Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 2, Number 1, February 2011, pages 16-26

Mitral Annular Systolic Velocities Predict Left Ventricular Wall Motion Abnormality During Dobutamine Stress Echocardiography

Figure 1. Mitral annular systolic velocity relationship with left ventricular wall motion score index at rest (left) and after dobutamine stress (right), in different groups of patients as depicted in each figure. S0: Systolic velocity at rest (cm/sec), S1: Systolic velocity after DSE (cm/sec), WMSI0: Wall motion score index at rest, WMSI1: Wall motion score index after DSE.

Figure 2. Scattergrams of mitral annular systolic velocities in normal subjects (rhomboids) and in patients with left ventricular wall motion abnormality (squares) at rest and after stress.

**Table 1.** Left Ventricular Wall Motion Score Index at Rest and After Stress Echocardiography in Subgroups of Wall Motion Abnormality
	WMSI-Rest	WMSI-Stress	HR Rest	HR Peak
Pt: All 26 subjects with WMA
Pt1: Subjects with WMA only after DSE
Pt2: Subjects with WMA at rest and improved after DSE
Pt3: Subjects with WMA at rest and did not changed after DSE
Pt4: Subjects with WMA at rest and worsened during DSE
Pt	1.166 ± 0.21	1.34 ± 0.18	62.4 ± 9.88	123.77 ± 14.38
Pt1	1 ± 0	1.33 ± 0.13	62.67 ± 10.79	130 ± 15.96
P value (Pt : Pt1)	0.00053	0.85634	0.950696	0.283587
Pt2	1.19 ± 0.09	1.06 ± 0.88	60 ± 7.07	118 ± 11.31
P value (Pt : Pt2)	0.800539	0.059406	0.7385	0.586514
Pt3	1.58 ± 0.32	1.58 ± 0.32	61.67 ± 15.57	109.33 ± 18.82
P value (Pt : Pt3)	0.154403	0.325027	0.90601	0.120262
Pt4	1.18 ± 0.12	1.34 ± 1.24	62.83 ± 9.33	123.67 ± 10.68
P value (Pt : Pt4)	0.761902	0.913018	0.90437	0.98257
Pt1 + Pt4	1.1 ± 0.13	1.34 ± 0.12	62.76 ± 9.7	126.4 ± 13.23
P value (Pt : Pt1 + Pt4)	0.43	0.113	0.45	0.26

Table 1. Left Ventricular Wall Motion Score Index at Rest and After Stress Echocardiography in Subgroups of Wall Motion Abnormality

WMSI-Rest

WMSI-Stress

HR Rest

HR Peak

Pt: All 26 subjects with WMA

Pt1: Subjects with WMA only after DSE

Pt2: Subjects with WMA at rest and improved after DSE

Pt3: Subjects with WMA at rest and did not changed after DSE

Pt4: Subjects with WMA at rest and worsened during DSE

1.166 ± 0.21

1.34 ± 0.18

62.4 ± 9.88

123.77 ± 14.38

Pt1

1 ± 0

1.33 ± 0.13

62.67 ± 10.79

130 ± 15.96

P value (Pt : Pt1)

0.00053

0.85634

0.950696

0.283587

Pt2

1.19 ± 0.09

1.06 ± 0.88

60 ± 7.07

118 ± 11.31

P value (Pt : Pt2)

0.800539

0.059406

0.7385

0.586514

Pt3

1.58 ± 0.32

61.67 ± 15.57

109.33 ± 18.82

P value (Pt : Pt3)

0.154403

0.325027

0.90601

0.120262

Pt4

1.18 ± 0.12

1.34 ± 1.24

62.83 ± 9.33

123.67 ± 10.68

P value (Pt : Pt4)

0.761902

0.913018

0.90437

0.98257

Pt1 + Pt4

1.1 ± 0.13

1.34 ± 0.12

62.76 ± 9.7

126.4 ± 13.23

P value (Pt : Pt1 + Pt4)

