Regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing -A comparison with stress echocardiography and perfusion scintigraphy

OBJECTIVES We evaluated regional diastolic function by pulsed Doppler myoca rdial mapping for the detection of left ventricular ischemia during pharmac ologic stress testing. BACKGROUND Evaluation and quantification of diastolic myocardial function r emain a challenge for imaging techniques in stress tests. METHODS A prospec tive study compared the detection of coronary artery stenosis: 1) by pulsed Doppler myocardial mapping, 2) by two-dimensional echocardiographic dobutamine stress test, and 3) by perfusion scintigraphy in 64 patients using coronary angiography for reference. An age matched subgroup of 10 patients with normal angiograms an d two-dimensional echocardiographic stress test served as control group. Pe ak myocardial contraction velocity (V-c and lengthening rate during early d iastolic left ventricular (LV) filling (V-E) were measured in 12 LV segment s from three apical views. RESULTS In controls, myocardial velocities increased during stress by great er than or equal to 3.6 cm/s (p < 0.001). In LV segments depending on a ste nosed artery (n = 70), V,decreased by greater than or equal to 1 cm/s and, thus, was different from control segments (n = 112, p < 0.001) and from sca r segments (n = 13, p < 0.01). whereas the change of V-C was similar to tha t in scar segments. A stress induced 2 cm/s reduction of V, discerned the b est diagnostic accuracy (sensitivity 84%, specificity 93%) in comparison wi th two-dimensional echocardiography (78% and 71%) and perfusion scintigraph y (61% and 86%). Using receiver operating curves at incremental levels of l uminal narrowing these relations persisted. CONCLUSIONS Quantification of diastolic myocardial function by pulsed Doppl er myocardial mapping during dobutamine stress test was shown to be a feasi ble, accurate, reproducible, noninvasive technique that should be considere d to be a sensitive alternative to the present echocardiographic and scinti graphic imaging techniques for stress tests. (C) 2000 by the American Colle ge of Cardiology.