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[Tissue Doppler in the assessment of myocardial function in stress echocardiography]
Rodolfo Citro1, Alessandro Salustri, Paolo Trambaiolo
1Dipartimento di Cardiologia, Ospedale San Luca, Vallo della Lucania, SA. citro63@libero.it
Insights
Tissue Doppler imaging quantifies regional myocardial function, overcoming stress echocardiography
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Myocardial Function Assessment
Background:
- Stress echocardiography is valuable for coronary artery disease but subjective.
- Quantitative analysis of wall motion can overcome interpretation limitations.
- Tissue Doppler provides quantitative regional myocardial velocity data.
Purpose of the Study:
- To evaluate the role of Tissue Doppler imaging in quantitative analysis of myocardial function during stress echocardiography.
- To explore Tissue Doppler's potential in detecting stress-induced changes and assessing myocardial viability.
Main Methods:
- Utilized pulsed wave and color-coded Tissue Doppler to measure myocardial velocities.
- Analyzed spectral and color-coded displays for systolic and diastolic function.
- Investigated parameters like myocardial velocity gradient, strain, and strain rate.
Main Results:
- Tissue Doppler accurately quantifies regional myocardial systolic and diastolic velocities.
- It detects stress-induced functional changes and assesses myocardial viability.
- Myocardial velocity gradient is more sensitive than peak systolic velocity for ischemia detection.
Conclusions:
- Tissue Doppler imaging offers quantitative assessment of regional myocardial function.
- This technique has potential for improved stress echocardiography interpretation.
- Further validation may lead to its integration into clinical practice.
Abstract:
Recently, stress echocardiography has emerged as a valuable tool for the diagnosis and evaluation of coronary artery disease, but its interpretation still remains subjective, relying on image quality and reader's experience. These problems could be overcome by quantitative analysis of wall motion. Tissue Doppler provides quantitative information on regional myocardial systolic and diastolic velocities that can be displayed either in spectral mode or color coded, reflecting the peak velocity increment induced by exercise or dobutamine administration. Pulsed wave tissue Doppler allows to measure regional instantaneous myocardial velocities with high temporal resolution and has been shown valuable for detecting stress-induced changes of both myocardial systolic and diastolic function. This method may also identify myocardial viability by measuring increase in systolic peak velocity at low-dose of dobutamine in dysfunctional myocardial segments. Color coded tissue Doppler resolves mean velocities with higher spatial resolution, and post-processing analysis of digital acquired images has been shown feasible and reproducible. Myocardial velocity gradient is a more sensitive parameter compared to the simple measurement of the peak endocardial systolic velocity for evaluating myocardial ischemia during dobutamine echocardiography. From the raw data, it is also possible to measure strain and strain rate. These new parameters have the potential to differentiate between wall motion and contractility, with obvious implications when applied to stress echocardiography. In conclusion, tissue Doppler is able to quantify regional myocardial function. After a large scale validation, this technique will be incorporated with stress echocardiography in clinical practice.