0.43

0.113

0.45

0.26

**Table 2.** Mitral Annular Systolic Velocities at Rest and After Dobutamine Stress Echocardiography in All Subjects
	Mean ± STD	septum	lat	inf	ant	post	antseptum
^(*)WMA = Wall motion abnormality
Normals	Systolic velocity at rest (cm/sec)	11.1 ± 1.6	13 ± 2.3	12.2 ± 1.8	11.7 ± 2.5	12.4 ± 1.8	10.1 ± 1.3
	Systolic velocity after stress (cm/sec)	19.2 ± 3.3	18.7 ± 3.6	17.97 ± 3.8	16.5 ± 4.3	17.95 ± 3	15.8 ± 3.5
	N: P value Rest : Stress	4.15E-14	4.92E-08	1.97E-08	1.91E-05	6.06E-10	1.68E-09
WMA(*)	Systolic velocity at rest (cm/sec)	10.7 ± 1.3	12 ± 1.6	11.2 ± 1.6	10.8 ± 1.4	11.1 ± 1.4	9.6 ± 1.3
	Systolic velocity after stress (cm/sec)	14.6 ± 2.5	16.7 ± 3.4	15.9 ± 3.2	15.1 ± 4.1	16.4 ± 2.6	14 ± 3.2
	WMA: P value Rest : Stress	3.83E-09	4.32E-08	1.6E-08	4.54E-06	4.21E-12	2.39E-08
P value Normal : WMA(*)	Systolic velocity at rest (cm/sec)	0.385106	0.072574	0.034469	0.128962	0.009679	0.203429
	Systolic velocity after DSE (cm/sec)	2.25E-6	0.050644	0.038527	0.23492	0.05088	0.065086

Table 2. Mitral Annular Systolic Velocities at Rest and After Dobutamine Stress Echocardiography in All Subjects

Mean ± STD

septum

lat

inf

ant

post

antseptum

^(*)WMA = Wall motion abnormality

Normals

Systolic velocity at rest (cm/sec)

11.1 ± 1.6

13 ± 2.3

12.2 ± 1.8

11.7 ± 2.5

12.4 ± 1.8

10.1 ± 1.3

Systolic velocity after stress (cm/sec)

19.2 ± 3.3

18.7 ± 3.6

17.97 ± 3.8

16.5 ± 4.3

17.95 ± 3

15.8 ± 3.5

N: P value Rest : Stress

4.15E-14

4.92E-08

1.97E-08

1.91E-05

6.06E-10

1.68E-09

WMA(*)

Systolic velocity at rest (cm/sec)

10.7 ± 1.3

12 ± 1.6

11.2 ± 1.6

10.8 ± 1.4

11.1 ± 1.4

9.6 ± 1.3

Systolic velocity after stress (cm/sec)

14.6 ± 2.5

16.7 ± 3.4

15.9 ± 3.2

15.1 ± 4.1

16.4 ± 2.6

14 ± 3.2

WMA: P value Rest : Stress

3.83E-09

4.32E-08

1.6E-08

4.54E-06

4.21E-12

2.39E-08

P value Normal : WMA(*)

Systolic velocity at rest (cm/sec)

0.385106

0.072574

0.034469

0.128962

0.009679

0.203429

Systolic velocity after DSE (cm/sec)

2.25E-6

0.050644

0.038527

0.23492

0.05088

0.065086

**Table 3.** Mitral Annular Systolic Velocity Calculated Parameters at Rest and After Dobutamine Stress Echocardiography in All Subjects
		septum	lat	int	ant	post	antseptum
S0: Systolic velocity at rest (cm/sec)
S1: Systolic velocity after DSE (cm/sec)
dS: S1 - S0
dS/S0: ratio
S1/S0: ratio
dS	Normals	8.1 ± 3.14	5.7 ± 3.7	5.8 ± 3.33	4.8 ± 2.9	5.6 ± 2.5	5.74 ± 3.6
	WMA	3.87 ± 2.25	4.77 ± 3.23	4.69 ± 2.66	4.27 ± 3.5	5.26 ± 2.3	4.39 ± 2.9
	P value (N : WMA)	2.79E-06	0.347103	0.219606	0.562961	0.624443	0.156402
dS/S0	Normals	0.75 ± 0.34	0.47 ± 0.33	0.48 ± 0.29	0.41 ± 0.24	0.47 ± 0.22	0.59 ± 0.37
	WMA	0.37 ± 0.23	0.4 ± 0.29	0.43 ± 0.24	0.39 ± 0.31	0.48 ± 0.23	0.46 ± 0.299
	P value (N : WMA)	4.13E-05	0.523187	0.456129	0.833189	0.778375	0.194333
S1/S0	Normals	1.75 ± 0.34	1.47 ± 0.33	1.48 ± 0.29	1.41 ± 0.24	1.47 ± 0.22	1.59 ± 0.37
	WMA	1.33 ± 0.35	1.41 ± 0.29	1.43 ± 0.24	1.39 ± 0.31	1.48 ± 0.23	1.46 ± 0.29
	P value (N : WMA)	7.7E-05	0.523187	0.456129	0.833189	0.778375	0.194333

