BACKGROUND: Although important advances in echocardiographic images have taken in the last 15
years, clinical evaluation of segmental function must rely on visual assessment. Recent studies have shown
that Doppler Tissue Imaging (DTI) can be used to evaluate the regional LV wall motion dynamics in thc
cardiac cycle quantitatively. Myocardial Velocity Gradient (MVG) has potential for the quantitative
assessment of regional Left Ventricular (LV) contraction abnormalities in patients with Ischemic Heart
Disease (IFID).
OBJECTIVE: The aim of this study was to determine whether MVG, assessed by pulsed wave DTI
could be of clinical relevance and represent reliable indicators of regional LV function after successful
myocardial revascularization.
PATIENTS AND METHODS: Thirty five Patients with IHD undergoing PCI or CABG were
studied. They were divided into two Groups: group (1) included 20 Patients which subdivided into 3
subgroups according to target vessel: subgroup (A): included 7 Patients to whom PCI were done for LAD,
subgroup (B): included 7 Patients to whom PCI were done for LCX, subgroup (C): included 7 Patients to
whom PCI were done for LAD & LCX. Group (II) included 15 Patients to whom CABG were done.
Conventional 2D Echo and pulsed wave DTI were obtained from 16 segments of LV in different views and
Segmental wall Motion Score (SWMS) and MVG were measured in the 16 segments of LV. MVG was
measured as the slope of regression line of the velocity profile across the myocardial wall in systole, its
normal range from 1- 3.851'.
RESULTS: SWMS of Group (1) before and after PCI. there was significant decrease in SWMS after
PCI. In Subgroup (A), the mean of SWMS in the anterior %van was (2.85 VS 1.80 with P value <0.01), in
the septal wall was (2 VS 1 with P value <0.01) and in the anteroseptal wall was (2.14 VS 1.35 with P
value <0.05), in Subgroup (B), the mean of SWMS in the inferior wall was (2.7 VS 1.7 with P value <0.01) and in
the lateral wall was (2 VS 1.2 with P value (0.05), in Subaroup(C), the mean of SWMS in the inferior wall was
(2.1 VS 1.4 with P value <0.01), in the lateral wall was ( -.5 vs 1.5 with P value <0.01), in the anterior wall was
(2.3 VS 1.43 with P value <0.05), in the septum was (1.92 VS 1.61 with P value <0.05) and in the anteroseptal wall
was (2 VS 1 with P value <0.01). In Group (II), the mean of SWMS in the anterior wall was (1.76 VS 1.22 with
P value <0.05), in the inferior wall was (1.58 VS 1.1 with P value <0.01), in the lateral wall was (1.11 VS 1.1
with P value > 0.05), in the septum was (1.42 VS 1.05 with P value <0.05), in the anteroseptal wall was (1.31
VS 1.1 with P value <0.05) and in the posterior wall was (1.04 VS I with P value> 0.05).
Mean MVG Pre and post PCI (group I) was measured in systole. In PT's underwent PCI of the LAD,
(sugroup A) there was a significant increase in the anterior wall (0.81±2111VS 1.410.4311 with P value
<0.01), ni the septum (0.8910.591' VS 1.34±0.431' with P value <0.05) and in the anteroseptal wall (1.53
0.51s VS 1.861 0.421 with P value <0.01). In patients underwent PCI of the LCX, (sugroup B) there
was an improvement in the inferior wall (0.82 ±0.2111 VS 1.5110.16r with P value <0.01) and in the
lateral wall (1.0310.7411 VS 1.2110.231' with P value <0.05). In patients underwent PCI of the IAD &
LCX, (sugroup C) there was an improvement in the inferior wall (0.9110.3011 VS 1.3510.25s- with P
value <0.05), in the lateral wall (1.1110.4811 VS 1.5310.2711 with P value <0.05), in the anterior wall
(0.9710.311' VS 1.3110.5311 with P value <0.05), in the maim was (1.02,10.2311 VS 1.2010.17s-1 with P
value <0.05) and in the anteroseptal wall (1.1210.391' VS I 51±0.37s” with P value <0.05).In patients
undergoing CABG (Group II) there was a significant increase in the anterior wall (1.1 10.2 s" VS
: 13510.62s-1 with P value <0.01), in the infsrior wall (0.8810.211' VS 151±0.27s with P "due 3:0.01), in ths
lateral wall (0.791-0.1811 VS 1.6310371' with P value < 0.Q1),in the septum (1.1110.42s ' VS 1.5110.29s '
with P value <0.01), in the anteroseptal wall (1.1710.381' VS 1.8910.3611 with P value <0.01) and in the
posterior wall (1.2310.681' VS 2.1210.7211 with P value <0.01),
CONCLUSION: Thus MVG allows the detection of early improvement in regional LV function after
the release of ischemia by successful PCI & CABG. These changes may preceed changes in SWM. |
