Regional response of myocardial acceleration during isovolumic contraction during dobutamine stress echocardiography: a color tissue Doppler study and comparison with angiocardiographic findings.
BACKGROUND
Color tissue Doppler imaging permits noninvasive quantitation of regional wall motion. In experimental studies, a new marker, the slope of the isovolumic contraction wave, isovolumic acceleration (IVA) was more insensitive to ventricular loading conditions than myocardial velocities. This study compared the regional response IVA to dobutamine stress echocardiography to angiographic findings.


METHODS
The Myocardial Doppler in Stress Echocardiography (MYDISE) study prospectively recruited 149 consecutive patients with chest pain for dobutamine stress tissue Doppler echocardiography prior to coronary angiography. This color tissue Doppler database was analyzed for IVA in 1,192 basal and mid segments at rest and again at peak stress. Angiographic findings were compared to IVA and peak systolic velocities (PSV) in corresponding cardiac segments. The diagnostic accuracy of IVA to predict coronary artery stenosis was determined using cut-off values for three representative segments and with the MYDISE diagnostic model including eight segments.


RESULTS
Regional IVA increased in a dose-dependent manner during dobutamine infusion. The response was blunted in the supply territory of stenosed coronary artery branches. IVA performed slightly better than PSV as single marker for coronary artery stenosis. A diagnostic model incorporating IVA and PSV was 85-95% accurate (area under receiver operating characterstic curves).


CONCLUSIONS
Regional changes of isovolumic acceleration during dobutamine stress echocardiography reflect regional wall motion and can be used to predict coronary artery stenosis with similar accuracy as a model based on systolic myocardial velocities. As a single marker, IVA performed better than myocardial velocities.
Pauliks
Linda B
LB
Tufts-New England Medical Center, 750 Washington Street, Boston, Massachusetts 02115, USA. lpauliks@tufts-nemc.org
Vogel
Michael
M
Mädler
Christoph F
CF
Williams
R Ian
RI
Payne
Nicola
N
Redington
Andrew N
AN
Fraser
Alan G
AG
D000054:Acceleration; D000790:Angiocardiography / Q000379:methods; D001783:Blood Flow Velocity / Q000502:physiology; D002637:Chest Pain / Q000209:etiology; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000175:diagnosis; D004280:Dobutamine; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D004280:Dobutamine