201
|
Lobato EB, Willert JL, Looke TD, Thomas J, Urdaneta F. Effects of Milrinone Versus Epinephrine on Left Ventricular Relaxation After Cardiopulmonary Bypass Following Myocardial Revascularization: Assessment by Color M-Mode and Tissue Doppler. J Cardiothorac Vasc Anesth 2005; 19:334-9. [PMID: 16130060 DOI: 10.1053/j.jvca.2005.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the left ventricular lusitropic effects of epinephrine versus milrinone after cardiopulmonary bypass. DESIGN Prospective randomized study. SETTING Single institution, university teaching hospital. PARTICIPANTS Adult patients undergoing coronary artery bypass grafting under cardiopulmonary bypass. INTERVENTIONS After separation from cardiopulmonary bypass, patients were randomized to receive intravenous epinephrine by continuous infusion (0.03 microg/kg/min) or milrinone (50 microg/kg followed by 0.5 microg/kg/min). Transesophageal echocardiographic evaluation of left ventricular diastolic function, with emphasis on relaxation, was performed before and after bypass and after the administration of either epinephrine or milrinone. MEASUREMENTS AND MAIN RESULTS Measurements included pulse-wave Doppler analysis of mitral inflow and pulmonary vein and left ventricular outflow tract velocities. Left ventricular inflow velocity of propagation measured with color M-mode and tissue Doppler assessment of early mitral annulus velocity were used to evaluate left ventricular relaxation. Values of velocity of propagation and mitral annulus velocity improved significantly after bypass, suggesting improved relaxation. The administration of either epinephrine or milrinone did not result in further improvement in left ventricular relaxation. CONCLUSIONS After cardiopulmonary bypass, left ventricular relaxation was significantly improved. Neither epinephrine nor milrinone exhibited favorable lusitropic effects after bypass.
Collapse
Affiliation(s)
- Emilio B Lobato
- Department of Anesthesiology, University of Florida College of Medicine and Veterans Affairs Medical Center, Gainesville, 32610, USA.
| | | | | | | | | |
Collapse
|
202
|
Tretjak M, Verovnik F, Benko D, Kozelj M. Tissue Doppler velocities of mitral annulus and NT-proBNP in patients with heart failure. Eur J Heart Fail 2005; 7:520-4. [PMID: 15921789 DOI: 10.1016/j.ejheart.2004.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 06/17/2004] [Accepted: 07/21/2004] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It has been shown that pulsed wave tissue Doppler velocities of mitral annulus correlate well with left ventricular (LV) diastolic and systolic functions. It is not yet clear whether these velocities can be used to estimate left ventricular dysfunction in an unselected population of patients with clinical signs and symptoms of heart failure (HF). AIM To determine whether LV mitral annulus velocities measured by tissue Doppler imaging (TDI) correlate with plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with HF. METHODS AND RESULTS Early diastolic (E(m)) and systolic (S(m)) TDI velocities of septal and lateral mitral annulus were measured in 50 patients with HF together with other conventional echocardiographic parameters, and compared with plasma NT-proBNP levels. Significant correlations were found between NT-proBNP level and E(m) velocity (r=-0.79), S(m) velocity (r=-0.43), early transmitral to E(m) velocity ratio (r=0.38), LV end diastolic diameter (r=0.29), LV ejection fraction (r=-0.44) and tricuspid regurgitant velocity (r=0.31). In multiple regression model (R(2)=0.733), the E(m) velocity was the most important predictor of NT-proBNP level. CONCLUSIONS Early diastolic mitral annulus velocity measured by TDI correlates strongly with plasma NT-proBNP levels, and provides a simple, accurate and reproducible echocardiographic index of heart failure.
Collapse
Affiliation(s)
- Martin Tretjak
- Department of Cardiology, General Hospital Slovenj Gradec, Gosposvetska 1, 2380 Slovenj Gradec, Slovenia.
| | | | | | | |
Collapse
|
203
|
Hoffmann R, Altiok E, Nowak B, Kühl H, Kaiser HJ, Buell U, Hanrath P. Strain rate analysis allows detection of differences in diastolic function between viable and nonviable myocardial segments. J Am Soc Echocardiogr 2005; 18:330-5. [PMID: 15846160 DOI: 10.1016/j.echo.2004.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Analysis of diastolic function for assessment of myocardial viability has not been evaluated. Strain rate (SR) analysis allows quantitative segmental analysis of myocardial function and has been used during dobutamine stimulation for assessment of systolic functional reserve. In 37 patients with ischemic left ventricular dysfunction diastolic function was evaluated at rest and during low-dose dobutamine stimulation (10 mug/kg/min) using SR imaging and related to F18-fluorodeoxyglucose positron emission tomography. Analysis of peak early (E waves) and late (A waves) diastolic myocardial SR was performed using apical views. In all, 317 segments had normal function at rest by 2-dimensional echocardiography. A total of 192 segments with dyssynergy at rest were classified by positron emission tomography as viable in 94 cases and nonviable in 98 cases. Dys-synergic segments had lower E and A waves SR compared with normal contracting segments. There were no significant differences in peak E and A waves SR at rest between dys-synergic viable and nonviable segments. With dobutamine stimulation peak E waves SR increased significantly for viable segments (0.89 +/- 0.51-1.06 +/- 0.51 L/s, P < .01) whereas it was unchanged for nonviable segments (0.77 +/- 0.49-0.78 +/- 0.48 L/s, P = .835). Peak A waves SR increased for viable (0.71 +/- 0.55-1.00 +/- 0.56 L/s, P < .01) and nonviable (0.57 +/- 0.47-0.71 +/- 0.58 L/s, P = .023) segments. However, during dobutamine stimulation peak A waves SR was larger ( P < .001) for viable than for nonviable segments. In conclusion, normal contracting segments at rest have higher E and A waves SR compared with dys-synergic segments. Dys-synergic viable myocardial segments demonstrate an increase in E and A waves SR with dobutamine stimulation whereas nonviable segments are less responsive to dobutamine.
