Published Online
on August 25, 2003

A more recent version of this article appeared on September 9, 2003

This Article Full Text (PDF) All Versions of this Article: 108/10/1214    most recent 01.CIR.0000087401.19332.B7v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Duncan, A. M. Articles by Henein, M. Y. Search for Related Content PubMed PubMed Citation Articles by Duncan, A. M. Articles by Henein, M. Y. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Cardiomyopathy Related Collections Echocardiography

Submitted on November 14, 2002
Revised on June 6, 2003
Accepted on June 10, 2003

Differentiation of Ischemic From Nonischemic Cardiomyopathy During Dobutamine Stress by Left Ventricular Long-Axis Function. Additional Effect of Left Bundle-Branch Block

Alison M. Duncan MRCP^*, Darrel P. Francis MD, Derek G. Gibson FRCP, and Michael Y. Henein MD, PhD

From the Department of Echocardiography, Royal Brompton Hospital and Imperial College, London, England.

^* To whom correspondence should be addressed. E-mail: a.duncan{at}ic.ac.uk.

Background--Resting regional wall-motion abnormalities do not reliably distinguish ischemic from nonischemic cardiomyopathy. Dobutamine stress echocardiography with use of the wall-motion score index (WMSI) identifies coronary artery disease (CAD) in dilated cardiomyopathy (DCM), but the technique is subjective and further complicated by left bundle-branch block (LBBB). Long-axis motion is sensitive to ischemia and can be assessed quantitatively. We aimed to compare long-axis function with WMSI for detecting CAD in DCM with or without LBBB.

Methods and Results--Seventy-three patients with DCM, 48 with CAD (16 with LBBB), and 25 without CAD (10 with LBBB) were studied. Long-axis M-mode, pulsed-wave tissue Doppler echograms (lateral, septal, and posterior walls), and WMSI were assessed at rest and at peak dobutamine stress. Failure to increase systolic amplitude (total amplitude minus postejection shortening) by 2 mm or early diastolic velocity by 1.1 cm/s was the best discriminator for CAD (systolic amplitude, sensitivity 85%, specificity 86%; lengthening velocity, 71% and 94%, respectively; P=NS). Both had greater predictive accuracy than did WMSI (sensitivity 67%, specificity 76%; P<0.001). The predictive accuracy of changes in septal long-axis function was similar to those of average long-axis function (systolic amplitude cutoff=1.5 mm, lengthening velocity cutoff=1.5 cm/s). However in LBBB, systolic amplitude proved to be the only significant discriminator for CAD, with sensitivity and specificity reaching 94% and 100%, respectively (P<0.01 versus early diastolic lengthening velocity).

Conclusions--Quantified stress long-axis function identifies CAD in DCM with greater sensitivity and specificity than does standard WMSI, particularly in the presence of LBBB.

Key words: coronary disease • cardiomyopathy • bundle-branch block • echocardiography • imaging

This article has been cited by other articles:

				S. V. Raman Coronary Artery or Myocyte: Wherein Lies the Diagnosis? Circ Cardiovasc Imaging, May 1, 2009; 2(3): 166 - 168. [Full Text] [PDF]

				U Sechtem, H Mahrholdt, and H Vogelsberg Cardiac magnetic resonance in myocardial disease Heart, December 1, 2007; 93(12): 1520 - 1527. [Abstract] [Full Text] [PDF]

				S. Ghostine, C. Caussin, B. Daoud, M. Habis, E. Perrier, D. Pesenti-Rossi, A. Sigal-Cinqualbre, C.-Y. Angel, B. Lancelin, A. Capderou, et al. Non-Invasive Detection of Coronary Artery Disease in Patients With Left Bundle Branch Block Using 64-Slice Computed Tomography J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1929 - 1934. [Abstract] [Full Text] [PDF]

				H. Mahrholdt, A. Zhydkov, S. Hager, G. Meinhardt, H. Vogelsberg, A. Wagner, and U. Sechtem Left ventricular wall motion abnormalities as well as reduced wall thickness can cause false positive results of routine SPECT perfusion imaging for detection of myocardial infarction Eur. Heart J., October 2, 2005; 26(20): 2127 - 2135. [Abstract] [Full Text] [PDF]

				A. M. Duncan, E. Lim, D. G. Gibson, and M. Y. Henein Effect of Dobutamine Stress on Left Ventricular Filling in Ischemic Dilated Cardiomyopathy: Pathophysiology and Prognostic Implications J. Am. Coll. Cardiol., August 2, 2005; 46(3): 488 - 496. [Abstract] [Full Text] [PDF]

				W. Li, T. S. Hornung, D. P. Francis, C. O'Sullivan, A. Duncan, M. Gatzoulis, and M. Henein Relation of Biventricular Function Quantified by Stress Echocardiography to Cardiopulmonary Exercise Capacity in Adults With Mustard (Atrial Switch) Procedure for Transposition of the Great Arteries Circulation, September 14, 2004; 110(11): 1380 - 1386. [Abstract] [Full Text] [PDF]