDSE in the DM group, the cutoff point was -13.81, with 83 segments classified as viable myocardium (LSLDDSE ≤ -13.81) and 34 segments as non-viable myocardium (LS LDDSE > -13.81). In terms of LSr rest, the cutoff point was -0.875, resulting in 98 segments classified as viable myocardium (LSr rest ≤ -0.875) and 19 segments as non-viable myocardium (LSr rest > -0.875) according to the gold standard. In the DM group, LSr LDDSE had a cutoff point of -1.12, with 108 segments classified as viable myocardium (LSr LDDSE ≤ -1.12) and 9 segments as non-viable myocardium (LSr LDDSE > -1.12). In the non-DM group, the cutoff point for LS rest was -12.33, with 123 out of 248 segments classified as viable myocardium (LS rest ≤ -12.33) and 125 segments as non-viable myocardium (LS rest > -12.33) according to the gold standard. Similarly, for LSLDDSE in the non-DM group, the cutoff point was -14.075, with 171 segments classified as viable myocardium (LS LDDSE ≤ -14.075) and 77 segments as non-viable myocardium (LS LDDSE > -14.075). Regarding LSr rest , the cutoff point was -1.075, resulting in 156 segments classified as viable myocardium (LSr rest ≤ -1.075) and 92 segments as non-viable myocardium (LSr rest > -1.075) according to the gold standard. In the non-DM group, LSr LDDSE had a cutoff point of -1.305, with 192 segments classified as viable myocardium (LSr LDDSE ≤ -1.305) and 56 segments as non-viable myocardium (LSr LDDSE > -1.305) according to the gold ststandard. Table 2: The value of detecting LS parameters in STE for diagnosing viable myocardium. status sensibility (%) specificity (%) accuracy (%) DM non-DM DM non-DM DM non-DM LS rest 39.32 $ 49.60 89.39 $ 77.98 57.38 Δ 58.26 LS LDDSE 70.94 Δ 68.95 87.88 $ 92.66 77.45 Δ 76.19 McNemar's 2 28.8 30.681 0 14.062 26.327 10.92 P 8.025e-08 3.042e-08 1 0.0001768 2.882e-07 0.0009511 $ DM compared with non-DM, P 0.05 Table 3: The value of detecting LSr parameters in STE for diagnosing viable myocardium. status sensibility (%) specificity (%) accuracy (%) DM non-DM DM non-DM DM non-DM LSr rest 83.76 $ 62.90 45.45 $ 66.06 69.95 $ 63.87 LSr LDDSE 92.31 $ 77.42 72.73 $ 88.07 85.25 $ 80.67 McNemar's 2 22.042 16.118 12.042 22.042 1.0652 1.21 P 2.668e-06 5.95e-05 0.0005202 2.668e-06 0.302 0.2713 $ DM compared with non-DM, P 0.05 Further parallel diagnostic testing was performed on the LS and LSr parameters at rest. In the DM group, the sensitivity, specificity, and accuracy were found to be 84.62%, 45.45%, and 70.49%, respectively. In the non-DM group, the sensitivity, specificity, and accuracy were 66.53%, 63.30%, and 65.55%, respectively. The DM group showed higher sensitivity and accuracy compared to the non-DM group, with statistically significant differences. However, the DM group had lower specificity compared to the non-DM group, also with statistically significant differences (Table 4 and 6).Parallel diagnostic testing was also conducted on the LS and LSr parameters under stress conditions. In the DM group, the sensitivity, specificity, and accuracy were 92.31%, 60.70%, and 84.15%, respectively. In the non-DM group, the sensitivity, specificity, and accuracy were 84.27%, 81.65%, and 83.47%, respectively (Table 5 and 6). The DM group exhibited higher sensitivity and accuracy compared to the non-DM group, with statistically significant differences. However, the DM group had lower specificity compared to the non-DM group, also with statistically significant differences. The accuracy was higher in the DM group, but the difference was not statistically significant. In the DM group, STE demonstrated higher sensitivity, specificity, and accuracy for detecting viable myocardium under stress conditions compared to rest. Additionally, STE at rest showed higher sensitivity and accuracy compared to the semi-quantitative visual assessment of LDDSE, with statistically significant differences. The specificity of STE at rest was higher than that of LDDSE, but the difference was not statistically significant. In the non-DM group, STE at stress showed higher sensitivity, specificity, and accuracy for detecting viable myocardium compared to rest, with statistically significant differences. STE at rest also exhibited higher sensitivity, specificity, and accuracy compared to LDDSE, with statistically significant differences (Table 6). Table 4: Conducting parallel diagnostic trials using LS rest and LSr rest in combination to detect viable myocardium. LS rest +LSr rest gold standard total viable myocardium Non-viable myocardium viable myocardium DM 99 36 135 viable myocardium non-DM 165 40 205 Non-viable myocardium DM 18 30 48 Non-viable myocardium non-DM 83 69 152 total DM 117 66 183 total non-DM 248 109 357 Table 5: Conducting parallel diagnostic trials using LS LDDSE and LS LDDSE in combination to detect viable myocardium. LS LDDSE +LSr LDDSE gold standard total viable myocardium Non-viable myocardium viable myocardium DM 108 20 128 viable myocardium non-DM 209 20 229 Non-viable myocardium DM 9 46 55 Non-viable myocardium non-DM 39 89 128 total DM 117 66 183 total non-DM 248 109 357 Table 6:The value of different diagnostic methods in diagnosing viable myocardium status sensibility (%) specificity (%) accuracy (%) LDDSE semi-quantitative DM LDDSE semi-quantitative non-DM 70.09 $ 55.69 43.94 $ 53.21 60.66 54.90 Resting STE DM Resting STE non-DM 84.62 *$ 66.53 * 45.45 #$ 63.30 * 70.49* 65.55* STE+LDDSE DM STE+LDDSE non-DM 92.31 *Δ$ 84.27 *Δ 60.70 *Δ$ 81.65 *Δ 84.15 *Δ 83.47 *Δ DM, * compared with LDDSE semi-quantitative, P 0.05, Δ P <0.05 compared to resting time; non-DM, * compared with LDDSE semi-quantitative, P <0.05, Δ P <0.05 compared to resting time $ DM compared with non-DM, P <0.05 Reproducibility Test To assess inter-observer variability, two experienced ultrasound examiners analyzed S and Sr parameters for 39 RWMA segments in 6 randomly selected subjects, resulting in an inter-observer variability of 5.3%. Intra-observer variability was assessed by having the same ultrasound examiner analyze S and Sr parameters for 50 RWMA segments in 8 randomly selected subjects, resulting in an intra-observer variability of 4.9%. These findings indicate good reproducibility of the STE measurements. Discussion Recent studies have highlighted the presence of viable myocardium, including stunned and hibernating myocardium, within areas of RWMA after AMI. Viable myocardium refers to myocardial tissue that can recover its function, either partially or completely, upon restoration of blood supply. Effective revascularization can lead to functional recovery of viable myocardium, improving clinical symptoms and prognosis. On the other hand, non-viable myocardium does not regain its function even with successful revascularization. Therefore, the assessment of myocardial viability is crucial for guiding treatment decisions in patients with STEMI. STE can track the movement of the myocardeum by recognizing the echo-speckle signal of the myocardeum in the image.This technology can evaluate the myocardial segmental strain from multiple directions without angle dependence, and can evaluate the local or global myocardial function changes. LDDSE is currently internationally recognized as the standard method for detecting the reserve of viable myocardial contractile function. The improvement of RWMA segments in resting echocardiography after LDDSE indicates the presence of viable myocardium in that segment. Dobutamine (dobu) is a synthetic catecholamine, which has a relative excitatory effect on β1 receptor, but a weak excitatory effect on β2 receptor and α receptor. Small dose of dobu(≤ 10 ug/kg/min) mainly excitates β1 receptor, has little effect on blood pressure and heart rate, enhances myocardial contractility and induces myocardial ischemia, which has important value in