ACTA FAC. MED. NAISS. 2003; 20 (2): 109-113

Original article

Quantitative assessment of contractile reserve during dobutamine Doppler myocardial imaging echocardiography

Marina Deljanin Ilić, Stevan Ilić, Dragan Djordjević,  Ivan Tasić, Ljubiša Nikolić, Todorka Savić

Institute for preventiontion, treatment and rehabilitation rheumatic and cardiovascular diseases, Niška Banja 

Adresss:
Prof. dr Marina Deljanin Ilić,
Institute for preventiontion, treatment and rehabilitation rheumatic and cardiovascular diseases,
18 205 Niška Banja 

Tel. 018 541 414

E mail: marinadi@bankerinter.net

Summary
The aim of the study was to evaluate the use of pulsed wave Doppler myocardial imaging ( PW DMI ), in combination with left ventricular stimulation, using dobutamine for the identification of contractile reserve (CR) in patients after acute myocardial infarction. In the group of 54 patients, 13 ± 3 days after acute myocardial infarction low dose dobutamine echocardiography (LDDE) was performed. Contractile reserve was defined as an improvement of wall motion during LDDE in dysfunctional left ventricular segment. At baseline and after LDDE, in each adequately visualized segment, presence of postsystolic motion (PSM) was analyzed and from apical approach peak myocardial velocity (m.v.) of systolic (S), PSM, early (E) and late (A) diastolic waves were measured and ratio E/A was calculated. At baseline echocardiography 197 (35,4%) out of 556 evaluated segments were dysfunctional. At LDDE 84 (42,6%) segments in 26 (48,1%) patients demonstrated CR. Baseline values of E and S m.v. and ratio E/A were significantly higher in segments with than without CR ( P< 0,001; P< 0,005 and P< 0,001). At baseline PW DMI examination PSM was present in all segments with CR and in 8/95(8,4%) segments without CR. After LDDE in segments with CR, E m.v. increased by 15,1% (P< 0,02), S m.v. increased by 19,3% (P< 0,005) and ratio E/A increased by 9,45 (P< 0,02), while PSM  m.v. decreased by 15,4% (P< 0,01) compared to baseline values. Myocardial velocities measured at baseline and after LDDE in segments without CR did not differ significantly.

In conclusion, PW DMI allows quantitative assessment of regional systolic and diastolic m.v. and detection of CR in basal condition and during LDDE.

Key words: Contractile reserve, Doppler myocardial imaging, dobutamine echocardiography