Review
Dobutamine Stress Echocardiography and Tissue Synchronization Imaging Dobutamin Stres Ekokardiyografi ve Doku Senkronizasyon Görüntüleme Hakan Tas1, Fuat Gundogdu2, Yekta Gurlertop2, Sule Karakelleoglu2 Department of Cardiology, Erzurum Regional Hospital, Erzurum, Turkey Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
1 2
Correspondence to: Dr. Fuat GÜNDOĞDU, Atatürk Üniversitesi, Tıp Fakültesi, Aziziye Araştırma Hastanesi, Kardiyoloji Servisi, 25070-Erzurum/TURKEY. Phone: +90.442.3166333, fax: +90.442.3166340, e-mail: [email protected]
Abstract
Özet
Dobutamine stress echocardiography has emerged as a reliable method for the diagnosis of coronary artery disease and the management of its treatment. Several studies have shown that that this technique works with 80-85% accuracy in comparison with other imaging methods. There are few studies aimed at developing the clinical utility of dobutamine stress echocardiography for the evaluation of normal and abnormal segments that result from dobutamine stress with Tissue Synchronization Imaging.
Dobutamin stres ekokardiyografi bilinen veya şüphelenilen koroner arter hastalığının hem tanı hem tedavisinde çok önemli bir tanı aracı haline gelmiştir. Geniş çalışmalar tekniğin %80-85 doğrulukla çalıştığını diğer görüntüleme yöntemleriyle karşılaştırarak ortaya koymuştur. Dobutamin strese cevap olarak oluşan normal ve anormal segmentlerin Doku Senkronizasyon Görüntüleme yöntemiyle senkronizasyonunu değerlendirip dobutamin stres ekokardiyografinin klinik kullanımını geliştirmek için az sayıda çalışma yapılmıştır.
Keywords: Ischemia, Synchronization, Stress echocardiography
Anahtar Kelimeler: İskemi, Senkronizasyon, Stres ekokardiyografi
The Eurasian Journal of Medicine
83
Tas et al.
D
obutamine stress echocardiography is a reliable, non invasive imaging method for the evaluation of ischemia. The technique enables the assessment of elderly patients limited by poor exercise capacity and decreased mobility. However, the interpretation of wall motion can be limited by the experience of the interpreter and the subjectivity of visual assessment [1]. The relationship between heart failure and myocardial synchronization has been shown using pathologic and physiologic data. Consequently, clinicians have become interested in the evaluation of myocardial dyssynchrony. The heart must keep a synchronous motion between the atrium and ventricles, between the left and right ventricles and between the different segments of the ventricles to maintain normal blood pumping function. This synchronization depends on a normal conduction system, excitation and contraction, myocardial structure and cardiac function. Because of inadequate technology, left ventricular dyssynchrony has been difficult to assess in coronary artery disease [2]. In 2004, Tissue Synchronization Imaging (TM, GE Vingmed, Horten, Norway) was developed to enable the visual assessment of left ventricular dyssynchrony. In this method, two-dimensional images are superimposed on color-coded images at the segmental velocity peak time, providing data on segmental motion. Tissue Synchronization Imaging (TSI) depends on the tissue Doppler method and automatically detects and measures positive peak velocity time (Ts) and peak velocity (Vp), color coding them and superimposing TSI images to tissue Doppler images. At the time of early myocardial contraction, myocardium achieving peak velocity is coded with green color and shows no delay (Ts 20-150 ms). Myocardium showing delayed motion is coded with yellow or red according to the degree of Vp delay, with a moderate degree of delay in yellow (Ts 150-300 ms), and a serious delay seen in red (Ts 300-500 ms) [3]. Using Tissue Synchronization Imaging to compare opposite segmental delays in apical images higher than 65 ms, a sensitivity of 87% and a specificity of 100% were achieved in assessing the
response to cardiac resynchronization therapy. The Tissue Synchronization Imaging method was reported to be an easy and reliable method for detecting segmental dyssynchrony. The combination of Dobutamine Stress Echocardiography and Tissue Synchronization Imaging could increase the sensitivity for detecting ischemia. However, some studies have not used TSI for detecting segmental dyssynchrony caused by ischemia and hypoxia. Studies investigating the effects of pacing-induced tachycardia, exercise or pharmacological stress on ventricular dyssynchrony have yielded conflicting results. In a study of patients with non ischemic left ventricular systolic dysfunction, pacing-induced tachycardia increased left ventricular dyssynchrony. A study by Valzania et al. that included 65 patients with heart failure reported a lack of increase in dyssynchrony indices. These measurements, obtained by dobutamine stress echocardiography, were not corrected for heart rate in patients with QRS>130 ms undergoing cardiac resynchronization therapy [4]. Neither Hummel et al. nor Da Costa et al. reported the effects of stress on dyssynchrony in heart failure patients with QRS
Dobutamine Stress Echocardiography and Tissue Synchronization Imaging Dobutamin Stres Ekokardiyografi ve Doku Senkronizasyon Görüntüleme Hakan Tas1, Fuat Gundogdu2, Yekta Gurlertop2, Sule Karakelleoglu2 Department of Cardiology, Erzurum Regional Hospital, Erzurum, Turkey Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
1 2
Correspondence to: Dr. Fuat GÜNDOĞDU, Atatürk Üniversitesi, Tıp Fakültesi, Aziziye Araştırma Hastanesi, Kardiyoloji Servisi, 25070-Erzurum/TURKEY. Phone: +90.442.3166333, fax: +90.442.3166340, e-mail: [email protected]
Abstract
Özet
Dobutamine stress echocardiography has emerged as a reliable method for the diagnosis of coronary artery disease and the management of its treatment. Several studies have shown that that this technique works with 80-85% accuracy in comparison with other imaging methods. There are few studies aimed at developing the clinical utility of dobutamine stress echocardiography for the evaluation of normal and abnormal segments that result from dobutamine stress with Tissue Synchronization Imaging.