Table 3. Mitral Annular Systolic Velocity Calculated Parameters at Rest and After Dobutamine Stress Echocardiography in All Subjects

septum

lat

int

ant

post

antseptum

S0: Systolic velocity at rest (cm/sec)

S1: Systolic velocity after DSE (cm/sec)

dS: S1 - S0

dS/S0: ratio

S1/S0: ratio

Normals

8.1 ± 3.14

5.7 ± 3.7

5.8 ± 3.33

4.8 ± 2.9

5.6 ± 2.5

5.74 ± 3.6

WMA

3.87 ± 2.25

4.77 ± 3.23

4.69 ± 2.66

4.27 ± 3.5

5.26 ± 2.3

4.39 ± 2.9

P value (N : WMA)

2.79E-06

0.347103

0.219606

0.562961

0.624443

0.156402

dS/S0

Normals

0.75 ± 0.34

0.47 ± 0.33

0.48 ± 0.29

0.41 ± 0.24

0.47 ± 0.22

0.59 ± 0.37

WMA

0.37 ± 0.23

0.4 ± 0.29

0.43 ± 0.24

0.39 ± 0.31

0.48 ± 0.23

0.46 ± 0.299

P value (N : WMA)

4.13E-05

0.523187

0.456129

0.833189

0.778375

0.194333

S1/S0

Normals

1.75 ± 0.34

1.47 ± 0.33

1.48 ± 0.29

1.41 ± 0.24

1.47 ± 0.22

1.59 ± 0.37

WMA

1.33 ± 0.35

1.41 ± 0.29

1.43 ± 0.24

1.39 ± 0.31

1.48 ± 0.23

1.46 ± 0.29

P value (N : WMA)

