Intermountain tackles speckle tracking in asymptomatic diabetics

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Intermountain Healthcare will conduct the Speckle Tracking by Echo study, which will use advanced ultrasound technology to determine if asymptomatic diabetics are at risk for coronary heart disease.

The Speckle Tracking by Echo is a substudy of the landmark faCTor(64 ) study, which assessed asymptomatic diabetics using cardiac CT angiography.

Speckle tracking uses wall motion tracking technology to detect if patients have a reduction in myocardial strain. Strain is the percentage change in muscle as the heart contracts. Any reduction in strain indicates a strong possibility of coronary heart disease, so the patient is sent to CT for further evaluation, according to J. Brent Muhlestein, MD, director of cardiovascular research, Intermountain Medical Center in Murray, Utah, and  lead investigator for the Speckle Tracking by Echo ultrasound substudy and the faCTor(64) study.

"Wall motion tracking is a new technique to help us more carefully analyze heart function, specifically the speed of muscle contraction and relaxation of multiple regions of the heart," Muhlestein said. "The goal of this substudy is to determine if the information gleaned through wall motion tracking can be used as an early predictor of adverse cardiac events. So far, wall motion tracking shows significant promise as an inexpensive, noninvasive tool to detect subtle differences in how regions of the heart muscle are working."

Muhlestein and colleagues intend to enroll more than 300 patients from its diabetes registry into the study. Similar to faCTor(64), the speckle tracking study is an outcomes-based trial. Half of the patients will be scanned with speckle tracking and referred further for intervention if needed, while half will undergo traditional diabetic management. After a specified follow up, researchers will determine which group experienced better outcomes.

Muhlestein's group is also assessing carotid intima-media thickness (CIMT) to detect plaque in the carotid artery, also known to be an early predictor of heart disease.

The speckle tracking results will be analyzed by Joao A.C. Lima, MD, professor of medicine, radiology and epidemiology at Johns Hopkins University School of Medicine in Baltimore.

Toshiba America Medical Systems, which sponsored the faCTor(64) study, is sponsoring the Speckle Tracking by Echo study as well. .