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CLINICAL STUDIES

Regional diastolic function by pulsed doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing

A comparison with stress echocardiography and perfusion scintigraphy

Helene von Bibra, MD^a, Anja Tuchnitz, MD^*, Annegret Klein, MD^*, Jan Schneider-Eicke, MD, Albert Schömig, MD^* and Markus Schwaiger, MD

^a Department of Clinical Physiology, Karolinska Hospital, Stockholm, Sweden
^* Medizinische Klinik, Technische Universität, Munich, Germany
Nuklearmedizinische Klinik, Technische Universität, Munich, Germany

Manuscript received January 8, 1999; revised manuscript received February 3, 2000, accepted March 30, 2000.

Reprint requests and correspondence: Dr. Helene von Bibra, Clinical Physiology, Thoracic Clinics, Karolinska Hospital, 17176 Stockholm, Sweden
bibra{at}thfys.ks.se

Objectives

We evaluated regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing.

Background

Evaluation and quantification of diastolic myocardial function remain a challenge for imaging techniques in stress tests.

METHODS

A prospective study compared the detection of coronary artery stenosis: 1) by pulsed Doppler myocardial mapping, 2) by two-dimensional echocardiographic dobutamine stress test, and 3) by perfusion scintigraphy in 64 patients using coronary angiography for reference. An age matched subgroup of 10 patients with normal angiograms and two-dimensional echocardiographic stress test served as control group. Peak myocardial contraction velocity (V_C) and lengthening rate during early diastolic left ventricular (LV) filling (V_E) were measured in 12 LV segments from three apical views.

RESULTS

In controls, myocardial velocities increased during stress by 3.6 cm/s (p < 0.001). In LV segments depending on a stenosed artery (n = 70), V_E decreased by 1 cm/s and, thus, was different from control segments (n = 112, p < 0.001) and from scar segments (n = 13, p < 0.01), whereas the change of V_C was similar to that in scar segments. A stress induced 2 cm/s reduction of V_E discerned the best diagnostic accuracy (sensitivity 84%, specificity 93%) in comparison with two-dimensional echocardiography (78% and 71%) and perfusion scintigraphy (61% and 86%). Using receiver operating curves at incremental levels of luminal narrowing, these relations persisted.

CONCLUSIONS

Quantification of diastolic myocardial function by pulsed Doppler myocardial mapping during dobutamine stress test was shown to be a feasible, accurate, reproducible, noninvasive technique that should be considered to be a sensitive alternative to the present echocardiographic and scintigraphic imaging techniques for stress tests.

Abbreviations and Acronyms   CX = circumflex coronary artery   LAD = left anterior descending coronary artery   LV = left ventricle or ventricular   PMD = pulsed Doppler myocardial mapping   RCA = right coronary artery   SPECT = perfusion scintigraphy   VA = peak velocity during atrial contraction   VC = peak contraction velocity during left ventricular ejection   VE = peak velocity during early diastolic filling   VPRE = peak velocity during preejection period

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