Myocardial time intervals preceding left ventricular filling in chronic coronary artery disease: value of a decreased septal ejection time.
The aim was to assess the capabilities of a two-segment myocardial recording to recognize patients with an underlying chronic ischemic process as a fast screening from controls, prior to the usual segment-to-segment tissue Doppler echocardiographic assessment of ischemia. Ischemia generates systolic and relaxation abnormalities. A flow Doppler index of global systolic and diastolic myocardial performance was recently drawn from time durations studied by coupling isovolumic relaxation (IR) to preejection (PEP)/ejection (ET) ratio (PEP/ET). We derived a similar tissue Doppler approach to the period preceding the left ventricular filling: PEP', the ejectional inward wall motion representing ET' and the prefilling (PreFg) period ranging from the end of ET' to the onset of the outward wall motion approximating IR, were measured and ratios calculated between variables. Spectral tissue Doppler was applied to septal and posterior walls of 28 patients with proven chronic coronary artery disease and preserved left ventricular function and of 12 age-matched controls. Data were compared with global flow data. Global information did not differentiate both groups, save for IR (sensitivity 32%, specificity 57%). In patients, tissue Doppler mean values of single variables (P=0.004-0.0006) and ratios (P=0.03-0.002) significantly differed from controls. Moreover, septal ET' differentiated 13 patients with one-vessel (219+/-34 ms) from 10 with two-vessel disease (158+/-70 ms, P=0.01). Sensitivity and specificity of a septal ET'<190 ms for a two-vessel disease were 80%. The two-segment tissue Doppler echocardiographic study provided a rapid screening of patients versus controls and helped to predict the number of diseased vessels.
Department of Cardiology, University Hospital Bicêtre, Paris-Sud Medical School, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France.
Denis
D
Pellerin
Fabrice
F
Larrazet
Laurent
L
Cohen
Serge
S
Witchitz
Colette
C
Veyrat
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D005260:Female; D006346:Heart Septum / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left