Usefulness of tissue velocity imaging technique in the detection of multi vessel coronary artery disease during dobutamine stress echocardiography

Abstract

Dobutamine stress echocardiography (DSE) often failed to diagnose multi vessel coronary artery disease because DSE is usually terminated at the first appearance of new wall motion abnormality. To clarify feasibility for diagnosing two vessels disease during DSE, we performed DSE using tissue velocity imaging (TVI) in 28 patients with angina pectoris who did not have LV asynergy at rest. Twenty patients had either left anterior descending coronary artery (LAD) disease (n=10) or right coronary artery (RCA) disease (n=10), and 8 had both LAD and RCA lesions (2-VD). Apical 4and 2-chamber views were obtained by TVI before and during low dose (10mcg/kg/min) DSE. Peak myocardial velocities of systole, early and late diastole were measured by TVI at the basal and mid segment in the septal and inferior wall. The differences of time intervals from R-wave on electrocariogram to peak of early diastolic myocardial velocity in the same cardiac cycle between basal and mid segment in the septal and inferior wall (dT-S, dT-I: ms) were also measured. Results: During low dose DSE, dT-S in LAD disease and dT-I in RCA disease were prolonged (25±14ms→52±15ms, 26±14ms→55±18ms, p 30ms in both dT-S and dT-I for diagnosing two vessels disease was 89%. Conclusions: During dobutamine infusion, regional diastolic asynchrony was observed at both the septum and the inferior wall before the appearance of new wall motion abnormality in 2-VD. DSE with TVI might be a useful technique for detecting coronary artery disease even in multi vessel disease.