Myocardial Doppler tissue imaging: Findings in inferior myocardial infarction and left ventricular hypertrophy - Wall motion assessment

Background: Because of the geometry of the basal inferior wall and its relation with the posterior medial papillary muscle, differentiating abnormal from normal basal inferior wall motion can be challenging. Methods: We performed pulsed wave Doppler echocardiography of the basal inferior wall and basal interventricular septum in 26 patients (63 ± 14 years) with a normal echocardiogram, 33 patients (67 ± 14 years) with inferior myocardial infarction (MI) associated with hypokinesis to dyskinesis of the basal inferior wall, and 38 patients (67 ± 14 years) with left ventricular hypertrophy (LVH). Results: Systolic velocity was significantly lower in the basal interventricular septum (0.071 ± 0.013 m/s versus 0.084 ± 0.023 m/s) and basal inferior wall (0.075 ± 0.014 m/s versus 0.085 ± 0.019 m/s) in the MI group compared with the LVH group, and both were significantly lower compared with normal values at the interventricular septum (0.090 ± 0.023 m/s, P < .001, analysis of variance) and basal inferior wall (0.095 ± 0.014 m/s, P < .0001, analysis of variance). The sum of the systolic (S), early diastolic (E′), and late diastolic (A′) velocities of 0.30 m/s at the basal inferior wall had 91%, 76%, and 84% sensitivity, specificity, and accuracy, respectively, for the differentiation of a normal wall from an infarcted basal inferior wall, and 76%, 73%, and 75% sensitivity, specificity, and accuracy, respectively, for the differentiation of a normal wall from a hypertrophied basal inferior wall. The sum of systolic and diastolic velocities of 0.25 m/s at the basal interventricular septum had 70%, 66%, and 68% sensitivity, specificity, and accuracy, respectively, for the differentiation of an infarcted from a hypertrophied basal interventricular septum. Mitral inflow early-filling wave deceleration time by pulsed wave Doppler was the most sensitive parameter for the differentiation of LVH from MI (P < .0001). Conclusion: Doppler tissue imaging velocities of the basal inferior wall and basal interventricular septum may help differentiate normal from infarcted and hypertrophied myocardium.