Collapse
|
204
|
Giardini A, Moore P, Brook M, Stratton V, Tacy T. Effect of transcatheter atrial septal defect closure in children on left ventricular diastolic function. Am J Cardiol 2005; 95:1255-7. [PMID: 15878007 DOI: 10.1016/j.amjcard.2005.01.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 01/17/2005] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
The acute impact of transcatheter atrial septal defect (ASD) closure on left ventricular (LV) diastolic function was assessed in 15 consecutive children, and pre- and postclosure data were compared with those in a matched group of controls. The data indicate that transcatheter ASD closure leads to an immediate improvement in LV diastolic function as assessed by septal myocardial Doppler tissue imaging and LV inflow velocity propagation. The improvement in LV diastolic properties correlates with the degree of right ventricular volume overload.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cardiac Catheterization
- Case-Control Studies
- Child, Preschool
- Diastole
- Echocardiography, Doppler, Color/methods
- Female
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/pathology
- Heart Septal Defects, Atrial/surgery
- Humans
- Infant
- Male
- Middle Aged
- Radiography
- Retrospective Studies
- Treatment Outcome
- Ultrasonography, Interventional/methods
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/surgery
Collapse
Affiliation(s)
- Alessandro Giardini
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Bologna, Italy
| | | | | | | | | |
Collapse
|
205
|
Galetta F, Franzoni F, Cupisti A, Morelli E, Santoro G, Pentimone F. Early detection of cardiac dysfunction in patients with anorexia nervosa by tissue Doppler imaging. Int J Cardiol 2005; 101:33-7. [PMID: 15860380 DOI: 10.1016/j.ijcard.2004.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Revised: 02/19/2004] [Accepted: 03/01/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiac damage is a major complication of chronic starvation. The aim of this study was to evaluate the changes of left ventricular function in patients with anorexia nervosa by means of pulsed tissue Doppler imaging. METHODS A total of 20 females (age 22.4+/-4.3 years) with overt anorexia nervosa, 20 matched healthy thin females with body mass index < 19 kg/m2 and 20 matched healthy normal-weight females underwent both standard echocardiography and tissue Doppler imaging. Myocardial systolic wave (Sm) and early (Em) and atrial (Am) diastolic waves were measured on the basal lateral segment and the basal interventricular septum from the apical four-chamber view. RESULTS When compared with control groups, the anorexia nervosa group showed lower left ventricular mass (p < 0.0001), lower Sm peak of both lateral wall (6.5+/-0.9 vs. 9.4+/-2.1 and vs. 9.5+/-1.9 cm/sec, p < 0.001) and septum (5.6+/-1.5 vs. 8.6+/-1.6 and vs. 8.8+/-1.5 cm/sec, p < 0.001), and comparable Em, Am and Em/Am ratio. The ratio between transmitral peak E and Em was significantly greater in anorexic patients than in controls (lateral wall: 8.1+/-0.1 vs. 6.8+/-0.2 and vs. 6.9+/-0.2, p < 0.001; septum: 10.8+/-0.4 vs. 8.8+/-0.5 and vs. 8.8+/-0.3, p < 0.001). No differences were observed between thin and normal-weight females. In the anorexia nervosa group, S(m) peak was significantly related to left ventricular mass indexed, at both septum (r = 0.55, p < 0.02) and lateral wall (r = 0.49, p < 0.03) levels. CONCLUSIONS These results show that anorexia nervosa is associated with left ventricular systolic dysfunction, which is related with the reduction of cardiac mass. Tissue Doppler imaging can give useful information in the identification of regional left ventricular dysfunction, in addition to traditional parameters.
Collapse
Affiliation(s)
- Fabio Galetta
- Department of Internal Medicine, School of Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy.
| | | | | | | | | | | |
Collapse
|
206
|
González-Vílchez F, Ayuela J, Ares M, Pi J, Castillo L, Martín-Durán R. Oxidative stress and fibrosis in incipient myocardial dysfunction in type 2 diabetic patients. Int J Cardiol 2005; 101:53-8. [PMID: 15860383 DOI: 10.1016/j.ijcard.2004.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Revised: 01/13/2004] [Accepted: 03/01/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND The existence of a diabetic cardiomyopathy has been recently supported by epidemiological studies. Increased oxidative stress and myocardial fibrosis has been hypothesized as etiopathogenic mechanisms. We sought to demonstrate the existence of incipient myocardial dysfunction in type 2 diabetes and its relation with markers of oxidative stress and myocardial fibrosis. METHODS We studied by echocardiography 25 uncomplicated type 2 diabetic patients and 12 sex- and age-matched control subjects. Stress-corrected endocardial and midwall shortening and systolic and early diastolic velocity of the lateral mitral annulus (Doppler tissue) were used as parameters of myocardial function. Serum levels of glutathione peroxidase and procollagen type I carboxy-terminal peptide were used as markers of oxidative stress and myocardial fibrosis, respectively. RESULTS Diabetics had significant lower values of corrected endocardial shortening than control subjects (P = 0.029). Both systolic and early diastolic mitral annulus velocities were significantly reduced in diabetics as compared to control subjects (P = 0.008 and P = 0.003, respectively). In diabetic patients, corrected endocardial (r = -0.56) and midwall shortening (r = -0.38) correlated with procollagen type I carboxy-terminal peptide, whereas systolic and early diastolic velocities of the mitral annulus correlated with glutathione peroxidase (both r = 0.44). CONCLUSIONS In a highly selected group of uncomplicated type 2 diabetic patients, we found evidence of systolic and diastolic myocardial dysfunction, especially with the use of pulsed Doppler tissue imaging. The correlations between parameters of myocardial function and glutathione peroxidase and procollagen type I carboxy-terminal peptide support a mechanistic role for the increased oxidative stress and myocardial fibrosis in the myocardial dysfunction of type 2 diabetes.
Collapse
Affiliation(s)
- Francisco González-Vílchez
- Servicio de Cardiología, 3a Sur, Hospital Universitario Marqués de Valdecilla, Avda. de Valdecilla s/n. 39008, Santander, Spain.
