Deterioration in peak systolic velocity is closely related to ischaemia during angioplasty: a vectorcardiographic and tissue Doppler imaging study

Abstract

We tested the hypothesis that the extent of signs of ischaemia detected by vectorcardiography (VCG) during elective coronary angioplasty (percutaneous transluminal coronary angioplasty; PTCA) is related to systolic and diastolic myocardial velocities, as determined by tissue Doppler echocardiography. A total of 15 patients undergoing PTCA (12 men/three women; age 61+/-9 years), without prior myocardial infarction and with an ejection fraction of >50%, were included. The balloon inflation was repeated three times, with minimum intervals of 2 min between inflations. Tissue Doppler echocardiography was performed, in an apical two- or four-chamber view, before and at the end of each inflation. Peak systolic velocity, time-to-peak systolic velocity (TTP), peak early (E(m)) and late (A(m)) diastolic velocities, the E(m)/A(m) ratio and isovolumic relaxation time were measured in the basal segments of the left ventricle. VCG recordings were carried out during the whole procedure. ST vector magnitude (ST-VM) and ST change vector magnitude (STC-VM) were monitored. The total duration and area of each VCG change during inflation were calculated for each patient. Isovolumic relaxation time, peak E(m) and A(m) values and the E(m)/A(m) ratio did not change significantly during inflation. Peak systolic velocity decreased (6.7+/-2.0 to 5.3+/-1.9 cm/s; P<0.001) and TTP increased (157+/-60 to 192+/-60 ms; P<0.01) during inflation. Both STC-VM time (r=-0.68, P<0.01) and STC-VM area (r=-0.68, P<0.01) were related to peak systolic velocity during inflation. STC-VM time was also related (r=0.55, P<0.05) to the difference in peak systolic velocity during compared with before inflation. ST-VM was less closely related to peak systolic velocity. Thus the duration and degree of ischaemia, as measured by VCG, are related to peak systolic velocity in the basal segments of the left ventricle.

Myocardial velocities measured during adenosine, dobutamine and supine bicycle exercise: a tissue Doppler study in healthy volunteers

“…Alam et al (2000) studied patients following first myocardial infarction using myocardial velocity to quantify LV systolic and diastolic functions. Another study has shown that deterioration of peak systolic velocity accompanied ischaemia during angioplastic balloon inflation (Jensen et al, 2001). Another study has shown that deterioration of peak systolic velocity accompanied ischaemia during angioplastic balloon inflation (Jensen et al, 2001).…”

“…It is thus logical to presume that cardiac response to stress very much depends on the stress modality. Colour tissue Doppler information, TVI (Brodin et al, 1998), has recently been used to study systolic and diastolic functions in myocardial ischaemia (Alam et al, 2000;Jensen et al, 2001). In a recent meta-analysis, however, dipyridamole was found to have provided more 'interpretable'; results of wall motion score compared with exercise stress (de Albuquerque Fonseca & Picano, 2001).…”

Tissue Doppler, a fundamental tool for parametric imaging

“…The timescale of the findings was also validated in animal studies performed by Derumeaux et al. (1998) who showed induction of velocity disturbances already after 5 s. The response in humans to acute ischaemia was shown by Jensen et al. (2001) in a study where they measured basal anterior and septal myocardial velocities during PTCA procedures in the left anterior descending (LAD) coronary artery.…”

“…The quantitative velocity response to ischaemia was early validated in experimental studies in animals against sonomicrometric crystals (Gorcsan et al, 1998). The timescale of the findings was also validated in animal studies performed by Derumeaux et al (1998) who showed induction of velocity disturbances already after 5 s. The response in humans to acute ischaemia was shown by Jensen et al (2001) in a study where they measured basal anterior and septal myocardial velocities during PTCA procedures in the left anterior descending (LAD) coronary artery. An induction of apical ischaemia induced systolic velocity changes even in the basal segments within 30 s of occlusion.…”

Angular error in ultrasound Doppler tissue velocities and its influence on the derived variable peak systolic strain

“…The study of tissue velocities in the myocard using an apical window may seem narrow, but this is in fact frequently used for the investigation of myocardial performance [4][5][6], as well as derived variables calculated using data acquired this way [7]. Thus both corrected and non-corrected velocities have been used for calculating strain, as peak systolic strain is an easily calculated variable.…”