Does the Post-Systolic Shortening of the Left Ventricle by Tissue Doppler Imaging Predict Coronary Artery Disease?

Background: Abnormalities in the velocity and pattern of myocardial shortening on tissue Doppler imaging (TDI) have been pro- posed to aid in the noninvasive diagnosis of coronary artery disease (CAD). Objectives: We investigated the diagnostic value of post-systolic shortening (PSS), a delayed ejection velocity of the myocardium after the closure of the aortic valve, on TDI in the diagnosis of CAD among patients with chest pain and normal resting wall motion on standard 2D echocardiography. Methods: Eighty consecutive patients (49% female) with typical ischemic chest pain but without prior myocardial infarction, coro- nary revascularization, arrhythmia, or heart failure, who had no regional wall motion abnormalities on resting echocardiography and who were scheduled to undergo coronary angiography, were selected. TDI was performed in each patient before coronary an- giography at 2 levels (basal and mid left ventricle (LV)) in each of the 4 LV walls (i.e., septal, anterior, inferior, and lateral). Coronary angiography was performed and interpreted per standard clinical protocols. Results: Compared to the patients with normal coronaries, those with angiographic CAD showed significantly increased myocar- dial isovolumic relaxation time (IVRT) velocity (P 4.0 m/sec, a positive PSS velocity had about 65% sensitivity and 85% specificity with a positive predictive value > 90% in predicting angiographic CAD. Conclusions: Among patients with chest pain and normal LV wall motion on 2D echocardiography, a prominent and prolonged IVRT on TDI may help predict the presence of significant CAD.