evaluating myocardial survival. Currently, there are many methods available, and combined with clinical research, a single method has limited diagnostic value. Therefore, clinical practice is gradually inclined towards joint diagnostic evaluation. Both of these methods are non-invasive and highly feasible methods for detecting viable myocardial muscle. Compared with SET or LDDSE, SET-LDDSE has significantly improved sensitivity, specificity, and accuracy.. Meanwhile, compared with MRI, STE-LDDSE has higher sensitivity and practicality in diagnosing viable myocardium in patients with myocardial infarction, indicating that STE-LDDSE should be the first choice for evaluating surviving myocardium in patients with myocardial infarction. It is important to note that this study had a small sample size and focused solely on RWMA, which may have limited the detection of viable myocardium in segments with normal wall motion. To enhance the study's validity and generalizability, it is recommended to expand the sample size in future research. Additionally, the follow-up echocardiography assessed improvement in wall motion compared to baseline, considering an improvement of ≥ 1 grade as indicative of viable myocardium. However, further analysis comparing improvements of ≥ 1 grade to improvements of ≥ 2 grades or more was not conducted due to the limited number of eligible segments. Future studies should consider including segments with normal wall motion to avoid potential underdiagnosis of viable myocardium. Additionally, exploring more comprehensive criteria for assessing viable myocardium, such as improvements of ≥ 2 grades or more, could provide further insights into the extent of functional recovery. These considerations would contribute to a more comprehensive understanding of myocardial viability assessment and its implications for clinical decision-making. In summary, compared to traditional and single examination methods, STE-LDDSE has higher sensitivity, specificity, and accuracy, which is more helpful in guiding patients to effectively evaluate viable myocardium before PCI, and has a certain guiding role in blood vessel reconstruction and prognosis. Conclusion STE-LDDSE detection has certain clinical value in assessing myocardial viability in STEMI patients, and is also safe and feasible for preoperative evaluation of myocardial survival ability before coronary artery revascularization. Moreover, it is more sensitive in assessing the viability of myocardium in DM patients with concurrent STEMI compared to non-DM patients. Materials and Methods Reagents Dobutamine: Shanghai First Biochemical Pharmaceutical Co., Ltd., 20mg:2ml*10 vials, National Drug Approval Number H3102190. Statistical Analysis SPSS 16.0 statistical analysis software was used for statistical analysis. All continuous data were expressed as mean ± standard deviation (±S). Paired data following a normal distribution were analyzed using t-tests, while independent samples were analyzed using independent sample t-tests. Binary logistic regression analysis was performed to select valuable S and Sr parameters for detecting viable myocardium. Receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC) and determine the optimal cutoff points, sensitivity, specificity, and accuracy for diagnosing viable myocardium. Chi-square test was used for intergroup comparison of rates. A p-value ≤0.05 was considered statistically significant, with a significance level of α=0.05. Additional methods can be found in SI Appendix, SI Materials and Methods. Declarations Funding No applicable DATA AVAILLABLITY No new data has been generated in this study. AUTHOR CONTRIBUTIONS AND APPROVAL Author contributions: W.Q., and Y.M. designed research; W.Q., R.Z., T.C. and Y.M.; provided samples; X.Z., and Y.M.; performed research; W.Q., and Y.M. analyzed data; W.Q., and Y.M. wrote the paper. Written informed consent was obtained from all the pariticipants prior to the enrollment of this study. ETHICAL APPROVAL This study was approved by the ethics committee of xuzhou medical university. We certify that the study was performed in accordance with the 1964 declaration of HELSINKI and later amendments. COMPETING INTERESTS The authors declare no competing interests. References Kranidis A, et al. Stress echocardiography using adenosine combined with nitroglycerin-dobutamine in the detection of viable myocardium in patients with previous myocardial infarction. Angiology. 1997;48(2):127–33. Wang CC, Reusch JE. Diabetes and cardiovascular disease: changing the focus from glycemic control to improving long-term survival. Am J Cardiol. 2012;110(9 Suppl):b58–68. Bourque JM, et al. Usefulness of cardiovascular magnetic resonance imaging of the superficial femoral artery for screening patients with diabetes mellitus for atherosclerosis. Am J Cardiol. 2012;110(1):50–6. van Loon RB, et al. Improved clinical outcome after invasive management of patients with recent myocardial infarction and proven myocardial viability: primary results of a randomized controlled trial (VIAMI-trial). Trials. 2012;13:1. Allman KC. Noninvasive assessment myocardial viability: current status and future directions. J nuclear cardiology: official publication Am Soc Nuclear Cardiol. 2013;20(4):618–37. quiz 638 – 619. Joyce E, et al. Differential response of LV sublayer twist during dobutamine stress echocardiography as a novel marker of contractile reserve after acute myocardial infarction: relationship with follow-up LVEF improvement. European heart journal. Cardiovasc Imaging. 2016;17(6):652–9. Uusitalo V, et al. Two-Dimensional Speckle-Tracking during Dobutamine Stress Echocardiography in the Detection of Myocardial Ischemia in Patients with Suspected Coronary Artery Disease. J Am Soc Echocardiography: official publication Am Soc Echocardiography. 2016;29(5):470–e479473. Ilardi F, et al. Quantitative detection of inducible ischemia during dobutamine stress by speckle tracking echocardiography: A dream comes true. Int J Cardiol. 2016;220:357–9. Wierzbowska-Drabik K, Plewka M, Kasprzak JD. Variability of longitudinal strain in left ventricular segments supplied by non-stenosed coronary artery: insights from speckle tracking analysis of dobutamine stress echocardiograms in patients with high coronary risk profile. Archives Med science: AMS. 2017;13(1):82–92. Tsang W, et al. Interinstitutional measurements of left ventricular volumes, speckle-tracking strain, and dyssynchrony using three-dimensional echocardiography. J Am Soc Echocardiography: official publication Am Soc Echocardiography. 2013;26(11):1253–7. Lee Y, et al. New approach for rotational dyssynchrony using three-dimensional speckle tracking echocardiography. Echocardiography (Mount Kisco N Y). 2014;31(4):492–8. Joyce E, et al. Quantitative Dobutamine Stress Echocardiography Using Speckle-Tracking Analysis versus Conventional Visual Analysis for Detection of Significant Coronary Artery Disease after ST-Segment Elevation Myocardial Infarction. J Am Soc Echocardiography: official publication Am Soc Echocardiography. 2015;28(12):1379–e13891371. Gong L, et al. Assessment of myocardial viability in patients with acute myocardial infarction by two-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography. Int J Cardiovasc Imaging. 2013;29(5):1017–28. Wang C, et al. Evaluation of myocardial viability in old myocardial infarcted patients with CHF: delayed enhancement MRI vs. low-dose dobutamine stress speckle tracking echocardiography. Am J translational Res. 2016;8(9):3731–43. Liu K, et al. Evaluation of myocardial viability in patients with acute myocardial infarction: Layer-specific analysis of 2-dimensional speckle tracking echocardiography. Medicine. 2019;98(3):e13959. Additional Declarations No competing interests reported. Supplementary Files SupplementaryInformation0906.