BACKGROUND: Echocardiography may permit the detection of a nonviable myocardium. The aim of this study was to test if resting pulsed wave-tissue Doppler imaging (PW-TDI) might yield additional markers. METHODS: Fifty patients (38 males, 12 females, mean age 63 +/- 6 years) with left ventricular dysfunction (ejection fraction 35 +/- 10%) underwent echocardiography. The posterior septum, anterior septum, lateral, inferior, anterior and posterior walls were sampled on the basal segments in the apical views at PW-TDI. The following variables and cardiac phases were tested: 1) the isovolumic contraction phase velocity, polarity or detectability, 2) the ejection phase velocity, a detectable interval between the ejection phase and aortic valve closure, or ejection phase shape, and 3) the isovolumic relaxation phase velocity or ejection velocity/post-systolic shortening ratio. From the tested PW-TDI variables, viable and nonviable patterns were assembled, taking rest-redistribution 201thallium single-photon emission computed tomography as the independent reference for myocardial viability. Patients with significant loading alterations, mitral or aortic valve disease, and arrhythmias were excluded. RESULTS: Out of 219 dyssynergic segments, viability as identified according to conventional rest echocardiographic criteria appeared in 94 (47%), as identified at PW-TDI in 116 (53%), and as identified at nuclear imaging in 105 (48%). The resting PW-TDI variables consistent with absent myocardial viability were as follows: 1) an isovolumic contraction phase velocity equal to the ejection phase velocity +/- 1 cm/s, or absent, 2) an ejection phase velocity < or = 4 cm/s, usually with a gap between the ejection phase and aortic valve closure, or any shape of ejection but the typical single phase, and 3) an isovolumic relaxation phase velocity < 5 cm/s with an ejection phase velocity/isovolumic relaxation phase velocity ratio < 0.8. The accuracy for the identification of myocardial viability was: agreement 73%, kappa 0.44 for echocardiography, and agreement 75%, kappa 0.47 for PW-TDI. CONCLUSIONS: PW-TDI nonviable patterns may be a helpful additional tool for the identification of patients without residual myocardial viability.
BACKGROUND: Echocardiography may permit the detection of a nonviable myocardium. The aim of this study was to test if resting pulsed wave-tissue Doppler imaging (PW-TDI) might yield additional markers. METHODS: Fifty patients (38 males, 12 females, mean age 63 +/- 6 years) with left ventricular dysfunction (ejection fraction 35 +/- 10%) underwent echocardiography. The posterior septum, anterior septum, lateral, inferior, anterior and posterior walls were sampled on the basal segments in the apical views at PW-TDI. The following variables and cardiac phases were tested: 1) the isovolumic contraction phase velocity, polarity or detectability, 2) the ejection phase velocity, a detectable interval between the ejection phase and aortic valve closure, or ejection phase shape, and 3) the isovolumic relaxation phase velocity or ejection velocity/post-systolic shortening ratio. From the tested PW-TDI variables, viable and nonviable patterns were assembled, taking rest-redistribution 201thallium single-photon emission computed tomography as the independent reference for myocardial viability. Patients with significant loading alterations, mitral or aortic valve disease, and arrhythmias were excluded. RESULTS: Out of 219 dyssynergic segments, viability as identified according to conventional rest echocardiographic criteria appeared in 94 (47%), as identified at PW-TDI in 116 (53%), and as identified at nuclear imaging in 105 (48%). The resting PW-TDI variables consistent with absent myocardial viability were as follows: 1) an isovolumic contraction phase velocity equal to the ejection phase velocity +/- 1 cm/s, or absent, 2) an ejection phase velocity < or = 4 cm/s, usually with a gap between the ejection phase and aortic valve closure, or any shape of ejection but the typical single phase, and 3) an isovolumic relaxation phase velocity < 5 cm/s with an ejection phase velocity/isovolumic relaxation phase velocity ratio < 0.8. The accuracy for the identification of myocardial viability was: agreement 73%, kappa 0.44 for echocardiography, and agreement 75%, kappa 0.47 for PW-TDI. CONCLUSIONS: PW-TDI nonviable patterns may be a helpful additional tool for the identification of patients without residual myocardial viability.