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Late apical filling by color Doppler M-mode during dipyridamole stress echocardiography: A useful contribution to wall motion analysis
Journal o f the American Society of Echocardiography /Vlay June 1996
4:00
Abstracts
601V
Assessment of LV Function Using Signal Averaged Acoustic Quantification Waveforms Under Inotropic Interventions Victor Mnr-Avi PhD, Lynn Weinert BS, Philippe Vignon MD, Kirk T. Spencer MD, Roberto Lang MD, University of Chicago, Chicago IL
601X
Acoustic quantification (AQ) provides continuous, on-line, noninvasive measurements of LV area. However, distortion of individual AQ waveforms by noise results in wide beat-to-beat variability in measured indices of LV function. Accordingly, we developed an algorithm for the evaluation of LV function based on signal averaging of AQ waveforms. The ability of this algorithm to reflect altered inotropic states was evaluated in 8 normal subjects (age 31_+4) under (1) baseline conditions, (2) EsmoloI 12 (200 btg/kg/min), (3) Dobutamine (15 , I , btg/kg/min). LV area signals from the ~ ~ i ~ . . ./. . . ! ' ........ short axis views were used. Endsystolic and end-diastolic area (ESA ~ ",, gL and EDA), and fractional area change >' 4 Esrn (FAC) were measured from the ~] bob average waveforms. Peak ejection and o o.5 time(see} peak filling rates (PER and PFR) were obtained from the corresponding time derivatives. Results. Signal averaged AQ waveforms reflected the expected drug-induced variations in inotropic and filling characteristics of the heart (figures, p<0.05). Conclusion. Signal averaging of AQ waveforms provides an objective and reliable noninvasive quantification of LV function. 100
LATE APICAL FILLING BY COLOR DOPPLER M-MODE DURING DIPYRIDAMOLE STRESS ECHOCARDIOGRAPHY: A USEFUL CONTRIBUTION TO WALL MOTION ANALYSIS Bojan Stojnid MD PhD, Biljana Ciri6 MD, Vesela Radrmjid MD, Mijat Proovi6 MD PhD. Department of Cardiology, Military Medical Academy, Belgrade, Yugoslavia
It has been shown that regional myocardial ischemia during angioplasty is associated with retarded apical filling. To test the ability of color Doppler M-mode to detect ischemia during dipyridamole (DIP) stress echo we evaluated 29 patients (pts) (12 females, age 57:!-8 years). The high dose DIP (0.84mg/kg over 10 rain) was used. The color M-mode record was used to calculate the duration of abnormal apical flow as measured from the onset of the QRS complex to the disappearance of color signals directed toward the apex. The test was positive if there was a delay in apical filling. Echocardiographic images were compared at rest and during stress to identify the presence of new or worsening wall motion abnormalities (WMA). Fourteen pts (Group A) were designated as having coronary disease on the basis of WMA during the stress test and abnormal coronary anatomy. Fifteen pts (grup B) without WMA in the presence of normal coronary anatomy were designated as having no coronary disease. All but two pts in Group A developed an abnormal apical filling response to DIP stress (sensitivity 86%). In these pts the marked retardation of apical filling was detected during tbe ischemia(55 _+ 18 ms v 120 _+34 ms)(p< 0.05). In group B there were no dynamics in apical filling (specificity 100%). Color M-mode DoppIer imaging revealed retarded apical filling during DIP induced myocardial ischemia.This abnormal filling pattern may be a useful adjunct to WMA during DIP stress echo.
