LATE APICAL FILLING BY COLOR DOPPLER M-MODE DURING DIPYRIDAMOLE STRESS ECHOCARDIOGRAPHY - A USEFUL CONTRIBUTION TO WALL-MOTION ANALYSIS

It has been shown that regional myocardial ischemia during angioplasty is associated with retarded apical filling. To test the importance of retarded apical filling by color Doppler M-mode to detect ischemia du ring dipyridamole stress echocardiography, we evaluated 29 patients (1 2 women, aged 57 to 87 years). High-dose dipyridamole (0.84 mg/kg for 10 minutes) was used. The color M-mode record was used to calculate th e duration of abnormal apical flow as measured from the onset of the Q RS complex to the disappearance of color signals directed toward the a pex. Echocardiographic images were compared at rest and during stress to identify the presence of new or worsening wall motion abnormalities (WMAs). Fourteen patients (group A) were designated as having coronar y artery disease on the basis on WMAs during the stress test and abnor mal coronary anatomy. Fifteen patients (group B) without WMAs in the p resence of normal coronary anatomy were designated as having no corona ry artery disease. All but toro patients in group A had an abnormal ap ical filling response to dipyridamole stress (sensitivity 86%). In the se patients the marked retardation of apical filling was detected duri ng ischemia (55 +/- 18 msec versus 120 +/- 34 msec) (p < 0.01). In gro up B there were no dynamics in apical filling (specificity 100%). Colo r M-mode Doppler imaging showed retarded apical filling during dipyrid amole-induced myocardial ischemia. This abnormal filling pattern mg be a useful adjunct to WMAs during dipyridamole stress echocardiography.