Evaluation of Myocardial Tissue Doppler Echocardiography as a Predictor
for Recovery of Left Ventricular Function after Percutaneous Coronary
revascularization for Patients with Coronary Artery Disease
Abstract
Background: Trials postulate that analysis of pre-ejection velocities is
closely sensitive to blood supply. Tissue velocities declines with
reduced regional perfusion and recover on reperfusion. Accordingly,
tissue doppler imaging (TDI) can predict myocardial function recovery
after revascularization. Purpose: To assess the value of Tissue Doppler
Imaging echocardiography in predicting recovery of myocardial function
after percutaneous coronary revascularization in patients with coronary
artery disease (CAD). Methods: 27 patients with CAD based on coronary
angiography were prospectively studied. Echocardiography with 2D
measurements, global systolic function and longitudinal myocardial
velocities; (IVCPv, S wave, AT, IVCT, CT and IVRT) of the affected
segments were recorded 24 hours before revascularization and 6 months
after revascularization. Functional recovery was defined as increase in
LVEF by ≥5 %. Results: All patients underwent PCI. Most of TDI
parameters changed significantly with revascularization, however only
mean IVCPv and S wave of dysfunctional segments at rest correlated
significantly with recovery of global systolic function. Mean
IVCPv> 2.8 cm/sec and mean S wave > 4.6 cm/sec
at baseline are an objective indicator of global systolic function
recovery with sensitivity, specificity and accuracy for IVCPv (85%,
70%, 79% respectively) and PPV was estimated to be 80% (AUC=0.789,
CI=0.603 -0.975, P value=0.02), while for S wave (87%, 77%, 83%
respectively) and PPV was 87% (AUC=0.833, CI=0.664 -1.000, P
value=0.007). Conclusions: The resting pattern of IVCPv & S wave by TDI
accurately predicts the recovery of global systolic function with high
PPV but not the regional function after revascularization in patients
with CAD.