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Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, Sawada SG. Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:1-41.e8. [DOI: 10.1016/j.echo.2019.07.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mostafa SA, Sanad Arafa O, Abo-El-Einin HM, Amaar SM, Khaled SM. Value of dobutamine stress tissue Doppler in evaluation of LV functional improvement after elective PCI. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wierzbowska-Drabik K, Plewka M, Kasprzak JD. Variability of longitudinal strain in left ventricular segments supplied by non-stenosed coronary artery: insights from speckle tracking analysis of dobutamine stress echocardiograms in patients with high coronary risk profile. Arch Med Sci 2017; 13:82-92. [PMID: 28144259 PMCID: PMC5206362 DOI: 10.5114/aoms.2016.60603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/14/2015] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Although global deformation parameters have been increasingly used for myocardial function analysis, there are sparse data concerning segmental deformation of the left ventricle (LV). Moreover, some studies suggest heterogeneity of strain among LV segments, which may be especially significant during stress echocardiography. We assessed quantitatively regional LV function in the setting of dobutamine stress echocardiography (DSE), to examine differences of longitudinal strain between basal, mid and apical LV segments and to compare variability of regional deformation between rest and the peak stage of DSE. MATERIAL AND METHODS Among 250 patients examined by DSE applied for diagnosis of ischemia, a subset of 111 patients without significant coronary stenoses in angiography was selected (68 females, mean age: 60 ±10 years). Systolic longitudinal strain (SLS) in individual LV segments at baseline and the peak stage of DSE was analyzed with speckle tracking echocardiography. RESULTS Inhomogeneity of SLS among the LV segments (p < 0.001) was observed at baseline and the peak stage. Dispersion indices were higher at the peak stage of DSE than at baseline (p < 0.001), and the lowest heterogeneity was observed among mid segments. The analysis of changes in SLS during DSE showed SLS reduction in basal and mid-ventricular segments and an increase in apical segments. CONCLUSIONS Significant heterogeneity of strain and the opposite direction of the longitudinal strain changes during DSE between apical and basal LV segments were observed. This variability among non-ischemic LV segments ought to be considered in quantification of LV function during DSE.
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Affiliation(s)
| | - Michał Plewka
- Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Jarosław D Kasprzak
- Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland
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Combination of single quantitative parameters into multiparametric model for ischemia detection is not superior to visual assessment during dobutamine stress echocardiography. Cardiovasc Ultrasound 2016; 14:13. [PMID: 27066783 PMCID: PMC4828852 DOI: 10.1186/s12947-016-0055-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/02/2016] [Indexed: 01/21/2023] Open
Abstract
Background To evaluate if the combination of several quantitative parameters into a mathematical model would enhance the detection of myocardial ischemia during dobutamine stress echocardiography (DSE) when compared to conventional wall motion analysis. Methods In a prospective study design 151 patients (age 61.8 ± 9.2) in test group and 105 patients (age 64.0 ± 10.6) in validation group were selected and underwent DSE between January 2008 and December 2012. In all patients coronary angiography was performed within 6-8 weeks from DSE, considering at least one stenosis ≥50 % per patient as significant coronary artery disease (CAD). Results of DSE visual assessment and myocardial velocity, strain and strain rate parameters derived from speckle tracking imaging were imported automatically to an originally created software. A mathematical model calculating prognosis of at least one stenosis per patient and stenosis in separate arteries was constructed. Results Myocardial ischemia was visually detected in 60 (39.7 %) and in 58 (54.2 %) patients of the test and validation group, respectively. A total of 76 (50.3 %) patients in the test group and 69 patients (65.7 %) in the validation group had ≥50 % coronary stenosis. Sensitivity and specificity of the mathematical model per patient in the test group were 91.6 % and 86.3 % compared to 76.8 % and 89.0 % of the visual assessment, respectively. However, in the validation group the sensitivity, specificity, positive predictive value and negative predictive value dropped down significantly becoming lower to visual assessment. Conclusions Myocardial deformation imaging may potentially replace visual assessment with an automated predictive model for stress-induced ischemia detection. However, a multiparametric mathematical model based on quantitative deformation markers did not demonstrate incremental value to visual assessment of wall motion.
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Kadappu KK, Thomas L. Tissue Doppler Imaging in Echocardiography: Value and Limitations. Heart Lung Circ 2015; 24:224-33. [DOI: 10.1016/j.hlc.2014.10.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
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Biventricular function and glycemic load in type 1 diabetic children: Doppler tissue-imaging study. Pediatr Cardiol 2015; 36:423-31. [PMID: 25304244 DOI: 10.1007/s00246-014-1030-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
To assess right- and left-ventricular function in children with type 1 diabetes mellitus (DM) as well as correlate cardiac function with diabetes duration and state of metabolic control. The present study included 30 patients with type 1 DM (group 1) and 20 apparently normal children with comparable age and sex as controls (group 2). All children were subjected to detailed history, clinical examination, and routine laboratory investigations, including glycated hemoglobin, as well as conventional echocardiographic and tissue Doppler examination. Children with type 1 DM have impaired diastolic function in both left and right ventricles before the development of systolic dysfunction when assessed with either conventional or tissue Doppler echocardiography. Resting heart rate in diabetic patients showed a significant positive correlation with mitral A flow velocity and a significant negative correlation with mitral and tricuspid E/A ratio. Regarding morphological parameters of the left ventricle, all dimensions and volumes were comparable between diabetic patients and controls; however, a significant positive correlation was found between interventricular septal thickness at diastole (IVSd), interventricular septal thickness at systole (IVSs), and left ventricular posterior wall at systole (LVPWs) and the duration of diabetes. Children with type 1 DM have impaired diastolic function in both left and right ventricles with normal systolic function when assessed with either conventional or tissue Doppler echocardiography.
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Darahim K, Attia I, Farag N, El-Hammady W, Onsy A. Pre-ejection mitral annular motion velocity responses to dobutamine infusion: A quantitative approach for assessment of myocardial viability. J Saudi Heart Assoc 2014; 26:15-22. [DOI: 10.1016/j.jsha.2013.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 07/29/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022] Open
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Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Celutkiene J, Zakarkaite D, Skorniakov V, Zvironaite V, Grabauskiene V, Burca J, Ciparyte L, Laucevicius A. Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography. Cardiovasc Ultrasound 2012; 10:31. [PMID: 22846395 PMCID: PMC3495225 DOI: 10.1186/1476-7120-10-31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/21/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE). METHODS Prospective analysis included data of 151 patients (age 61.8 ± 9.2) who underwent dobutamine stress echocardiography for known (n = 35) or suspected coronary artery disease (CAD) (n = 36) or symptomatic chest pain (n = 80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ≥70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis. RESULTS The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52. CONCLUSIONS Multiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD.
