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Updated: Jun 26, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
[Quantitative evaluation of ischemic myocardium by adenosine tissue Doppler stress echocardiography.]
Yin-Guang Sun1, Qin-Hua Zhao, Ru-Min He
1Department of Cardiology, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Insights
Adenosine stress echocardiography using tissue Doppler imaging (TDI) reliably detects ischemic myocardium. TDI parameters accurately identify reduced myocardial motion in patients with coronary artery disease (CAD).
Area of Science:
- Cardiovascular Imaging
- Diagnostic Cardiology
- Myocardial Perfusion Imaging
Background:
- Coronary artery disease (CAD) diagnosis often relies on assessing myocardial ischemia.
- Traditional stress echocardiography can be limited in quantifying subtle myocardial dysfunction.
- Tissue Doppler imaging (TDI) offers enhanced sensitivity for evaluating myocardial motion.
Purpose of the Study:
- To evaluate the diagnostic value of adenosine-induced stress echocardiography with TDI for detecting ischemic myocardium.
- To assess the accuracy of TDI-derived parameters in identifying myocardial dysfunction in patients with suspected CAD.
Main Methods:
- Adenosine stress echocardiography was performed on 40 patients with chest pain.
- Tissue Doppler imaging (TDI) acquired myocardial velocity and strain parameters before and after adenosine infusion.
- TDI data were analyzed offline and compared with coronary angiography (CAG) findings.
Main Results:
- Adenosine significantly increased myocardial velocities and strain parameters in both ischemic and non-ischemic segments.
- Baseline and peak stress systolic and diastolic velocities were significantly lower in ischemic segments compared to non-ischemic segments.
- Reductions in peak systolic strain (Smax) and early diastolic strain rate (Se) were more pronounced in ischemic segments, with Se showing the highest area under the curve (0.740) for ischemia detection.
Conclusions:
- Parameters derived from tissue Doppler imaging provide reliable and accurate information regarding ischemic myocardium during adenosine stress echocardiography.
- TDI-enhanced stress echocardiography is a valuable tool for the non-invasive diagnosis of coronary artery disease.
Objective:
To evaluate the value of adenosine tissue Doppler stress echocardiography on ischemic myocardium.
Methods:
Routine dosage (140 microgxkg(-1)xmin(-1) IV for 6 min) adenosine stress echocardiography was performed on 40 patients with chest pain for diagnosis of coronary artery disease (CAD). The images of left ventricular myocardial motion were acquired by tissue Doppler imaging (TDI) based on traditional 2D stress echocardiography before and 3 min, 6 min after adenosine stress (GE Vivid 7, USA). The myocardial velocity, strain and strain rate in 16 segments were offline measured and analyzed on ECHOPAC software. The results were compared with that of coronary angiography (CAG).
Results:
CAG identified 18 CAD and 22 non-CAD patients with 159 ischemic segments and 465 non-ischemic segments. Adenosine significantly increased the systolic velocity (Sm), early diastolic velocity (Em), late diastolic velocity (Am), peak systolic strain (Smax), systolic strain rate (SRs), early diastolic strain rate (SRe) and late diastolic strain rate (SRa) both ischemic and non-ischemic segments (all P < 0.05). The baseline Sm and Em in ischemic segments were significant lower than non-ischemic segments [(3.16 +/- 1.20) cm/s vs (4.03 +/- 1.27) cm/s, P < 0.01; (3.75 +/- 1.67) cm/s vs (4.66 +/- 1.70) cm/s, P < 0.05]. At peak stress the differences in Sm and Em were more significant [(3.98 +/- 1.63) cm/s vs (5.07 +/- 1.52) cm/s; (4.51 +/- 2.32) cm/s vs (6.52 +/- 2.56) cm/s; P < 0.01]. The reductions on Smax and Se were more significant in ischemic segments compared those in non-ischemic segments (16.91% +/- 3.35% vs 19.56% +/- 5.47%, P < 0.01 and 9.53% +/- 2.89% vs 13.06% +/- 4.63%, P < 0.001). The biggest area under curve (AUC) in peak stress was seen in Se by ROC curve analysis (AUC = 0.740, with sensitivity 67% and specificity 83%).
Conclusion:
Parameters derived from TDI offer reliable and accurate information on ischemic myocardium during adenosine stress echocardiography.
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