Th e inclusion of IVUS-guided PCI has yet to become a routine approach in invasive cardiology

Slika 3. Desna koronarna arterija (RCA) bez restenoze unutar stenta. Slika 4. Potpun protok TIMI III u distalnoj RCA nakon implantacije dva BMS stenta.

A clear distinction between two of the most common forms of dilated cardiomyopathy is very important due to their diff erent prediction and therapeutic approaches. Dobutamine stress echocardiography appears to be a noninvasive selection method due to its clear diff erentiation potential. Major factors infl uence test interpretation, resulting in a wide interval of diagnostic accuracy for this test. Fraction fl ow reserve (FFR) is a novel invasive method for estimating coronary artery stenosis responsible for myocardium ischaemia. Decisions about lesion signifi cance in coronary blood vessels have thus far been based on angiographic estimations, but this approach is being replaced by FFR measurements, which serve as a new gold standard and involve a noninvasive test. Th e goal of this study was to clearly diff erentiate two forms of dilated cardiomyopathies through analysis of the segmented mobility of the left ventricular wall. Fifty patients were analysed: 20 with ischaemic dilated cardiomyopathy, which was confi rmed not only through coronary angiography but also functionally through FFR measurement, and 30 patients with nonischaemic dilated cardiomyopathy, which was confi rmed by coronary angiography. A standard dobutamine stress echocardiography protocol was implemented. A positive dobutamine stress echocardiography test was defi ned as the presence of emerging incidents in segment contractility or worsening of existing incidents in at least one segment. Statistically relevant diff erences in the movement dynamics of a number of diff erently characterised segments during the observed time intervals (ANOVA p=0.000) was noted in both groups of patients, as was variation in the index value of the summarized mobility of the left chamber wall. In patients with ischaemic cardiomyopathies, regional contractility worsened at the maximum dose of dobutamine; in contrast, this feature slightly improved in nonischaemic cardiomyopathy patients. Th e results indicate that by analysing segmental motion, these two forms of dilated cardiomyopathies can be diff erentiated with high sensitivity (Sn=90%) and specifi city (Sp=98%), which can be interpreted as concrete evidence of truly ischaemic lesions in coronary blood vessels.