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Affiliation(s)
- Jelena Celutkiene
- Centre of Innovative Medicine, Zygimantu 9, LT-01102, Vilnius, Lithuania
| | - Diana Zakarkaite
- Clinic of Cardiovascular diseases, Vilnius University Medical Faculty, Santariskiu 2, LT-08661, Vilnius, Lithuania
| | - Viktor Skorniakov
- Faculty of Mathematics and Informatics, Vilnius University, Naugarduko 24, LT-03225, Vilnius, Lithuania
| | - Vida Zvironaite
- Centre of Innovative Medicine, Zygimantu 9, LT-01102, Vilnius, Lithuania
- Clinic of Cardiovascular diseases, Vilnius University Medical Faculty, Santariskiu 2, LT-08661, Vilnius, Lithuania
| | - Virginija Grabauskiene
- Clinic of Cardiovascular diseases, Vilnius University Medical Faculty, Santariskiu 2, LT-08661, Vilnius, Lithuania
| | - Jelizaveta Burca
- Centre of Innovative Medicine, Zygimantu 9, LT-01102, Vilnius, Lithuania
| | - Laura Ciparyte
- Centre of Innovative Medicine, Zygimantu 9, LT-01102, Vilnius, Lithuania
| | - Aleksandras Laucevicius
- Centre of Innovative Medicine, Zygimantu 9, LT-01102, Vilnius, Lithuania
- Clinic of Cardiovascular diseases, Vilnius University Medical Faculty, Santariskiu 2, LT-08661, Vilnius, Lithuania
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Elsherbiny IA. The significance of E/E′ to detect coronary artery disease during dobutamine stress echocardiography. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2011.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yang Y, Li RJ, Li ZA, Song L, Wang Z. Regional Atrial Myocardial Velocity in Normal Fetuses: Evaluation by Quantitative Tissue Velocity Imaging. Echocardiography 2011; 29:182-6. [DOI: 10.1111/j.1540-8175.2011.01562.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bhavsar R, Sloth E, Folkersen L, Greisen JR, Jakobsen CJ. Sufentanil preserves hemodynamics and left ventricular function in patients with ischemic heart disease. Acta Anaesthesiol Scand 2011; 55:1002-9. [PMID: 21770902 DOI: 10.1111/j.1399-6576.2011.02479.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Sufentanil has been reported to provide stable hemodynamics similar to other opioids. However, it has not been reliably established whether this stability can be attributed only to Sufentanil and translates into fully preserved left ventricular (LV) function. The purpose of this study was to evaluate the effect of Sufentanil on hemodynamics and LV systolic and diastolic function using invasive monitoring and echocardiography in patients with ischemic heart disease. METHODS Prospective observational study of thirty patients acting as their own control undergoing echocardiographic imaging before and after bolus Sufentanil 1.5-2.0 μg/kg. Full invasive hemodynamic monitoring was established before Sufentanil administration. Global LV systolic function was evaluated with a global longitudinal peak systolic strain (GLPSS) by speckle tracking ultrasound; systolic displacement by tissue tracking (TT) and diastolic function was evaluated using Doppler tissue imaging and pulse wave Doppler. RESULTS Hemodynamic monitoring showed a minor decline in systolic blood pressure from 159 to 154 mmHg (P=0.046). No changes were observed in the cardiac index, stroke volume index and heart rate. An unchanged TT score index (9.9 vs. 10.2 mm, P=0.428) and GLPSS (14.3 vs. 14.5%, P=0.658) indicated preserved LV global systolic function and unchanged E'/A' (0.95 vs. 0.89, P=0.110) and E/E' ratio (15.4 vs. 14.9, P=0.612) indicated unchanged diastolic function. CONCLUSION Sufentanil preserves hemodynamic parameters as well as echocardiographic indices of LV systolic and diastolic function in patients with ischemic heart disease (IHD).
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Affiliation(s)
- R Bhavsar
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Denmark
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MacLaren G, Kluger R, Connelly KA, Royse CF. Comparative Feasibility of Myocardial Velocity and Strain Measurements Using 2 Different Methods With Transesophageal Echocardiography During Cardiac Surgery. J Cardiothorac Vasc Anesth 2011; 25:216-20. [DOI: 10.1053/j.jvca.2010.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Indexed: 11/11/2022]
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Normal Parameters of Right Ventricular Mechanics With Exertion in Healthy Individuals: A Tissue Doppler Imaging Study. Am J Med Sci 2011; 341:23-7. [DOI: 10.1097/maj.0b013e3181f1fde3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jakobsen CJ, Torp P, Vester AE, Folkersen L, Thougaard A, Sloth E. Ketamine reduce left ventricular systolic and diastolic function in patients with ischaemic heart disease. Acta Anaesthesiol Scand 2010; 54:1137-44. [PMID: 20712843 DOI: 10.1111/j.1399-6576.2010.02283.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Ketamine may be followed by a general increase in haemodynamics and oxygen consumption, which may be of concern in patients with ischaemic heart disease. The purpose of this study was to evaluate the effect of ketamine on left ventricular (LV) systolic and diastolic function by different modalities of echocardiography and tissue Doppler imaging in patients with ischaemic heart disease. METHODS AND RESULTS Prospective observational study of 11 patients acting as own control based on echocardiographic imaging before and after bolus ketamine 0.5 mg/kg. Simpson's 2 D-volumetric method was used to quantify left ventricular volume and ejection fraction. General global LV deformation was assessed by Speckle tracking ultrasound, systolic LV longitudinal displacement was assessed by Tissue Tracking score index and the diastolic function was evaluated from changes in early-(E') and atrial (A') peak velocities during diastole. Average heart rate (34%) and blood pressure (35%) increased significantly after ketamine (P<0.0001). Mean tissue tracking score index decreased from 11.2 ± 2.3 to 8.3 ± 2.6 (P=0.005) and Global Speckle tracking 2D strain from 17.7 ± 2.7 to 13.7 ± 3.6 (P=0.0014) indicating a decrease in LV global systolic function. The E'/A' ratio decreased from 1.11 ± 0.43 to 0.81 ± 0.46 (P=0.044) indicating impaired relaxation. CONCLUSION Different modalities of echocardiography in combination with tissue Doppler indicate both diminished systolic and diastolic function after ketamine administration in patients with ischaemic heart disease.
