| Abstract: |
Diagnosis of coronary artery disease CAD is of importance in the contemporary society of ever-increasing CAD (Bonow et al., 2002). Tissue Doppler imaging (TDI) is a new echocardiographic technique well suited for the evaluation of longitudinal myocardial function, which is suspected to be initially affected in various cardiac diseases. Clinical studies have shown that TDI provides diagnostic and prognostic information incremental to conventional echocardiography in some cardiac diseases, although the primary TDI measure remains to be established. Conventional echocardiography is a strong predictor of death even in the general population, but whether preclinical left ventricular dysfunction by TDI has prognostic significance is unknown (Wang et al., 2003).Isovolumic relaxation velocity (VIR), Postsystolic motion or postsystolic shortening (PSS) is a delayed ejection motion of the myocardium occurring after the aortic valve closure during a generally prolonged isovolumic relaxation time, which is related with myocardial ischemia in human (Kulkulski et al., 2003 and Song et al., 2004) and in experimental studies (Skulstad et al., 2002). Spectral tissue Doppler imaging (TDI) is a simple echocardiographic technique that can provide velocity measurement of the myocardial segments (Garcia et al., 1996). A positive myocardial velocity during isovolumic relaxation phase (VIR) detected by TDI, which corresponds to postsystolic motion or PSS, has been shown to indicate severely ischemic myocardium (Edvardsen et al., 2002). So, detection of positive VIR by spectral TDI may be used as a noninvasive, nonprovocative method to predict possible CAD; specially for those with coexisting morbidities, such as peripheral artery disease in the lower limb, orthopedic diseases. This study was carried out in Cardiology Department, Zagazig University from April 2011 to December 2012. The study included: 80 patients; 41 females (51%) & 39 males (49%)) with typical ischemic chest pain and no regional wall motion abnormalities detected by resting echocardiography. Patients were divided into 2 groups according to presence of significant coronary artery lesion by coronary angiography; group A (patients with CAD) and group B (patients without CAD). All patients were subjected to all of the following 1Complete history taking 2)Thorough physical examination3)12- lead surface ECG 4)Plain X- ray chest and heart5) Echo-cardiographic evaluation6 TDI: All the following parameters were measured by TDI; 5 peak velocities during; Isovolumic contraction phase (VIC), Systolic ejection phase (S’), Early diastolic relaxation phase (Em), Atrial contraction phase (Am) and Isovolumic relaxation phase (VIR) if present and VIR time. Then coronary angiography was done for all patients7)Cardiac catheterization: Left sided cardiac catheterization study was done for the first 2 groups of patients using retrograde percutaneous transfemoral technique. The data were coded, entered and checked to SPSS file using SPSS version 12-computer package RESULTS: As regard to presence of VIR velocity, there was significant difference between group A and group B at mid septal and anterior walls, highly significant difference (<0.001) at basal septal and anterior walls. There was highly significant difference between group A and B at mid and basal lateral and inferior walls. There was highly significant correlation between coronary angiography and VIR velocity regarding detection of positive and negative cases and also there was highly significant correlation between previous 2 tests by Kappa test p value (<0.001). detected by spectral tissue Doppler imaging is a useful indicator of CAD in patients with apparently normal left ventricular contraction and chest pain At the present time, tissue Doppler velocity imaging can be recommended for clinical use, especially the pulsed mode for detection of significant CAD. But needs further refinement before it is ready for routine clinical use .Wider use for more segments of the myocardium, to predict presence of significant CAD, to go side by side with coronary angiography.
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