7.7E-05

0.523187

0.456129

0.833189

0.778375

0.194333

**Table 4.** Mitral Annular Systolic Velocities at Rest and After Dobutamine Stress Echocardiography in Different Subgroups of Change in Wall Motion Abnormality
		septum	lat	inf	ant	post	antseptum
Pt1 (subjects with WMA only after DSE)	Systolic velocity at rest	10.87 ± 1.34	11.76 ± 2.06	16.9 ± 3.69	10.79 ± 1.48	10.4 ± 1.44	9.7 ± 1.55
	P value (N : Pt1)	0.69675	0.15398	0.10018	0.19628	0.02306	0.54178
	Systolic velocity after stress	14.3 ± 2.65	16.43 ± 2.34	16.14 ± 6.25	16.22 ± 4.83	16.3 ± 3.03	14.49 ± 3.64
	P value (N : Pt1)	0.00039	0.04428	0.23442	0.86926	0.18459	0.363378
Pt2 (subjects with WMA at rest and improved after DSE)	Systolic velocity at rest	11.15 ± 1.63	12.65 ± 0.21	11.6 ± 1.69	12.35 ± 2.33	12.2 ± 0.14	11 ± 0
	P value (N : Pt2)	0.96563	0.48167	0.71058	0.78023	0.69484	0.00167
	Systolic velocity after stress	17.05 ± 0.21	18.2 ± 5.37	17.5 ± 2.12	16.95 ± 1.06	15.2 ± 0.71	15.6 ± 0.57
	P value (N : Pt2)	0.00564	0.91552	0.80624	0.72899	0.01318	0.80086
Pt3 (subjects with WMA at rest and did not chang after DSE)	Systolic velocity at rest	10.6 ± 1.64	11 ± 0.4	10.9 ± 1.65	11.5 ± 2.04	11.37 ± 2.33	9.93 ± 1.29
	P value (N : Pt3)	0.675163	0.001023	0.288473	0.869686	0.55201	0.868895
	Systolic velocity after stress	14.9 ± 3.72	16.5 ± 5.77	15.33 ± 4.73	15.67 ± 5.90	15.7 ± 3.89	12.57 ± 3.07
	P value (N : Pt3)	0.200295	0.58228	0.45039	0.829103	0.43644	0.188043
Pt4 (subjects with WMA at rest and worsened during DSE)	Systolic velocity at rest	10.583 ± 1.24	12.23 ± 1.49	11.13 ± 1.92	10.4 ± 0.88	11.03 ± 1.32	9.23 ± 1.02
	P value (N : Pt4)	0.3074	0.23317	0.11806	0.03138	0.01883	0.039109
	Systolic velocity after stress	14.31 ± 2.21	16.75 ± 3.66	15.51 ± 2.72	13.83 ± 3.098	16.74 ± 2.33	13.74 ± 3.26
	P value (N : Pt4)	1.18E-05	0.140344	0.03286	0.038515	0.19485	0.093108
Pt1 + Pt4 (all subjects with worse WMA after DSE)	Systolic velocity at rest	10.7 ± 1.26	12 ± 1.73	11.2 ± 1.67	10.6 ± 1.15	11 ± 1.34	9.43 ± 1.26
	P value (N : Pt4 + Pt1)	0.187	0.057	0.02	0.026	0.0025	0.048
	Systolic velocity after stress	14.3 ± 2.34	16.6 ± 3.1	15.8 ± 3.1	14.85 ± 4	16.55 ± 2.59	14.06 ± 3.35
	P value (N : Pt4 + Pt1)	5.83E-07	0.02	0.019	0.09	0.05	0.04

Table 4. Mitral Annular Systolic Velocities at Rest and After Dobutamine Stress Echocardiography in Different Subgroups of Change in Wall Motion Abnormality

septum

lat

inf

ant

post

antseptum

Pt1
(subjects with WMA only after DSE)

Systolic velocity at rest

10.87 ± 1.34

11.76 ± 2.06

16.9 ± 3.69

10.79 ± 1.48

10.4 ± 1.44

9.7 ± 1.55

P value (N : Pt1)

0.69675

0.15398

0.10018

0.19628

0.02306

0.54178

Systolic velocity after stress

14.3 ± 2.65

16.43 ± 2.34

16.14 ± 6.25

16.22 ± 4.83

16.3 ± 3.03

14.49 ± 3.64

P value (N : Pt1)

0.00039

0.04428

0.23442

0.86926

0.18459

0.363378

Pt2
(subjects with WMA at rest and improved after DSE)

Systolic velocity at rest

11.15 ± 1.63

12.65 ± 0.21

11.6 ± 1.69

12.35 ± 2.33

12.2 ± 0.14

11 ± 0

P value (N : Pt2)

0.96563

0.48167

0.71058

0.78023

0.69484

0.00167

Systolic velocity after stress

17.05 ± 0.21

18.2 ± 5.37

17.5 ± 2.12

16.95 ± 1.06

15.2 ± 0.71

15.6 ± 0.57

P value (N : Pt2)

0.00564

0.91552

0.80624

0.72899

0.01318

0.80086

Pt3
(subjects with WMA at rest and did not chang after DSE)

Systolic velocity at rest

10.6 ± 1.64

11 ± 0.4

10.9 ± 1.65

11.5 ± 2.04

11.37 ± 2.33

9.93 ± 1.29

P value (N : Pt3)

0.675163

0.001023

0.288473

0.869686

0.55201

0.868895

Systolic velocity after stress

14.9 ± 3.72

16.5 ± 5.77

15.33 ± 4.73

15.67 ± 5.90

15.7 ± 3.89

12.57 ± 3.07

P value (N : Pt3)

0.200295

0.58228

0.45039

0.829103

0.43644

0.188043

Pt4
(subjects with WMA at rest and worsened during DSE)

Systolic velocity at rest

10.583 ± 1.24

12.23 ± 1.49

11.13 ± 1.92

10.4 ± 0.88

11.03 ± 1.32

9.23 ± 1.02

P value (N : Pt4)

