Tissue doppler imaging predicts recovery of left ventricular function after recanalization of an occluded coronary artery
Martin Penicka, MD*,
Jozef Bartunek, MD, PhD*,
William Wijns, MD, PhD*,
Ilse De Wolf, RN*,
Guy R. Heyndrickx, MD, PhD*,
Herbert De Raedt, MD*,
Emanuele Barbato, MD* and
Bernard De Bruyne, MD, PhD*,*
* Cardiovascular Center, Aalst, Belgium
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Figure 1 Normal myocardial velocity pattern during the preejection period (i.e., before the opening of the aortic valve). +VIC = positive preejection velocity; –VIC = negative preejection velocity.
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Figure 2 Correspondence between the myocardial segments analyzed on the biplane left ventricular angiogram (analysis of myocardial wall motion, left panels) and the two apical echocardiographic views (analysis of tissue Doppler imaging-derived preejection velocities, right panels): myocardial segments 1, 2, 3, 6, and 7 were analyzed on the right anterior oblique (RAO) projection and in the apical two-chamber view, respectively. Myocardial segments 4, 5, and 8 were analyzed in the left anterior oblique (LAO) projection plus 20° cranial inclination and the apical long-axis view, respectively. Myocardial segments 1, 2, 3, 4, and 5 were considered to belong to the perfusion territory of the left anterior descending coronary artery; myocardial segments 6, 7, and 8 were considered to belong to the perfusion territory of the dominant right coronary artery (15,16).
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Figure 3 Representative tissue Doppler imaging (TDI) tracing from akinetic anterior segments in two patients with large anterior infarction, one with marked recovery of segmental shortening at follow-up (P1) and one without significant improvement (P2). In P1, presence of the positive preejection velocity (+VIC) (arrow) in reperfused anterior segments was predictive of a recovery of contractile function at follow-up. In P2, absence of +VIC indicated nonrecovery despite revascularization. A large negative wave can be seen suggesting paradoxical outward bulging of this segment during preejection and early ejection.
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Figure 4 Relationship between the percentage of dysfunctional segments with preserved positive preejection velocity (+VIC) at tissue Doppler imaging in patients with an occlusion of the left anterior descending coronary artery and the change of left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) between baseline and three-month follow-up left ventricular angiograms. Mean LVEF was 47 ± 14% at baseline and 59 ± 12% at follow-up. Corresponding WMSI values were 1.99 ± 0.33 and 1.48 ± 0.36, respectively.
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