| | | | | | | | | | | |
Collapse
|
207
|
Paelinck BP, de Roos A, Bax JJ, Bosmans JM, van Der Geest RJ, Dhondt D, Parizel PM, Vrints CJ, Lamb HJ. Feasibility of tissue magnetic resonance imaging: a pilot study in comparison with tissue Doppler imaging and invasive measurement. J Am Coll Cardiol 2005; 45:1109-16. [PMID: 15808772 DOI: 10.1016/j.jacc.2004.12.051] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2004] [Revised: 11/18/2004] [Accepted: 12/13/2004] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This research was intended to determine the feasibility of tissue magnetic resonance (MR) imaging in comparison with tissue Doppler imaging and its potential implications for the estimation of filling pressure, in comparison with invasive measurement. BACKGROUND Evaluation of diastolic function using MR imaging is commonly confined to the study of transmitral flow. However, transmitral flow is unreliable for the estimation of left ventricular (LV) filling pressures in hypertrophy and normal systolic function. Normalizing early mitral velocity (E) for the influence of myocardial relaxation by combining E with early diastolic mitral septal tissue velocity (Ea) provides better Doppler estimates of filling pressures. METHODS Eighteen patients with hypertensive heart disease (LV mass index: 114 +/- 21 g/m(2)), absence of valvular regurgitation, and with normal or mildly reduced systolic function (LV ejection fraction: 57.6 +/- 6.5%) referred for cardiac catheterization, underwent consecutive measurement of mitral flow and septal tissue velocities with phase-contrast MR and Doppler. These data were compared with mean pulmonary capillary wedge pressure (PCWP). RESULTS There was a strong relation between MR (11.6 +/- 4.3) and Doppler-assessed (12.1 +/- 3.5) E/Ea (95% confidence interval of -1.5 to 0.5) (r = 0.89, p < 0.0001). In addition, E/Ea related strongly to invasively measured PCWP (MR: r = 0.80, p < 0.0001 and Doppler: r = 0.85, p < 0.0001). CONCLUSIONS Tissue MR imaging is a feasible method to assess Ea. Combining E and Ea allowed similar estimation of filling pressure by MR and Doppler, in good agreement with invasive measurement. The potential confounding effect of valvular regurgitation needs further study.
Collapse
Affiliation(s)
- Bernard P Paelinck
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
208
|
Keser N, Yildiz S, Kurtoğ N, Dindar I. Modified TEI Index: A Promising Parameter in Essential Hypertension? Echocardiography 2005; 22:296-304. [PMID: 15839984 DOI: 10.1111/j.1540-8175.2005.03141.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Modified TEI index is pointed to be more effective in the evaluation of global cardiac functions compared to systolic and diastolic measurements alone. We planned to determine its applicability in hypertension and relation with left ventricular mass index (LVMI). METHODS We studied 48 patients with mild/moderate hypertension and normal coronary angiograms. In total 22 patients (12 men, 10 women, mean age: 55 +/- 6) with normal LVMI were studied in group I, 26 patients (12 men, 14 women, mean age: 57 +/- 7) with increased LVMI in group II, and 20 patients (10 men, 10 women, mean age: 53 +/- 7) with normal blood pressure as a control group. Standard 2D, Doppler, and mitral annulus pulse wave tissue Doppler were used for all measurements. Modified TEI index was calculated as diastolic time interval measured from end of Am wave to origin of Em (a') minus systolic Sm duration (b') divided by b(a'-b'/b'). RESULTS Modified TEI index was significantly higher in both groups than normal group and in group II than in group I. ( CONTROL GROUP 0.33 +/- 0.05, group I: 0.51 +/- 0.17, group II: 0.68 +/- 0.16, P< 0.0001). CONCLUSION Modified TEI index, a marker of left ventricular systolic and diastolic functions, is impaired in hypertensives before hypertrophy develops and impairment is more prominent in hypertrophy. Therefore, (1) modified TEI index in hypertensives is a safe, feasible, and sensitive index for evaluation of global ventricular functions. (2) Evaluation of hypertensives with this index periodically may guide interventions directed toward saving systolic and diastolic functions. (3) Modified TEI index is gaining importance as a complementary parameter to standard Doppler or in cases where standard Doppler has its limitations.
Collapse
Affiliation(s)
- Nurgül Keser
- Department of Cardiology, University of Maltepe-Istanbul, Istanbul, Turkey.
| | | | | | | |
Collapse
|
209
|
Hung KC, Huang HL, Chu CM, Chen CC, Hsieh IC, Chang ST, Fang JT, Wen MS. Evaluating preload dependence of a novel Doppler application in assessment of left ventricular diastolic function during hemodialysis. Am J Kidney Dis 2005; 43:1040-6. [PMID: 15168384 DOI: 10.1053/j.ajkd.2004.03.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction, commonly found in hemodialysis (HD) patients, is a major cause of intradialytic hypotension. Conventional Doppler interrogation of mitral flow velocities typically is load dependent. Tissue Doppler imaging (TDI) recently was proposed as a new and relatively load-independent approach to assess diastolic function. The aim of this study is to determine whether HD-related volume reduction affects mitral annular velocities in a large number of patients. METHODS One hundred twenty-eight uremic patients underwent Doppler echocardiography 1 hour before and after HD. Two-dimensional and M-mode echocardiography were used to analyze LV size, volume, mass, systolic function, and the inferior vena cava. Doppler signals were obtained from the mitral inflow and TDI of the mitral annulus to measure variations in hemodynamics and LV diastolic filling parameters. RESULTS After HD, LV size, volume, mass, stroke volume, and cardiac output were significantly decreased (all P < 0.001). Peak early (E) and late diastolic velocities (A) and E/A ratio decreased significantly after HD (all P < 0.001). Mitral annulus E' velocity and E'/A' ratio also changed significantly (both P < 0.001), whereas A' did not. Consequently, changes in E and A significantly differed with respect to the varying amount of ultrafiltration (both P < 0.05). CONCLUSION Our larger cohort study shows that the proposed technique of TDI is still volume dependent. Therefore, LV diastolic function in HD patients must be assessed carefully in a timely manner, even when the new Doppler application is used.
