Isovolumic but not ejection phase doppler tissue indices detect left ventricular dysfunction caused by coronary stenosis

BackgroundIsovolumic acceleration (IVA) obtained by tissue Doppler echocardiography (TDE) is a sensitive and relatively load-independent index for assessing systolic ventricular function. IVA also has the ability to describe the force-frequency relationship during incremental atrial pacing in vivo.ObjectiveWe sought to assess the ability of IVA to detect global left ventricular (LV) dysfunction induced by coronary constriction.MethodsIn 6 open-chest anesthetized pigs we examined right ventricular and LV long-axis function by TDE (4-chamber view) with simultaneous invasive measurements of intraventricular pressure, maximum dP/dt, minimum dP/dt, and τ by microtip catheter. A pneumatic cuff was placed around the proximal portion of left anterior descending coronary artery (LAD) and distal flow was monitored by transonic flow probe. Mean arterial pressures were monitored by indwelling cannula. Baseline studies assessed force-frequency relationships with TDE and invasive measurements during incremental pacing from 100 to 200/min (20/min increments every 10 minutes). The protocol was repeated 10 minutes after balloon inflation to reduce LAD blood flow by 50%.ResultsCompared with baseline, LV pressure decreased significantly (P = .03, 2-way analysis of variance) as did maximum dP/dt (P <.004) with LAD constriction. At the same time IVA and isovolumic velocity at the LV free wall were significantly reduced (P <.002 and P = .04, respectively) and both IVA and isovolumic velocity were correlated with dP/dt (r = 0.45, P <.002, and r = 0.35, P <.02, respectively). TDE systolic indices were unchanged in the right ventricle.ConclusionIVA detects changes in global LV systolic function during LAD constriction and may be a useful clinical tool to diagnose ischemia.