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4061629","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":281129808,"identity":"ea435c68-54bd-4754-b1df-c3e2e8e34deb","order_by":0,"name":"Wei Qian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYDACZhBRIWEnz97Y+PAD8VrO2CQb9hxuNpYg2ibGljTGhhvpbQI8xKjmO8787DFvw2FmxpkP2xgkGOzkdBsIaJE8zGZuzLvjMB+7dGLbgwKGZGOzAwS0GBxmMJPOPQO0ZXZiu4EEw4HEbYS1sH+Tzm07zNhw82CbBA9xWniAtrSBvM9IpBbJwzxl0n/AgZwIDGQDIvzCd/74NskZ4Kg8/vDhhwo7OYJaGFAVGBBSjqllFIyCUTAKRgEWAADp0kMytnk14AAAAABJRU5ErkJggg==","orcid":"","institution":"The Affiliated Hospital of Xuzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Qian","suffix":""},{"id":281129809,"identity":"238f9fc0-2d2e-4c32-ac65-80b4cdd5bd57","order_by":1,"name":"Ran Zhou","email":"","orcid":"","institution":"The Affiliated Hospital of Xuzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ran","middleName":"","lastName":"Zhou","suffix":""},{"id":281129810,"identity":"32137868-2258-4e2d-a825-2e4eb0fd76e7","order_by":2,"name":"Tao Chen","email":"","orcid":"","institution":"The Affiliated Hospital of Xuzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Chen","suffix":""},{"id":281129811,"identity":"8aebe1da-b56b-4cac-a969-07fd8834d45a","order_by":3,"name":"Xueshan Zhang","email":"","orcid":"","institution":"The Affiliated Hospital of Xuzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xueshan","middleName":"","lastName":"Zhang","suffix":""},{"id":281129812,"identity":"8455c4d9-9559-4433-ab69-9cf47cfd2fbb","order_by":4,"name":"Yanfeng Ma","email":"","orcid":"","institution":"The Affiliated Hospital of Xuzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanfeng","middleName":"","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2024-03-10 04:29:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4061629/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4061629/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53185280,"identity":"6dfef05c-3aac-4361-8bf8-f4953ba7adeb","added_by":"auto","created_at":"2024-03-21 16:10:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54255,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSTE method for measuring LSr\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) represents the pre-LDDSE condition, while (B) shows the post-LDDSE condition. Arrow 1 indicates the apical region of the interventricular septum, and arrow 2 represents the time curve of peak LS during systole in the apical region of the interventricular septum\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4061629/v1/6a71deccd9f66ad7b17e9c09.png"},{"id":53185279,"identity":"c4e85c95-f5dc-47d5-b855-3b030d027403","added_by":"auto","created_at":"2024-03-21 16:10:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":75066,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve for detecting viable myocardium\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) and (B) display the ROC curves of LS and LSr in the DM group for detecting viable myocardium during resting and LDDSE. (C) and (D) show the ROC curves of LS and LSr in the non-DM group for detecting viable myocardium during resting and LDDSE.\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4061629/v1/1e928b83274c00aaa647992f.png"},{"id":53382111,"identity":"e22dd87d-99e4-473d-831e-dd8bcace8e29","added_by":"auto","created_at":"2024-03-25 10:20:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":999415,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4061629/v1/ec42c920-cf3f-4bdc-8856-b918ca3b4ddb.pdf"},{"id":53185278,"identity":"7e12a90d-9f31-47b7-8e25-ee8cafb16a88","added_by":"auto","created_at":"2024-03-21 16:10:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21840,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformation0906.docx","url":"https://assets-eu.researchsquare.com/files/rs-4061629/v1/98da674fbb24205f31c2442f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The value of STE-LDDSE to detect viable myocardium","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDM is a systemic metabolic disorder, and more than 70% of diabetic patients develop coronary heart disease (CHD), which exhibits a wider range and faster progression of coronary artery disease compared to non-diabetic individuals. The main lesions in CHD occur in the epicardium, whereas in DM, the primary lesions involve the myocardium and microvasculature. When both conditions coexist, the aforementioned lesions may be more extensive and severe. Clinical observations have shown that DM patients with concomitant CHD have a higher prevalence and severity of multi-vessel and diffuse coronary lesions compared to non-diabetic patients(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies have confirmed that after acute myocardial infarction (AMI), the region of RWMA comprises not only necrotic myocardium but also viable myocardium, including stunned myocardium and hibernating myocardium(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). So far, there are three main approaches used to identify viable myocardium(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e): (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Assessment of myocardial cellular metabolism, including oxidative metabolism, glucose metabolism, and fatty acid metabolism; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Evaluation of myocardial perfusion; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Monitoring of myocardial contractile reserve. Among these, dobutamine stress echocardiography (DSE) is internationally recognized as the standard method for monitoring myocardial contractile reserve and is widely employed.\u003c/p\u003e \u003cp\u003eAt present, STE-LDDSE offers significant advantages over traditional methods for assessing viable myocardium(\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). It mainly tracks the speckles of high-frame-rate two-dimensional images frame by frame, allowing for the calculation and delineation of myocardial motion velocity and deformation. By observing myocardial motion trajectories, it accurately measures myocardial fiber motion strain, strain rate, and rotation angles. Due to its angle-independent nature, STE can provide more accurate assessments of local and global myocardial function, making it highly valuable for detecting viable myocardium. The combination of STE and LDDSE further enhances the sensitivity and specificity, maximizing the detection of viable myocardium(\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBasic Clinical Characteristics of Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 85 patients were included in the study, including 30 patients in the DM group and 55 patients in the non-DM group\u0026nbsp;（Dataset 1）. All patients successfully completed the examinations, and satisfactory cardiac ultrasound images were obtained (Fig. 1A\u0026nbsp;and B). No malignant arrhythmias or cardiovascular events occurred during the entire examination process. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChanges in Hemodynamic Parameters pre/post LDDSE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe comparison of heart rate and blood pressure pre/post LDDSE in the 85 patients (Table S1). The results showed an increase in heart rate after medication, while blood pressure did not show significant changes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Echocardiographic Wall Motion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1,445 segments from the 85 patients were included in the study, including 540 segments with RWMA. After LDDSE in the DM group, 119 segments were classified as viable myocardium, and 64 segments were classified as non-viable myocardium. In the non-DM group, 189 segments were classified as viable myocardium, and 168 segments were classified as non-viable myocardium (Table S2).