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CLINICAL RESEARCH: ECHOCARDIOGRAPHY

Tissue doppler imaging predicts recovery of left ventricular function after recanalization of an occluded coronary artery

^* Cardiovascular Center, Aalst, Belgium

Manuscript received April 28, 2003; revised manuscript received July 24, 2003, accepted July 28, 2003.

^* Reprint requests and correspondence: Dr. Bernard De Bruyne, Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium.
bernard.de.bruyne{at}olvz-aalst.be

OBJECTIVES: We tested the hypothesis that the tissue Doppler imaging (TDI)-derived positive preejection velocity (+VIC) can predict the recovery of contractile function after revascularization in patients with a recent myocardial infarction.

BACKGROUND: In experimental studies, the presence and extent of TDI-derived +VIC correlated with the extent of viable myocardium.

METHODS: Forty-three patients with a large myocardial infarction and an occluded left anterior descending (n = 38) or dominant right coronary (n = 5) artery were selected. The median duration of occlusion was 24 h. Longitudinal myocardial velocities were recorded at rest by pulsed-wave TDI echocardiography 6 ± 2 h after revascularization. Functional recovery was defined as an increase in segmental chordal shortening 10% at three-month follow-up left ventricular angiogram as compared with baseline.

RESULTS: A good quality TDI signal was obtained in 309 of 324 analyzed segments (95.4%). Severe dysfunction was present in 198 segments of which 126 (64%) showed recovery at three-month follow-up. Sampling of all dysfunctional segments lasted 11 ± 4 min per patient. Sensitivity, specificity, and accuracy of the +VIC to predict segmental recovery were 91%, 71%, and 84%, respectively. The percentage of segments that were dysfunctional at angiography but showed a +VIC correlated with improvement of both global left ventricular ejection fraction (r = 0.60, p = 0.001) and wall motion score index (r = –0.78, p < 0.0001) at follow-up.

CONCLUSIONS: Assessment of +VIC by pulsed-wave TDI is a simple and accurate method that predicts recovery of contractile function after revascularization in patients with a recent myocardial infarction.

Abbreviations and Acronyms   LAD = left anterior descending coronary artery   LAO = left anterior oblique artery   LV = left ventricle/ventricular   MI = myocardial infarction   RAO = right anterior oblique artery   RCA = right coronary artery   TDI = tissue Doppler imaging   +VIC = positive preejection velocity

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