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Published on: February 10, 2013
Pre-ejection tissue-Doppler velocity changes during low dose dobutamine stress predict segmental myocardial viability
Constadina Aggeli1, Georgios Giannopoulos, George Roussakis
11st Cardiology Department, School of Medicine, University ofAthens, Hippokration Hospital, Athens, Greece. caggeli@hol.gr
Insights
Low-dose dobutamine stress echocardiography with tissue Doppler imaging effectively predicts myocardial recovery after revascularization. Velocity changes during dobutamine infusion offer a quantitative method for assessing viable heart muscle.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Viability Assessment
Background:
- Assessing myocardial viability is crucial for guiding revascularization in coronary artery disease.
- Low-dose dobutamine stress echocardiography (LDDSE) combined with tissue Doppler imaging (TDI) was investigated for quantitative viability assessment.
Purpose of the Study:
- To evaluate the efficacy of LDDSE with TDI in quantitatively assessing myocardial viability.
- To determine if changes in ejection (Ej) and pre-ejection (pre-Ej) velocities predict functional recovery post-revascularization.
Main Methods:
- Echocardiography with LDDSE and TDI was performed on 41 patients with coronary artery disease before and after revascularization.
- Measurements included resting and stress ejection (Ej), pre-ejection (pre-Ej), and diastolic velocities (Ea, Aa).
- Myocardial recovery was defined by improved regional function 3 months post-revascularization.
Main Results:
- LDDSE with TDI demonstrated good sensitivity and specificity in predicting myocardial recovery.
- Significant increases in Ej, pre-Ej, and Ea velocities were observed during LDDSE.
- Optimal cut-off values for Ej, pre-Ej, and Ea velocities were identified using ROC curves, showing high predictive accuracy.
Conclusions:
- Measurement of ejection and pre-ejection velocities during dobutamine stimulation is an effective method for predicting myocardial recovery.
- LDDSE with TDI provides a quantitative approach to assessing myocardial viability and guiding treatment decisions.
Introduction:
We tested the hypothesis that low dose dobutamine stress echocardiography (LDDSE) combined with tissue Doppler imaging (TDI) can be used for the quantitative assessment of the content of viable myocardium.
Methods:
Forty-one patients with coronary artery disease and left ventricular dysfunction (ejection fraction < or =40%), already scheduled for revascularisation, underwent echocardiographic assessment of viability at rest and during low-dose dobutamine infusion (2.5 microg/kg/min up to 10 micro/kg/min) at two time points, 2 days before and 3 months after revascularisation. Pulsed-wave TDI was performed at rest and during LDDSE; ejection (Ej), pre-ejection (pre-Ej) and diastolic velocities (Ea, Aa) were recorded at rest and at 10 microg/kg/min dobutamine infusion. Recovery of regional function was defined as improvement of one or more grades 3 months post-revascularisation.
Results:
A total of 112 vessels were revascularised. Out of 492 segments, 274 segments were characterised as viable and the remaining 218 as non-viable, according to postoperative functional myocardial recovery. Conventional qualitative LDDSE showed a sensitivity of 78% and specificity of 85% in predicting myocardial recovery. Ej, pre-Ej and Ea velocities increased significantly during LDDSE, while Aa velocity did not change significantly. Using ROC curves, the optimal cut-off value for viability assessment was an increase of 0.5 cm/s in Ej during LDDSE (80% sensitivity and 88% specificity, area under the curve 0.801), 0.6 cm/s in pre-Ej (91% sensitivity and 90% specificity, area under the curve 0.890), and 0.44 cm/s in Ea velocity (80% sensitivity and 81% specificity, area under the curve 0.780).
Conclusions:
Despite its technical limitations, the measurement of ejection and pre-ejection velocities during dobutamine stimulation appears to be an effective way of predicting myocardial segmental recovery following reperfusion.