\u003c/p\u003e\n\u003cp\u003eFollow-up echocardiography was performed at 1, 3, and 6 months after PCI. The improvement of RWMA systolic function after PCI is recognized as the \u0026quot;gold standard\u0026quot; for judging viable myocardium.Based on the \u0026quot;gold standard\u0026quot;, 540 segments were followed up, which 365 segments classified as viable myocardium and 175 segments classified as non-viable myocardium(13-16). Among the 183 segments followed up in the DM group, which 117 segments were classified as viable myocardium and 66 segments were classified as non-viable myocardium. In the non-DM group, 357 segments were followed up, which 248 segments classified as viable myocardium and 109 segments classified as non-viable myocardium (Table S3).\u003c/p\u003e\n\u003cp\u003eComparison with the \u0026quot;gold standard\u0026quot; showed that the sensitivity, specificity, and accuracy of LDDSE semi-quantitative visual assessment for evaluating viable myocardium in the DM group were 70.09%, 43.94%, and 60.66%, respectively. In the non-DM group, the sensitivity, specificity, and accuracy were 55.65%, 53.21%, and 54.90%, respectively. The DM group had higher sensitivity and accuracy compared to the non-DM group, with statistically significant differences (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). However, the specificity was lower in the DM group compared to the non-DM group, with statistically significant differences (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Value of STE-LDDSE in Evaluating Viable Myocardium\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt involves quantitative analysis of S and Sr parameters in 540 segments with RWMA by QLAB 8.1 software. Binary logistic regression analysis was performed to evaluate the value of different S and Sr parameters at rest for detecting viable myocardium. The results showed that CS, LS, and LSr had significant value (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) in detecting viable myocardium (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: The value of using binary logistic stepwise regression analysis to detect viable myocardium using different S and Sr parameters in the resting state.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.80782918149466%\"\u003e\n \u003cp\u003efactor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.98576512455516%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.20640569395018%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.80782918149466%\"\u003e\n \u003cp\u003eRSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eCS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eLS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eLSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.98576512455516%\"\u003e\n \u003cp\u003e-1.310\u003c/p\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.20640569395018%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSubsequently, LS, LSr and ROC curves were plotted to determine the optimal cutoff points for detecting viable myocardium using STE. Accordingly, sensitivity, specificity, and accuracy were calculated (Fig. 2A-D, Table 2 and 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the DM group, the cutoff point for LS\u003csub\u003erest\u003c/sub\u003e was determined to be -13.27, with 46 out of 117 segments classified as viable myocardium (LS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e \u0026le; -13.27) and 71 segments as non-viable myocardium (LS\u003cem\u003e\u003csub\u003erest\u0026nbsp;\u003c/sub\u003e\u003c/em\u003e\u0026gt; -13.27) according to the gold standard. Similarly, for LS\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e in the DM group, the cutoff point was -13.81, with 83 segments classified as viable myocardium (LSLDDSE \u0026le; -13.81) and 34 segments as non-viable myocardium (LS\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e \u0026gt; -13.81). In terms of LSr\u003cem\u003e\u003csub\u003erest,\u003c/sub\u003e\u003c/em\u003e the cutoff point was -0.875, resulting in 98 segments classified as viable myocardium (LSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e \u0026le; -0.875) and 19 segments as non-viable myocardium (LSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e \u0026gt; -0.875) according to the gold standard. In the DM group, LSr\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e had a cutoff point of -1.12, with 108 segments classified as viable myocardium (LSr\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e \u0026le; -1.12) and 9 segments as non-viable myocardium (LSr\u003cem\u003e\u003csub\u003eLDDSE\u0026nbsp;\u003c/sub\u003e\u003c/em\u003e\u0026gt; -1.12).\u003c/p\u003e\n\u003cp\u003eIn the non-DM group, the cutoff point for LS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e was -12.33, with 123 out of 248 segments classified as viable myocardium (LS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e \u0026le; -12.33) and 125 segments as non-viable myocardium (LS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e \u0026gt; -12.33) according to the gold standard. Similarly, for LSLDDSE in the non-DM group, the cutoff point was -14.075, with 171 segments classified as viable myocardium (LS\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e \u0026le; -14.075) and 77 segments as non-viable myocardium (LS\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e \u0026gt; -14.075). Regarding LSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e, the cutoff point was -1.075, resulting in 156 segments classified as viable myocardium (LSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e \u0026le; -1.075) and 92 segments as non-viable myocardium (LSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e \u0026gt; -1.075) according to the gold standard. In the non-DM group, LSr\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e had a cutoff point of -1.305, with 192 segments classified as viable myocardium (LSr\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e \u0026le; -1.305) and 56 segments as non-viable myocardium (LSr\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e \u0026gt; -1.305) according to the gold ststandard.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e\u003cstrong\u003eThe value of detecting LS parameters in STE for diagnosing viable \u0026nbsp;myocardium.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.12297734627832%\" rowspan=\"2\"\u003e\n \u003cp\u003estatus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.375404530744337%\" colspan=\"2\"\u003e\n \u003cp\u003esensibility (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\" colspan=\"2\"\u003e\n \u003cp\u003especificity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.77346278317152%\" colspan=\"2\"\u003e\n \u003cp\u003eaccuracy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.774703557312254%\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.438735177865613%\"\u003e\n \u003cp\u003enon-DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.379446640316207%\"\u003e\n \u003cp\u003enon-DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.984189723320156%\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.379446640316207%\"\u003e\n \u003cp\u003enon-DM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.12297734627832%\"\u003e\n \u003cp\u003eLS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.372168284789645%\"\u003e\n \u003cp\u003e39.32\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.003236245954692%\"\u003e\n \u003cp\u003e49.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.679611650485437%\"\u003e\n \u003cp\u003e89.39\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.048543689320388%\"\u003e\n \u003cp\u003e77.