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Myocardial Doppler at rest for the identification of myocardial viability
Riccardo Rambaldi1, Alessandro Desideri, Riccardo Bigi
1Department of Medical Surgery and Odontology, University of Milan, San Paolo Hospital, Milan, Italy. ricram@iol.it
Insights
Resting pulsed wave-tissue Doppler imaging (PW-TDI) offers additional markers for detecting nonviable myocardium. These PW-TDI patterns can help identify patients without residual myocardial viability, improving diagnostic accuracy.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Echocardiography is used to detect nonviable myocardium.
- The study aimed to explore if resting pulsed wave-tissue Doppler imaging (PW-TDI) could provide additional markers for this assessment.
Purpose of the Study:
- To evaluate the utility of resting pulsed wave-tissue Doppler imaging (PW-TDI) in identifying myocardial viability.
- To determine if PW-TDI can offer additional markers beyond conventional echocardiography for nonviable myocardium detection.
Main Methods:
- Fifty patients with left ventricular dysfunction underwent echocardiography with PW-TDI sampling of basal segments.
- Key PW-TDI variables tested included isovolumic contraction/relaxation phase velocities, ejection phase velocity/shape, and ratios.
- Myocardial viability was assessed using PW-TDI patterns and compared against 201thallium single-photon emission computed tomography.
Main Results:
- PW-TDI identified viability in 53% of dyssynergic segments, compared to 47% with conventional echocardiography and 48% with nuclear imaging.
- Specific PW-TDI patterns indicative of absent myocardial viability were defined.
- PW-TDI showed slightly higher accuracy (75%, kappa 0.47) than conventional echocardiography (73%, kappa 0.44) in identifying myocardial viability.
Conclusions:
- Resting pulsed wave-tissue Doppler imaging (PW-TDI) demonstrates potential as an additional tool for identifying nonviable myocardium.
- PW-TDI patterns can aid in identifying patients lacking residual myocardial viability, enhancing diagnostic capabilities.
Background:
Echocardiography may permit the detection of a nonviable myocardium. The aim of this study was to test if resting pulsed wave-tissue Doppler imaging (PW-TDI) might yield additional markers.
Methods:
Fifty patients (38 males, 12 females, mean age 63 +/- 6 years) with left ventricular dysfunction (ejection fraction 35 +/- 10%) underwent echocardiography. The posterior septum, anterior septum, lateral, inferior, anterior and posterior walls were sampled on the basal segments in the apical views at PW-TDI. The following variables and cardiac phases were tested: 1) the isovolumic contraction phase velocity, polarity or detectability, 2) the ejection phase velocity, a detectable interval between the ejection phase and aortic valve closure, or ejection phase shape, and 3) the isovolumic relaxation phase velocity or ejection velocity/post-systolic shortening ratio. From the tested PW-TDI variables, viable and nonviable patterns were assembled, taking rest-redistribution 201thallium single-photon emission computed tomography as the independent reference for myocardial viability. Patients with significant loading alterations, mitral or aortic valve disease, and arrhythmias were excluded.
Results:
Out of 219 dyssynergic segments, viability as identified according to conventional rest echocardiographic criteria appeared in 94 (47%), as identified at PW-TDI in 116 (53%), and as identified at nuclear imaging in 105 (48%). The resting PW-TDI variables consistent with absent myocardial viability were as follows: 1) an isovolumic contraction phase velocity equal to the ejection phase velocity +/- 1 cm/s, or absent, 2) an ejection phase velocity < or = 4 cm/s, usually with a gap between the ejection phase and aortic valve closure, or any shape of ejection but the typical single phase, and 3) an isovolumic relaxation phase velocity < 5 cm/s with an ejection phase velocity/isovolumic relaxation phase velocity ratio < 0.8. The accuracy for the identification of myocardial viability was: agreement 73%, kappa 0.44 for echocardiography, and agreement 75%, kappa 0.47 for PW-TDI.
Conclusions:
PW-TDI nonviable patterns may be a helpful additional tool for the identification of patients without residual myocardial viability.