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Affiliation(s)
- C-J Jakobsen
- Department of Anaesthesia & Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
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Peteiro J, Bouzas-Mosquera A. Exercise echocardiography. World J Cardiol 2010; 2:223-32. [PMID: 21160588 PMCID: PMC2998822 DOI: 10.4330/wjc.v2.i8.223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 08/01/2010] [Accepted: 08/08/2010] [Indexed: 02/06/2023] Open
Abstract
Exercise echocardiography has been used for 30 years. It is now considered a consolidated technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). Of the stress echocardiography techniques, it represents the first choice for patients who are able to exercise. Given that the cost-effectiveness and safety of stress echocardiography are higher than those of other imaging techniques, its use is likely to be expanded further. Recent research has also proposed this technique for the evaluation of cardiac pathology beyond CAD. Although the role of new technology is promising, the assessment of cardiac function relies on good quality black and white harmonic images.
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Affiliation(s)
- Jesus Peteiro
- Jesus Peteiro, Alberto Bouzas-Mosquera, Laboratory of Echocardiography, Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, 15011-A Coruña, Spain
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ZNAChENIE STRESS-EKhOKARDIOGRAFII S DOBUTAMINOM V DOOPERATsIONNOY OTsENKE RISKA KARDIAL'NYKh OSLOZhNENIY U BOL'NYKh S ATEROSKLEROZOM AORTY I MAGISTRAL'NYKh ARTERIY. КЛИНИЧЕСКАЯ ПРАКТИКА 2010. [DOI: 10.17816/clinpract1252-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Assessment of right ventricle function during exercise echocardiography by using tissue Doppler imaging in patients with coronary artery disease. Coron Artery Dis 2009; 20:525-30. [DOI: 10.1097/mca.0b013e328330d52c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee YS, Kim KS. Relationship between post-systolic motion during dobutamine stress echocardiography and functional recovery of myocardium after successful percutaneous coronary intervention. Korean Circ J 2009; 39:477-81. [PMID: 19997543 PMCID: PMC2790124 DOI: 10.4070/kcj.2009.39.11.477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 05/11/2009] [Accepted: 06/03/2009] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Doppler myocardial imaging (DMI) has been suggested as a method of quantifying inducible ischemia during dobutamine stress echocardiography (DSE). Post-systolic motion (PSM) detected by DMI is related to peri-infarct ischemia during DSE. We hypothesized that PSM during DSE would predict recovery of dysfunctional myocardium after successful percutaneous coronary intervention (PCI). SUBJECTS AND METHODS Thirty patients with dysfunctional myocardium in the left anterior descending coronary artery (LAD) territory were divided into two groups according to improvement of wall motion score index (WMSI) in the LAD territory at 6 months after successful PCI of the LAD. DMI was evaluated in the LAD territory during DSE. Fifteen patients showed improved WMSI (1.42+/-0.39) while the other 15 had unchanged WMSI (1.75+/-0.46) 1 month after PCI. Myocardial velocity was measured in the mid-septal, apico-septal, and basal anterior segments of the LAD artery territory. PSM was defined as a positive wave appearing after the curve of systolic ejection had reached the zero line. RESULTS Although there was no difference between resting PSMs in both groups, PSM during DSE was significantly higher in the improved WMSI group than in the WMSI group where it was unchanged. CONCLUSION PSM during DSE predicts recovery of dysfunctional myocardium after successful PCI.
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Affiliation(s)
- Young-Soo Lee
- Division of Cardiology, College of Medicine, Catholic University of Daegu, Daegu, Korea
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Sadigh B, Quintana M, Sylvén C, Berglund M, Brodin LA. The ischemic preconditioning effect of adenosine in patients with ischemic heart disease. Cardiovasc Ultrasound 2009; 7:52. [PMID: 19891770 PMCID: PMC2779183 DOI: 10.1186/1476-7120-7-52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 11/05/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In vivo and in vitro evidence suggests that adenosine and its agonists play key roles in the process of ischemic preconditioning. The effects of low-dose adenosine infusion on ischemic preconditioning have not been thoroughly studied in humans. AIMS We hypothesised that a low-dose adenosine infusion could reduce the ischemic burden evoked by physical exercise and improve the regional left ventricular (LV) systolic function. MATERIALS AND METHODS We studied nine severely symptomatic male patients with severe coronary artery disease. Myocardial ischemia was induced by exercise on two separate occasions and quantified by Tissue Doppler Echocardiography. Prior to the exercise test, intravenous low-dose adenosine or placebo was infused over ten minutes according to a randomized, double blind, cross-over protocol. The LV walls were defined as ischemic if a reduction, no increment, or an increment of < 15% in peak systolic velocity (PSV) was observed during maximal exercise compared to the baseline values observed prior to placebo-infusion. Otherwise, the LV walls were defined as non-ischemic. RESULTS PSV increased from baseline to maximal exercise in non-ischemic walls both during placebo (P = 0.0001) and low-dose adenosine infusion (P = 0.0009). However, in the ischemic walls, PSV increased only during low-dose adenosine infusion (P = 0.001), while no changes in PSV occurred during placebo infusion (P = NS). CONCLUSION Low-dose adenosine infusion reduced the ischemic burden and improved LV regional systolic function in the ischemic walls of patients with exercise-induced myocardial ischemia, confirming that adenosine is a potential preconditioning agent in humans.
