ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1641044
This article is part of the Research TopicMulti-Parametric Echocardiography in the Detection of Coronary Artery DiseaseView all 5 articles
The role of post-systolic strain and electrocardiographic changes during dobutamine stress echocardiography in enhancing detection of symptomatic coronary artery disease
Provisionally accepted
Aleksandra Zivanic*
Ivan StankovicIvona VranicMilos Panic
Milica ScepanovicAleksandra MaksimovicPredrag MilicevicTijana Kalezic RadmiliAleksandar N. Neskovic- University of Belgrade, Belgrade, Serbia
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Background: To enhance the diagnosis of coronary artery disease (CAD) during dobutamine stress echocardiography (DSE), subjective visual evaluation of left ventricular (LV) wall motion abnormalities may be complemented by analyzing myocardial deformation and electrocardiographic (ECG) changes. Aims: This study evaluates the post-systolic strain index (PSI) measured during the recovery phase of DSE for detecting obstructive CAD and explores its relationship with wall motion abnormalities and ECG changes during DSE in patients with anginal symptoms. Methods: We retrospectively analyzed data from 72 patients who underwent both DSE and coronary angiography. We compared visual interpretation of DSE at peak stress, ECG abnormalities during DSE, and PSI during the recovery phase with obstructive CAD. Results: LV wall motion abnormalities induced by dobutamine were independently associated with obstructive CAD (odds ratio [OR] 8.58, 95% confidence interval [CI] 2.67-27.50, p<0.011), diagnosed in 44% of patients. Significant ECG changes during DSE correlated with obstructive CAD (OR 4.41, 95%CI 1.41-13.81, p=0.011). PSI during recovery did not correlate with DSE-induced wall motion abnormalities (OR 1.45, 95%CI 0.49-4.24, p=0.497) or obstructive CAD (OR 1.00, 95%CI 0.342-2.926, p=1.00), but was associated with pathological ECG changes (OR 5.51, 95%CI 1.05-28.99, p=0.044). Conclusions: PSI measured during the recovery phase of DSE is not associated with DSE-induced wall motion abnormalities and obstructive CAD in patients with anginal symptoms. However, PSI may be related to ECG changes and could potentially reflect subtle, stress-induced myocardial dysfunction, possibly involving coronary microvascular impairment.
Keywords: Dobutamine, Stress echocardiography, Coronary Artery Disease, microvascular dysfunction, Electrocardiography
Received: 04 Jun 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Zivanic, Stankovic, Vranic, Panic, Scepanovic, Maksimovic, Milicevic, Kalezic Radmili and Neskovic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aleksandra Zivanic, a_dimic@yahoo.com
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