Traditional and color M-mode parameters of left ventricular diastolic function during low-dose dobutamine stress echocardiography: relations to contractility reserve.
BACKGROUND
Cross-sectional studies reported that left ventricular (LV) systolic and diastolic functions are correlated. However, whether changes in wall-motion score index (WMSI) or 2-dimensional ejection fraction (EF) predict changes of Doppler parameters of LV diastolic function is unclear.


METHODS
Patients with known or suspected history of coronary artery disease underwent assessment of LV systolic function (WMSI, EF) and diastolic function at baseline and during stress echocardiography by low-dose dobutamine (LDD) (peak infusion 10 microg/kg/min). Peak velocities of early (E) and late (A) LV filling waves and E wave deceleration time were measured according to standard protocol. E wave propagation rate (EVp) was assessed by color Doppler M-mode across the mitral valve. Tei index was calculated as: (A wave to E wave time - ejection time)/ejection time. Changes at LDD were calculated as: 100 x (value at LDD - value at baseline)/baseline.


RESULTS
The study group comprised 66 patients, mean age 61 +/- 10 years, 80% men. Worse LV systolic function was associated with more severely impaired LV diastolic function both at baseline and at LDD. However, percent change of WMSI and change in EF did not correlate with percent change of EVp and E/E wave propagation rate, but with percent change of Tei index. At LDD, patients with myocardial viability did not show greater percent change of LV diastolic function parameters but significantly lower Tei index.


CONCLUSIONS
In patients with suspected or known coronary artery disease, assessment of diastolic function reserve by LDD stress echocardiography using traditional and color M-mode Doppler may add quantitative information on myocardial function beyond traditional assessment of contractility reserve by WMSI or EF.
Palmieri
Vittorio
V
Department of Clinical and Experimental Medicine, Federico II University School of Medicine, Naples, Italy.
Innocenti
Francesca
F
Agresti
Chiara
C
Caldi
Francesca
F
Masotti
Giulio
G
Pini
Riccardo
R
D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000008:administration & dosage; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
D002316:Cardiotonic Agents; D004280:Dobutamine