Collapse
Affiliation(s)
- Kuo-Chun Hung
- Second Section of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
210
|
Palka P, Lange A, Galbraith A, Duhig E, Clarke BE, Parsonage W, Donnelly JE, Stafford WJ, Burstow DJ. The role of left and right ventricular early diastolic Doppler tissue echocardiographic indices in the evaluation of acute rejection in orthotopic heart transplant. J Am Soc Echocardiogr 2005; 18:107-15. [PMID: 15682046 DOI: 10.1016/j.echo.2004.09.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim was to evaluate whether Doppler tissue echocardiographic early diastolic indices of both the right and left ventricle (LV) may assist in the detection of acute heart transplant (HT) rejection. METHODS In all, 44 consecutive patients with HT (mean age 52.0 +/- 9.6 years, 39 men) were divided into group 1 with no rejection (histopathology grade < or = 2) and group 2 with acute (severe) rejection (grade > or = 3A). In group 2, echocardiographic examinations were performed before (A), during (B), and after (C) acute rejection. RESULTS Although patients with HT in group 2B compared with group 1 had lower early diastolic velocities at medial/septal (E Med ) and tricuspid/lateral (E Tric ) annulus, as a result of substantial data overlapping this finding did not allow for the detection of patients with acute rejection. In group 2B, both onsets of E Med and E Tric were delayed and LV early diastolic mitral/lateral annulus velocities (E Mitr ) markedly preceded E Tric (E Tric -E Mitr 68 +/- 45 milliseconds for group 2B vs 7 +/- 43 milliseconds for group 1 and 14 +/- 40 milliseconds for group 2A; P < .01). Additionally, patients with HT in group 2B had pathologically positive late isovolumic relaxation myocardial velocity gradient of LV posterior wall compared with group 1 or group 2A (1.5 +/- 1.4 s -1 vs -0.3 +/- 2.0 s -1 or 0.3 +/- 1.8, respectively; P < .01). Late isovolumic relaxation myocardial velocity gradient greater than 0.1 s -1 and timing differences between onsets of: (1) mitral early diastolic velocity (E wave) and E Med greater than -35 milliseconds; and (2) E Tric -E Mitr greater than 15 milliseconds allowed for the distinction of patients with acute HT rejection (group 2B vs 1) with sensitivity and specificity greater than 0.80. CONCLUSIONS For patients with HT and acute rejection abnormal Doppler tissue echocardiographic indices may be caused by both: (1) altered early diastolic untwist of the oblique LV fibers; and (2) the delay in early diastolic right ventricular relaxation. Late isovolumic relaxation myocardial velocity gradient and early diastolic timing intervals (mitral E wave-E Med and E Tric -E Mitr ) are promising new echocardiographic markers that can be used in the surveillance for acute rejection in patients with HT.
Collapse
Affiliation(s)
- Przemysław Palka
- St. Andrew's Heart Institute, Prince Charles Hospital and Royal Brisbane Hospital, 33 N Street, Spring Hill, Brisbane, Queensland 4000, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
211
|
Giorgi D, Di Bello V, Talini E, Palagi C, Delle Donne MG, Nardi C, Verunelli F, Mariani MA, Di Cori A, Caravelli P, Mariani M. Myocardial function in severe aortic stenosis before and after aortic valve replacement: A Doppler tissue imaging study. J Am Soc Echocardiogr 2005; 18:8-14. [PMID: 15637482 DOI: 10.1016/j.echo.2004.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of the study was to assess the value of Pulsed-wave Doppler tissue imaging (DTI) in assessing diastolic and systolic function in patients with severe aortic value stenosis. METHODS Thirty-five patients with aortic stenosis (AS) (valve orifice < or = 1 cm 2 , mean age 71.8 +/- 6.2) and 35 comparable healthy subjects were studied. All subjects performed conventional 2-dimensional Doppler echocardiography and DTI at mitral annulus level. Patients with AS were divided into 2 groups: 16 patients who presented initial signs of HF and a depressed left ventricular systolic function (AS I) (EF: 35%-50%) and 19 patients were asymptomatic and had normal left ventricular systolic function (EF > 50%) (ASII). The 16 symptomatic AS patients underwent surgical aortic valve replacement and were examined after 1 year. RESULTS DTI was able to detect abnormalities of systolic and diastolic function in AS: the significantly lower peak S velocity in AS I than in AS II and in controls, both at septum and lateral wall level; the significantly lower peak E velocity in AS I than in AS II and in controls both at septum and lateral wall level; the significantly higher peak A velocity in AS I than in AS II and in controls both at septum and lateral wall level; the significant lower E/A ratio in AS I than in AS II and in controls both at septum and lateral wall level. CONCLUSION We found a significant inverse correlation between DTI lateral S velocity, DTI peak E velocity, lateral DTI E/A ratio, and AS peak and mean gradient. According to the results of this study we can affirm that DTI parameters surely had an important physiopathological impact in the knowledge of myocardial function in patients with severe aortic stenosis.
Collapse
Affiliation(s)
- Davide Giorgi
- Cardiac and Thoracic Department, University of Pisa, 56124 Pisa, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
212
|
Teshima K, Asano K, Sasaki Y, Kato Y, Kutara K, Edamura K, Hasegawa A, Tanaka S. Assessment of Left Ventricular Function Using Pulsed Tissue Doppler Imaging in Healthy Dogs and Dogs with Spontaneous Mitral Regurgitation. J Vet Med Sci 2005; 67:1207-15. [PMID: 16397378 DOI: 10.1292/jvms.67.1207] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pulsed tissue Doppler imaging (pulsed TDI) has been demonstrated to be useful for the estimation of left ventricular (LV) systolic and diastolic functions in various human cardiac diseases. The objectives of this study were to investigate the relationship between pulsed TDI and LV function by using cardiac catheterization in healthy dogs and to evaluate the clinical usefulness of pulsed TDI in dogs with spontaneous mitral regurgitation (MR). The peak early diastolic velocity (E'), peak atrial systolic velocity (A'), and peak systolic velocity (S') were detectable in the velocity profiles of the mitral annulus in all the dogs. In the healthy dogs, S' and E' were correlated with LV peak +dP/dt and -dP/dt, respectively. E' was lower in dogs with MR than in dogs without cardiac diseases. E/E' in the MR dogs with decompensated heart failure was significantly increased in comparison with those with compensated heart failure. The sensitivity and specificity of the E/E' cutoff value of 13.0 for identifying decompensated heart failure were 80% and 83%, respectively. In addition, E/E' was significantly correlated with the ratio of left atrial to aortic diameter. These findings suggest that canine pulsed TDI can be applied clinically for estimation of cardiac function and detection of cardiac decompensation and left atrial volume overload in dogs with MR.