< 0
6 0 1 W ACCURACY OF PEAK ENDOCARDIAL VELOCITY BY HIGH FRAME RATE TISSUE DOPPLER IMAGING DURING DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR DETECTION OF ABNORMAL WALL MOTION William Katz MD, Vijay K Gulati MD, Christine M. Mahler MS, John Gorcsan IlI MD. University of Pittsburgh, Pittsburgh PA Segmental wall motion assessment during dobutamine stress echo (DSE) is subjective. A new high frarae rate tissue Doppler imaging (TDI) system (Toshiba SSA-380A) has been evaluated recently for quantifying abnormal wall motion during DSE. However the sensitivity, specificity, and accuracy of peak endocardial velocity by TDI to detect abnormal segmental function has not been reported. Accordingly, 55 pts had digitally acquired routine 2-D echo images and TDI images with a multicolor velocity map (range:0.5-11.5 cm/sec at 32 Hz) at rest and at peak DSE. Nineteen pts, aged 62:/-12 yrs, had abnormal studies defined as hypokinetic or akinctic segments at peak stress by 2-D criteria. Twenty-two pts, aged 58±12 yrs, who reached >85% of their age predicted HR and had a normal DSE by 2-D criteria were selected as a control group Peak HR and dobutamine dose were similar in both groups: 144:t:10vs.137±15 beats/min and 46±5 vs. 42±8 lag/kg/min, respectively. Peak endocardial velocity data were analyzed from the standard 16 segment model. Of 114 abnormal segments from the parastemal views at peak stress, the pooled segmental velocities were lower than fire corresponding normal segments: 3.0±1.4" vs.7.2±1.8 cm/sec (*p < 0.05). Of 113 abnormal segments from the apical views at peak stress, pooled segmental velocities were lower only in the basal (3.7 ±i.5" vs.7.6±1.9 crrgsec) and mid segments (3.4 ±l.4*vs. 6.4 ±2.0 cm/sec) compared to the corresponding normal segments. No significant differences in abnormal vs. normal apical velocities were observed. Sensitivity, specificity and accuracy results for a peak velocity of 5.5 era/see to identify an abnormal segment appear below: LAX SAX A4-BASE A4-MID A2-BASE A2-MID Sensitivity 100% 91% 100% 1.00% 86% 94% Specificity 86% 78% 89% 76 % 92% 59% Accuracy 91.% 83% 93% 85% 90% 70% Conclusion: Although TDI data was limited from apical segments, peak endocardial velocity by high frame TDI has potential for detecting basal and midventricular abnormal segmental wall motion during DSE.
601Y
A NEW INDEX FOR EVALUATION OF HEMODYNAMiC RESPONSE IN PATIENTS WITH AORTIC VALVE PROSTHESIS BY DOBUTAMINE ECHOCARDIOGRAPHY Sanjeev Pud, MD, Melda S. Dolan, MD, Frederick A. Dressier, MD, Jeannette A. St. Vrain, RDMS, Ramon Castello, MD, L. Michele Vaughn, RN, Dawn Gamblin, RN, Andrew Fiore, MD, Arthur J. Labovitz, MD, Saint Louis University School of Medicine, St. Louis, MO Oobutamine echocardiography (DE) has been widely utilized in evaluation of ischemic heart disease, however, little data exists in the hemodynamic response of prosthetic valves to Dobutamine. We therefore performed Dobutamine echocardiography in 47 patients (27 male and 20 female) age 64-+14 years with prosthetic aortic valves (26 MedtroNc Hall; 21 St. Jude). In each patient, we calculated the body surface area (BSA), mean and peak gradient (PG), cardiac output, heart rate at baseline and at peak tRrated dose ot Dobutamine up to a maximum 40 mg/kg/min. The valve resistance index (VRI) was calculated at base and peak infusion as the ratio of percent change in mean gradient to cardiac output. For the purpose of analysis, valves were divided by size (small < 23 mm). Heart rate increased from 71+_10to 122_+24,and other hemodynamic changes are as fogows. BSA Small 1.76+0.1 Large 2.0-+0.1 p 0.001
PG (base) rn're~
PG (peak) mmHg
26_+9 22-+9 N8
67-+35 62-+33 NS
VRI (base) 6.34-+4.7 1.97-+1.0 0.0008
VRI (peak) 11.4+10 3.9-+2.8 0.015
The VRI was significantly greater in the smaller valves. Late peaking systolic concave pattern (HOCM) was found on cardiac Doppler in only 7 of 47 patients studied, all of which were in the small group. Six of these patients had a St. Jude and one patient had a Medtronic valve. No adverse events were noted in the study. Dobutamine echocardiography is a safe method tar evaluation of prosthetic aortic valves at high flow rates. A significant difference in VRI, a new marker for vaTve resistance, was observed between the small and large prosthetic valves. The significance of HOCM pattern and its predominance in the smaller valve size needs further evaluation.
