937-1Color Doppler M-Mode Assessment of Flow Velocity Propagation During Early Filling; A Useful Adjunct to Wall Motion Analysis During Dobutamine Stress Echocardiography

Abstract

Flow velocity propagation (FVP) during early left ventricular (LV) filling correlates with LV relaxation and has been shown to be a sensitive index of ischemia during angioplasty. To test the ability of color Doppler M-mode to detect ischemia during dobutamine (Db) stress echo we prospectively evaluated 26 pts (13 females. age 61 ± 13 y). FVP was evaluated in digitally acquired recordings of color Doppler M-mode as the slope of the color/non-color (black to red) transition of transmitral flow during early filling, at rest and with each increment of Db. An abnormal FVP response was defined by reduction of the slope with increase of Db dose. Digitized echo images were compared at rest and during stress to identify the presence of new or worsening wall motion abnormalities (WMA). Nine pts (group A) were designated as having coronary disease on the basis of WMA. typical angina and ST depression. and abnormal coronary anatomy. Seventeen pts (group B) without WMA in the presence of normal coronary anatomy or low ( < 10%) pretest probability of disease were designated as having no curonary disease. All pts in group A developed an abnormal FVP response to Db stress (sensitivity 100%). In group B, 7 of 17 pts without coronary disease presented an abnormal response as evaluated by FVP (specificity 59%). Of the false positive group. 86% had echocardiographic evidence of left ventricular hypertrophy, with a strain pattern by EKG. compared with only 30% in the true negative group (p < 0001). i) Color Doppler M-mode is very sensitive to ischemia during dobutamine stress echo, ii) Other conditions as left ventricular hypertrophy with strain pattern can produce the same response, iii) Color Doppler M-mode evaluation of diastolic function may be a useful tool during dobutamine stress echo.