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.724919093851133%\"\u003e\n \u003cp\u003e57.38\u003csup\u003e\u0026Delta;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.048543689320388%\"\u003e\n \u003cp\u003e58.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.12297734627832%\"\u003e\n \u003cp\u003eLS\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.372168284789645%\"\u003e\n \u003cp\u003e70.94\u003csup\u003e\u0026Delta;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.003236245954692%\"\u003e\n \u003cp\u003e68.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.679611650485437%\"\u003e\n \u003cp\u003e87.88\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.048543689320388%\"\u003e\n \u003cp\u003e92.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.724919093851133%\"\u003e\n \u003cp\u003e77.45\u003csup\u003e\u0026Delta;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.048543689320388%\"\u003e\n \u003cp\u003e76.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.12297734627832%\"\u003e\n \u003cp\u003eMcNemar\u0026apos;s \u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.372168284789645%\"\u003e\n \u003cp\u003e28.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.003236245954692%\"\u003e\n \u003cp\u003e30.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.679611650485437%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.048543689320388%\"\u003e\n \u003cp\u003e14.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.724919093851133%\"\u003e\n \u003cp\u003e26.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.048543689320388%\"\u003e\n \u003cp\u003e10.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.12297734627832%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.372168284789645%\"\u003e\n \u003cp\u003e8.025e-08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.003236245954692%\"\u003e\n \u003cp\u003e3.042e-08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.679611650485437%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.048543689320388%\"\u003e\n \u003cp\u003e0.0001768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.724919093851133%\"\u003e\n \u003cp\u003e2.882e-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.048543689320388%\"\u003e\n \u003cp\u003e0.0009511\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e$\u003c/sup\u003eDM\u0026nbsp;compared with non-DM,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.05, \u003csup\u003e\u0026Delta;\u0026nbsp;\u003c/sup\u003eCompare with resting, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e\u003cstrong\u003eThe value of detecting LSr parameters in STE for diagnosing viable myocardium.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.152350081037277%\" rowspan=\"2\"\u003e\n \u003cp\u003estatus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.173419773095624%\" colspan=\"2\"\u003e\n \u003cp\u003esensibility (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.632090761750405%\" colspan=\"2\"\u003e\n \u003cp\u003especificity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.042139384116695%\" colspan=\"2\"\u003e\n \u003cp\u003eaccuracy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.613861386138613%\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.02970297029703%\"\u003e\n \u003cp\u003enon-DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.613861386138613%\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.81188118811881%\"\u003e\n \u003cp\u003enon-DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.267326732673267%\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.663366336633663%\"\u003e\n \u003cp\u003enon-DM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.152350081037277%\"\u003e\n \u003cp\u003eLSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.235008103727715%\"\u003e\n \u003cp\u003e83.76\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.938411669367909%\"\u003e\n \u003cp\u003e62.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.235008103727715%\"\u003e\n \u003cp\u003e45.45\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.39708265802269%\"\u003e\n \u003cp\u003e66.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85899513776337%\"\u003e\n \u003cp\u003e69.95\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.183144246353322%\"\u003e\n \u003cp\u003e63.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.152350081037277%\"\u003e\n \u003cp\u003eLSr\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.235008103727715%\"\u003e\n \u003cp\u003e92.31\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.938411669367909%\"\u003e\n \u003cp\u003e77.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.235008103727715%\"\u003e\n \u003cp\u003e72.73\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.39708265802269%\"\u003e\n \u003cp\u003e88.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85899513776337%\"\u003e\n \u003cp\u003e85.25\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.183144246353322%\"\u003e\n \u003cp\u003e80.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.152350081037277%\"\u003e\n \u003cp\u003eMcNemar\u0026apos;s \u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.235008103727715%\"\u003e\n \u003cp\u003e22.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.938411669367909%\"\u003e\n \u003cp\u003e16.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.235008103727715%\"\u003e\n \u003cp\u003e12.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.39708265802269%\"\u003e\n \u003cp\u003e22.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85899513776337%\"\u003e\n \u003cp\u003e1.0652\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.183144246353322%\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.152350081037277%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.235008103727715%\"\u003e\n \u003cp\u003e2.668e-06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.938411669367909%\"\u003e\n \u003cp\u003e5.95e-05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.235008103727715%\"\u003e\n \u003cp\u003e0.0005202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.39708265802269%\"\u003e\n \u003cp\u003e2.668e-06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.85899513776337%\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.183144246353322%\"\u003e\n \u003cp\u003e0.2713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e$\u003c/sup\u003eDM\u0026nbsp;compared with non-DM,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.05, \u003csup\u003e\u0026Delta;\u0026nbsp;\u003c/sup\u003eCompare with resting, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05\u003c/p\u003e\n\u003cp\u003eFurther parallel diagnostic testing was performed on the LS and LSr parameters at rest. In the DM group, the sensitivity, specificity, and accuracy were found to be 84.62%, 45.45%, and 70.49%, respectively. In the non-DM group, the sensitivity, specificity, and accuracy were 66.53%, 63.30%, and 65.55%, respectively. The DM group showed higher sensitivity and accuracy compared to the non-DM group, with statistically significant differences. However, the DM group had lower specificity compared to the non-DM group, also with statistically significant differences (Table 4 and 6).Parallel diagnostic testing was also conducted on the LS and LSr parameters under stress conditions. In the DM group, the sensitivity, specificity, and accuracy were 92.31%, 60.70%, and 84.15%, respectively. In the non-DM group, the sensitivity, specificity, and accuracy were 84.27%, 81.65%, and 83.47%, respectively (Table 5 and 6). The DM group exhibited higher sensitivity and accuracy compared to the non-DM group, with statistically significant differences. However, the DM group had lower specificity compared to the non-DM group, also with statistically significant differences. The accuracy was higher in the DM group, but the difference was not statistically significant.