ABSTRACT
Introduction: stress echocardiography is a well established tool for diagnosis of patients with suspected CAD. DSE is a pharmacological stress echocardiography, which is feasible, non exercise multistage [each stage range from 3-10 min.] test promising innovation to a standard diagnostic procedure for CAD
Aim: the current study aimed at evaluating safety and accuracy of DSE in the detection of CAD in patients with LBBB
Patients and Methods: the study was conducted in forty patients had LBBB, 28 males [70%] and 12 females [30%] with their age ranged from 40 to 66 years with mean value 55.3 +/- 6.9 years. They were classified according to finding of coronary angiography into two groups: Group I: Included 25 patients [19 males and 6 females] with significant CAD. Group 11: Included 15 patients [9 males and 6 females] with normal coronary arteries. All patients underwent thorough history taking and full clinical examination, standard 12-leads resting ECG, laboratory investigations. Chest X-ray. Coronary angiography and dobutamine stress echocardiography
Results: the age of patients in both groups was comparable and there was male preponderance in both groups. The risk factors of CAD were more in-group I. The heart rate, systolic blood pressure and diastolic blood pressure increased significantly from resting to peak stress. New or worsening WMA were significantly higher in-group I. Systolic septa1 thickening was significantly impaired at peak stress in-group I. Both left ventricular end systolic and diastolic dimensions decreased with stress but there were significantly higher dimensions in group I. Regarding ejection fraction and fractional shortening they increased with stress hut become significantly higher in group II . Side effects of DSE were minimal arid transient, no major complication in the form of mortality, infarction, or serious arrhythmias have occurred. Coronary angiography detected LAD artery lesion in 18 patients [72%] RCA artery lesion in 14 patients [56%] and LCX artery lesion in 8 patients [32%] [Group I]. Sensitivity, specificity and accuracy for WMSI were 92%, 86.7% and 90% respectively and as for both positive and negative predictive value they were 92% and 86.7% respectively
Conclusion: all of these results revealed that multi stages DSE is feasible, safe, highly sensitive and specific for detection of CAD. We must assess segmental WMA, systolic thickening impairment together with left ventricular dimensions and functions which give a good insight about ischemia and functional viability in patients with LtSBB. DSE is more closely linked to the physiologic significance than anatomic appearance of the stenotic corollaries and is not affected by functional factor as coronary tone modulation or coronary vasospasm
Recommendations: 1- DSE is recommended for all patients with LBBB for diagnosis of CAD and selection of patients that are candied for further invasive procedure. 2 in LBBB patients who will undergo revascularization therapy, low dose DSE is the technique of choice to detect viability of the myocardium to determine the benefit of revascularization therapy
Clinical implications: DSE can be considered a major diagnostic tool for CAD particularly in peripheral centers where limited resources interfere with strict selection of patients to be submitted to a tertiary referral center
ABSTRACT
Background : coronary artery disease [CAD] as affecting the myocardium in a non-homogenous way, may disturb the intraventricular synchronization. This behavior could be the early mechanical dysfunction occur. The present study investigated the occurrence of regional left ventricular [LV] systolic asynchrony as an early marker for CAD diagnosis
Methods : the study included 47 patients with angiographic ally proven CAD who had nor- mal electrocardiogram [ECG] and normal LV systolic function [regional and global] and 15 healthy subjects as a control group. The following tissue Doppler imaging [TDI] derived parameters were assessed, regional systolic peak velocity [Sm]. Regional systolic times in isovolumic contraction and time to peak [Tivc and Ts] and systolic time differences of the facing walls [S-L and A-I de- lay]
Results : nineteen [40.4%] had 3 vessel disease, 16[34%] had LAD and RCA lesions and 12[25.6%] had LAD lesion only. There was no significant difference in regional Sm between CAD groups and control group [P > 0.05]. The LV of normal coronaries group during systole was highly synchronized without significant difference in regional Tivc and Ts [P > 0.05]. However, the septum was 11.8 +/- 4.8 and 13.3k1.5 msec earlier than the lateral wall and the anterior wall was earlier than the inferior wall by 13.8 +/- 2.4 and 13.1 k4.0 msec in Tivc and Ts respectively [negative values of S-L and A-I delay]. On the other hand, significant systolic LV asynchrony was observed in CAD related walls based on pro- longed Tivc and Ts [P < 0.001]. Cut off points of Tivc and Ts in msec > 76.2 and 165 for septum, > 92 and 177 for lateral, > 79.4 and 171 for anterior and > 90.4 and 181.1 for inferior wall respectively were accurate in detecting diseased related territories. Also, LV asynchrony based on reversal of normal earlier longitudinal movements of septum and anterior wall toward apex [positive S-L and A-I delay in Tivc and Ts] was evident in LAD lesion. High positive values of S-L and A-I delay [Tivc > 23.3 and > 22,Ts > 48.5 and > 44.3 msec respectively] suggested isolated LAD lesion, while lower positive values were observed in the presence of concomitant lesion of the territory supplying the facing wall
Conclusion: the systolic LV asynchrony could characterize patients with CAD even those with normal ECG and normal LV systolic function. TDI as a supplementary method to the surface ECG and conventional echocardiography is strongly recommended in CAD diagnosis
ABSTRACT
This study aimed to evaluate the diagnostic power of the simple Doppler index of the mitral/aortic flow velocity time integral [VTI] ratio to identify subjects with haemodynamically significant MR compared with three valid quantitative echocardiographic methods [regurgitant volume, fraction and orifice area]. This work studied 30 patients with MR of different grades and etiologies and 10 healthy volunteers as a control group. All were subjected to complete history taking and clinical examination, ECG, plain X-ray, complete echocardiographic and Doppler examination of the heart and determination of the severity of MR by pulsed wave Doppler [PWD]. The study found that the mitral/aortic flow VTI ratio has accepted sensitivity, specificity, P predictive value and total accuracy in quantitation of the severity of MR compared with the quantitative 2D Doppler methods used for quantitation of the severity of MR. Also, it has the advantage of being a very simple method because in the presence of MR, if the mitral/aortic flow VTI ratio is [0.82 +/- 0.12] the MR is mild, if the ratio is [1.11 +/- 0.20] the MR is moderate and if the ratio is [1.39 +/- 0.29] the MR is severe. It was concluded that the mitral/aortic flow VTI ratio has the diagnostic power to identify subjects with hacmodynamically significant MR. Also, it is a simple and accurate method that can be used for grading of MR, sensitive and valid with accepted total accuracy