Predictive accuracy of tissue Doppler imaging for assessment of noninfarct myocardial region in patients with acute myocardial infarction.

Objectives: To investigate the value of pulsed tissue Doppler imaging (TDI) in order to predict significant coronary artery stenosis supplying the noninfarct region in patients after acute anterior myocardial infarction.

Subjects And Methods: Transthoracic echocardiography and coronary angiography were performed on 220 patients with acute anterior myocardial infarction. The TDI-derived variables of the mitral valve annulus in the noninfarct region, systolic velocity (Sm), early diastolic velocity (Em) and late diastolic velocity (Am), were estimated in centimeters per second, and the Em/Am ratio was calculated.

Results: Predictive indices revealed that the impaired TDI-derived variables, Sm, Em, Am and the Em/Am ratio, were an indicator for predicting significant coronary stenosis in the noninfarct region. Multivariate analysis revealed that the impaired Sm and Em velocities were significantly associated with age of the patients, coronary collaterals and infarct-related artery stenosis (p < 0.05). Receiver-operating characteristic curve data of TDI-derived variables for prediction of significant coronary stenosis revealed that the cut-off values of Sm, Em, Am and Em/Am ratio were 7.2 cm/s, 6.4 cm/s, 12.1 cm/s and 0.56, respectively. The kappa coefficient value indicated that there was an agreement between coronary angiography and the TDI-derived variables Sm, Em, Am and Em/Am ratio in noninfarct regions (kappa = 0.770, 0.731, 0.693 and 0.679, respectively). There was a significant correlation between the severity of coronary artery stenosis (independent variable) and impaired Sm and Em/Am ratio (dependent variables), y = 11.5 - 0.05x, r = -0.902, (p < 0.05), and y = - 0.14x + 1.87, r = -0.754, (p < 0.05), respectively.

Conclusion: TDI can be used to identify patients with significant stenosis of the coronary arteries supplying the noninfarct region and consequently may be helpful in considering patients for coronary angiography in the early postinfarction period.