Dobutamin stres ekokardiyografi bilinen veya şüphelenilen koroner arter hastalığının hem tanı hem tedavisinde çok önemli bir tanı aracı haline gelmiştir. Geniş çalışmalar tekniğin %80-85 doğrulukla çalıştığını diğer görüntüleme yöntemleriyle karşılaştırarak ortaya koymuştur. Dobutamin strese cevap olarak oluşan normal ve anormal segmentlerin Doku Senkronizasyon Görüntüleme yöntemiyle senkronizasyonunu değerlendirip dobutamin stres ekokardiyografinin klinik kullanımını geliştirmek için az sayıda çalışma yapılmıştır.
Keywords: Ischemia, Synchronization, Stress echocardiography
Anahtar Kelimeler: İskemi, Senkronizasyon, Stres ekokardiyografi
The Eurasian Journal of Medicine
83
Tas et al.
D
obutamine stress echocardiography is a reliable, non invasive imaging method for the evaluation of ischemia. The technique enables the assessment of elderly patients limited by poor exercise capacity and decreased mobility. However, the interpretation of wall motion can be limited by the experience of the interpreter and the subjectivity of visual assessment [1]. The relationship between heart failure and myocardial synchronization has been shown using pathologic and physiologic data. Consequently, clinicians have become interested in the evaluation of myocardial dyssynchrony. The heart must keep a synchronous motion between the atrium and ventricles, between the left and right ventricles and between the different segments of the ventricles to maintain normal blood pumping function. This synchronization depends on a normal conduction system, excitation and contraction, myocardial structure and cardiac function. Because of inadequate technology, left ventricular dyssynchrony has been difficult to assess in coronary artery disease [2]. In 2004, Tissue Synchronization Imaging (TM, GE Vingmed, Horten, Norway) was developed to enable the visual assessment of left ventricular dyssynchrony. In this method, two-dimensional images are superimposed on color-coded images at the segmental velocity peak time, providing data on segmental motion. Tissue Synchronization Imaging (TSI) depends on the tissue Doppler method and automatically detects and measures positive peak velocity time (Ts) and peak velocity (Vp), color coding them and superimposing TSI images to tissue Doppler images. At the time of early myocardial contraction, myocardium achieving peak velocity is coded with green color and shows no delay (Ts 20-150 ms). Myocardium showing delayed motion is coded with yellow or red according to the degree of Vp delay, with a moderate degree of delay in yellow (Ts 150-300 ms), and a serious delay seen in red (Ts 300-500 ms) [3]. Using Tissue Synchronization Imaging to compare opposite segmental delays in apical images higher than 65 ms, a sensitivity of 87% and a specificity of 100% were achieved in assessing the
response to cardiac resynchronization therapy. The Tissue Synchronization Imaging method was reported to be an easy and reliable method for detecting segmental dyssynchrony. The combination of Dobutamine Stress Echocardiography and Tissue Synchronization Imaging could increase the sensitivity for detecting ischemia. However, some studies have not used TSI for detecting segmental dyssynchrony caused by ischemia and hypoxia. Studies investigating the effects of pacing-induced tachycardia, exercise or pharmacological stress on ventricular dyssynchrony have yielded conflicting results. In a study of patients with non ischemic left ventricular systolic dysfunction, pacing-induced tachycardia increased left ventricular dyssynchrony. A study by Valzania et al. that included 65 patients with heart failure reported a lack of increase in dyssynchrony indices. These measurements, obtained by dobutamine stress echocardiography, were not corrected for heart rate in patients with QRS>130 ms undergoing cardiac resynchronization therapy [4]. Neither Hummel et al. nor Da Costa et al. reported the effects of stress on dyssynchrony in heart failure patients with QRS