\u003c/p\u003e\n\u003cp\u003eIn the DM group, STE demonstrated higher sensitivity, specificity, and accuracy for detecting viable myocardium under stress conditions compared to rest. Additionally, STE at rest showed higher sensitivity and accuracy compared to the semi-quantitative visual assessment of LDDSE, with statistically significant differences. The specificity of STE at rest was higher than that of LDDSE, but the difference was not statistically significant. In the non-DM group, STE at stress showed higher sensitivity, specificity, and accuracy for detecting viable myocardium compared to rest, with statistically significant differences. STE at rest also exhibited higher sensitivity, specificity, and accuracy compared to LDDSE, with statistically significant differences (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e\u003cstrong\u003eConducting parallel diagnostic trials using LS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e and LSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e in combination to detect viable myocardium.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"559\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.821428571428573%\" rowspan=\"2\"\u003e\n \u003cp\u003eLS\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e +LSr\u003cem\u003e\u003csub\u003erest\u003c/sub\u003e\u003c/em\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.107142857142854%\" colspan=\"2\"\u003e\n \u003cp\u003egold standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.071428571428573%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.834983498349835%\"\u003e\n \u003cp\u003eviable myocardium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.165016501650165%\"\u003e\n \u003cp\u003eNon-viable myocardium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.86583184257603%\"\u003e\n \u003cp\u003eviable myocardium \u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.012522361359572%\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.191413237924866%\" colspan=\"2\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.86583184257603%\"\u003e\n \u003cp\u003eviable myocardium\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.012522361359572%\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.191413237924866%\" colspan=\"2\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.86583184257603%\"\u003e\n \u003cp\u003eNon-viable myocardium \u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.012522361359572%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.191413237924866%\" colspan=\"2\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.86583184257603%\"\u003e\n \u003cp\u003eNon-viable myocardium\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.012522361359572%\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.191413237924866%\" colspan=\"2\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.86583184257603%\"\u003e\n \u003cp\u003etotal\u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.012522361359572%\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.191413237924866%\" colspan=\"2\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.86583184257603%\"\u003e\n \u003cp\u003etotal\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.012522361359572%\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.191413237924866%\" colspan=\"2\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e\u003cstrong\u003eConducting parallel diagnostic trials using LS\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e and LS\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e in combination to detect viable myocardium.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"560\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.777183600713013%\" rowspan=\"2\"\u003e\n \u003cp\u003eLS\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e+LSr\u003cem\u003e\u003csub\u003eLDDSE\u003c/sub\u003e\u003c/em\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"54.01069518716577%\" colspan=\"3\"\u003e\n \u003cp\u003egold standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.21212121212121%\" rowspan=\"2\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.834983498349835%\" colspan=\"2\" style=\"width: 45.5357%;\"\u003e\n \u003cp\u003eviable myocardium \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.165016501650165%\" style=\"width: 23.9286%;\"\u003e\n \u003cp\u003eNon-viable myocardium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.777183600713013%\"\u003e\n \u003cp\u003eviable myocardium\u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.916221033868094%\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.094474153297682%\" colspan=\"2\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.777183600713013%\"\u003e\n \u003cp\u003eviable myocardium\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.916221033868094%\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.094474153297682%\" colspan=\"2\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.777183600713013%\"\u003e\n \u003cp\u003eNon-viable myocardium\u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.916221033868094%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.094474153297682%\" colspan=\"2\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.777183600713013%\"\u003e\n \u003cp\u003eNon-viable myocardium\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.916221033868094%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.094474153297682%\" colspan=\"2\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.777183600713013%\"\u003e\n \u003cp\u003etotal\u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.916221033868094%\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.094474153297682%\" colspan=\"2\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.777183600713013%\"\u003e\n \u003cp\u003etotal\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.916221033868094%\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.094474153297682%\" colspan=\"2\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:The value of different diagnostic methods in diagnosing viable myocardium\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"572\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.67600700525394%\"\u003e\n \u003cp\u003estatus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.71628721541156%\"\u003e\n \u003cp\u003esensibility (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.066549912434326%\"\u003e\n \u003cp\u003especificity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.541155866900176%\"\u003e\n \u003cp\u003eaccuracy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.67600700525394%\"\u003e\n \u003cp\u003eLDDSE semi-quantitative\u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLDDSE semi-quantitative\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.71628721541156%\"\u003e\n \u003cp\u003e70.09\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e55.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.066549912434326%\"\u003e\n \u003cp\u003e43.94\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e53.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.541155866900176%\"\u003e\n \u003cp\u003e60.66\u003c/p\u003e\n \u003cp\u003e54.