4:00
Abstracts
601V
Assessment of LV Function Using Signal Averaged Acoustic Quantification Waveforms Under Inotropic Interventions Victor Mnr-Avi PhD, Lynn Weinert BS, Philippe Vignon MD, Kirk T. Spencer MD, Roberto Lang MD, University of Chicago, Chicago IL
601X
Acoustic quantification (AQ) provides continuous, on-line, noninvasive measurements of LV area. However, distortion of individual AQ waveforms by noise results in wide beat-to-beat variability in measured indices of LV function. Accordingly, we developed an algorithm for the evaluation of LV function based on signal averaging of AQ waveforms. The ability of this algorithm to reflect altered inotropic states was evaluated in 8 normal subjects (age 31_+4) under (1) baseline conditions, (2) EsmoloI 12 (200 btg/kg/min), (3) Dobutamine (15 , I , btg/kg/min). LV area signals from the ~ ~ i ~ . . ./. . . ! ' ........ short axis views were used. Endsystolic and end-diastolic area (ESA ~ ",, gL and EDA), and fractional area change >' 4 Esrn (FAC) were measured from the ~] bob average waveforms. Peak ejection and o o.5 time(see} peak filling rates (PER and PFR) were obtained from the corresponding time derivatives. Results. Signal averaged AQ waveforms reflected the expected drug-induced variations in inotropic and filling characteristics of the heart (figures, p<0.05). Conclusion. Signal averaging of AQ waveforms provides an objective and reliable noninvasive quantification of LV function. 100
LATE APICAL FILLING BY COLOR DOPPLER M-MODE DURING DIPYRIDAMOLE STRESS ECHOCARDIOGRAPHY: A USEFUL CONTRIBUTION TO WALL MOTION ANALYSIS Bojan Stojnid MD PhD, Biljana Ciri6 MD, Vesela Radrmjid MD, Mijat Proovi6 MD PhD. Department of Cardiology, Military Medical Academy, Belgrade, Yugoslavia
It has been shown that regional myocardial ischemia during angioplasty is associated with retarded apical filling. To test the ability of color Doppler M-mode to detect ischemia during dipyridamole (DIP) stress echo we evaluated 29 patients (pts) (12 females, age 57:!-8 years). The high dose DIP (0.84mg/kg over 10 rain) was used. The color M-mode record was used to calculate the duration of abnormal apical flow as measured from the onset of the QRS complex to the disappearance of color signals directed toward the apex. The test was positive if there was a delay in apical filling. Echocardiographic images were compared at rest and during stress to identify the presence of new or worsening wall motion abnormalities (WMA). Fourteen pts (Group A) were designated as having coronary disease on the basis of WMA during the stress test and abnormal coronary anatomy. Fifteen pts (grup B) without WMA in the presence of normal coronary anatomy were designated as having no coronary disease. All but two pts in Group A developed an abnormal apical filling response to DIP stress (sensitivity 86%). In these pts the marked retardation of apical filling was detected during tbe ischemia(55 _+ 18 ms v 120 _+34 ms)(p< 0.05). In group B there were no dynamics in apical filling (specificity 100%). Color M-mode DoppIer imaging revealed retarded apical filling during DIP induced myocardial ischemia.This abnormal filling pattern may be a useful adjunct to WMA during DIP stress echo.
