Alternations in Intraventricular Filling Pattern by Color Doppler M-mode during Induced Myocardial Ischemia

It has been shown that regional myocardial ischemia during angioplasty is associated with retarded apical filling. To test the importance of retarded apical filling by color Doppler M-mode to detect ischemia during dipyridamole (DIP)stress echo we evaluated 29 patients (pts) (12 females, age 57±87 years).The high dose DIP (0.84 mg/kg over 10 min) was used. The color M mode record was used to calculate the duration of abnormal apical flow as measured from the onset of the QRS complex to the disappearance of color signals directed toward the apex. Echocardiographic images were compared at rest and during stress to identify the presence of new or worsening wall motion abnormalities (WMA). Fourtheen pts (group A) were designated as having coronary artery disease on the basis on WMA during the stress test and abnormal coronary anatomy. Fifteen pts (group B) without WMA in the presence of normal coronary anatomy were designated as having no coronary artery disease. All but two pts in group A developed an abnormal apical filling response to DIP stress (sensitivity 86%). In these pts the marked retardation of apical filling was detected during the ischemia (55±18 ms v 120±34 ms) (p<0.01).In Group B there were no dynamics in apical filling (specificity 100%). Color M mode Doppler imaging revealed retarded apical filling during DIP induced myocardial ischemia. This abnormal filling pattern may be a useful adjunct to WMA during DIP stress echo.