Collapse
Affiliation(s)
- Kenji Teshima
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Japan
| | | | | | | | | | | | | | | |
Collapse
|
213
|
Wang M, Yip GW, Wang AY, Zhang Y, Ho PY, Tse MK, Yu CM, Sanderson JE. Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy. J Hypertens 2005; 23:183-91. [PMID: 15643141 DOI: 10.1097/00004872-200501000-00029] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We sought to determine the prognostic value of left ventricular (LV) mitral annular velocities measured by tissue Doppler imaging (TDI) in hypertensive patients with echocardiographic evidence of LV hypertrophy. BACKGROUND Echo LV hypertrophy and LV geometry provide additional predictive value of all-cause mortality beyond traditional cardiovascular risk factors. Limited data exist regarding the predictive value of TDI velocities for cardiovascular risk stratification in treated hypertensive patients. METHODS Two-dimensional and Doppler echocardiograms were obtained in 252 consecutive subjects, including 174 subjects with systemic hypertension and 78 age-matched normal subjects. The end point was cardiac death in subsequent median follow-up of 19 months. RESULTS Nineteen patients (7.54%) died of cardiac causes. The TDI mitral annulus systolic velocity and the early diastolic mitral annular velocity (Em) were significantly lower in the non-survivors (all P < 0.001). The pseudonormal (PN) or restrictive filling pattern (RFP) was associated with cardiac mortality. The other parameters associated with cardiac mortality were LV ejection fraction, LV mass index, inter-ventricular septal wall thickness in diastole and the ratio of early mitral inflow to early myocardial velocity. In multivariate analysis, Em, inter-ventricular septal wall thickness in diastole and either PN or RFP were the strongest predictors. The addition of Em < 3.5 cm/s significantly improved the outcome of a model that contained clinical risk factors, inter-ventricular septal wall thickness in diastole > 1.4 cm and either PN or RFP (P = 0.043). CONCLUSIONS Early diastolic mitral annulus velocity measured by TDI provides prognostic information, incremental to clinical data and standard echocardiographic variables, for risk stratification of hypertensive patients under treatment.
Collapse
Affiliation(s)
- Mei Wang
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | | | | | | | | | | | | |
Collapse
|
214
|
Yu WC, Lee WS, Huang WP, Wu CC, Lin YP, Chen CH. Evaluation of cardiac function by tissue Doppler echocardiography: hemodynamic determinants and clinical application. ULTRASOUND IN MEDICINE & BIOLOGY 2005; 31:23-30. [PMID: 15653227 DOI: 10.1016/j.ultrasmedbio.2004.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Revised: 09/12/2004] [Accepted: 09/16/2004] [Indexed: 05/24/2023]
Abstract
A total of 32 patients without regional wall motion abnormality of the left ventricle underwent sequential tissue Doppler echocardiography and cardiac catheterization. Peak velocities of systolic (Sa), early diastolic (Ea), and late diastolic (Aa) motion of the mitral annulus were measured. Normal references for Sa, Ea and Aa were obtained from 138 volunteers. Indices of left ventricular (LV) systolic and diastolic function were evaluated using high-fidelity LV pressure and volume signals. By multivariate analysis, Sa, Ea and As were significantly and independently related to the maximum of the first derivative of pressure over time (dP/dt(max)), LV relaxation time constant (tau), and LV ejection fraction (EF), respectively. Using the fifth percentiles of the age-stratified normal references as cut-offs, low Sa, low Ea and low Aa identified declined dP/dt(max), prolonged tau and reduced EF, respectively, with good sensitivities and specificities. In conclusion, mitral annulus velocities by tissue Doppler echocardiography can be used to identify patients with declined dP/dt(max), prolonged tau and reduced EF.
Collapse
Affiliation(s)
- Wen-Chung Yu
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | | | | | | | | | | |
Collapse
|
215
|
Jacques DC, Pinsky MR, Severyn D, Gorcsan J. Influence of Alterations in Loading on Mitral Annular Velocity by Tissue Doppler Echocardiography and Its Associated Ability To Predict Filling Pressures. Chest 2004; 126:1910-8. [PMID: 15596692 DOI: 10.1378/chest.126.6.1910] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Early diastolic mitral annular velocity (E') by tissue Doppler echocardiography (TD) has been reported to be a load-independent index of left ventricular (LV) diastolic function, allowing the early diastolic mitral inflow velocity (E)/E' ratio to be used clinically to predict LV filling pressures. However, preload independence of E' has remained controversial, and E/E' may not consistently be predictive of LV filling pressures. Our objectives were to test the hypotheses that E' is affected by preload, and that alterations of preload, afterload, and contractility also affect E/E'. DESIGN, INTERVENTIONS, AND MEASUREMENTS: An open-chest dog model was used (n = 8). High-fidelity pressure and conductance catheters were used for pressure-volume relations, and E' was obtained by pulsed TD from the apical four-chamber view. Changes in preload and afterload were induced by vena caval and partial aortic occlusions, respectively. Data were collected during control phase and during infusions of dobutamine and esmolol to alter contractility. RESULTS E' was consistently and significantly associated with acute decreases in LV end-diastolic pressure in each dog (n = 200 beats; r = 0.93 +/- 0.06 [mean +/- SD]). Similar results occurred with dobutamine and esmolol infusions. This preload sensitivity was reflected in E/E', which was inversely (rather than directly) correlated with LV diastolic pressure (r = - 0.67). E/E' was less affected by preload when diastolic dysfunction was induced by sustained partial aortic occlusion (time constant of relaxation increased from 46 +/- 19 to 53 +/- 21 ms, p < 0.001). CONCLUSIONS E' was significantly influenced by preload with preserved LV function and low filling pressures (< 12 mm Hg); accordingly, E/E' was less predictive of LV filling pressures in this scenario. E/E' was more predictive of LV filling pressures in the presence of diastolic dysfunction.
Collapse
Affiliation(s)
- Didier C Jacques
- Division of Cardiology,University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | | | | | | |
Collapse
|
216
|
Pelà G, Bruschi G, Montagna L, Manara M, Manca C. Left and right ventricular adaptation assessed by Doppler tissue echocardiography in athletes. J Am Soc Echocardiogr 2004; 17:205-11. [PMID: 14981416 DOI: 10.1016/j.echo.2003.12.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Changes induced by intensive training in the morphology and kinetics of both ventricles in athletes (soccer players) were assessed by 2-dimensional echocardiography and Doppler tissue echocardiography (DTE). DTE has yet to find widespread application in sports medicine, and the right ventricle (RV) is often neglected in the examination of athletes. DTE-determined velocities were measured along the short and long axis in the left ventricle (LV) and over the long axis in the RV. Wall displacements (systolic shortenings and diastolic elongations) were computed at each site as time-velocity integrals. Normalized velocities and excursions were calculated with reference to the long and short diastolic dimensions. METHODS A total of 20 athletes and 15 age- and sex-matched control subjects were enrolled in the study. All participants underwent history screening, physical examination, electrocardiogram, and blood analysis. RESULTS The athletes had significantly greater RV long-axis dimension and LV short-axis dimension than control subjects. LV ejection fraction was similar in the 2 groups. In athletes, peak systolic velocities were significantly increased along the LV short axis and the RV long axis. Early diastolic velocities were significantly increased for the LV short axis and nonsignificantly increased at all other sites. The ratio of these peak velocities to the proper diastolic dimension (fractional or normalized velocities) did not significantly differ between the groups. Time-velocity integrals (ie, wall tissue displacements) were increased in all directions examined in both ventricles, both in systole and early diastole. However, normalized or percent shortenings and elongations were similar in athletes and control subjects. CONCLUSION These data suggest that an increase in RV and LV cavity size is associated with higher DTE-reported velocities in athletes. These higher velocities correspond to greater excursions of the muscle segments involved. Normalized velocities and excursions, however, indicate an unchanged fractional shortening, so that contractility has to be considered unaffected in these athletes. We suggest that DTE is instructive in unveiling functional adaptations of the heart in athletes, but questions of data interpretation have to be settled. For example, one should be cautious in comparing absolute velocities between chambers of different size. Nonnormalized velocities may be an objectionable index in the presence of cardiac enlargement.
