engleski

The shape of the aortic outflow velocity profile in coronary artery disease. Might it be related to contractile function ? An automated analysis using mathematical modeling.

From isolated cells, it was suggested that chronic ischemia decreases but prolongs contraction. Additionally, severe aortic stenosis shows, higher but often prolonged outflow velocities. Outflow velocities represent the pressure gradient between LV and aorta and thus influenced by either of them. However, a dynamically increasing resistance in the vessel tree reduces late velocities while late increases should be related to prolonged contraction. We assumed a relationship between the morphology and duration of aortic outflow velocities and myocardial function in coronary artery disease (CAD). We studied 109 pts undergoing routine dobutamine stress echo (DSE). Pts were divided in 2 groups: group A: 61 pts without evidence of CAD and/or normal DSE, group B: 48 pts with angiographically proven CAD and/or positive DSE. Automated analysis using modelling was applied on digitally stored aortic CW traces and deceleration time (TF: from peak to end of spectrum) and symmetry measure (symm: ratio of area under the curve of left and right half of the spectrum). Figure 1 left shows a CW trace and curve analysis of a normal: triangular in shape, with an early peak, while right (CAD) shows typical broadening with a much more rounded shape and later peak. Group A: symm=0, 34&#177; 0, 07 ; TF=79, 90&#177; 11.58 ms. Group B: symm=0, 31&#177; 0, 08* ; TF=73, 10&#177; 12, 71 ms* (*p<0, 02 vs. normal). A broadened profile (symm<0, 25) was present in 6% of group A pts and 25% of group B pts. This shows that an important percentage of CAD patients show broadening of the aortic outflow profile which might be related to a reduction in global myocardial contractility. Automated analysis using modelling can be used to categorize Doppler data and provides additional clinical information on the functional impact of CAD.

Doppler echocardiography; mathematical modeling; aortic outflow profile; coronary artery disease; contractile function

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