Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging

Aims The aim of this study was to determine the utility of pulsed wave Dopp ler tissue imaging in the evaluation of regional left ventricular diastolic function in patients with ischaemic heart disease. Methods and Results In 30 normal subjects and 43 patients with ischaemic he art disease, Doppler tissue imaging was performed in each of the 16 segment s of the myocardium. The following diastolic pulsed wave Doppler tissue ima ging parameters were obtained for each segment: (1) regional early diastoli c peak velocity (regional e wave cm . s(-1)); (2) regional late diastolic p eak velocity (regional a wave cm . s(-1)); (3) regional diastolic ela veloc ity ratio; and (4) the regional isovolumic relaxation time, defined as the time interval from the second heart sound to the onset of the diastolic E w ave. In patients with ischaemic heart disease, each of these parameters was evaluated and compared in ischaemic and normally perfused segments, based on the presence or absence of obstructive lesions of the supplying Coronary artery. In patients with coronary artery disease, several differences were observed between diseased and normal wall segments: the mean segmental pea k early diastolic velocity (e wave) was reduced (mean +/- SD: 6.4 +/- 2.1 c m . s(-1) vs 8.5 +/- 2.8 cm . s(-1); P<0.01); the e/a diastolic velocity ra tio was decreased (0.95 +/- 0.3 vs 1.5 +/- 0.6, respectively; P<0.01) and t he regional isovolumic relaxation time was prolonged (104 +/- 36.7 ms vs 69 .6 +/- 30 ms; P < 0.01. No differences were observed in any of these parame ters between the normally perfused segments of ischaemic patients and norma l subjects. Patients with a normal transmitral diastolic Doppler inflow pat tern had a mean of 3.7 +/- 2.7 myocardial segments with a local ela pulsed wave Doppler tissue imaging velocity ratio <1, fewer than those with an inv erted diastolic transmitral Doppler inflow pattern (10.3 +/- 3 segments; P < 0.001). Overall sensitivity and specificity for an inverted local ela rat io and a local isovolumetric relaxation time greater than or equal to 85 ms were of 62% and 72% and 69% and 80%, respectively. Conclusion Regional diastolic wall motion is impaired at baseline in ischae mic myocardial segments. even when systolic contraction is preserved. Pulse d wave Doppler tissue imaging is a useful non-invasive technique which allo ws the assessment of regional diastolic performance and dynamics of the lef t ventricular myocardium. Further studies are required to define this role in the evaluation of coronary heart disease.