Is post-systolic motion the optimal ultrasound parameter to detect induced ischaemia during dobutamine stress echocardiography?

• Published in: European heart journal Vol. 25; no. 11; pp. 932 - 942
• Main Authors: Celutkiene, Jelena, Sutherland, George R, Laucevicius, Aleksandras, Zakarkaite, Diana, Rudys, Alfredas, Grabauskiene, Virginija
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-06-2004; Oxford Publishing Limited (England)
• Subjects: Biological and medical sciences; Blood Flow Velocity - physiology; Cardiology. Vascular system; Coronary Angiography; Coronary Stenosis - diagnostic imaging; Dobutamine stress echocardiography; Doppler myocardial imaging; Echocardiography, Doppler - standards; Echocardiography, Stress - standards; Female; Humans; Induced ischaemia; Male; Medical sciences; Middle Aged; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - physiopathology; Post-systolic motion; Prospective Studies; Regional myocardial function; Sensitivity and Specificity; Doppler ultrasound study; Sonography; Pharmacologic test; Motion; Cardiac performance; Echocardiography; Induced ischaemia; Cardiovascular disease; Regional; Regional myocardial function; Dobutamine stress echocardiography; Heart disease; Post-systolic motion; Myocardium; Medical imagery; Parameter; Doppler myocardial imaging; Circulatory system; Ultrasound
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1016/j.ehj.2004.04.005

Aims Doppler myocardial imaging (DMI) has been suggested as a method of quantifying induced ischaemia during dobutamine stress echocardiography (DSE). The aim of the present study was to investigate both standard systolic and diastolic parameters, but more specifically to address the phenomenon of post-systolic motion (PSM) as a marker of acquired ischaemia during DSE using pulsed-wave DMI. Methods and results We examined 60 patients without previous myocardial infarction who underwent DSE. Peak systolic, post-systolic, early and late diastolic velocities were measured at rest and during stress. Myocardial segments (\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=908\) \end{document}) were divided into ISCHAEMIC and NON-ISCHAEMIC groups according to the presence of significant angiographic coronary stenosis. ISCHAEMIC segments (\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=357\) \end{document}) compared with NON-ISCHAEMIC segments (\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=551\) \end{document}) demonstrated a reduced increase of systolic velocity (8.0–12.7 vs 9.3–16.4 cm/s, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P{<}0.05\) \end{document}), prominent PSM (5.8–8.3 vs 0.63–2.1 cm/s, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P{<}0.000001\) \end{document}) and reduced early diastolic velocity (6.5–10.2 vs 7.9–13.2 cm/s, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P{<}0.04\) \end{document}) during stress. The peak velocity of PSM was the most accurate index of induced ischaemia (sensitivity 73–100%, specificity 82–97%) compared to systolic and early diastolic velocities (sensitivity 52–77% and 63–68%, specificity 63–77% and 59–81%, respectively). Conclusion PSM derived by pulsed-wave DMI during DSE was the most sensitive index of acquired ischaemia compared to other functional DMI indices.