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Affiliation(s)
- Bita Sadigh
- The Karolinska Institute, Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Shan Y, Villarraga HR, Pislaru C, Shah AA, Cha SS, Pellikka PA. Quantitative Assessment of Strain and Strain Rate by Velocity Vector Imaging During Dobutamine Stress Echocardiography to Predict Outcome in Patients With Left Bundle Branch Block. J Am Soc Echocardiogr 2009; 22:1212-9. [DOI: 10.1016/j.echo.2009.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Indexed: 10/20/2022]
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Hovland A, Bjørnstad H, Prytz J, Støylen A, Vik-Mo H. Feasibility of Using Tissue Doppler Velocities in Stress Echo during Upright Bicycle Exercise. Echocardiography 2009; 26:1041-9. [DOI: 10.1111/j.1540-8175.2009.00923.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Geleijnse ML, Krenning BJ, van Dalen BM, Nemes A, Soliman OII, Bosch JG, Galema TW, ten Cate FJ, Boersma E. Factors affecting sensitivity and specificity of diagnostic testing: dobutamine stress echocardiography. J Am Soc Echocardiogr 2009; 22:1199-208. [PMID: 19766453 DOI: 10.1016/j.echo.2009.07.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical characteristics of patients, angiographic referral bias, and several technical factors may all affect the reported diagnostic accuracy of tests. The aim of this study was to assess their influence on the diagnostic accuracy of dobutamine stress echocardiography (DSE). METHODS The medical literature from 1991 to 2006 was searched for diagnostic studies using DSE and meta-analysis was applied to the 62 studies thus retrieved, including 6881 patients. These studies were analyzed for patient characteristics, angiographic referral bias, and several technical factors. RESULTS The sensitivity of DSE was significantly related to the inclusion of patients with prior myocardial infarctions (0.834 vs 0.740, P < .01) and defining the results of DSE as already positive in case of resting wall motion abnormalities rather than obligatory myocardial ischemia (0.786 vs 0.864, P < .01). Specificity tended to be lower when patients with resting wall motion abnormalities were included in a study (0.812 vs 0.877, P < .10). The presence of referral bias adversely affected the specificity of DSE (0.771 vs 0.842, P < .01). CONCLUSION This analysis suggests that the reported sensitivity of DSE is likely higher and the specificity lower than expected in routine clinical practice because of the inappropriate inclusion of patients with prior myocardial infarctions, the definition of positive results on DSE, and the negative influence of referral bias. However, in the patient subset that will be sent to coronary angiography, the opposite results can be expected.
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Preconditioning effects of adenosine in patients with severe coronary artery disease but preserved coronary flow reserve. Coron Artery Dis 2009; 20:354-9. [DOI: 10.1097/mca.0b013e32832ac5c1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Plewka M, Krzemińska-Pakuła M, Drozdz J, Ciesielczyk M, Wierzbowska K, Kasprzak JD. Tissue Doppler echocardiographic identification of ischemic etiology in patients with dilated cardiomyopathy. SCAND CARDIOVASC J 2009; 39:334-41. [PMID: 16352485 DOI: 10.1080/14017430510035970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the left ventricular function in patients with ischemic and nonischemic cardiomyopathy using tissue Doppler echocardiography (TDE). METHODS We studied 30 patients after myocardial infarction (MI group), 30 patients with dilated cardiomyopathy (DCM group) and 60 healthy volunteers in corresponding control groups. TDE velocities, time intervals of cardiac cycle were measured and dispersion index of TDE parameters was calculated. RESULTS Early diastolic velocities were lower in MI group than in DCM group, with similar systolic and late diastolic velocities. The dispersion index of systolic velocities was significantly higher in MI than in DCM group and in controls (respectively 33.1+/-6.0% vs 12.6+/-3.7% vs 15.9+/-5.6%; p < 0.001) and differentiated ischemic from idiopathic dilated cardiomyopathy. In MI group, preejection period was shorter and isovolumic relaxation and diastasis time were longer than in DCM group, with no differences in dispersion index of time intervals between the groups. CONCLUSIONS TDE parameters: early diastolic velocity, preejection period, isovolumic relaxation time and the dispersion index of systolic velocities differentiate ischemic and nonischemic etiology of dilated cardiomyopathy.
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Affiliation(s)
- Michał Plewka
- II Chair and Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Kniaziewicza 115, 9A-347 Lodz, Poland.
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Argyle R, Ray S. Stress and strain: double trouble or useful tool? EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:716-22. [DOI: 10.1093/ejechocard/jep066] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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The diagnostic and prognostic value of tissue Doppler imaging during dobutamine stress echocardiography in end-stage renal disease. Coron Artery Dis 2009; 20:230-7. [PMID: 19387250 DOI: 10.1097/mca.0b013e32832ac5eb] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether a quantitative measurement of peak systolic velocity (PSV) during dobutamine stress echocardiography (DSE) detects severe coronary artery disease (CAD) and predicts mortality in patients with end-stage renal disease. METHODS One hundred and forty renal transplant candidates had DSE and coronary angiography. DSE analysis was performed using conventional visual wall motion assessment, longitudinal PSV, and combining the two modalities. Failure of PSV to rise by more than 50% predicted an ischemic response. Significant CAD was defined as luminal stenosis greater than 70%. RESULTS The number of positive DSE studies according to conventional, PSV, and combined criteria was 41 (30%), 42 (31%), and 46 (34%) respectively. Forty patients (29%) had significant CAD at angiography. The sensitivity, specificity, positive and negative predictive values for conventional DSE analysis were 84, 91, 86, and 90% respectively. The same values for PSV analysis were 86, 92, 86, and 91%, respectively. The same values for the combination of visual and PSV analysis were 88, 94, 87, and 92% respectively. The differences between the three methods were not statistically significant. Sensitivity for single-vessel CAD (P=0.05) and circumflex artery disease (P=0.05) diagnosis was higher with PSV compared with conventional DSE analysis. Failure of PSV to rise by more than 50% during DSE was associated with significantly increased mortality (P=0.001). CONCLUSION A quantitative interpretation of DSE, based on the percentage rise of PSV during stress, accurately detects CAD and predicts prognosis in end-stage renal disease.
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Zacà V, Ballo P, Galderisi M, Mondillo S. Echocardiography in the assessment of left ventricular longitudinal systolic function: current methodology and clinical applications. Heart Fail Rev 2009; 15:23-37. [DOI: 10.1007/s10741-009-9147-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jakobsen CJ, Nygaard E, Norrild K, Kirkegaard H, Nielsen J, Torp P, Sloth E. High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart. Acta Anaesthesiol Scand 2009; 53:559-64. [PMID: 19419349 DOI: 10.1111/j.1399-6576.2009.01939.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two-dimensional (2D) echocardiography and TDI in patients with ischemic heart disease. METHODS The effect of a high epidural block (at least Th1-Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early (E'') and atrial (A'') peak velocities during diastole. RESULTS After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 +/- 1.53 to 6.86 +/- 1.38 (P<0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E''/A'' ratio increased from 0.75 +/- 0.27 to 1.09 +/- 0.32 (P=0.0026), indicating improved relaxation. CONCLUSION A 2D-echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease.
