Quantitative analysis of myocardial response to dobutamine by measurement of left ventricular wall motion using omnidirectional M-mode echocardiography

• Published in: The American journal of cardiology 1999-03, Vol.83 (5), p.765-769
• Main Authors: Iwado, Yasuyoshi, Mizushige, Katsufumi, Watanabe, Kazufumi, Ueda, Takashi, Furumoto, Wataru, Nozaki, Shiro, Sakamoto, Seiji, Ohmori, Koji, Matsuo, Hirohide
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Agonists - administration & dosage; Angina Pectoris - diagnostic imaging; Biological and medical sciences; Cardiology; Cardiovascular disease; Cardiovascular system; Collateral Circulation - drug effects; Coronary Angiography; Coronary Circulation - drug effects; Coronary Disease - diagnostic imaging; Dobutamine - administration & dosage; Drug therapy; Echocardiography; Female; Heart - drug effects; Humans; Incidence; Infusions, Intravenous; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Myocardial Contraction - drug effects; Myocardial Ischemia - diagnostic imaging; Pharmacology; Physical Exertion; Radiopharmaceuticals; Stress; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Ultrasonic investigative techniques; Ventricular Function, Left - drug effects
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00986-2

Although dobutamine stress echocardiography is important for assessing cardiac ischemia and viability, analysis of wall motion is qualitatively performed. We quantitatively evaluated left ventricular wall motion using a newly developed omnidirectional M-mode echocardiography that can depict the M-mode at the site of region of interest on the 2-dimensional image in real time, and established its usefulness for analyzing the myocardial response to dobutamine infusion. Dobutamine stress echocardiography with omnidirectional M-mode was performed in 57 patients with coronary lesions. In 38 of these patients, exercise stress single-photon emission computed tomographic thallium scintigraphy (Tl-201 SPECT) was performed. Endocardial excursion of 103 regions was measured from omnidirectional M-mode at baseline, low-dose (6 μg/kg/min), and at peak dose (30 μg/kg/min) dobutamine. A decrease and increase in wall excursion was scored (from −3 to 3) for a changes of every 2 mm, and a quantitative wall motion score (QWMS) was calculated as a summation of the scores from baseline to low dose and from low to peak doses. Quantitative coronary stenosis score (QCSS) was calculated as a summation of stenotic and collateral scores. The stenosis scores were graded as: 1 = 0% to 50%, 2 = 50% to 75%, 3 = 75% to 90%, 4 = 90% to 95%, 5 = 95% to 100%; collateral scores were graded as: −1 = poor collateral, −2 = good collateral. Based on the QWMS at each dose of dobutamine, the serial changes in wall motion were divided into 4 groups: augmented, biphasic, no change, and worsening. The QCSS was clearly different among these groups. QWMS was significantly correlated with QCSS (r = 0.657, p