Acute regional myocardial ischemia identified by 2-dimensional multiregiontissue Doppler imaging technique

Background and Objective: Tissue Doppler echocardiography (TDE) is a promis ing method for the assessment of regional myocardial function, but pulsed T DE does not provide quantitative data from multiple regions simultaneously. This feature is Important for the objective assessment of regional differe nces in myocardial function. In the present study, we investigated a new of f-line TDE method that provides quantitative pulsed velocity data from an u nlimited number of regions selected within a 2-dimensional (2D) image. The goal of the study was to determine the ability of this new approach to quan tify regional myocardial function during acute myocardial ischemia induced by balloon angioplasty. Methods: Twenty-two patients undergoing angioplasty of the left anterior de scending coronary artery (LAD) were studied. Left ventricular longitudinal wall motion was assessed by 2D TDE from the apical 4-chamber view before, d uring, and after angioplasty. Images were sampled at a rate of 69 +/- 15 fr ames/s, and the off-line analysis allowed simultaneous measurement of veloc ities in multiple myocardial segments. Results: There were 3 major alterations in the systolic velocity pattern du ring LAD occlusion. Peak early systolic velocities along the apical septum were significantly reduced during LAD occlusion (2.8 +/- 1.2 cm/s to 0.6 +/ - 1.7 cm/s, P <.001). Myocardial velocities in mid systole suggested parado xical wall motion (1.0 <plus/minus> 1.2 cm/s to -0.8 +/- 0.9 cm/s, P < .001 ). When comparing the ischemic regions of the left ventricle with the nonis chemic regions, each patient demonstrated lower myocardial systolic velocit ies in the ischemic region. Furthermore, during early diastole, the wall mo tion of the ischemic segments showed a postsystolic contraction pattern wit h velocities changing from -0.9 <plus/minus> 1.0 cm/s to 1.9 +/- 1.3 cm/s ( P < .001). Conclusion: This new 2D TDE approach is able to quantify detailed myocardia l velocity profiles from multiple regions simultaneously. Single-beat compa risons of ischemic and nonischemic regions might enhance the sensitivity fo r diagnosing ischemic heart disease. Reversed systolic wall motion during m idsystole and marked positive velocity during early diastole might be new a nd important markers of myocardial wall ischemia.