Collapse
Affiliation(s)
- Giovanna Pelà
- Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, Università degli Studi, via Gramsci 14, 43100 Parma, Italy.
| | | | | | | | | |
Collapse
|
217
|
Eidem BW, McMahon CJ, Cohen RR, Wu J, Finkelshteyn I, Kovalchin JP, Ayres NA, Bezold LI, O'Brian Smith E, Pignatelli RH. Impact of cardiac growth on Doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiogr 2004; 17:212-21. [PMID: 14981417 DOI: 10.1016/j.echo.2003.12.005] [Citation(s) in RCA: 294] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Doppler tissue imaging (DTI) is a useful modality to quantitatively assess regional myocardial function. Studies attempting to establish reference values for DTI velocities in healthy children have been limited by small sample sizes and limited age distribution. In addition, the clinical effect of cardiac growth and other demographic and echocardiographic parameters on DTI velocities during childhood has not been adequately evaluated. METHODS Pulsed wave DTI velocities were obtained in 325 healthy children at the lateral mitral annulus, interventricular septum, and lateral tricuspid annulus during early diastole, late diastole, and ventricular systole and were compared with demographic and echocardiographic study variables. RESULTS In healthy children, parameters of cardiac growth, most notably left ventricular end-diastolic dimension, have the most significant correlation with the majority of DTI velocities. Age was also significantly correlated with most DTI velocities whereas sex, heart rate, and other echocardiographic parameters demonstrated minimal or no correlation. CONCLUSIONS This study establishes reference values for DTI velocities and demonstrates the important clinical effects of cardiac growth and age on DTI velocities in neonates and children.
Collapse
Affiliation(s)
- Benjamin W Eidem
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin-MC 19-345C, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
218
|
Nottin S, Nguyen LD, Terbah M, Obert P. Long-term endurance training does not prevent the age-related decrease in left ventricular relaxation properties. ACTA ACUST UNITED AC 2004; 181:209-15. [PMID: 15180793 DOI: 10.1111/j.1365-201x.2004.01284.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Diastolic filling dynamics in the long-term endurance trained elderly has previously been examined by transmitral flow velocity, which has been shown to be preload dependent. The aim of this study was to assess the effect of long-term endurance training on left ventricular (LV) relaxation in older individuals by using pulsed tissue Doppler imaging. METHODS Fourteen master athletes with a history of intensive long-term endurance training, 14 aged-matched sedentary controls and 15 young adult men underwent standard Doppler echocardiography and pulsed Doppler tissue imaging, performed in four-chambers apical view, by placing a sample volume at the level of the mitral annulus. RESULTS Stroke volume was significantly higher and heart rate lower in master athletes compared with aged-matched sedentary subjects. Transmitral Peak E velocity and ratio E/A were significantly higher in master athletes, but did not reach the values of young men. Peak LV wall motion during the early filling phase, an index of LV relaxation, were significantly higher in young men than in both groups of older individuals. However, similar values were obtained between master athletes and sedentary counterparts. CONCLUSIONS Our data provide evidence that long-term training does not reduce the age-related decline in LV relaxation properties in humans. This finding implies that other mechanisms, such as increased LV filling pressures due to expanded blood volume, are probably responsible for the higher contribution of early diastolic filling to LV filling in master athletes compared with their sedentary counterparts. However this hypothesis needs to be confirmed.
Collapse
Affiliation(s)
- S Nottin
- Laboratory of Cardio-Vascular Adaptations to Exercise, Faculty of Sciences, 33 Rue Louis Pasteur, Avignon, France
| | | | | | | |
Collapse
|
219
|
Abstract
PURPOSE OF REVIEW Although two-dimensional, M-mode, and Doppler echocardiography have played a major role in the assessment of amyloid deposition in the heart, diagnosis of cardiac amyloidosis (CA) based on these conventional techniques is often only possible once the disease is in a relatively advanced stage. To optimize survival, early diagnosis and institution of therapy are essential. Recently, tissue Doppler imaging (TDI) and myocardial strain rate (SR) have emerged as important clinical tools in the assessment of CA. RECENT FINDINGS Tissue Doppler imaging-derived modalities including TDI velocities, strain, and SR are currently being used in the early diagnosis and evaluation of patients with CA. Although these new indices have been examined in relatively few patients, findings suggest an important and expanding role of TDI in amyloid infiltration of the heart. SUMMARY This review summarizes the recent literature addressing the role of TDI velocities, strain, and SR in the diagnosis and assessment of CA.
Collapse
Affiliation(s)
- John A Sallach
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | |
Collapse
|
220
|
Abstract
Echocardiography is an exceptionally useful technique for diagnosing cardiovascular disease in small animals. It is noninvasive and provides a wealth of data concerning cardiac morphology and function. For many patients, echocardiography is the definitive diagnostic tool. A well-performed study coalesces the findings of the physical examination, electrocardiogram, and radiographs into a clearly defined diagnosis on which treatment decisions can be based. More so than other diagnostic techniques, echocardiography is highly operator dependent and relies on the proper acquisition and interpretation of results by an examiner who is familiar with the principles, capabilities, and limitations of ultrasound imaging. This article reviews the basics of echocardiography, measurement of cardiac dimensions, and assessment of cardiac function. Within these sections, emerging technologies that expand the capabilities of the echocardiographic examination are introduced.