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Affiliation(s)
- C-J Jakobsen
- Department of Anaesthesia & Intensive Care, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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Manouras A, Shahgaldi K, Winter R, Brodin LA, Nowak J. Measurements of left ventricular myocardial longitudinal systolic displacement using spectral and colour tissue Doppler: time for a reassessment? Cardiovasc Ultrasound 2009; 7:12. [PMID: 19292894 PMCID: PMC2661320 DOI: 10.1186/1476-7120-7-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 03/17/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Echocardiographic measurements of left ventricular (LV) myocardial displacement may produce different results depending on the choice of employed modality and subjective adjustments during data acquisition and analysis. METHODS In this study, left ventricular longitudinal systolic displacement was quantified in 57 patients (31 women and 26 men, 50 +/- 16 years) using colour (colour TD) and spectral tissue Doppler (spectral TD) before and after temporal filtering (30 to 70 milliseconds in 20-millisecond steps) and changed offline gain saturation (0%, 50% and 100%), respectively. The results were compared with those obtained with anatomic M-mode. RESULTS Whereas only minor differences occurred between the results of colour TD and anatomic M-mode measurements, spectral TD significantly overestimated the results obtained with both these methods. However, the limits of agreement between the results produced by all three studied methods were not clinically acceptable in any of the cases. The spectral TD displacement values increased along with increasing offline gain saturation whereas the effect of temporal filtering on colour Doppler measurements was insignificant. CONCLUSION Measurements of LV myocardial longitudinal displacement employing spectral TD, colour TD or anatomic M-mode produce different results, thus discouraging interchangeable use of these modalities. Whereas the results of spectral TD measurements can be significantly altered by changing offline gain setting, the effect of temporal filtering on colour TD measurements is insignificant, a fact that increases clinical practicality of the latter method.
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Affiliation(s)
- Aristomenis Manouras
- Department of Clinical Physiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
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Oberhoffer R, Mühlbauer F, Kühn A, Högel J, Vogt M. Sample volume positioning in colour-coded Doppler myocardial imaging: effect of systolic and diastolic tracking. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:186-192. [PMID: 19010587 DOI: 10.1016/j.ultrasmedbio.2008.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 08/13/2008] [Accepted: 08/24/2008] [Indexed: 05/27/2023]
Abstract
To date, Doppler myocardial imaging (DMI) is no longer an intriguing new research tool only, but is rather on the verge of becoming a routinely used diagnostic method in adult and pediatric cardiology. Clinical studies have proven its diagnostic relevance for global left and right ventricular function. Concerns about reliability and reproducibility of DMI functional analysis, however, rely on lacking standards for the acquisition and analysis of DMI parameters. This study focuses on the effect of sample volume positioning during the cardiac cycle on the absolute myocardial velocities. Our hypothesis was that systolic sample volume placement leads to altered diastolic measurements, and diastolic placement vice versa to altered systolic measurements, when compared with continuous systolic and diastolic tracking. The effect of tracking on intra- and interobserver variability was a second endpoint of the study. Twenty healthy women underwent color-coded Doppler myocardial imaging. Clips of three heart cycles were stored in digital format for off-line analysis, administering sector angles of approximately 30 degrees and a mean frame rate of 280 frames per second. Using the Echopac software (GE, Germany), the sample volume was positioned immediately below the atrioventricular valvar annulus within the basal segments of the right and left ventricular free wall and the interventricular septum. Three conditions were investigated: conventional end-systolic or end-diastolic placement of the Doppler probe, or continuous tracking to the ideal position during systole or diastole. Descriptive statistics, intra and interobserver variabilities and Bland-Altman analyses were performed. Tracking revealed higher values of early diastolic myocardial velocities compared with measurements during systolic sample volume placement only, and higher systolic myocardial velocities, preejection acceleration and late diastolic myocardial velocities using diastolic sample volume placement. Inter and intraobserver reproducibility improved remarkably with the new procedure with the exception of isovolumic acceleration (IVA), which could not be reproduced satisfactorily at all. In summary, tracking is a promising method that helps to improve reproducibility of DMI-derived myocardial velocities. It helps to minimize the effect of changing myocardial velocities during the natural longitudinal cardiac movement, and should be considered as standard method during DMI.
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Affiliation(s)
- R Oberhoffer
- German Heart Centre Munich, Department of Pediatric Cardiology and Congenital Heart Defects, Technical University of Munich, Munich, Germany.
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Nguyen T, Ahmadie R, Fang T, Lytwyn M, Francis A, Barac I, Hussain F, Zieroth S, Jassal DS. Stress Echocardiography: Abnormal Tissue Doppler Imaging in the Absence of Cardiac Allograft Vasculopathy in Heart Transplant Recipients. Echocardiography 2009; 26:182-8. [DOI: 10.1111/j.1540-8175.2008.00793.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Westholm C, Bjällmark A, larsson M, Jacobsen P, Brodin LÅ, Winter R. Velocity tracking, a new and user independent method for detecting regional function of the left ventricle. Clin Physiol Funct Imaging 2009; 29:24-31. [DOI: 10.1111/j.1475-097x.2008.00828.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVES Ischemia affects the left ventricular (LV) diastolic function earlier than the systolic function. The ratio of the early diastolic transmitral velocity to the early diastolic tissue velocity (E/E') measured by tissue Doppler echocardiography allows a reliable assessment of the diastolic function. We investigated whether exercise-induced changes in E/E' ratio may help in the detection of coronary artery disease (CAD). METHODS The study population consisted of 114 patients undergoing coronary angiography. Patients with impaired LV ejection fraction, earlier myocardial infarction, arterial hypertension greater than stage I, or LV hypertrophy were excluded. Patients underwent a treadmill exercise test combined with an echocardiogram at baseline and within the first minute after exercise. RESULTS Coronary angiography showed a stenosis more than 70% in 72 (63%) patients (CAD group), the remaining 42 formed the non-CAD group. The two groups did not differ regarding age, sex, LV dimensions, and function. At baseline, the E/E' lateral and septal ratios and their average did not differ between the two groups. The exercise-induced changes of the E/E' ratios were higher in the CAD group (change of E/E' average: 1.9+/-3.3 vs. -1.1+/-2.3, P<0.001). In the CAD group, 78% showed an exercise-induced increase of E/E' average compared with 24% in the non-CAD group (P<0.001). In multivariate analysis, the association between an increase of E/E' average and the presence of obstructive CAD was independent of traditional risk factors, exercise test result or exercise-induced wall motion abnormalities (odds ratio=8.1, P<0.001). CONCLUSION Exercise-induced changes in E/E' ratio may offer significant assistance in the detection of CAD.
