Regional diastolic function by pulsed doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing

Bibra, H. von; Tuchnitz, Anja; Klein, Annegret; Schneider-Eicke, Jan; Schömig, Albert; Schwaiger, Markus

doi:10.1016/s0735-1097(00)00735-x

Cited by 94 publications

(70 citation statements)

References 31 publications

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“…Regarding late diastolic velocity (A), there was no significant difference between the two groups. These results are in agreement with data reported by Von Bibra et al [37] using pulsed Doppler myocardial mapping of 12 left ventricular segments during DSE, and reported, a stress-induced reduction of peak lengthening of early diastolic velocity which was accurate and superior to peak systolic tissue Doppler recordings for detecting coronary artery stenosis [37].…”

Section: Changes In Myocardial Velocities and Time Intervals During Dsupporting

confidence: 92%

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Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease

Elnoamany

Badran

Khalil

et al. 2011

WJCD

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Background: Coronary artery disease (CAD) is often silent in diabetic patients, and it is typically in advanced stages of development by the time it manifests. Various forms of stress testing have been investigated to detect obstructive CAD in diabetes mellitus. Objectives: To assess the diagnostic value of dobutamine stress pulsed-wave Doppler tissue imaging (DTI) compared with standard wall motion analysis in detection of myocardial ischemia in diabetic patients with suspected CAD. Methods: The study comprised 46 diabetic patients with suspected CAD underwent dobutamine stress echocardiography (DSE) with DTI within 4 weeks before coronary angiography(CA). Dobutamine infusion started at 5 µ/kg/min and increased up to 40 µ/kg/min with additional atropine during submaximal heart rate responses. In addition to wall-motion score index (WMSI) analysis, pulsedwave DTI examination of basal and mid segments of posteroseptal, lateral, anterior, inferior and anteroseptal walls was performed. Myocardial velocities were measured at rest in the apical 4, 3 and 2-chamber views. The measurements were repeated at low dose (10 -15 µ/kg/min) and at peak stress (40 µ/kg/min). DTI measurements included peak systolic velocity (S), peak early diastolic velocity (E) and peak late diastolic velocity (A) and the results were compared to WMSI analysis. Patients were classified into two groups according to CA results; group (I) diabetics with positive CA (n = 27) and group (II) diabetics with negative CA (n = 19). Results: There was no significant difference between the two groups in duration of diabetes, global WMSI at rest or the ∆ changes (stress-rest/rest) of WMSI (P > 0.05). Global S and global E were significantly lower in group I compared to group II at peak stress (11.3 ± 3.7 cm/sec vs. 14.5 ± 2.2 cm/sec, p < 0.01) and (11.3 ± 1.6 cm/sec vs. 13.1 ± 2.1 cm/sec, p < 0.01) respectively. The cutoff points for global S and global E to detect obstructive CAD in diabetics were 11.3 cm/s and 11.2 cm/s respectively with 75.7%, 73.4% sensitivity and 94.7%, 89.47% specificity respectively. An increment (∆ changes) less than 0.56 in S or 0.26 in E from rest to peak stress identified CAD with 78.8 %, 89.3% sensitivity and 94.7%, 90.7% specificity respectively. The accuracy of DTI parameters during peak stress was higher than WMSI analysis (sensitivity 74.1% vs. 59.3% and specificity 90% vs. 79%, P < 0.01 for each). In multivariate regression analysis, only ∆S and ∆E were independent predictors of obstructive CAD in diabetics (odd ratio: 36.16, 95% CI, 1.34-532.01 and 63.77, 95% CI, 3.19-721.47) respectively. Conclusion: Quantitative analysis, using DTI during DSE, adds new dimension in diagnosis of myocardial ischemia. It is more sensitive, specific, accurate and reproducible compared with standard wall motion analysis for recognition of significant CAD in diabetic patients.

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Section: Changes In Myocardial Velocities and Time Intervals During Dsupporting

confidence: 92%

“…The peak velocity response for both systole and diastole has been shown to be significantly lower during dobutamine stress in malperfused myocardial regions compared to normal [37,38].…”

Section: Changes In Myocardial Velocities and Time Intervals During Dmentioning

confidence: 96%

Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease

Elnoamany

Badran

Khalil

et al. 2011

WJCD

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“…Pulsed wave tissue Doppler images were recorded on a commercially available ultrasound system (Vingmed System FiVe; GE Medical Systems, Milwaukee, WI) with a 2.5 MHz transducer. The technique of using tissue Doppler imaging has been recently described (14). In short, the Doppler sampling gate (8 mm) was consecutively placed in the basal septal, anteroseptal, anterior, lateral, posterior, and inferior wall for the assessment of longitudinal left ventricular function.…”

Section: Methodsmentioning

confidence: 99%

“…This technique has been used for the assessment of both global and regional myocardial function and is reported to be more sensitive to functional changes than traditional echocardiographic and Doppler methods (13,14).…”

