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

doi:10.1136/heart.85.2.165

Heart 2001;85:165-170; doi:10.1136/heart.85.2.165

Heart 2001;85:165-170 ( February )

Cardiovascular medicine

Prediction of contractile reserve by cyclic variation of integrated backscatter of the myocardium in patients with chronic left ventricular dysfunction T Muro, T Ota, H Watanabe, M Teragaki, K Takeuchi, J Yoshikawa

First Department of Internal Medicine, Osaka City University Medical School, 1-4-3 Asahi-machi Abeno-ku, Osaka 545-8585, Japan

Correspondence to: Dr Muro tmuro{at}med.osaka-cu.ac.jp

Accepted 11 September 2000

OBJECTIVE $---$ To clarify whether assessment of the acoustic properties of the myocardium at rest can predict contractile reserve in patientswith chronic left ventriculardysfunction.
METHODS $---$ 23 patients (mean (SD) age 63 (12) years) with chronic left ventricular dysfunction were studied. The magnitude of cardiaccycle dependent variation of integrated backscatter (CVIB) ofthe myocardium was measured at rest in the basal and mid segmentof the septum and posterior wall of the left ventricle, usinga real time two dimensional integrated backscatter imaging system.The results were compared with the percentage wall thickeningand the wall motion at rest and during low dose dobutamine infusion.The wall motion was graded as normal, hypokinetic, or akineticand contractile reserve was considered present when an akineticor hypokinetic segment improved during dobutamineinfusion.
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 significantlygreater in segments with contractile reserve than in those without(p < 0.0001). CVIB above 3 dB at rest predicted segments withcontractile 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 segmentalcontractile reserve in patients with chronic left ventriculardysfunction.

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

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