title: Pre-ejection mitral annular motion velocity responses to dobutamine infusion: A quantitative approach for assessment of myocardial viability.
abstract: BACKGROUND
  Dobutamine stress echocardiography (DSE) is widely used for detection of myocardial viability. The main limitation of DSE is its subjective interpretation. Assessment of mitral annular motion velocities with tissue Doppler imaging is a simple and quantitative measurement.
  
  
  OBJECTIVE
  To determine the relationship between myocardial viability and regional systolic mitral annular motion tissue Doppler velocities responses to dobutamine stress.
  
  
  METHODS
  Our study group included 42 patients with previous myocardial infarction referred for coronary angiography and revascularization. We did dobutamine stress tissue Doppler echocardiography (DSTDE) measuring velocities of pre-ejection wave (pre-Ej) and peak ejection wave (Ej) at rest and during low-dose dobutamine infusion. We did follow up echocardiography after 1 month.
  
  
  RESULTS
  After exclusion of the normokinetic walls, we analyzed 196 walls. Using receiver operator characteristic ROC curves, the optimal cut-off value for viability assessment was an increase of 1.75 cm/s in pre-ejection velocity during DSTDE (area under the curve 0.70, p < 0.001). On the other hand, the optimal cut-off value for viability assessment was an increase of 1.75 cm/s in ejection velocity during DSTDE (area under the curve 0.613, p = 0.01). The sensitivity, specificity, and total accuracy of the DSTSE (pre-Ej) versus the gold standard for detection of myocardial viability were 66.15%, 67.94%, and 67.35%, respectively. The sensitivity, specificity, and total accuracy of the DTSE (Ej) were 56.92%, 64.12%, and 61.43%, respectively. There was a good correlation between the pre-Ej at 5 ug/kg/min dobutamine infusion and the pre-Ej after revascularization (r = 0.64, p = 0.01) while the correlation with the Ej was moderate (r = 0.50, p = 0.01).
  
  
  CONCLUSIONS
  Viable left ventricular myocardium could be identified easily and quantitatively with pre-ejection mitral annular velocity during dobutamine infusion. The pre-ejection wave during DSTDE showed greater sensitivity and specificity for the prediction of myocardial viability than the ejection wave.
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Medicine, Ain Shams University, Cairo.
authors.forename: Khaled
authors.initials: K
authors.lastname: Darahim
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Medicine, Ain Shams University, Cairo.
authors.forename: Ihab
authors.initials: I
authors.lastname: Attia
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Medicine, Ain Shams University, Cairo.
authors.forename: Nabil
authors.initials: N
authors.lastname: Farag
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Medicine, Ain Shams University, Cairo.
authors.forename: Walid
authors.initials: W
authors.lastname: El-Hammady
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Medicine, Ain Shams University, Cairo.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Onsy
keywords: Dobutamine stress echocardiography; Myocardial viability; Tissue Doppler imaging