Comparison of 2 myocardial velocity gradient assessment methods during dobutamine infusion with Doppler myocardial imaging

Myocardial velocity gradient (MVG) has been shown to be the best quantitative parameter for the detection of ischemic myocardium during dobutamine infusion with the use of Doppler myocardial imaging. MVG has been previously assessed by velocity measurements across the thickness of the myocardium at the time of visually selected maximal color brightness (thickness-velocity plot method). We hypothesized that MVG could be assessed by velocity measurements throughout the cardiac cycle in the subendocardium parallel to the endocardial boundary to the left ventricular cavity and in the subepicardium parallel to the epicardial boundary (time-velocity plot method). This study was designed to compare MVG obtained from the thickness-velocity plot method and from the time-velocity plot method in quantifying dobutamine-induced changes in myocardial wall motion in 8 phases of the cardiac cycle on color M-mode Doppler myocardial imaging recordings of the left ventricular posterior wall performed in 8 conscious dogs at baseline and at steady state during dobutamine infusion (10 mu g/kg per minute). For both methods, MVG was considered present if its mean value was significantly different from zero and if endocardial and epicardial velocities were significantly different. There was close agreement between the 2 methods. MVG was present during the preejection period, systole, rapid ventricular filling, and atrial contraction. Dobutamine induced significant increase in MVG during the preejection period (from 2.64 +/- 0.83 to 4.05 +/- 0.81 seconds(-1)), systole (from 2.14 +/- 0.59 to 6.08 +/- 2.20 seconds(-1) in early systole, from 1.90 +/- 1.06 to 5.31 +/- 2.95 seconds(-1) in mid systole, from 1.37 +/- 0.57 to 2.44 +/- 0.53 seconds(-1) in end systole), and rapid ventricular filling (from 3.06 +/- 1.12 to 7.82 +/- 2.58 seconds(-1)), related to a greater rise in endocardial than in epicardial velocities. The time-velocity plot method showed that ejection and diastole were 11% and 28% decreased during dobutamine infusion, respectively, as heart rate was 31% increased. Thus according to our quantitative criteria, both MVG assessment procedures enabled objective interpretation of dobutamine effects on left ventricular wall motion. In addition, the time-velocity plot method provided automatic detection of peak velocity, timing, and duration of wall velocity changes over time.