In patients with severe chronic multivessel disease and left ventricular dy
sfunction, tissue Doppler echocardiography could distinguish viable from no
nviable segments on the basis of transmural velocities and endocardium midv
elocity gradient calculated at rest and with low-dose dobutamine. An unusua
l bell-shaped myocardial velocity gradient pattern, characterized by promin
ent midvelocities increasing with dobutamine, featured viable segments.