Key result
Patients with coronary artery disease (DSE positive) had a higher prevalence of abnormally symmetric aortic outflow profiles (27.3%) compared to DSE negative patients (2.9%) and healthy controls (0%).
Why the study?
Does decreased contractility in coronary artery disease change aortic outflow timing and profile symmetry?
Observational (n=111)
No
Does decreased contractility in coronary artery disease change aortic outflow timing and profile symmetry?
Absolute Event Rate: 27.3% vs 2.9%
Decreased myocardial function in coronary artery disease results in a more symmetrical aortic outflow velocity profile, suggesting outflow symmetry could serve as a non-invasive marker of contractility.
May support outflow symmetry as a marker of contractility in CAD; leaves open its adoption without prospective validation.
AIMS: Myocardium contracts in the beginning of ejection causing outflow acceleration, resulting in asymmetric outflow velocity profiles peaking around one-third of ejection and declining when force development declines. This article aimed to demonstrate that decreased contractility in coronary artery disease (CAD) changes outflow timing and profile symmetry. METHODS AND RESULTS: Seventy-nine patients undergoing routine full dose dobutamine stress-echo (DSE) were divided into two groups based on resting wall motion and DSE response: DSE negative (DSE(neg)) (35 of 79 patients) and positive (DSE(pos)) (44 of 79 patients) which were compared with 32 healthy volunteers. Aortic CW-Doppler traces at rest were analysed semi-automatically; time-to-peak (T(mod)), ejection-time (ET(mod)), rise-time (t(rise)), and fall-time (t(fall)) were quantified. Asymmetry (asymm) was calculated as the normalized difference of left and right half of the spectrum. Normal curves were triangular, early-peaking, whereas patients showed more rounded shapes and later peaks. T(rise) was longest in DSE(pos). T(fall) was shortest in DSE(pos), followed by controls and DSE(neg). Asymm was lowest in DSE(pos), followed by controls and DSE(neg). Abnormally symmetric profiles (asymm <0.25) were found in none of the controls, 2.9% DSE(neg), and 27.3% DSE(pos). A good correlation was found between assym and ejection fraction (EF) and T(mod)/ET(mod) and EF. Notably, an LV dynamic gradient was induced in 71.4% DSE(neg) and in 18.2% DSE(pos), associated with LV hypertrophy and supernormal (very asymmetric) traces. CONCLUSION: Decreased myocardial function results in a more symmetrical outflow, while very asymmetrical traces suggest increased contractility, potentially inducing intra-cavity gradients during DSE. Therefore, including outflow symmetry as a clinical measurement provides additional information on patients with CAD.
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Kalinić et al. (2009) conducted an observational in Coronary Artery Disease (n=111). Coronary artery disease (DSE positive) vs. DSE negative patients and healthy controls was evaluated on Abnormally symmetric aortic outflow profile (asymmetry factor < 0.25). Patients with coronary artery disease (DSE positive) had a higher prevalence of abnormally symmetric aortic outflow profiles (27.3%) compared to DSE negative patients (2.9%) and healthy controls (0%).
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