Value Of Doppler Imaging In Quantification Of Regional Left Ventricular Function In Patients With Ischemie Cardiomyopathy

SummaryDobutamine stress echocardiography (DSE) is widely used to predict reversible left ventricular dysfunction, but evaluation by this method is subjective.The recently developed tissue Doppler imaging (TDI) may permit objective and quantitative assessment of changes in wall motion induced by DSE.The purpose of this study is to detect whether there is difference in viability in the patients with ischemic cardiomyopathy with previous history of Q or non Q-wave myocardial infarction using WMS, WMSI and TDI during rest and low dose DSE.The study included 40 patients with ischemic cardiomyopathy and previous history of Q-wave and non Q-wave myocardial infarction and with documented significant left ventricular dysfunction (LVEF<45)It’s divided into two groups; group (A) patients with Q-wave MI included 25 patients; 20 males (80%) and 5 females (20%) with age range from 46 years to 70 years with mean value of (58.3±52) and group (B) patients with non Q-wave MI included 15 patients; 11 males (73.3%) and 4 females (26.7%) with age range from 48 years to74 years with mean value of (59±7.1) years. Every group is subdivided into 2 subgroups according to viability:• Subgroup A1: Q-wave MI and viable myocardium• Subgroup A2: Q-wave MI and non viable myocardium• Subgroup B1: Non Q-wave MI and viable myocardium• Subgroup B2: Non Q-wave MI and non viable myocardiumAll patients subjected to careful history taking and clinical examination, 12 lead surface ECG, chest x-ray, resting echocardiographic study, low dose DSE with assessment of LV WMS and WMSI at rest and low dose DSE, TDI with measurement of SV, E, A velocity for each region at rest and at low dose DSE.This study showed there was non significant difference between both groups A and B as regard the incidence of viable myocardium assessed by WMSI, TDI at rest and low dose DSE.This study showed that there was significant difference between subgroups A1 and A2 as regard the incidence of viable myocardium assessed by TDI at rest and LDDSE.Also it showed that there was significant difference between subgroups B1 and B2 as regard the incidence of viable myocardium assessed by TDI at rest and LDDSE.So, we recommend that all patients with ICM and history of either Q wave or non Q wave MI must be treated with the same level of importance as regard revascularization.Conclusion and RecommendationsFrom this study we can concluded that among patients with LV dysfunction due to ischemic cardiomyopathy with Q and non Q-wave MI, the Q waves on the ECG does not indicate more severe dysfunction and myocardial contractile reserve was comparable in Q-wave and non Q-wave dysfunction myocardium. That is to say that incidence of viable myocardium was the same and showed non significant difference in patients with Q and non Q wave myocardial infarction (MI) as shown in our study by assessment of viability using low dose DSE and TDI at rest and LDDSE, so we recommended that all patients with ICM and history of either Q wave or non Q wave MI must be treated with the same level of importance as regard revascularization.