Ischemia, Myocardial Clinical Trial
Official title:
Development, Validation and Implementation of a New Quantitative Stress Echocardiographic Test for Myocardial Ischaemia
Patients with chest pain on exertion need a reliable non-invasive test to identify if they
have inducible myocardial ischaemia. This would reduce the use of diagnostic coronary
arteriography, avoid its risks and costs, and guide clinical decisions. Conventional stress
echocardiography has poor reproducibility because it relies on qualitative and subjective
interpretation. Quantitative approaches based on precise and reliable measurements of
myocardial velocity, strain, strain rate and global longitudinal strain have been shown to be
able to accurately diagnose myocardial ischaemia. A more accurate test using myocardial
velocity imaging was not implemented by ultrasound vendors although it provided an objective
measurement of myocardial functional reserve on a continuous scale from normality to severe
ischaemia.
The investigators propose an original approach to create a diagnostic software tool that can
be used in routine clinical practice. The investigators will extract and compare quantitative
data obtained through myocardial velocity imaging and speckle tracking in subjects who
undergo dobutamine stress echocardiography.
The data will be analysed using advanced computational mathematics including multiple kernel
learning and joint statistics applied to multivariate data across multiple dimensions
(including velocity, strain and strain rate traces). This approach will be validated against
quantitative coronary arteriography and fractional flow reserve. The results will be
displayed as parametric images and placed into a reporting tool. The output will determine
the presence and severity of myocardial ischaemia. These new tools will have the capacity for
iterative learning so that the precision of the diagnostic conclusions can be continuously
refined.
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