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. 2001 Feb;85(2):165–170. doi: 10.1136/heart.85.2.165

Prediction of contractile reserve by cyclic variation of integrated backscatter of the myocardium in patients with chronic left ventricular dysfunction

T Muro 1, T Ota 1, H Watanabe 1, M Teragaki 1, K Takeuchi 1, J Yoshikawa 1
PMCID: PMC1729606  PMID: 11156666

Abstract

OBJECTIVE—To clarify whether assessment of the acoustic properties of the myocardium at rest can predict contractile reserve in patients with chronic left ventricular dysfunction.
METHODS—23 patients (mean (SD) age 63 (12) years) with chronic left ventricular dysfunction were studied. The magnitude of cardiac cycle dependent variation of integrated backscatter (CVIB) of the myocardium was measured at rest in the basal and mid segment of the septum and posterior wall of the left ventricle, using a real time two dimensional integrated backscatter imaging system. The results were compared with the percentage wall thickening and the wall motion at rest and during low dose dobutamine infusion. The wall motion was graded as normal, hypokinetic, or akinetic and contractile reserve was considered present when an akinetic or hypokinetic segment improved during dobutamine infusion.
RESULTS—The CVIB at rest correlated with per cent wall thickening at rest and during dobutamine infusion (at rest, r = 0.61, p < 0.0001, during dobutamine, r = 0.76, p < 0.0001). Of the 76 segments examined, 27 showed contractile reserve. The mean CVIB at rest was significantly greater in segments with contractile reserve than in those without (p < 0.0001). CVIB above 3 dB at rest predicted segments with contractile reserve with a sensitivity and specificity of 81% and 60%, respectively (p < 0.0001).
CONCLUSIONS—CVIB reflected not only myocardial contractility but also the functional capacity of the myocardium. It predicted segmental contractile reserve in patients with chronic left ventricular dysfunction.


Keywords: contractile reserve; acoustic properties of myocardium; cyclic variation of integrated backscatter; left ventricular dysfunction

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Figure 1  .

Figure 1  

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Two dimensional (cross sectional) integrated backscatter imaging interfaced with acoustic densitometry. Parasternal long axis integrated backscatter images were stored in digital format. An elliptical region of interest was placed in the mid myocardium of the mid or basal myocardial segment of the interventricular septum and posterior wall.

Figure 2  .

Figure 2  

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Individual values of per cent wall thickening (%WT) (A) and magnitude of cardiac cycle dependent variation of integrated backscatter of the myocardium (CVIB) (B) for segments with contractile reserve (CR+) and those without (CR−). There was a weak but significant difference in %WT at rest between segments with and without contractile reserve. The magnitude of CVIB was significantly greater in segments with contractile reserve that in those without.

Figure 3  .

Figure 3  

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Scatterplot showing the correlation between the magnitude of cardiac cycle dependent variation of integrated backscatter at rest and systolic wall thickening at rest (A) and that during dobutamine infusion (B).

Figure 4  .

Figure 4  

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Representative curves of cyclic variation of integrated backscatter in a segment with contractile reserve (A) and a segment without contractile reserve (B). Cyclic variation shows a synchronous pattern in the segment with contractile reserve, but an asynchronous pattern in the segment without.

Selected References

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