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Marcucci C, Lauer R, Mahajan A. New Echocardiographic Techniques for Evaluating Left Ventricular Myocardial Function. Semin Cardiothorac Vasc Anesth 2008; 12:228-47. [DOI: 10.1177/1089253208328581] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ultrasound imaging of the heart continues to play an important role in diagnosis and management of patients with cardiovascular diseases. Recent advances in ultrasound technology and introduction of newer imaging modalities have enabled improved assessment of left ventricular myocardial function. Tissue Doppler imaging and 2-dimensional speckle tracking allow more objective quantification of myocardial function in the form of tissue velocities, displacement, strain, and strain rate. Similarly, contrast-enhanced echocardiography and 3-dimensional echocardiography have provided a unique insight into left ventricular form and function that was not possible by unenhanced 2-dimensional echocardiography. In this review, the authors discuss the clinical application of these new imaging techniques in the assessment of left ventricular myocardial function.
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Affiliation(s)
- Carlo Marcucci
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Ryan Lauer
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Aman Mahajan
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California,
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Hyodo E, Hirata K, Hirose M, Kamimori K, Kawarabayashi T, Shimada K, Yoshikawa J, Yoshiyama M. Clinical Use of Doppler Echocardiography and Doppler Tissue Imaging in the Estimation of Myocardial Ischemia During Dobutamine Stress Echocardiography. J Am Soc Echocardiogr 2008; 21:331-6. [DOI: 10.1016/j.echo.2007.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Indexed: 11/24/2022]
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Picard MH, Popp RL, Weyman AE. Assessment of Left Ventricular Function by Echocardiography: A Technique in Evolution. J Am Soc Echocardiogr 2008; 21:14-21. [DOI: 10.1016/j.echo.2007.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 2007; 20:1021-41. [PMID: 17765820 DOI: 10.1016/j.echo.2007.07.003] [Citation(s) in RCA: 510] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Patricia A Pellikka
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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Beshai JF, Grimm R. The resynchronization therapy in narrow QRS study (RethinQ study): Methods and protocol design. J Interv Card Electrophysiol 2007; 19:149-55. [PMID: 17899346 DOI: 10.1007/s10840-007-9156-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 08/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Numerous trials have demonstrated the effectiveness of cardiac resynchronization therapy (CRT) as an adjunct to medical therapy for the relief of heart failure (HF) symptoms in patients with a wide QRS duration (QRSd). Current guidelines recommend CRT in patients with an EF <35%, medically refractory NYHA Class III-IV HF and QRSd >or=120 ms. Previous studies have demonstrated QRSd as a marker of electrical dyssynchrony fails to predict response to CRT. In addition, studies have demonstrated significant differences in QRSd post CRT between responders and non-responders. Moreover, smaller non-controlled studies demonstrated that HF patients with a narrow QRSd may benefit from CRT. A growing body of evidence suggests that echocardiographic criteria may be a better method to evaluate mechanical dyssynchrony (MD) which may predict those that will benefit from CRT, particularly those with a narrow QRSd. The Resynchronization Therapy In Narrow QRS (RethinQ) study will evaluate mechanical dyssynchrony using echocardiography (both M mode and TDI) as an eligibility requirement for CRT. METHODS The RethinQ study is a prospective, multi-center, randomized, double blind controlled clinical study. The objective of the RethinQ study is to evaluate the effectiveness of CRT in patients with approved ICD indication, advanced HF (NYHA Classification III), narrow QRSd (<130 ms) and evidence of MD measured by echocardiography. CONCLUSION We hypothesize that patients with narrow QRS <130 ms, advanced HF, and MD as measured by echocardiography will benefit from CRT.
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Affiliation(s)
- John F Beshai
- University of Chicago Hospital, 5758 South Maryland Avenue, MC 9024, Chicago, Illinois 60637, USA.
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40
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Speckle Tracking Echocardiography is a Sensitive Tool for the Detection of Myocardial Ischemia: A Pilot Study from the Catheterization Laboratory During Percutaneous Coronary Intervention. J Am Soc Echocardiogr 2007; 20:974-81. [DOI: 10.1016/j.echo.2007.01.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Indexed: 11/19/2022]
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41
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Jassal DS, Neilan TG, Picard MH, Wood MJ. Stress Echocardiography: Abnormal Response of Tissue Doppler?Derived Indices to Dobutamine in the Absence of Obstructive Coronary Artery Disease in Patients with Chronic Renal Failure. Echocardiography 2007; 24:580-6. [PMID: 17584197 DOI: 10.1111/j.1540-8175.2007.00455.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Abnormal tissue Doppler (TD)-derived indices during dobutamine stress echocardiography (DSE) can predict the presence of coronary artery disease (CAD) in patients with normal renal function. These indices include a reduction in annular systolic velocity (S'), a decrease in early diastolic annular velocity (E'), and prolongation of the time to E'. However, the ability of these indices to detect or exclude CAD in patients with chronic renal failure (CRF) is unclear. OBJECTIVE To examine the ability of TD-derived indices to detect or exclude the presence of CAD in patients with CRF. METHODS We evaluated a total of 30 patients (13 males, mean age 57 +/- 15 years) using both DSE and coronary angiography. This cohort consisted of 12 control patients with normal renal function (mean creatinine 0.5 mg/dL) and 18 patient with CRF (mean creatinine 2.5 mg/dL). At each stage of the DSE, left ventricular (LV) diastolic function was assessed using conventional (peak early (E) and late (A) transmitral, E/A ratio, E-wave deceleration time (DT), and isovolumic relaxation time (IVRT)) and TD-derived indices (lateral annular systolic (S'), early diastolic (E'), and late atrial velocities (A'), time to E' and E/E'). RESULTS All 30 patients had a normal DSE based on systolic regional function and a normal coronary angiogram. There was no difference in E, A, E/A, DT or IVRT between the two groups at each stage. Despite normal coronaries, patients with CRF demonstrated lower S' and E' velocities at peak stress compared to the control patients (8.0 +/- 2.2 cm/sec vs 15.1 +/- 2.6, P < 0.05 and 6.7 +/- 1.6 cm/sec vs 13.3 +/- 3.1, P < 0.05, respectively). During DSE, the time to E' at peak stress in CRF patients was also prolonged compared to control (400 +/- 44 ms vs 329 +/- 51, P < 0.05). Patients with CRF also had increased filling pressures (as estimated by E/E') as compared to controls at peak stress (14.7 +/- 5.2 vs 7.4 +/- 1.5, P < 0.05, respectively). CONCLUSION In patients with CRF, a reduction in TD derived indices does not predict the presence of obstructive CAD.