Collapse
Affiliation(s)
- Mark A Oyama
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
| |
Collapse
|
221
|
Ha JW, Ommen SR, Tajik AJ, Barnes ME, Ammash NM, Gertz MA, Seward JB, Oh JK. Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiography. Am J Cardiol 2004; 94:316-9. [PMID: 15276095 DOI: 10.1016/j.amjcard.2004.04.026] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Revised: 04/13/2004] [Accepted: 04/13/2004] [Indexed: 11/27/2022]
Abstract
This study evaluated the diagnostic role of early diastolic mitral annular velocity (E') by tissue Doppler echocardiography for differentiating constrictive pericarditis from restrictive cardiomyopathy (primary restrictive cardiomyopathy and cardiac amyloidosis). The study group consisted of 75 patients (53 men, 22 women; mean age 62 years, range 27 to 87). Of these, 23 patients had surgically confirmed constrictive pericarditis, 38 had biopsy-proved systemic amyloidosis and typical echocardiographic features of cardiac involvement, and 14 had primary restrictive cardiomyopathy. Standard mitral inflow characteristics were measured. Tissue Doppler echocardiography was used to measure E' at the septal annulus. E' was significantly higher in patients with constrictive pericarditis than in those with primary restrictive cardiomyopathy or cardiac amyloidosis (12.3 vs 5.1 cm/second, p <0.001). An E' cut-off value > or =8 cm/second resulted in 95% sensitivity and 96% specificity for the diagnosis of constrictive pericarditis. There was no overlap of E' between patients who had constrictive pericarditis and those who had cardiac amyloidosis. In a subgroup analysis of restrictive cardiomyopathy, E' of patients who had cardiac amyloidosis was significantly lower than that of patients who had primary restrictive cardiomyopathy (4.6 vs 6.3 cm/second, p <0.001). Thus, E' velocity can distinguish between constrictive pericarditis and restrictive cardiomyopathy with a specific cut-off value in patients with clinical and echocardiographic evidence of diastolic heart failure.
Collapse
Affiliation(s)
- Jong-Won Ha
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | |
Collapse
|
222
|
Sutherland GR, Di Salvo G, Claus P, D'hooge J, Bijnens B. Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 2004; 17:788-802. [PMID: 15220909 DOI: 10.1016/j.echo.2004.03.027] [Citation(s) in RCA: 410] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
On the basis of color Doppler myocardial motion data, 1-dimensional regional natural strain rate and strain curves can now be calculated by comparing local myocardial velocity profiles. Such deformation data sets may be an important, new, and more sensitive approach to quantifying both regional radial and long-axis function of the left or right ventricle in both acquired and congenital heart disease. The normal ranges of regional velocity, strain rate, and strain values have already been determined in both adults and children. This review will focus both on the potential clinical applications of these new ultrasound-based deformation parameters and the current limitations inherent in implementing the technique in everyday practice.
Collapse
Affiliation(s)
- George R Sutherland
- Department of Cardiology, University Hospital Gasthuisberg, Lueven, Belgium.
| | | | | | | | | |
Collapse
|
223
|
Yamada H, Oki T, Yamamoto T, Tanaka H, Tabata T, Wakatsuki T, Nomura M, Ito S, Thomas JD. Potential application of tissue Doppler imaging to assess regional left ventricular diastolic function in patients with hypertrophic cardiomyopathy: comparison with 123I-beta-methyl iodophenyl pentadecanoic acid myocardial scintigraphy. Clin Cardiol 2004; 27:33-9. [PMID: 14743854 PMCID: PMC6654016 DOI: 10.1002/clc.4960270109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tissue Doppler imaging (TDI) has been utilized to evaluate left ventricular myocardial dysfunction in patients with hypertrophic cardiomyopathy (HCM); however, no clear explanation for the abnormality of TDI variables has been forthcoming. HYPOTHESIS Peak negative myocardial velocity gradient (MVG) derived from TDI may correlate with a disorder of fatty acid metabolism in patients with HCM. METHODS Tissue Doppler imaging and 123I-beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP) myocardial scintigraphy were performed in 15 patients with asymmetric septal hypertrophy (mean age 47 +/- 18 years) and in 12 healthy controls (mean age 43 +/- 10 years). RESULTS In early 123I-BMIPP images, accumulation defects were observed in the ventricular septum in 12 patients and in the posterior wall in 8 patients with HCM. Peak negative MVG in the ventricular septum (1.1 +/- 0.5 vs. 2.8 +/- 0.5, p < 0.0001) and posterior wall (5.2 +/- 1.4 vs. 6.7 +/- 0.8, p < 0.01 ) was significantly lower in the HCM group than in the controls; also, these parameters were significantly lower in patients with than in those without a defect in the region in question. The peak negative MVG in the ventricular septum and posterior wall correlated inversely with the washout rate in all subjects. CONCLUSIONS Peak negative MVG according to TDI is related to disorder of fatty acid metabolism in the regional left ventricular myocardium of patients with HCM.
Collapse
Affiliation(s)
- Hirotsugu Yamada
- Department of Cardiovascular Medicine, Section on Cardiovascular Imaging, the Cleveland Foundation, Cleveland, Ohio, USA
| | - Takashi Oki
- The Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Takashi Yamamoto
- The Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Hideji Tanaka
- The Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Tomotsugu Tabata
- The Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Tetsuzo Wakatsuki
- The Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Masahiro Nomura
- The Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Susumu Ito
- The Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - James D. Thomas
- Department of Cardiovascular Medicine, Section on Cardiovascular Imaging, the Cleveland Foundation, Cleveland, Ohio, USA
| |
Collapse
|
224
|
Sohn DW, Kim YJ, Park YB, Choi YS. Clinical validity of measuring time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 2004; 43:2097-101. [PMID: 15172419 DOI: 10.1016/j.jacc.2004.02.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 02/04/2004] [Accepted: 02/10/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study was performed to validate the clinical usefulness of measuring the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity (T(E'-E)) for the evaluation of left ventricular (LV) diastolic function. BACKGROUND In recent studies, T(E'-E) correlated well with the time constant of LV pressure decay (tau), and the ratio of IVRT/T(E'-E), where IVRT is isovolumic relaxation time, was useful in the prediction of elevated LV filling pressure. METHODS Simultaneous left heart catheterization and Doppler echocardiography were performed in 40 patients. RESULTS The T(E'-E) was evaluated in the same cardiac cycle and in the same hemodynamic status in 31 patients. Despite the wide range of tau (31 to 70 ms), there was no delay in the onset of mitral annulus velocity compared with the onset of mitral inflow (T(E'-E) = 0) in 27 patients and, therefore, T(E'-E) did not correlate with tau. Only three patients showed prolongation in T(E'-E), and all three showed tau >or=50 ms and pre-A-wave pressure >or=18 mm Hg. In one patient, mitral annulus velocity began earlier than the onset of mitral inflow. Because T(E'-E) was 0 in the majority of patients, the LV filling pressure could not be predicted by the previously suggested index of IVRT/T(E'-E.) CONCLUSIONS In contrast to previous studies, T(E'-E) did not correlate with tau, and IVRT/ T(E'-E) could not be applied in the prediction of filling pressure, because of the limitation of a zero denominator. However, prolongation of T(E'-E) might suggest an elevated filling pressure in the setting of prolonged tau.