< 0
6 0 1 W ACCURACY OF PEAK ENDOCARDIAL VELOCITY BY HIGH FRAME RATE TISSUE DOPPLER IMAGING DURING DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR DETECTION OF ABNORMAL WALL MOTION William Katz MD, Vijay K Gulati MD, Christine M. Mahler MS, John Gorcsan IlI MD. University of Pittsburgh, Pittsburgh PA Segmental wall motion assessment during dobutamine stress echo (DSE) is subjective. A new high frarae rate tissue Doppler imaging (TDI) system (Toshiba SSA-380A) has been evaluated recently for quantifying abnormal wall motion during DSE. However the sensitivity, specificity, and accuracy of peak endocardial velocity by TDI to detect abnormal segmental function has not been reported. Accordingly, 55 pts had digitally acquired routine 2-D echo images and TDI images with a multicolor velocity map (range:0.5-11.5 cm/sec at 32 Hz) at rest and at peak DSE. Nineteen pts, aged 62:/-12 yrs, had abnormal studies defined as hypokinetic or akinctic segments at peak stress by 2-D criteria. Twenty-two pts, aged 58±12 yrs, who reached >85% of their age predicted HR and had a normal DSE by 2-D criteria were selected as a control group Peak HR and dobutamine dose were similar in both groups: 144:t:10vs.137±15 beats/min and 46±5 vs. 42±8 lag/kg/min, respectively. Peak endocardial velocity data were analyzed from the standard 16 segment model. Of 114 abnormal segments from the parastemal views at peak stress, the pooled segmental velocities were lower than fire corresponding normal segments: 3.0±1.4" vs.7.2±1.8 cm/sec (*p < 0.05). Of 113 abnormal segments from the apical views at peak stress, pooled segmental velocities were lower only in the basal (3.7 ±i.5" vs.7.6±1.9 crrgsec) and mid segments (3.4 ±l.4*vs. 6.4 ±2.0 cm/sec) compared to the corresponding normal segments. No significant differences in abnormal vs. normal apical velocities were observed. Sensitivity, specificity and accuracy results for a peak velocity of 5.5 era/see to identify an abnormal segment appear below: LAX SAX A4-BASE A4-MID A2-BASE A2-MID Sensitivity 100% 91% 100% 1.00% 86% 94% Specificity 86% 78% 89% 76 % 92% 59% Accuracy 91.% 83% 93% 85% 90% 70% Conclusion: Although TDI data was limited from apical segments, peak endocardial velocity by high frame TDI has potential for detecting basal and midventricular abnormal segmental wall motion during DSE.
601Y
A NEW INDEX FOR EVALUATION OF HEMODYNAMiC RESPONSE IN PATIENTS WITH AORTIC VALVE PROSTHESIS BY DOBUTAMINE ECHOCARDIOGRAPHY Sanjeev Pud, MD, Melda S. Dolan, MD, Frederick A. Dressier, MD, Jeannette A. St. Vrain, RDMS, Ramon Castello, MD, L. Michele Vaughn, RN, Dawn Gamblin, RN, Andrew Fiore, MD, Arthur J. Labovitz, MD, Saint Louis University School of Medicine, St. Louis, MO Oobutamine echocardiography (DE) has been widely utilized in evaluation of ischemic heart disease, however, little data exists in the hemodynamic response of prosthetic valves to Dobutamine. We therefore performed Dobutamine echocardiography in 47 patients (27 male and 20 female) age 64-+14 years with prosthetic aortic valves (26 MedtroNc Hall; 21 St. Jude). In each patient, we calculated the body surface area (BSA), mean and peak gradient (PG), cardiac output, heart rate at baseline and at peak tRrated dose ot Dobutamine up to a maximum 40 mg/kg/min. The valve resistance index (VRI) was calculated at base and peak infusion as the ratio of percent change in mean gradient to cardiac output. For the purpose of analysis, valves were divided by size (small < 23 mm). Heart rate increased from 71+_10to 122_+24,and other hemodynamic changes are as fogows. BSA Small 1.76+0.1 Large 2.0-+0.1 p 0.001
PG (base) rn're~
PG (peak) mmHg
26_+9 22-+9 N8
67-+35 62-+33 NS
VRI (base) 6.34-+4.7 1.97-+1.0 0.0008
VRI (peak) 11.4+10 3.9-+2.8 0.015
The VRI was significantly greater in the smaller valves. Late peaking systolic concave pattern (HOCM) was found on cardiac Doppler in only 7 of 47 patients studied, all of which were in the small group. Six of these patients had a St. Jude and one patient had a Medtronic valve. No adverse events were noted in the study. Dobutamine echocardiography is a safe method tar evaluation of prosthetic aortic valves at high flow rates. A significant difference in VRI, a new marker for vaTve resistance, was observed between the small and large prosthetic valves. The significance of HOCM pattern and its predominance in the smaller valve size needs further evaluation.