LEFT-VENTRICULAR DIASTOLIC FILLING CHANGES DURING DIPYRIDAMOLE-INDUCED ISCHEMIA - AN ECHO-DOPPLER STUDY

Objective To evaluate the usefulness of the Doppler assessment of left ventricular diastolic functioning during dipyridamole-induced ischaem ia in patients with coronary artery disease (CAD). Methods We studied 28 patients with angiographically proven CAD [18 men, aged 62 +/- 7 ye ars (mean +/- SD)] and 18 normal subjects (12 men, aged 59 +/- 7.5 yea rs). Two-dimensional and transmitral flow Doppler echocardiography stu dies were performed at baseline and after intravenous administration o f a high dose of dipyridamole (0.84 mg/kg during 10 min). Left ventric ular wall motion was evaluated by two-dimensional Doppler echocardiogr aphy, with the left ventricle divided into a 16-segment model, whereas peak velocities of early and late diastolic flow, the early:late dias tolic flow ratio and the deceleration rate of early diastolic flow wer e determined from transmitral flow Doppler echocardiography. Results S ixteen patients developed new wall-motion abnormalities (WMA), whereas the remaining 12 patients and the controls did not. Multivariate logi stic regression analysis was performed to identify which of the parame ters had independent diagnostic value for revealing CAD. WMA was enter ed at the first step and yielded a 57% sensitivity and 100% specificit y; the changes in deceleration rate were entered as the second step, w hich improved the sensitivity to 85.5%, and reduced the specificity to 83% and raised the overall accuracy to 85% from 70% for WMA alone. Mo re specifically, the sensitivity improved from 37.5, 63.5 and 65.5% to 62.5, 91 and 100%, respectively, for patients with one-, two-and thre e-vessel disease. The cut-off value of the change in deceleration rate was 7%. Conclusions Patients could be classified as having CAD either if they developed new WMA or if the deceleration rate of early diasto lic flow during dipyridamole-stress echocardiography increased by more than 7% compared with the rest value. (C) Rapid Science Publishers IS SN 0954-6928.