TITLE:
Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease
AUTHORS:
Mohamed Fahmy Elnoamany, Hala Mahfouz Badran, Tarek Salah Khalil, Abdalla Mostafa Kamal, Amany Ragab Serag, Rehab Ebraheem Yaseen
KEYWORDS:
Doppler Tissue Imaging, Dobutamine Stress, Diabetes Mellitus
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.1 No.1,
October
24,
2011
ABSTRACT: Background: Coronary artery disease (CAD) is often silent in diabetic patients, and it is typically in ad-vanced stages of development by the time it manifests. Various forms of stress testing have been investigated to detect obstructive CAD in diabetes mellitus. Ob-jectives: To assess the diagnostic value of dobutamine stress pulsed-wave Doppler tissue imaging (DTI) compared with standard wall motion analysis in de-tection of myocardial ischemia in diabetic patients with suspected CAD. Methods: The study comprised 46 diabetic patients with suspected CAD underwent dobutamine stress echocardiography (DSE) with DTI within 4 weeks before coronary angiography(CA). Dobutamine infusion started at 5 µ/kg/min and in-creased up to 40 µ/kg/min with additional atropine during submaximal heart rate responses. In addition to wall-motion score index (WMSI) analysis, pulsed- wave DTI examination of basal and mid segments of posteroseptal, lateral, anterior, inferior and antero- septal walls was performed. Myocardial velocities were measured at rest in the apical 4, 3 and 2-cham- ber views. The measurements were repeated at low dose (10 - 15 µ/kg/min) and at peak stress (40 µ/kg/min). DTI measurements included peak systolic velocity (S), peak early diastolic velocity (E) and peak late diastolic velocity (A) and the results were com-pared to WMSI analysis. Patients were classified into two groups according to CA results; group (I) di-abetics with positive CA (n = 27) and group (II) di-abetics with negative CA (n = 19). Results: There was no significant difference between the two groups in duration of diabetes, global WMSI at rest or the ? changes (stress-rest/rest) of WMSI (P > 0.05). Global S and global E were significantly lower in group I compared to group II at peak stress (11.3 ± 3.7 cm/sec vs. 14.5 ± 2.2 cm/sec, p