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.67600700525394%\"\u003e\n \u003cp\u003eResting STE\u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eResting STE\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.71628721541156%\"\u003e\n \u003cp\u003e84.62\u003csup\u003e*$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e66.53\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.066549912434326%\"\u003e\n \u003cp\u003e45.45\u003csup\u003e#$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e63.30\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.541155866900176%\"\u003e\n \u003cp\u003e70.49*\u003c/p\u003e\n \u003cp\u003e65.55*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.67600700525394%\"\u003e\n \u003cp\u003eSTE+LDDSE\u003csup\u003eDM\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSTE+LDDSE\u003csup\u003enon-DM\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.71628721541156%\"\u003e\n \u003cp\u003e92.31\u003csup\u003e*\u0026Delta;$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e84.27\u003csup\u003e*\u0026Delta;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.066549912434326%\"\u003e\n \u003cp\u003e60.70\u003csup\u003e*\u0026Delta;$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e81.65\u003csup\u003e*\u0026Delta;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.541155866900176%\"\u003e\n \u003cp\u003e84.15\u003csup\u003e*\u0026Delta;\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e83.47\u003csup\u003e*\u0026Delta;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDM, \u003csup\u003e*\u003c/sup\u003e compared with LDDSE semi-quantitative, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, \u003csup\u003e#\u003c/sup\u003e compared with LDDSE semi-quantitative, \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05, \u003csup\u003e\u0026Delta;\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 compared to resting time;\u003csup\u003e\u0026nbsp;\u003c/sup\u003enon-DM, \u003csup\u003e*\u003c/sup\u003e compared with LDDSE semi-quantitative, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, \u003csup\u003e\u0026Delta;\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 compared to resting time\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e$\u003c/sup\u003eDM\u0026nbsp;compared with non-DM,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReproducibility Test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess inter-observer variability, two experienced ultrasound examiners analyzed S and Sr parameters for 39 RWMA segments in 6 randomly selected subjects, resulting in an inter-observer variability of 5.3%. Intra-observer variability was assessed by having the same ultrasound examiner analyze S and Sr parameters for 50 RWMA segments in 8 randomly selected subjects, resulting in an intra-observer variability of 4.9%. These findings indicate good reproducibility of the STE measurements.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRecent studies have highlighted the presence of viable myocardium, including stunned and hibernating myocardium, within areas of RWMA after AMI. Viable myocardium refers to myocardial tissue that can recover its function, either partially or completely, upon restoration of blood supply. Effective revascularization can lead to functional recovery of viable myocardium, improving clinical symptoms and prognosis. On the other hand, non-viable myocardium does not regain its function even with successful revascularization. Therefore, the assessment of myocardial viability is crucial for guiding treatment decisions in patients with STEMI.\u003c/p\u003e \u003cp\u003eSTE can track the movement of the myocardeum by recognizing the echo-speckle signal of the myocardeum in the image.This technology can evaluate the myocardial segmental strain from multiple directions without angle dependence, and can evaluate the local or global myocardial function changes.\u003c/p\u003e \u003cp\u003eLDDSE is currently internationally recognized as the standard method for detecting the reserve of viable myocardial contractile function. The improvement of RWMA segments in resting echocardiography after LDDSE indicates the presence of viable myocardium in that segment. Dobutamine (dobu) is a synthetic catecholamine, which has a relative excitatory effect on β1 receptor, but a weak excitatory effect on β2 receptor and α receptor. Small dose of dobu(\u0026le;\u0026thinsp;10 ug/kg/min) mainly excitates β1 receptor, has little effect on blood pressure and heart rate, enhances myocardial contractility and induces myocardial ischemia, which has important value in evaluating myocardial survival.\u003c/p\u003e \u003cp\u003eCurrently, there are many methods available, and combined with clinical research, a single method has limited diagnostic value. Therefore, clinical practice is gradually inclined towards joint diagnostic evaluation. Both of these methods are non-invasive and highly feasible methods for detecting viable myocardial muscle.\u003c/p\u003e \u003cp\u003eCompared with SET or LDDSE, SET-LDDSE has significantly improved sensitivity, specificity, and accuracy.. Meanwhile, compared with MRI, STE-LDDSE has higher sensitivity and practicality in diagnosing viable myocardium in patients with myocardial infarction, indicating that STE-LDDSE should be the first choice for evaluating surviving myocardium in patients with myocardial infarction.\u003c/p\u003e \u003cp\u003eIt is important to note that this study had a small sample size and focused solely on RWMA, which may have limited the detection of viable myocardium in segments with normal wall motion. To enhance the study's validity and generalizability, it is recommended to expand the sample size in future research. Additionally, the follow-up echocardiography assessed improvement in wall motion compared to baseline, considering an improvement of \u0026ge;\u0026thinsp;1 grade as indicative of viable myocardium. However, further analysis comparing improvements of \u0026ge;\u0026thinsp;1 grade to improvements of \u0026ge;\u0026thinsp;2 grades or more was not conducted due to the limited number of eligible segments.\u003c/p\u003e \u003cp\u003eFuture studies should consider including segments with normal wall motion to avoid potential underdiagnosis of viable myocardium. Additionally, exploring more comprehensive criteria for assessing viable myocardium, such as improvements of \u0026ge;\u0026thinsp;2 grades or more, could provide further insights into the extent of functional recovery. These considerations would contribute to a more comprehensive understanding of myocardial viability assessment and its implications for clinical decision-making.\u003c/p\u003e \u003cp\u003eIn summary, compared to traditional and single examination methods, STE-LDDSE has higher sensitivity, specificity, and accuracy, which is more helpful in guiding patients to effectively evaluate viable myocardium before PCI, and has a certain guiding role in blood vessel reconstruction and prognosis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSTE-LDDSE detection has certain clinical value in assessing myocardial viability in STEMI patients, and is also safe and feasible for preoperative evaluation of myocardial survival ability before coronary artery revascularization. Moreover, it is more sensitive in assessing the viability of myocardium in DM patients with concurrent STEMI compared to non-DM patients.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eReagents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDobutamine: Shanghai First Biochemical Pharmaceutical Co., Ltd., 20mg:2ml*10 vials, National Drug Approval Number H3102190.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS 16.0 statistical analysis software was used for statistical analysis. All continuous data were expressed as mean \u0026plusmn; standard deviation (\u0026plusmn;S). Paired data following a normal distribution were analyzed using t-tests, while independent samples were analyzed using independent sample t-tests. Binary logistic regression analysis was performed to select valuable S and Sr parameters for detecting viable myocardium. Receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC) and determine the optimal cutoff points, sensitivity, specificity, and accuracy for diagnosing viable myocardium. Chi-square test was used for intergroup comparison of rates. A p-value \u0026le;0.05 was considered statistically significant, with a significance level of \u0026alpha;=0.05.