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Traditional and color M-mode parameters of left ventricular diastolic function during low-dose dobutamine stress
Vittorio Palmieri1, Francesca Innocenti, Chiara Agresti
1Department of Clinical and Experimental Medicine, Federico II University School of Medicine, Naples, Italy.
Insights
Changes in left ventricular (LV) systolic function, assessed by wall-motion score index (WMSI) and ejection fraction (EF), do not predict diastolic function changes. However, the Tei index may offer insights into diastolic function reserve during dobutamine stress echocardiography.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Cross-sectional studies suggest a correlation between left ventricular (LV) systolic and diastolic functions.
- The predictive value of changes in LV systolic function parameters for LV diastolic function parameters remains unclear.
Purpose of the Study:
- To investigate whether changes in wall-motion score index (WMSI) or ejection fraction (EF) predict changes in Doppler parameters of LV diastolic function.
- To assess diastolic function reserve using low-dose dobutamine (LDD) stress echocardiography.
Main Methods:
- 66 patients with suspected or known coronary artery disease underwent baseline and LDD stress echocardiography.
- LV systolic function (WMSI, EF) and diastolic function (E/A wave velocities, E wave deceleration time, E wave propagation rate [EVp], Tei index) were assessed.
- Changes were calculated as 100 x (LDD value - baseline value)/baseline value.
Main Results:
- Worse LV systolic function correlated with more impaired LV diastolic function.
- Percent change in WMSI and EF did not correlate with percent change in EVp.
- Percent change in WMSI and EF correlated with percent change in Tei index, indicating its potential as a diastolic function reserve marker.
Conclusions:
- LDD stress echocardiography with Doppler parameters provides quantitative information on myocardial function.
- Diastolic function reserve assessment may offer insights beyond traditional contractility reserve evaluation by WMSI or EF in patients with coronary artery disease.
Background:
Cross-sectional studies reported that left ventricular (LV) systolic and diastolic functions are correlated. However, whether changes in wall-motion score index (WMSI) or 2-dimensional ejection fraction (EF) predict changes of Doppler parameters of LV diastolic function is unclear.
Methods:
Patients with known or suspected history of coronary artery disease underwent assessment of LV systolic function (WMSI, EF) and diastolic function at baseline and during stress echocardiography by low-dose dobutamine (LDD) (peak infusion 10 microg/kg/min). Peak velocities of early (E) and late (A) LV filling waves and E wave deceleration time were measured according to standard protocol. E wave propagation rate (EVp) was assessed by color Doppler M-mode across the mitral valve. Tei index was calculated as: (A wave to E wave time - ejection time)/ejection time. Changes at LDD were calculated as: 100 x (value at LDD - value at baseline)/baseline.
Results:
The study group comprised 66 patients, mean age 61 +/- 10 years, 80% men. Worse LV systolic function was associated with more severely impaired LV diastolic function both at baseline and at LDD. However, percent change of WMSI and change in EF did not correlate with percent change of EVp and E/E wave propagation rate, but with percent change of Tei index. At LDD, patients with myocardial viability did not show greater percent change of LV diastolic function parameters but significantly lower Tei index.
Conclusions:
In patients with suspected or known coronary artery disease, assessment of diastolic function reserve by LDD stress echocardiography using traditional and color M-mode Doppler may add quantitative information on myocardial function beyond traditional assessment of contractility reserve by WMSI or EF.
