Use of tissue Doppler imaging to facilitate the prediction of events in patients with abnormal left ventricular function by dobutamine echocardiography

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Abstract

The extent of abnormality in patients with positive dobutamine echocardiography (DE) is predictive of risk, but the wall motion score (WMS) has low concordance among observers. We sought whether quantifying the extent of abnormal wall motion using tissue Doppler (TD) could guide risk assessment in patients with abnormal DE in 576 patients with known or suspected coronary artery disease; standard DE was combined with color TD imaging at peak dose. WMS was assessed by an expert observer and studies were identified as abnormal in the presence of ≥1 segments with resting or stress-induced wall motion abnormalities. Patients with abnormal DE had peak systolic velocity measured in each segment. Tissue tracking was used to measure myocardial displacement. Follow-up for death or infarction was performed after 16 ± 12 months. Of 251 patients with abnormal DE, 22 patients died (20 from cardiac causes) and 7 had nonfatal myocardial infarctions. The average WMS in patients with events was 1.8 ± 0.5, compared with 1.7 ± 0.5 in patients without events (p = NS). The average systolic velocity in patients with events was 4.9 ± 1.7 cm/s and 6.4 ± 6.5 cm/s in the patients without events (p <0.001). The average tissue tracking in patients with events was 4.5 ± 1.5 mm and was significant (5.7 ± 3.1 mm) in those without events (p <0.001). Thus, TD is an alternative to WMS for quantifying the total extent of abnormal left ventricular function at DE, and appears to be superior for predicting adverse outcomes.

Section snippets

Patient selection

Of 576 patients who underwent dobutamine echocardiography (DE) over a 16-month period from September 1998 to January 2000, 251 had abnormal DE as assessed by wall motion score (WMS). The clinical characteristics of these patients are listed in Table 1.

Dobutamine echocardiography

A standard dobutamine-atropine stress protocol was performed, using a starting dose of 5 μg/kg/min, and increasing the dosage every 3 minutes to 10, 20, 30, and 40 μg/kg/min.4 Atropine was given (to a maximum of 1 mg) if 85% of age-predicted

Dobutamine echocardiography

The dobutamine stress test was terminated due to side effects in 43 patients (17%). The most common side effects were hypertension (4%), hypotension (3%), and nonsustained ventricular tachycardia (1%). Angina pectoris occurred in 73 patients (29%), and electrocardiographic changes of ischemia were present in 75 patients (30%).

All patients had an abnormal dobutamine echocardiogram. Wall motion abnormalities at rest were present in 60%, 27% of whom showed augmentation at low-dose dobutamine The

Discussion

The results of this study indicate that the measurement of peak systolic velocity in the basal segments at peak dobutamine stress is a powerful predictor of adverse events in follow-up. Although myocardial displacement also showed valuable prognostic information, peak velocity is the simplest and most robust tool. Moreover, over a 2-year follow-up, the average velocity parameters were better predictors of adverse outcome than the WMS.

In patients with stable chronic coronary disease, the finding

References (24)

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