Résumé
No study has yet fully compared long axis systolic function [LASF] with wall motion analysis [WMA] of left ventricle [LV] which remains the routine method of patient evaluation despite being semi-subjective and particularly difficult to interpret in the presence of a myocardial infarction [MI] on the base line study. 1- To describe changes in LASF during dobutamine stress echocardiography [DSE] in patients with coronary artery disease [CAD]. 2- To test whether a change in LASF is more accurate than WMA for detection of significant CAD in patients with normal resting wall motion. 3- To see if LASF improves the detection of multi-vessel involvement in patients with a resting wall motion abnormality. A total of 134 subjects divided into 3 main groups; Group I: 68 patients with clinical suspicion of CAD undergoing coronary angiography; Group II: 46 patients had old MI undergoing coronary angiography; Group III: 20 normal subjects of same age and sex as a control group. They were subjected to: Clinical history taking, through physical examination, 12-leads surface ECG, chest X-ray, Echo -Doppler study at rest and during DSE for parameters of LASF of left ventricle, and coronary angiography. The mean ages, sex, heart rate of studied population were comparable with no significant difference among the three studied groups. The mean values of systolic and diastolic blood pressure presence of diabetes mellitus ejection fraction, resting wall motion abnormalities, and coronary angiography patterns were significantlly differe between patient groups and control one. In group I there were 42 [61.8%] patients had single vessel disease while in group II there were 11 [23.9%] patients had single vessel disease. There were 16 [23.5%] and 22 [47.8%] patients had two vessel disease in group I and 11 respectivelly. There were 10 [14.7%] and 13 [28.3%] patients had multi vessel disease in group I and II respectivelly. Patient groups had a highly significant group of LV reduction septal and lateral LASF parameters [amplitude, rate of shortening and Q-onset delay] than control group during DSE group I had a significant reduction of seplul and lateral LASE parameters of LV. Compared with group II during DSE. Patients had two vessel disease and patients had multiple vessel disease had a highly significant reduction in LASF parameters of LV compared with that of single vessel disease. And also, those with multiple vessel disease had a highly significant reduction in LASF parameters of LV compared with that of two vessel disease. Patients having resting wall motion abnormality had a highly significant reduction of septal and lateral walls LASF parameters compared to that patients having normal resting wall motion. 1- The LASF assessment is more reliable and accurate than WMA for the detection of CAD in our patients. 2- LASF parameters measurements were easy, reproducible with less intraobserver variations, specially in patients with poor endocardial delineation. 3- LASF parameters had a higher sensitivity, specificity and predictive values than WMA assessment in diagnosis of CAD. We recommend using of LASF parameters as a technique for detection of ischemia in patients having left bundle branch block by DSE