Doppler Tissue Imaging positive preejection velocity wave is a sign of non-transmural necrosis: comparison with delayed-enhancement cardiac magnetic resonance.
OBJECTIVE
Our purpose was to test the hypothesis that Tissue Doppler Imaging (TDI)-derived positive preejection velocity (PPV) is associated with transmural extent of necrosis in delayed-enhancement cardio-magnetic resonance (DE-CMR) in patients with reperfused myocardial infarction (MI).


RESULTS
Longitudinal myocardial velocities were recorded by TDI in 24 patients with MI reperfused with primary angioplasty, using an Acuson-Sequoia equipment. The same day a CMR study was performed, including cine images in short axis and long axis views and DE images in the same views using a 3D-T1-Turbo-field-echo sequence, 15 min after administration of gadodiamide. Transmural extent of hyperenhancement in each segment was compared to presence or absence of PPV wave. A total of 384 segments were evaluated. Normo-hypokinetic segments (100%) showed a PPV wave, whereas it was only present in 53% of akinetic-dyskinetic segments (p=0.0005). One hundred percent of the segments with absent-mild DE showed a PPV wave; this percentage was lower in segments with intermediate and transmural DE (63 and 10%, p=0.001). The presence of PPV wave in an akinetic segment ruled out transmural necrosis with 97% sensitivity and 90% specificity.


CONCLUSIONS
The absence of PPV is strongly associated to transmural necrosis in MI and therefore to absence of viability.
David
Esther Pérez
EP
Laboratory of Echocardiography, Department of Cardiology, Hospital Gregorio Marañón, C/Dr Esquerdo, 46. 28007 Madrid, Spain. eperezdavid@terra.es
Fernández
Miguel Angel García
MA
Casado
Patricia Mahía
PM
Anta
Ignacio Gómez
IG
Fernández
Teresa López
TL
de Diego
José Juan Gómez
JJ
Moreno
Mar
M
Lafuente
Javier
J