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Affiliation(s)
- Davinder S Jassal
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Bjällmark A, Larsson M, Winter R, Westholm C, Jacobsen P, Lind B, Brodin LA. Velocity Tracking–A Novel Method for Quantitative Analysis of Longitudinal Myocardial Function. J Am Soc Echocardiogr 2007; 20:847-56. [PMID: 17617311 DOI: 10.1016/j.echo.2006.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Indexed: 11/29/2022]
Abstract
Doppler tissue imaging is a method for quantitative analysis of longitudinal myocardial velocity. Commercially available ultrasound systems can only present velocity information using a color Doppler-based overlapping continuous color scale. The analysis is time-consuming and does not allow for simultaneous analysis in different projections. We have developed a new method, velocity tracking, using a stepwise color coding of the regional longitudinal myocardial velocity. The velocity data from 3 apical projections are presented as static and dynamic bull's-eye plots to give a 3-dimensional understanding of the function of the left ventricle. The static bull's-eye plot can display peak systolic velocity, late diastolic tissue velocity, or the sum of peak systolic velocity and early diastolic tissue velocity. Conversely, the dynamic bull's-eye plot displays how the myocardial velocities change over one heart cycle. Velocity tracking allows for a fast, simple, and intuitive visual analysis of the regional longitudinal contraction pattern of the left ventricle with a great potential to identify characteristic pathologic patterns.
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Affiliation(s)
- Anna Bjällmark
- School for Technique and Health, Royal Institute of Technology, Huddinge, Sweden
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Larsen JR, Torp P, Norrild K, Sloth E. Propofol reduces tissue-Doppler markers of left ventricle function: a transthoracic echocardiographic study. Br J Anaesth 2007; 98:183-8. [PMID: 17251211 DOI: 10.1093/bja/ael345] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Propofol is thought to minimally depress myocardial function, but mainly to reduce blood pressure by vasodilation. Transthoracic tissue-Doppler echocardiography (TDE) is a novel, validated method of quantifying myocardial function. It provides new insight into myocardial function by measuring myocardial motion. We examined the effects of propofol upon myocardial function by measuring changes in left ventricle function by TDE. METHODS We assessed change in myocardial function in propofol anaesthetized ASA I patients tissue tracking displacement (TTD) before anaesthesia onset and repeated measurements after a single propofol bolus dose. Tissue tracking score (TTS), a marker of ejection fraction, was also used (n = 10). RESULTS Propofol 1.5-2 mg kg(-1) significantly attenuated PSV from 5.64 (1.17) to 4.66 (0.55) cm s(-1) (P < 0.0001) and TTD from 10.2 (2.1) to 8.5 (1.4) mm (P = 0.0091), whereas TTP was unchanged [all data: mean (SD)]. TTS declined from 7.2 (1.3) to 6.1 (0.6) mm (P < 0.01). Non-invasive mean blood pressure declined 17% (P < 0.0001). CONCLUSIONS The results indicate that myocardial contractile function is compromised concomitantly with reduced cyclic displacement after propofol dosing. Blood pressure declined accordingly. From these results, it is impossible to ascertain whether this was secondary to reduced cardiac filling or a consequence of a direct negative inotropic action of propofol, but it represents a left-shift of the Starling curve. The novel TDE yields new information on myocardial velocities and motion.
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Affiliation(s)
- J R Larsen
- Department of Anaesthesiology and Intensive Care, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.
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Hoffmann R. Tissue Doppler and innovative myocardial-deformation imaging techniques for assessment of myocardial viability. Curr Opin Cardiol 2006; 21:438-42. [PMID: 16900005 DOI: 10.1097/01.hco.0000240579.82182.63] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Visual analysis of stress echocardiography allows evaluation of myocardial viability in acutely and chronically impaired left-ventricular function. Tissue Doppler and derived echocardiographic imaging techniques provide a tool for quantification of regional left-ventricular function which overcomes the limitations of subjective, experience-dependent reading of stress echocardiography. RECENT FINDINGS Regional systolic and diastolic myocardial velocities as well as the derived myocardial-deformation parameters strain and strain rate are impaired in patients with left-ventricular dysfunction. Increase of myocardial velocities, strain and strain rate during stress stimulation are indicators of functional reserve in viable segments, while failure to increase indicates nonviability. Previous studies with very precise determination of regional myocardial deformation have shown that even analysis of resting function without evaluation of the functional reserve during stimulation allows assessment of myocardial viability. New two-dimensional echocardiography-based tissue-tracking techniques yield an angle-independent imaging modality that is likely to further improve the clinical applicability of echocardiographic imaging techniques to define regional myocardial viability. SUMMARY This review attempts to define the role of tissue Doppler and new innovative myocardial-deformation imaging techniques for identification of myocardial viability in patients with impaired left-ventricular function.
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Maclaren G, Kluger R, Prior D, Royse A, Royse C. Tissue Doppler, Strain, and Strain Rate Echocardiography: Principles and Potential Perioperative Applications. J Cardiothorac Vasc Anesth 2006; 20:583-93. [PMID: 16884996 DOI: 10.1053/j.jvca.2006.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Graeme Maclaren
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia.
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Caso P, D'Andrea A, Trambaiolo P, Di Salvo G, Severino S, Caso I, Ancona R, Calabrò P, Mininni N, Calabrò R. Potential clinical perspectives of Doppler myocardial imaging and strain rate imaging during stress echocardiography. J Cardiovasc Med (Hagerstown) 2006; 7:480-90. [PMID: 16801809 DOI: 10.2459/01.jcm.0000234766.65830.1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Stress echocardiography has become a common non-invasive test in patients with chest pain and known or suspected coronary artery disease, but, as with exercise electrocardiography, it shows several major limitations. Analysis of gray-scale images based on subjective visual interpretation of wall motion and thickening has considerable variability even among experts. Doppler myocardial imaging and strain rate imaging echocardiography provides additional information in comparison with conventional echocardiography. These techniques provide quantification of regional wall motion at rest and during stress. Quantification of both systolic and diastolic myocardial function by either Doppler myocardial imaging or strain rate imaging mapping during dobutamine stress test has been shown to be a feasible, accurate, non-invasive tool that should be considered to be a sensitive alternative to the present echocardiographic and scintigraphic imaging techniques for stress tests. Time consuming off-line analysis of color images is required in the present state of technology. However, these non-invasive techniques are rapidly evolving and expanding. Further refinements in signal processing and quantitative analysis are likely in the near future.
