Prediction of viability by pulsed-wave Doppler tissue sampling of asynergic myocardium during low-dose dobutamine challenge

Altinmakas, Suat; Dağdeviren, Bahadır; Uyan, Ci̇hangi̇r; Keser, Nurgül; Gümüş, Vakkas; Pektaş, Oral

doi:10.1016/s0167-5273(00)00226-6

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…Incorporation of TDI measures of systolic function in exercise testing to assess for ischemia, viability, and contractile reserve has been suggested 5 because peak Sa velocity normally increases with dobutamine infusion and exercise 6 and de-creases with ischemia. 7 The technical difficulties of timely acquisition of both 2-dimensional and TDI data during exercise represent the major limitations to routine integration in stress testing.…”

Section: Assessment Of LV Systolic Functionmentioning

confidence: 99%

A Clinician’s Guide to Tissue Doppler Imaging

2006

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T issue Doppler imaging (TDI) is a relatively new echocardiographic technique that usesDoppler principles to measure the velocity of myocardial motion. We describe the principles behind and the clinical utility of TDI. Principles of TDIDoppler echocardiography relies on detection of the shift in frequency of ultrasound signals reflected from moving objects. With this principle, conventional Doppler techniques assess the velocity of blood flow by measuring high-frequency, low-amplitude signals from small, fast-moving blood cells. In TDI, the same Doppler principles are used to quantify the higheramplitude, lower-velocity signals of myocardial tissue motion.There are important limitations to TD interrogation. As with all Doppler techniques, TDI measures only the vector of motion that is parallel to the direction of the ultrasound beam. In addition, TDI measures absolute tissue velocity and is unable to discriminate passive motion (related to translation or tethering) from active motion (fiber shortening or lengthening). The emerging technology of Doppler strain imaging provides a means to differentiate true contractility from passive myocardial motion by looking at relative changes in tissue velocity.TDI can be performed in pulsedwave and color modes. Pulsed-wave TDI is used to measure peak myocardial velocities and is particularly well suited to the measurement of long-axis ventricular motion because the longitudinally oriented endocardial fibers are most parallel to the ultrasound beam in the apical views. Because the apex remains relatively stationary throughout the cardiac cycle, mitral annular motion is a good surrogate measure of overall longitudinal left ventricular (LV) contraction and relaxation. 1 To measure longitudinal myocardial velocities, the sample volume is placed in the ventricular myocardium immediately adjacent to the mitral annulus. The cardiac cycle is represented by 3 waveforms (Figure): (1) Sa, systolic myocardial velocity above the baseline as the annulus descends toward the apex; (2) Ea, early diastolic myocardial relaxation velocity below the baseline as the annulus ascends away from the apex; and (3) Aa, myocardial velocity associated with atrial contraction. The lower-case "a" for annulus or "m" for myocardial (Ea or Em) and the superscripted prime symbol (E') are used to differentiate tissue Doppler velocities from conventional mitral inflow. Pulsed-wave TDI has high temporal resolution but does not permit simultaneous analysis of multiple myocardial segments.With color TDI, a color-coded representation of myocardial velocities is superimposed on gray-scale 2-dimensional or M-mode images to indicate the direction and velocity of myocardial motion. Color TDI mode has the advantage of increased spatial resolution and the ability to evaluate multiple structures and segments in a single view. Clinical Applications of TDI Assessment of LV Systolic FunctionSystolic myocardial velocity (Sa) at the lateral mitral annulus is a measure of longitudinal systolic function and is correlated with me...

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Section: Assessment Of LV Systolic Functionmentioning

confidence: 99%

A Clinician’s Guide to Tissue Doppler Imaging

2006

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“…DTI of asynergic myocardium during dobutamine stress echocardiography can also be used to quantitatively identify viable myocardium. Assuming 35% increase in systolic myocardial velocity velocities caused by dobutamine as a cutoff for viability, 89% sensitivity and 86% specificity were achieved for predicting postrevascularization functional recovery 10 …”

Section: Pulsed Doppler Myocardial Imagingmentioning

confidence: 99%

New Techniques for the Assessment of Regional Left Ventricular Wall Motion

Garcı́a-Fernández

Bermejo²,

Pérez-David³

et al. 2003

Echocardiography

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The assessment of regional left ventricular (LV) function has been an important yet unresolved problem since the introduction of echocardiography as a diagnostic tool. Abnormal regional LV wall motion is an early finding in multiple cardiac pathologies and its diagnosis is of critical importance. In the last few years diagnostic procedures based on combined use of existing echocardiographic technologies were geared toward improving the accuracy of detection of baseline and/or induced regional wall motion abnormalities. One of the assumptions is that the combination of reduced LV wall thickening and reduced myocardial velocities can be used to accurately diagnose regional myocardial dysfunction. In this article we will discuss several new techniques for the quantification of regional LV function using Doppler echocardiography.

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“…Secondly, previous studies described inhomogeneous results concerning the used cutoff values and the resulting diagnostic accuracy: Jun et al [10] demonstrated that the increase of peak velocities during dobutamine stress echocardiography of more than 150% and the relation of regional pre-ejection period / regional ejection time < 100% may be useful criteria for the diagnosis of viable myocardium. Altinmakas et al [11] reported that a cut-off value of 35% concerning the increase of regional myocardial velocity during dobutamine stimulation for the detection of viability is useful with a calculated sensitivity of 89% and a specificity of 86%. Yuan et al [12] reported sensitivities of 68% and 67% and specificities of 75% and 75% for cut-off values of an increase of 1.25 cm/s and of 29% and more to differentiate viable from nonviable segments.…”

Section: Comparison With Previous Tissue Doppler Studiesmentioning

confidence: 99%