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confidence: 99%

C-Peptide Exerts Beneficial Effects on Myocardial Blood Flow and Function in Patients With Type 1 Diabetes

et al. 2002

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Myocardial dysfunction, perfusion abnormalities, and the extent to which these abnormalities may be reversed by C-peptide administration was assessed in type 1 diabetic patients. Eight patients were studied before and during a 0.84-mg/kg dipyridamole administration using a randomized double-blind crossover protocol with infusion of C-peptide (6 pmol ⅐ kg -1 ⅐ min -1 ) or saline during 60 min on two different days. Myocardial function was measured as peak myocardial velocity during systole (Vs) and early diastole (Vd) by pulsed tissue Doppler imaging. Myocardial contrast echocardiography was used for assessment of myocardial blood volume (SI max ) and myocardial blood flow index (MBFI) calculated from the relation between trigger interval and signal intensity. Eight age-matched healthy volunteers served as control subjects. In the basal state, Vd (13.8 ؎ 0.6 vs. 15.6 ؎ 0.5 cm/s, P < 0.04) and SI max (6.6 ؎ 0.6 vs. 8.2 ؎ 0.6 a.u. P < 0.04) were reduced in patients compared with control subjects. Dipyridamole administration significantly increased indexes of myocardial function and blood flow to a similar extent in patients and control subjects. During C-peptide administration, Vs and Vd increased by 12% (P ‫؍‬ 0.03), SI max increased from 6.6 ؎ 0.6 to 8.1 ؎ 0.7 a.u. (P < 0.02), and MBFI increased from 3.3 ؎ 0.4 to 5.3 ؎ 0.9 (P < 0.05). The results demonstrate that type 1 diabetic patients have impaired myocardial function and perfusion in the basal state that can be improved by short-term replacement of C-peptide. Diabetes 51:3077-3082, 2002

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“…One study has demonstrated that dobutamine induced changes in peak Ew of the LV wall (≥2 cm/s) can be used to detect myocardial ischemia [77]. Moreover, a study of athletes has indicated that the Ew for the LV inferior wall is a useful marker of aerobic training [78].…”

Section: Figmentioning

confidence: 99%

The Role of Tissue Doppler Imaging as a New Diagnostic Option in Evaluating Left Ventricular Function

Oki

2003

J Echocardiogr

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In general, pump function and myocardial contractility should be assessed when evaluating left ventricular (LV) systolic function. Ejection fraction obtained from left ventriculography is routinely used as an index of pump function, and the maximum value of the first derivative of LV pressure curve (peak dP/dt) has been used as an index of myocardial contractility. On the other hand, active relaxation of the LV myocardium during early diastole and LV passive filling or compliance during mid-to late diastole are important factors in evaluating LV diastolic function. To obtain this information, the time constant of the LV pressure decay during isovolumic diastole (tau) and LV end-diastolic pressure, which are calculated from the LV pressure curve recorded during cardiac catheterization, is used. However, invasive hemodynamic measurements cannot be performed in all patients, nor are they appropriate for follow-up evaluation involving repeated examinations.Recently, routine echocardiography has facilitated the noninvasive evaluation of LV systolic and diastolic function. The percent fractional shortening of the LV based on M-mode echocardiography and the LV ejection fraction determined by two-dimensional echocardiography are indices of LV pump function, and therefore cannot accurately evaluate LV myocardial contractility. On the other hand, "diastology" has become an important clinical topic [1]. There are several reasons why assessment of diastolic function is important: 1) 30 to 40% of patients evaluated for congestive heart failure have normal LV pump function [2,3]; 2) the transmitral flow velocity pattern, which is recorded using the pulsed Doppler method, may be an index for noninvasive evaluation of LV diastolic function [4]; and 3) the prognosis is poor in patients with LV systolic dysfunction and pseudonormalization or restrictive pattern of the transmitral flow velocity [5,6]. However, it has been shown that the diastolic indices obtained from transmitral and pulmonary venous flow velocities are influenced by loading conditions, especially by the pre- The Role of Tissue Doppler Imaging as a New Diagnostic Option in Evaluating Left AbstractThe widespread use of the pulsed Doppler echocardiography has facilitated the noninvasive evaluation of hemodynamic abnormalities of the left atrium and left ventricle (LV) based on transmitral and pulmonary venous flow velocity patterns. However, it has been shown that loading conditions, especially preload, influence the indices obtained from these velocity patterns. Recently, tissue Doppler imaging (TDI) has been applied to the clinical setting to assess LV myocardial function. In particular, this procedure has the following characteristics: 1) it can provide circumferential and longitudinal information for the LV myocardium; 2) the early diastolic LV myocardial parameters determined by TDI are not influenced by preload; 3) LV myocardial contractility can be evaluated from the early systolic parameters; 4) LV systolic and diastolic asynchrony can be detected; 5) myoca...

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Regional diastolic function by pulsed doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing

Cited by 94 publications

References 31 publications

Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease

Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease

C-Peptide Exerts Beneficial Effects on Myocardial Blood Flow and Function in Patients With Type 1 Diabetes

The Role of Tissue Doppler Imaging as a New Diagnostic Option in Evaluating Left Ventricular Function

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