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Differentiation of ischemic from nonischemic cardiomyopathy during dobutamine stress by left ventricular long-axis

Alison M Duncan1, Darrel P Francis, Derek G Gibson

  • 1Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. a.duncan@ic.ac.uk

Circulation
|August 27, 2003
PubMed

Insights

Quantified long-axis function during dobutamine stress echocardiography is more accurate than wall-motion score index for detecting coronary artery disease in dilated cardiomyopathy, especially with left bundle-branch block.

Area of Science:

  • Cardiology
  • Echocardiography
  • Medical Imaging

Background:

  • Resting wall motion abnormalities are insufficient for differentiating ischemic from non-ischemic cardiomyopathy.
  • Dobutamine stress echocardiography (DSE) with wall-motion score index (WMSI) can identify coronary artery disease (CAD) in dilated cardiomyopathy (DCM), but is subjective and challenged by left bundle-branch block (LBBB).
  • Long-axis motion is sensitive to ischemia and amenable to quantitative assessment.

Purpose of the Study:

  • To compare the efficacy of quantitative long-axis function versus WMSI in detecting CAD in DCM patients, with or without LBBB.

Main Methods:

  • Seventy-three DCM patients (48 with CAD, 25 without) were studied.
  • Long-axis M-mode, pulsed-wave tissue Doppler, and WMSI were assessed at rest and peak dobutamine stress.
  • Discriminators for CAD included failure to increase systolic amplitude by 2 mm or early diastolic velocity by 1.1 cm/s.

Main Results:

  • Quantitative long-axis function (systolic amplitude and lengthening velocity) demonstrated higher predictive accuracy for CAD than WMSI (85%/86% and 71%/94% vs. 67%/76%).
  • Changes in septal or average long-axis function showed similar predictive accuracy.
  • In patients with LBBB, systolic amplitude was the sole significant discriminator for CAD, achieving 94% sensitivity and 100% specificity.

Conclusions:

  • Quantified stress long-axis function offers superior sensitivity and specificity for identifying CAD in DCM compared to standard WMSI.
  • This quantitative approach is particularly valuable in the presence of LBBB, where WMSI is less reliable.
Abstract

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