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. 2025 Oct 17:12:1641044.
doi: 10.3389/fcvm.2025.1641044. eCollection 2025.

The role of post-systolic strain and electrocardiographic changes during dobutamine stress echocardiography in enhancing detection of symptomatic coronary artery disease

Aleksandra Zivanic #  1 , Ivan Stankovic #  1   2 , Ivona Vranic Jovanovic  1 , Milos Panic  1 , Milica Scepanovic  1 , Aleksandra Maksimovic  1 , Predrag Milicevic  1 , Tijana Kalezic-Radmili  1 , Aleksandar N Neskovic  1   2
Affiliations

The role of post-systolic strain and electrocardiographic changes during dobutamine stress echocardiography in enhancing detection of symptomatic coronary artery disease

Aleksandra Zivanic et al. Front Cardiovasc Med. .

Abstract

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: coronary artery disease; dobutamine; electrocardiography; microvascular dysfunction; stress echocardiography.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Assessment of the post-systolic index (PSI) during the recovery phase of dobutamine stress echocardiography (DSE). The PSI was automatically calculated for each left ventricular (LV) segment using software and displayed in a polar map as a percentage. PSI values were considered positive if two or more adjacent LV segments had PSI values exceeding the predefined cutoff of 25%. (A) Example of a patient with a negative PSI during the recovery phase, where all LV segments had low PSI values. (B) Example of a patient with a positive PSI, where several LV segments (circled) exhibited PSI values ≥25.
Figure 2
Figure 2
Alluvial plot illustrating associations between the post-systolic index (PSI), electrocardiogram (ECG), wall motion abnormalities (WMA), dobutamine stress echocardiography (DSE) and obstructive coronary artery desease (CAD). Numbers indicate the absolute number of patients in each category.
Figure 3
Figure 3
An example of a patient presenting with anginal symptoms and significant ST-segment depressions during dobutamine stress echocardiography (DSE), but with no obstructive coronary artery disease detected on invasive coronary angiography. Although there were no wall motion abnormalities observed during DSE, significant abnormalities in post-systolic myocardial deformation were evident, as indicated by elevated PSI values in multiple left ventricular segments.
See this image and copyright information in PMC

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