Time to peak velocity measurements by pulsed wave Doppler tissue imaging to quantify ischemia-related regional myocardial asynchrony

A total of 173 patients with chest pain but without visually discernible wall-motion abnormalities by 2-dimensional echocardiography underwent pulsed wave Doppler tissue imaging examination before angiography. Segmental longest time to peak contraction velocity (Tpv) was acquired through 3 apical views. The longest time period from electrocardiographic R wave to peak velocity on segmental velocity integrals of nonapical segments was measured. Receiver operating characteristic curve analysis was performed for correlation analysis between segmental Tpv and significant (≥50% luminal diameter stenosis) coronary artery stenosis. Analysis of variance test was used to compare among different patient groups with 0, 1, 2, and 3 coronary artery stenoses. Delay in Tpv on any 1 or more of the 12 nonapical segments was noted in 72 of 116 patients with angiographically significant coronary stenosis. When the longest segmental Tpv of ≥340 milliseconds was selected as a cut-off value for identification of a significant left circumflex or multivessel coronary artery stenosis, the area under receiver operating characteristic curve was 0.69 and 0.72, respectively (P = .000 and .0013, respectively). In conclusion, pulsed wave Doppler tissue imaging technique provides objective quantitative information for identification of multivessel or left circumflex coronary artery stenosis in patients with chest pain but without apparent wall-motion abnormalities on echocardiography.