Diagnostic significance of tissue doppler imaging in patients with acute inferior myocardial infarction and precordial ST segment depression

ABSTRACT

To evaluate patients presenting with acute inferior myocardial infarction [IMI] and ST segment depression in the chest leads and to identify patients with anterior ischemia from those with reciprocal ECG changes using Tissue Doppler Imaging [TDI] derived variables. Cohort observational study. Department of Medicine, Sabah and Farwania Hospitals, Kuwait. One hundred and fifty patients with acute ST segment elevation IMI, stratified into Group 1105 patients with acute IMI and precordial ST segment depression and Group II 45 patients with acute IMI without precordial ST segment depression. Transthoracic echocardiography with TDI and coronary angiography. Predictive indices revealed that impaired Systolic velocity [Sm] is a predictor for coronary artery stenosis in the non-infarcted region. Sensitivity was 86%, specificity 80%, accuracy 84%, positive predictive value 88% and negative predictive value 77%. Multivariate logistic analysis revealed that the site and persistence of ST-segment depression, ST-depression > 2 mm, coronary collaterals, left circumflex coronary artery dominance and 0.2 SWM score index increment are significantly associated with impaired Sm velocity of TDI corresponding to anterior non-infarct region, [p < 0.05]. Receiver operating characteristic [ROC] curve data revealed that the best cutoff value of Sm was 7.1 cm/sec with sensitivity 86%, false positive 17%, positive likelihood ratio 4.78 and negative likelihood ratio 0.160 for prediction of likelihood of multivessel coronary artery disease. TDI can be used to identify patients with likelihood of significant coronary artery disease in the non-infarcted region after acute IMI