Doppler tissue imaging quantitates regional wall motion during myocardial ischemia and reperfusion.

BACKGROUND Quantification of regional myocardial function is a major unresolved issue in cardiology. We evaluated the accuracy of pulsed Doppler tissue imaging (DTI), a new echocardiographic technique, to quantify regional myocardial dysfunction induced by acute ischemia and reperfusion. METHODS AND RESULTS In nine open-chest anesthetized pigs, various degrees of regional wall motion abnormalities were induced by graded reduction of left anterior descending coronary artery (LAD) blood flow. Pulsed Doppler tissue imaging was performed from an epicardial apical four-chamber view with the sample placed within the middle part of the septal wall. Peak septal velocities were calculated during systole, isovolumic relaxation, and early and late diastole. Regional myocardial blood flow and systolic and diastolic dysfunctions were assessed by radioactive microspheres and ultrasonic crystals, respectively. Ischemia resulted in a significant rapid reduction of systolic velocities and an early decrease in the ratio of early to late diastolic velocities. Both changes were detected by pulsed DTI within 5 seconds of coronary artery occlusion. The decrease in systolic velocity significantly correlated with both systolic shortening (r=.90, P<.0001) and regional myocardial blood flow (r=.96, P<.0001) during reduction of LAD blood flow. CONCLUSIONS These results suggest that DTI may be a promising new tool for the quantification of ischemia-induced regional myocardial dysfunction.

[1]  I Schnittger,et al.  Computerized quantitative analysis of left ventricular wall motion by two-dimensional echocardiography. , 1984, Circulation.

[2]  G Osakada,et al.  Nonuniformity of inner and outer systolic wall thickening in conscious dogs. , 1985, The American journal of physiology.

[3]  A. Weyman,et al.  Cross-sectional Echocardiographic Analysis of the Extent of Left Ventricular Asynergy in Acute Myocardial Infarction , 1980, Circulation.

[4]  Daniel E. Guyer,et al.  A comparison of quantitative echocardiographic methods for delineating infarct-induced abnormal wall motion. , 1984, Circulation.

[5]  J. Ross,et al.  Sustained regional dysfunction produced by prolonged coronary stenosis: gradual recovery after reperfusion. , 1983, Circulation.

[6]  J. Weiss,et al.  Two‐dimensional Echocardiographic Recognition of Myocardial Injury in Man: Comparison with Postmortem Studies , 1981, Circulation.

[7]  S. Kitamura,et al.  Geometric and functional abnormalities of the left ventricle with a chronic localized noncontractile area. , 1973, The American journal of cardiology.

[8]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[9]  C. Feldman,et al.  Quantitative Detection of Regional Left Ventricular Contraction Abnormalities by Two‐dimensional Echocardiography.: I. Analysis of Methods , 1981, Circulation.

[10]  J M Nicklas,et al.  Effects of repeated brief coronary occlusion on regional left ventricular function and dimension in dogs. , 1985, The American journal of cardiology.

[11]  G. Leopold,et al.  Posterior wall velocity: an unreliable index of total left ventricular performance in patients with coronary artery disease. , 1974, The American journal of cardiology.

[12]  Mario J. Garcia,et al.  Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. , 1996, Journal of the American College of Cardiology.

[13]  H. White,et al.  Postsystolic shortening of acutely ischemic canine myocardium predicts early and late recovery of function after coronary artery reperfusion. , 1988, Circulation.

[14]  G R Sutherland,et al.  Color Doppler myocardial imaging: a new technique for the assessment of myocardial function. , 1994, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[15]  J. Ross,et al.  Significance of Regional Wall Thickening Abnormalities Relative to Transmural Myocardial Perfusion in Anesthetized Dogs , 1980, Circulation.

[16]  Daniel E. Guyer,et al.  An echocardiographic technique for quantifying and displaying the extent of regional left ventricular dyssynergy. , 1986, Journal of the American College of Cardiology.

[17]  R. Kloner,et al.  Partial coronary stenosis is sufficient and complete reperfusion is mandatory for preconditioning the canine heart. , 1992, Circulation research.

[18]  L Weinert,et al.  Echocardiographic quantification of regional left ventricular wall motion with color kinesis. , 1996, Circulation.

[19]  D Franklin,et al.  Regional Myocardial Function during Acute Coronary Artery Occlusion and Its Modification by Pharmacologic Agents in the Dog , 1974, Circulation research.

[20]  R. Bache,et al.  Persistence of regional left ventricular dysfunction after exercise-induced myocardial ischemia. , 1986, The Journal of clinical investigation.

[21]  R Beyar,et al.  Ventricular interaction and septal deformation: a model compared with experimental data. , 1993, The American journal of physiology.

[22]  G. Maurer,et al.  Quantitation of Regional Cardiac Function by Two–dimensional Echocardiography: I. Patterns of Contraction in the Normal Left Ventricle , 1983, Circulation.

[23]  I. Leusen,et al.  Depression of regional blood flow and wall thickening after brief coronary occlusions. , 1978, The American journal of physiology.

[24]  M. Yamagishi,et al.  New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies. , 1995, Journal of the American College of Cardiology.

[25]  W. McDicken,et al.  Age-related transmural peak mean velocities and peak velocity gradients by Doppler myocardial imaging in normal subjects. , 1996, European heart journal.

[26]  N B Ingels,et al.  Evaluation of Methods for Quantitating Left Ventricular Segmental Wall Motion in Man Using Myocardial Markers as a Standard , 1980, Circulation.

[27]  C. Slager,et al.  Quantitative echocardiographic analysis of global and regional left ventricular function: a problem revisited. , 1990, Journal of the American Society of Echocardiography.

[28]  Donovan,et al.  Quantitative Doppler Tissue Imaging for Assessment of Regional Myocardial Velocities During Transient Ischemia and Reperfusion , 1996 .

[29]  J. Thomas,et al.  Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy. , 1996, American heart journal.

[30]  M. Uematsu,et al.  Myocardial velocity gradient as a new indicator of regional left ventricular contraction: detection by a two-dimensional tissue Doppler imaging technique. , 1995, Journal of the American College of Cardiology.

[31]  R. Kerber,et al.  Correlation between Echocardiographically Demonstrated Segmental Dyskinesis and Regional Myocardial Perfusion , 1975, Circulation.

[32]  D G Gibson,et al.  Analysis of left ventricular wall movement during isovolumic relaxation and its relation to coronary artery disease. , 1976, British heart journal.

[33]  P. Guéret,et al.  Experimental Evaluation of the Extent of Myocardial Dyssynergy and Infarct Size by Two‐dimensional Echocardiography , 1981, Circulation.

[34]  E Picano,et al.  Stress echocardiography and the human factor: the importance of being expert. , 1990, Journal of the American College of Cardiology.

[35]  G M Hutchins,et al.  Two‐dimensional Echocardiography and Infarct Size: Relationship of Regional Wall Motion and Thickening to the Extent of Myocardial Infarction in the Dog , 1981, Circulation.

[36]  K. Isaaz,et al.  Doppler echocardiographic measurement of low velocity motion of the left ventricular posterior wall. , 1989, The American journal of cardiology.

[37]  G R Sutherland,et al.  Colour Doppler velocity imaging of the myocardium. , 1992, Ultrasound in medicine & biology.

[38]  J. G. Miller,et al.  On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging. , 1992, Journal of the American College of Cardiology.