Relation between Doppler transmitral flow and wall motion abnormalities during dipyridamole echocardiography in coronary artery disease

Journal of Clinical and Basic Cardiology 2000; 3 (1): 47-51

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Keywords: Dipyridamol-Echokardiographie,  myokardiale Ischämie,  transmitrale Dopplerechokardiographie,  dipyridamole echocardiography,  Doppler transmitral flow,  myocardial ischaemia

Myocardial ischaemia impairs left ventricular relaxation phase and diastolic function. Pulsed wave Doppler transmitral flow velocities have been proposed as a useful non-invasive tool to examine left ventricular diastolic function. With the present study we sought to evaluate whether changes in Doppler transmitral flow profile are related to the severity and extent of dipyridamole-induced wall motion abnormalities in patients with coronary artery disease. Thirty-five patients (mean age 61.3 ± 12 years, 21 men) with known coronary artery disease (>= 75 % in one or more vessels) underwent Dipyridamole Stress Echocardiography (DSE). Doppler-derived transmitral flow velocities were recorded at rest and immediately after drug infusion. At the same times wall motion score index (WMSI) was also calculated. E/A ratio decreased during dipyridamole infusion in 20 patients (group A) and increased in 15 patients (group B). The 2 groups resulted homogeneous with respect to demographic, echocardiographic and angiographic variables; however in group A 16 patients (80 %) had a positive DSE compared to 3 patients (20 %, p < 0.001) in group B. In group A time to ischaemia was lower (7.6 ± 3 vs. 10.1 ± 0.4 minutes, p < 0.01) and WMSI at peak was greater (1.43 ± 0.29 vs. 1.12 ± 0.15, p < 0.001) than in group B. The WMSI at peak was also lower in those 3 patients with positive DSE and increased E/A ratio compared to the positive DSE patients with reduced E/A ratio (1.27 ± 0.03 vs. 1.51 ± 0.27, p < 0.05). Finally, 8 patients (40 %) in group A and none in group B had an ischaemic response to low dose dipyridamole infusion (p < 0.01). A significant negative correlation was observed between the induced changes in wall motion abnormalities and the decrease in E/A ratio during dipyridamole infusion (r = -0.72, p < 0.0001) In patients with coronary artery disease a reduced E/A ratio during dipyridamole stress echocardiography is often associated with a positive ischaemic response and is related to the severity and extent of induced wall motion abnormalities. J Clin Basic Cardiol 2000; 3: 47-51.