0.3074

0.23317

0.11806

0.03138

0.01883

0.039109

Systolic velocity after stress

14.31 ± 2.21

16.75 ± 3.66

15.51 ± 2.72

13.83 ± 3.098

16.74 ± 2.33

13.74 ± 3.26

P value (N : Pt4)

1.18E-05

0.140344

0.03286

0.038515

0.19485

0.093108

Pt1 + Pt4
(all subjects with worse WMA after DSE)

Systolic velocity at rest

10.7 ± 1.26

12 ± 1.73

11.2 ± 1.67

10.6 ± 1.15

11 ± 1.34

9.43 ± 1.26

P value (N : Pt4 + Pt1)

0.187

0.057

0.02

0.026

0.0025

0.048

Systolic velocity after stress

14.3 ± 2.34

16.6 ± 3.1

15.8 ± 3.1

14.85 ± 4

16.55 ± 2.59

14.06 ± 3.35

P value (N : Pt4 + Pt1)

5.83E-07

0.02

0.019

0.09

0.05

0.04

**Table 5.** Mitral Annular Systolic Velocities at Rest and After Dobutamine Stress Echocardiography According to Location of Wall Motion Abnormality Compared to Normal
		septum	lat	inf	ant	post	antseptum
P value: versus Normal
WMA lat	Systolic velocity at rest	10.75 ± 1.69	11.3 ± 2.61	10.7 ± 2.16	10.48 ± 0.98	10.9 ± 1.88	10.2 ± 2.17
	P value	0.7122	0.28568	0.25436	0.102278	0.22409	0.91791
	Systolic velocity after DSE	13.16 ± 3.18	13.5 ± 3.57	14.78 ± 4.1	12.28 ± 2.42	14.98 ± 3.26	12.1 ± 2.89
	P value	0.025677	0.05386	0.218365	0.02454	0.162935	0.06997
WMA inf	Systolic velocity at rest	10.52 ± 1.13	12.15 ± 1.51	11.03 ± 1.46	10.61 ± 1.18	10.92 ± 1.08	9.35 ± 0.95
	P value	0.173157	0.152316	0.02069	0.06015	0.002898	0.038125
	Systolic velocity after DSE	14.32 ± 2.28	16.58 ± 2.95	15.72 ± 3.11	14.94 ± 4.25	16.29 ± 2.47	14.16 ± 3.23
	P value	1.51E-06	0.038304	0.03795	0.23025	0.05339	0.11599
WMA ant	Systolic velocity at rest	10.3 ± 1.80	10.33 ± 2.14	10.27 ± 2.42	10.03 ± 0.51	10.47 ± 2.04	10.27 ± 2.65
	P value	0.546108	0.1366	0.30985	0.009865	0.266757	0.913125
	Systolic velocity after DSE	13.4 ± 1.29	15.75 ± 8.84	14.13 ± 4.77	12.83 ± 2.63	14.73 ± 3.95	11.3 ± 2.95
	P value	0.13139	0.17168	0.311784	0.1252	0.306382	0.09256
WMA post	Systolic velocity at rest	10.48 ± 1.02	11.78 ± 1.91	11.09 ± 0.59	10.39 ± 1.08	10.76 ± 0.95	9.09 ± 0.94
	P value	0.227	0.139556	0.010516	0.039644	0.00307	0.02527
	Systolic velocity after DSE	14.59 ± 2.16	16.49 ± 2.48	16.68 ± 3.49	14.31 ± 2.89	16.41 ± 2.79	13.63 ± 2.47
	P value	0.00012	0.05679	0.368676	0.09697	0.18818	0.05932
WMA apex	Systolic velocity at rest	10.72 ± 1.59	12.13 ± 1.34	11.32 ± 1.62	11.17 ± 1.38	11.73 ± 1.79	10.1 ± 1.16
	P value	0.62475	0.24804	0.26814	0.47069	0.47243	0.96421
	Systolic velocity after DSE	15.78 ± 2.55	16.98 ± 4.05	17.38 ± 3.75	16.37 ± 3.83	16.07 ± 3.17	13.95 ± 2.89
	P value	0.022146	0.36996	0.7406	0.92985	0.22995	0.211088