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Affiliation(s)
- Pio Caso
- Non-invasive Cardiology, Department of Cardiology, Monaldi Hospital Naples, Italy.
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47
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Schneider C, Bahlmann E, Malisius R, Hertting K, Antz M, Kuck KH. Tissue velocity imaging during dobutamine stimulation for assessment of myocardial viability: Segmental analysis in patients after myocardial infarction. Int J Cardiol 2006; 110:15-21. [PMID: 16087258 DOI: 10.1016/j.ijcard.2005.06.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Revised: 03/26/2005] [Accepted: 06/17/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dobutamine stress echocardiography (DSE) is an established method for the detection of viable myocardium, but evaluation of this method is subjective. Tissue velocity Imaging (TVI) allows quantitative analysis of regional myocardial wall motion by assessment of systolic myocardial velocities. The aim of this study was to evaluate the diagnostic value of DSE and TVI for detection of viable myocardium. METHODS In 56 patients (58+/-12 years) with previous myocardial infarction (130+/-42 days, mean ejection fraction 42+/-15%) low-dose DSE was combined with analysis of peak systolic myocardial velocities (Vpeak) by TVI for assessment of myocardial viability. As reference served a follow-up echocardiography after successful revascularization (mean 91+/-3 days). RESULTS Of a total of 896 segments 200 showed abnormal wall motion (31 mildly hypokinetic, 50 severely hypokinetic, 115 akinetic, 4 dyskinetic). In 125 of these 200 segments regional improvement of regional wall motion was observed (62.5% viable). An increase of Vpeak>1 cm/s during dobutamine stimulation allowed the identification of viable myocardium with a sensitivity of 82% and a specificity 82% (DSE: 77% and 80%). By receiver operating characteristic (ROC) curve analysis, a cut-off value of 1.0 cm/s was the best parameter to differ viable from nonviable myocardium (area under the curve 0.85; p<0.01; 95% CI 0.79 to 0.90). Improvement of global ejection fraction after revascularization (47+/-13%, p=0.11) corresponded with three TVI viable segments with a sensitivity of 92% and a specificity of 89% (p=0.012). CONCLUSIONS TVI allows the identification of viable myocardium during dobutamine stimulation and enables a quantitative interpretation of DSE.
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48
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Pauliks LB, Vogel M, Mädler CF, Williams RI, Payne N, Redington AN, Fraser AG. Regional Response of Myocardial Acceleration During Isovolumic Contraction During Dobutamine Stress Echocardiography: A Color Tissue Doppler Study and Comparison with Angiocardiographic Findings. Echocardiography 2005; 22:797-808. [PMID: 16343161 DOI: 10.1111/j.1540-8175.2005.00135.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Color tissue Doppler imaging permits noninvasive quantitation of regional wall motion. In experimental studies, a new marker, the slope of the isovolumic contraction wave, isovolumic acceleration (IVA) was more insensitive to ventricular loading conditions than myocardial velocities. This study compared the regional response IVA to dobutamine stress echocardiography to angiographic findings. METHODS The Myocardial Doppler in Stress Echocardiography (MYDISE) study prospectively recruited 149 consecutive patients with chest pain for dobutamine stress tissue Doppler echocardiography prior to coronary angiography. This color tissue Doppler database was analyzed for IVA in 1,192 basal and mid segments at rest and again at peak stress. Angiographic findings were compared to IVA and peak systolic velocities (PSV) in corresponding cardiac segments. The diagnostic accuracy of IVA to predict coronary artery stenosis was determined using cut-off values for three representative segments and with the MYDISE diagnostic model including eight segments. RESULTS Regional IVA increased in a dose-dependent manner during dobutamine infusion. The response was blunted in the supply territory of stenosed coronary artery branches. IVA performed slightly better than PSV as single marker for coronary artery stenosis. A diagnostic model incorporating IVA and PSV was 85-95% accurate (area under receiver operating characterstic curves). CONCLUSIONS Regional changes of isovolumic acceleration during dobutamine stress echocardiography reflect regional wall motion and can be used to predict coronary artery stenosis with similar accuracy as a model based on systolic myocardial velocities. As a single marker, IVA performed better than myocardial velocities.
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Affiliation(s)
- Linda B Pauliks
- Tufts-New England Medical Center, 750 Washington Street, Boston, Massachusetts 02115, USA.
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49
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Abstract
PURPOSE OF REVIEW This review highlights recent progress in the quantitative approach to the interpretation of stress echocardiograms. Recent literature regarding the application of tissue Doppler and strain rate imaging for the diagnosis of coronary artery disease is summarized. RECENT FINDINGS The high temporal and spatial resolution of tissue Doppler and strain rate imaging permit recognition of regional myocardial dysfunction. These techniques have been performed during low- and high-dose dobutamine stress echocardiography and have been applied to exercise echocardiography. During stress, the peak systolic velocity and early diastolic velocity increased to a greater degree in normal segments compared to ischemic segments. With tissue Doppler imaging, viable segments show increases in systolic velocities in contrast to infarcted segments. Presently, the feasibility of strain rate imaging is slightly less than that of conventional wall motion assessment. However, in preliminary studies, tissue Doppler parameters and especially strain rate parameters appear to offer advantages in accuracy compared to conventional wall motion assessment. SUMMARY Tissue Doppler and strain rate imaging offer great promise for the accurate, reproducible quantification of regional myocardial function. Further studies are indicated to prove their accuracy, efficiency, and superiority over existing methods.
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Affiliation(s)
- Patricia A Pellikka
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Sade LE, Gorcsan J, Severyn DA, Edelman K, Katz WE. Usefulness of angle corrected tissue Doppler to assess segmental left ventricular function during dobutamine stress echocardiography in patients with and without coronary artery disease. Am J Cardiol 2005; 96:141-7. [PMID: 15979454 DOI: 10.1016/j.amjcard.2005.03.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 03/03/2005] [Accepted: 03/03/2005] [Indexed: 11/23/2022]
Abstract
The application of angle correction to tissue Doppler (TD) during dobutamine stress echocardiography (DSE) extends the application of TD to all left ventricular segments, improves the differentiation of abnormal from normal segmental responses to stress, and has promise to improve its clinical utility for objectively evaluating wall motion during DSE.
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Affiliation(s)
- L Elif Sade
- Cardiovascular Institute, University of Pittsburgh, Pennsylvania, USA
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