\u003c/p\u003e\n\u003cp\u003eAdditional methods can be found in SI Appendix, SI Materials and Methods.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILLABLITY\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo new data has been generated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS AND APPROVAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor contributions: W.Q., and Y.M. designed research; W.Q., R.Z., T.C. and Y.M.; provided samples; X.Z., and Y.M.; performed research; W.Q., and Y.M. analyzed data; W.Q., and Y.M. wrote the paper. Written informed consent was obtained from all the pariticipants prior to the enrollment of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of xuzhou medical university. We certify that the study was performed in accordance with the 1964 declaration of HELSINKI and later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKranidis A, et al. Stress echocardiography using adenosine combined with nitroglycerin-dobutamine in the detection of viable myocardium in patients with previous myocardial infarction. Angiology. 1997;48(2):127\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang CC, Reusch JE. Diabetes and cardiovascular disease: changing the focus from glycemic control to improving long-term survival. Am J Cardiol. 2012;110(9 Suppl):b58\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBourque JM, et al. Usefulness of cardiovascular magnetic resonance imaging of the superficial femoral artery for screening patients with diabetes mellitus for atherosclerosis. Am J Cardiol. 2012;110(1):50\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Loon RB, et al. Improved clinical outcome after invasive management of patients with recent myocardial infarction and proven myocardial viability: primary results of a randomized controlled trial (VIAMI-trial). Trials. 2012;13:1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllman KC. Noninvasive assessment myocardial viability: current status and future directions. J nuclear cardiology: official publication Am Soc Nuclear Cardiol. 2013;20(4):618\u0026ndash;37. quiz 638\u0026thinsp;\u0026ndash;\u0026thinsp;619.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoyce E, et al. Differential response of LV sublayer twist during dobutamine stress echocardiography as a novel marker of contractile reserve after acute myocardial infarction: relationship with follow-up LVEF improvement. European heart journal. Cardiovasc Imaging. 2016;17(6):652\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUusitalo V, et al. Two-Dimensional Speckle-Tracking during Dobutamine Stress Echocardiography in the Detection of Myocardial Ischemia in Patients with Suspected Coronary Artery Disease. J Am Soc Echocardiography: official publication Am Soc Echocardiography. 2016;29(5):470\u0026ndash;e479473.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIlardi F, et al. Quantitative detection of inducible ischemia during dobutamine stress by speckle tracking echocardiography: A dream comes true. Int J Cardiol. 2016;220:357\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWierzbowska-Drabik K, Plewka M, Kasprzak JD. Variability of longitudinal strain in left ventricular segments supplied by non-stenosed coronary artery: insights from speckle tracking analysis of dobutamine stress echocardiograms in patients with high coronary risk profile. Archives Med science: AMS. 2017;13(1):82\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsang W, et al. Interinstitutional measurements of left ventricular volumes, speckle-tracking strain, and dyssynchrony using three-dimensional echocardiography. J Am Soc Echocardiography: official publication Am Soc Echocardiography. 2013;26(11):1253\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee Y, et al. New approach for rotational dyssynchrony using three-dimensional speckle tracking echocardiography. Echocardiography (Mount Kisco N Y). 2014;31(4):492\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoyce E, et al. Quantitative Dobutamine Stress Echocardiography Using Speckle-Tracking Analysis versus Conventional Visual Analysis for Detection of Significant Coronary Artery Disease after ST-Segment Elevation Myocardial Infarction. J Am Soc Echocardiography: official publication Am Soc Echocardiography. 2015;28(12):1379\u0026ndash;e13891371.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGong L, et al. Assessment of myocardial viability in patients with acute myocardial infarction by two-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography. Int J Cardiovasc Imaging. 2013;29(5):1017\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang C, et al. Evaluation of myocardial viability in old myocardial infarcted patients with CHF: delayed enhancement MRI vs. low-dose dobutamine stress speckle tracking echocardiography. Am J translational Res. 2016;8(9):3731\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu K, et al. Evaluation of myocardial viability in patients with acute myocardial infarction: Layer-specific analysis of 2-dimensional speckle tracking echocardiography. Medicine. 2019;98(3):e13959.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"speckle tracking echocardiography, low dose dobutamine stress echocardiography, ST-elevation myocardial infarction, diabetes mellitus, viable myocardium","lastPublishedDoi":"10.21203/rs.3.rs-4061629/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4061629/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTo explore the value of speckle tracking echocardiography (STE) with low dose dobutamine stress echocardiography (LDDSE) for evaluation of viable myocardium (VM) in the acute ST-elevation myocardial infarction (STEMI) patients with or without type 2 diabetes mellitus (DM). Here, we show that a total of 183 regional wall motion abnormalities (RWMA) were detected in the DM group, of which 117 (63.93%) segments were viable myocardium; 357 RWMA were detected in non DM patients, of which 248 (69.47%) segments of viable myocardium were detected by echocardiography. The sensitivity, accuracy, and specificity of STE-LDDSE in detecting viable myocardium in DM group were 70.94%、77.45%、87.88% ; 92.31%、72.73% and 85.25% for LS and LSr. In the non DM group, the sensitivity, specificity, and accuracy of LS and LSr were 68.95%、92.66%、76.19% ; 77.42%、88.07% and 80.67%, respectively. Further parallel diagnostic tests were conducted on LS and LSr parameters. The sensitivity, specificity, and accuracy of detecting viable myocardium in the DM and non DM groups were 84.62%、45.45%、70.49%, 66.53%、63.30% and 65.55%, respectively, at rest; They were 84.62%、45.45%、70.49%, 66.53%、63.30% and 65.55%, respectively, during low dose dobutamine stress. In summary, Parallel diagnostic test for LS and LSr is the best choice in detecting VM in the patients with STEMI and is more sensitive for the patients with type 2 DM.\u003c/p\u003e","manuscriptTitle":"The value of STE-LDDSE to detect viable myocardium","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-21 16:10:36","doi":"10.21203/rs.3.rs-4061629/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c57f6136-9110-414a-8df3-bbe369c52d74","owner":[],"postedDate":"March 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-26T11:38:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-21 16:10:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4061629","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4061629","identity":"rs-4061629","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}