Regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing: a comparison with stress echocardiography and perfusion scintigraphy.
OBJECTIVE
We evaluated regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing.


BACKGROUND
Evaluation and quantification of diastolic myocardial function remain a challenge for imaging techniques in stress tests.


METHODS
A prospective study compared the detection of coronary artery stenosis: 1) by pulsed Doppler myocardial mapping, 2) by two-dimensional echocardiographic dobutamine stress test, and 3) by perfusion scintigraphy in 64 patients using coronary angiography for reference. An age matched subgroup of 10 patients with normal angiograms and two-dimensional echocardiographic stress test served as control group. Peak myocardial contraction velocity (Vc) and lengthening rate during early diastolic left ventricular (LV) filling (VE) were measured in 12 LV segments from three apical views.


RESULTS
In controls, myocardial velocities increased during stress by > or =3.6 cm/s (p < 0.001). In LV segments depending on a stenosed artery (n = 70), VE decreased by > or =1 cm/s and, thus, was different from control segments (n = 112, p < 0.001) and from scar segments (n = 13, p < 0.01), whereas the change of Vc was similar to that in scar segments. A stress induced 2 cm/s reduction of VE discerned the best diagnostic accuracy (sensitivity 84%, specificity 93%) in comparison with two-dimensional echocardiography (78% and 71%) and perfusion scintigraphy (61% and 86%). Using receiver operating curves at incremental levels of luminal narrowing, these relations persisted.


CONCLUSIONS
Quantification of diastolic myocardial function by pulsed Doppler myocardial mapping during dobutamine stress test was shown to be a feasible, accurate, reproducible, noninvasive technique that should be considered to be a sensitive alternative to the present echocardiographic and scintigraphic imaging techniques for stress tests.
Department of Clinical Physiology, Karolinska Hospital, Stockholm, Sweden. bibra@thfys.ks.se
H
H
von Bibra
A
A
Tuchnitz
A
A
Klein
J
J
Schneider-Eicke
A
A
Schömig
M
M
Schwaiger
D002316:Cardiotonic Agents / Q000627:therapeutic use*; D017023:Coronary Angiography; D003971:Diastole / Q000502:physiology*; D004280:Dobutamine; D018619:Echocardiography, Doppler, Pulsed; D005080:Exercise Test; D005240:Feasibility Studies; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology*; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
D002316:Cardiotonic Agents; D004280:Dobutamine