Original article
Diagnosis of viable myocardium using velocity data of doppler myocardial imaging: Comparison with positron emission tomography

https://doi.org/10.1016/j.echo.2004.05.001Get rights and content

Abstract

To test whether velocity data of Doppler myocardial imaging (DMI) at rest is useful for diagnosis of myocardial viability, 25 consecutive patients (age 64 ± 10 years) with regional wall-motion abnormalities at the left anterior descending coronary artery territory and left ventricular dysfunction (ejection fraction: 31 ± 7%) underwent both DMI at rest and positron emission tomography. The peak systolic velocity (Vpeak) and postsystolic thickening (PST) velocity were measured in myocardial segments of left anterior descending coronary artery territory from apical views. A total of 71 segments were classified by positron emission tomography as normal or viable in 38 (group A) and nonviable in 33 (group B). Although Vpeak did not show any difference between groups (1.81 ± 1.77 vs 1.29 ± 0.94 cm/s, P = .107), PST velocity was significantly higher in group A (2.48 ± 1.68 vs 0.89 ± 0.72 cm/s, P < .001). The sensitivity and specificity of PST velocity > 2.0 cm/s for diagnosis of viability were 61% (23/38) and 97% (32/33), respectively. In segments with PST velocity was ≤2.0 cm/s, Vpeak > 1.8 cm/s could discriminate group A from B with a sensitivity of 67% (10/15) and a specificity of 91% (29/32). The algorithm using both PST velocity and Vpeak of DMI showed sensitivity and specificity of 87% and 88%, respectively, for diagnosis of myocardial viability. Velocity data of DMI at rest provides robust information regarding viability in selected patients, and an advantage of this technique is that no stress testing is needed.

Section snippets

Methods

A total of 25 consecutive patients (64 ± 10 years; 16 men) with LV dysfunction (ejection fraction ≤ 40%) and regional wall-motion abnormalities at the left anterior descending coronary artery (LAD) territory were included. Patients with dyskinetic movement at rest, significant arrhythmia, or left bundle branch block were excluded. Their mean ejection fraction was 31 ± 7% and wall-motion score index was 2.1 ± 0.3 (Table 1). In all, 12 patients (48%) had a history of myocardial infarction (MI)

Results

Among 75 ischemic segments of LAD territory in 25 patients, analysis of DMI velocity data was feasible in 71 segments (95%). There was a weak negative correlation between Vpeak and logarithmic value of PST velocity in ischemic segments of LAD territory (r = −0.257, P = .042) (Figure 2). Table 2 presents velocity data of DMI in ischemic segments of LAD territory according to the coronary angiographic findings. Angiographic findings, such as totally occluded LAD, the proximal stenosis, or

Discussion

In this clinical study, although confined to the LAD territory, we have confirmed that: (1) PST velocity of ischemic segments determined by DMI is a very specific marker of myocardial viability in patients with chronic ischemic heart disease and has excellent positive predictive value; and (2) both PST velocity and Vpeak of ischemic segments can be used to provide robust information regarding myocardial viability. As these velocity data can be simply obtained during a routine clinical study

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    Copyright © 2004 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.