2D-STI combined with gated 99Tcm-MIBI MPI for the diagnosis of myocardial ischemia in hypercholesterolemia patients

This study aimed to investigate the reliability of ultrasound two-dimensional speckle tracking imaging (2D-STI) for the evaluation of myocardial ischemia in familial hypercholesterolemia (FH) patients. We recruited 28 patients clinically diagnosed with homozygous familial hypercholesterolemia (HoFH) and subjected them to 2D-STI, gated transthoracic Doppler echocardiography (TTDE), and 99Tcm-methoxyisobutylisonitrile myocardial perfusion imaging (99Tcm-MIBI MPI). The sensitivity, specificity and diagnostic accordance rate of TTDE and 2D-STI for myocardial ischemia in HoFH patients were compared with the 99Tcm-MIBI scores. According to the diagnosis of ischemia in the three main coronary arteries (LAD, LCX, and RCA) by MPI, patients were further divided into different groups for comparing segmental strain by 2D-STI. The total correlation between TTDE and 99Tcm-MIBI MPI for evaluation of myocardial ischemia was r=0.483 and between 2D-STI and 99Tcm-MIBI MPI was 0.786. The total correlation index for ejection fraction (EF) between TTDE and 99Tcm-MIBI MPI was r=0.606 and for 2D-STI and 99Tcm-MIBI MPI was r=0.919. TTDE indicated that differences among LVDd, LVDs, IVS, LVPW, AO Vmax, PG, E/e', and DT were statistically significant. STI indicated that the total strain of the ischemia group was lower than that of the non-ischemia group. The total systolic strain and total early diastolic strain of the ischemia group were lower than that of the non-ischemia group. TTDE can be used for primary observation and evaluation of ventricular wall ischemia for HoFH patients. Ultrasound 2D-STI is better than TTDE in the evaluation of myocardial ischemia in HoFH patients. Ultrasound 2D-STI shows the same effectiveness as 99Tcm-MIBI MPI for the detection of myocardial ischemia, serving as good tool for prognosis and treatment evaluation in HoFH patients.