Table 5. Mitral Annular Systolic Velocities at Rest and After Dobutamine Stress Echocardiography According to Location of Wall Motion Abnormality Compared to Normal

septum

lat

inf

ant

post

antseptum

P value: versus Normal

WMA lat

Systolic velocity at rest

10.75 ± 1.69

11.3 ± 2.61

10.7 ± 2.16

10.48 ± 0.98

10.9 ± 1.88

10.2 ± 2.17

P value

0.7122

0.28568

0.25436

0.102278

0.22409

0.91791

Systolic velocity after DSE

13.16 ± 3.18

13.5 ± 3.57

14.78 ± 4.1

12.28 ± 2.42

14.98 ± 3.26

12.1 ± 2.89

P value

0.025677

0.05386

0.218365

0.02454

0.162935

0.06997

WMA inf

Systolic velocity at rest

10.52 ± 1.13

12.15 ± 1.51

11.03 ± 1.46

10.61 ± 1.18

10.92 ± 1.08

9.35 ± 0.95

P value

0.173157

0.152316

0.02069

0.06015

0.002898

0.038125

Systolic velocity after DSE

14.32 ± 2.28

16.58 ± 2.95

15.72 ± 3.11

14.94 ± 4.25

16.29 ± 2.47

14.16 ± 3.23

P value

1.51E-06

0.038304

0.03795

0.23025

0.05339

0.11599

WMA ant

Systolic velocity at rest

10.3 ± 1.80

10.33 ± 2.14

10.27 ± 2.42

10.03 ± 0.51

10.47 ± 2.04

10.27 ± 2.65

P value

0.546108

0.1366

0.30985

0.009865

0.266757

0.913125

Systolic velocity after DSE

13.4 ± 1.29

15.75 ± 8.84

14.13 ± 4.77

12.83 ± 2.63

14.73 ± 3.95

11.3 ± 2.95

P value

0.13139

0.17168

0.311784

0.1252

0.306382

0.09256

WMA post

Systolic velocity at rest

10.48 ± 1.02

11.78 ± 1.91

11.09 ± 0.59

10.39 ± 1.08

10.76 ± 0.95

9.09 ± 0.94

P value

0.227

0.139556

0.010516

0.039644

0.00307

0.02527

Systolic velocity after DSE

14.59 ± 2.16

16.49 ± 2.48

16.68 ± 3.49

14.31 ± 2.89

16.41 ± 2.79

13.63 ± 2.47

P value

0.00012

0.05679

0.368676

0.09697

0.18818

0.05932

WMA apex

Systolic velocity at rest

10.72 ± 1.59

12.13 ± 1.34

11.32 ± 1.62

11.17 ± 1.38

11.73 ± 1.79

10.1 ± 1.16

P value

0.62475

0.24804

0.26814

0.47069

0.47243

0.96421

Systolic velocity after DSE

15.78 ± 2.55

16.98 ± 4.05

17.38 ± 3.75

16.37 ± 3.83

16.07 ± 3.17

13.95 ± 2.89

P value

0.022146

0.36996

0.7406

0.92985

0.22995

0.211088

**Table 6.** Diagnostic Value of Mitral Annular Systolic Velocity Parameters for the Detection of Wall Motion Abnormality
	Sensitivity (%)	Specificity (%)	Diagnostic Accuracy (%)
S0: Systolic velocity at rest (cm/sec)
S1: Systolic velocity after DSE (cm/sec)
dS: S1 - S0
dS/S0: ratio
S1/S0: ratio
S1 < 17	92	80	88
S1/S0 < 1.5	85	88	86
dS < 6	88	79	84
dS/S0 < 0.55	85	79	82

Table 6. Diagnostic Value of Mitral Annular Systolic Velocity Parameters for the Detection of Wall Motion Abnormality

Sensitivity (%)

Specificity (%)

Diagnostic Accuracy (%)

S0: Systolic velocity at rest (cm/sec)

S1: Systolic velocity after DSE (cm/sec)

dS: S1 - S0

dS/S0: ratio

S1/S0: ratio

S1 < 17

S1/S0 < 1.5

dS < 6

dS/S0 < 0.55