Late apical filling by color Doppler M-mode during dipyridamole stress echocardiography: A useful contribution to wall motion analysis

Abstract

It has been shown that regional myocardial ischemia during angioplasty is associated with retarded apical filling. To test the importance of retarded apical filling by color Doppler M-mode to detect ischemia during dipyridamole stress echocardiography, we evaluated 29 patients (12 women, aged 57 to 87 years). High-dose dipyridamole (0.84 mg/kg for 10 minutes) 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. Echocardiographic images were compared at rest and during stress to identify the presence of new or worsening wall motion abnormalities (WMAs). Fourteen patients (group A) were designated as having coronary artery disease on the basis on WMAs during the stress test and abnormal coronary anatomy. Fifteen patients (group B) without WMAs in the presence of normal coronary anatomy were designated as having no coronary artery disease. All but two patients in group A had an abnormal apical filling response to dipyridamole stress (sensitivity 86%). In these patients the marked retardation of apical filling was detected during ischemia (55 ± 18 msec versus 120 ± 34 msec) ( p <0.01). In group B there were no dynamics in apical filling (specificity 100%). Color M-mode Doppler imaging showed retarded apical filling during dipyridamole-induced myocardial ischemia. This abnormal filling pattern may be a useful adjunct to WMAs during dipyridamole stress echocardiography. (J Am Soc Echocardiogr 1997;10:205-9.)