Collapse
Affiliation(s)
- Dae-Won Sohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | | | | | | |
Collapse
|
225
|
Koyama J, Davidoff R, Falk RH. Longitudinal myocardial velocity gradient derived from pulsed Doppler tissue imaging in AL amyloidosis: a sensitive indicator of systolic and diastolic dysfunction. J Am Soc Echocardiogr 2004; 17:36-44. [PMID: 14712185 DOI: 10.1016/j.echo.2003.09.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was performed to clarify whether the longitudinal myocardial velocity gradient could give new insights into the features of congestive heart failure in patients with primary amyloidosis. METHODS A total of 33 consecutive patients with biopsy specimen-proven primary amyloidosis were examined by pulsed Doppler tissue imaging. RESULTS In all, 22 had evidence of heart involvement, of whom 11 had clinical congestive heart failure. Sample volumes were placed on basal and midventricle in the apical 2- and 4-chamber views. Peak systolic, and peak early and late diastolic wall-motion velocities were measured at each site. Longitudinal myocardial velocity gradients were calculated as the difference between basal and midmyocardial velocities. Single-point analysis of pulsed Doppler tissue imaging could not distinguish any difference among groups, whereas the longitudinal myocardial velocity gradients in systole and early diastole were significantly impaired in the patients with congestive heart failure compared with both the patients without cardiac involvement and those with cardiac amyloidosis without congestive heart failure. CONCLUSION Longitudinal myocardial velocity gradient is a sensitive method for detecting systolic and diastolic dysfunction in cardiac amyloidosis and is superior to single-point analysis Doppler tissue imaging.
Collapse
Affiliation(s)
- Jun Koyama
- Boston University Amyloidosis Treatment and Research Program, Boston, Massachusetts, USA
| | | | | |
Collapse
|
226
|
Oki T, Tanaka H, Yamada H, Tabata T, Oishi Y, Ishimoto T, Nagase N, Shinohara H, Sakabe K, Fukuda N. Diagnosis of cardiac amyloidosis based on the myocardial velocity profile in the hypertrophied left ventricular wall. Am J Cardiol 2004; 93:864-9. [PMID: 15050490 DOI: 10.1016/j.amjcard.2003.12.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2003] [Revised: 12/08/2003] [Accepted: 12/08/2003] [Indexed: 11/18/2022]
Abstract
The myocardial velocity profile (MVP), derived from color-coded tissue Doppler imaging (TDI), can identify transmural heterogeneity based on the physiology and pathology of the myocardium. This study sought to clarify whether the MVP can differentiate cardiac amyloidosis from other causes of left ventricular hypertrophy. We recorded the MVP and determined its myocardial velocity gradient (MVG) in the ventricular septum and left ventricular posterior wall using color-coded TDI in 10 patients with cardiac amyloidosis, in 25 patients with hypertensive hypertrophied left ventricular wall, in 25 patients with asymmetric septal hypertrophy of hypertrophic cardiomyopathy, and in 20 clinically normal controls. End-diastolic ventricular septal thickness was similar among the cardiac amyloidosis, hypertension, and hypertrophic cardiomyopathy groups. Percent systolic thickening of the ventricular septum and left ventricular posterior wall calculated from M-mode left ventricular echocardiograms was lower in the cardiac amyloidosis group than in the hypertension, hypertrophic cardiomyopathy, or control group. Peak MVGs during systole and early diastole were lowest in the cardiac amyloidosis group, followed, in order, by the control, hypertension, and hypertrophic cardiomyopathy groups. The systolic and early diastolic MVPs in the ventricular septum and left ventricular posterior wall showed a characteristic serrated pattern in all patients with cardiac amyloidosis, but not in any other patient groups. In conclusion, MVPs in the ventricular septum and left ventricular posterior wall show a distinctive serrated pattern that may be related to amyloid deposition in the myocardium. Myocardial tissue characterization using color-coded TDI provides diagnostic information in patients with cardiac amyloidosis.
Collapse
MESH Headings
- Adult
- Amyloidosis/diagnostic imaging
- Amyloidosis/physiopathology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/physiopathology
- Diagnosis, Differential
- Echocardiography, Doppler, Color
- Echocardiography, Doppler, Pulsed
- Female
- Heart Diseases/diagnostic imaging
- Heart Diseases/physiopathology
- Humans
- Hypertension/complications
- Hypertension/diagnostic imaging
- Hypertension/physiopathology
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Middle Aged
- Myocardial Contraction/physiology
Collapse
Affiliation(s)
- Takashi Oki
- Cardiovascular Section, National Higashi Tokushima Hospital, Itano, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
227
|
Ahn J, Varagic J, Slama M, Susic D, Frohlich ED. Cardiac structural and functional responses to salt loading in SHR. Am J Physiol Heart Circ Physiol 2004; 287:H767-72. [PMID: 15059772 DOI: 10.1152/ajpheart.00047.2004] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Increased dietary salt intake induces cardiac fibrosis in the spontaneously hypertensive rat (SHR), yet little information details its effects on left ventricular (LV) function. Additionally, young normotensive rats are more sensitive to the trophic effect of dietary sodium than older rats. Thus cardiac responses to salt loading were evaluated at two ages in the SHR; LV collagen content was also examined. SHR (8 or 20 wk of age) were given an 8% salt diet; their age-matched controls received standard chow. Echocardiographic indexes, arterial pressure, and LV hydroxyproline concentration were measured at 16 and 52 wk in the younger and older SHR groups, respectively. In most SHR, salt excess increased arterial pressure, LV mass, and hydroxyproline concentration and impaired LV relaxation manifested by prolonged isovolumic relaxation time, decreased early and atrial filling velocity ratio (V(E)/V(A)), and slower propagation velocity of E wave (V(P)). LV systolic function remained normal. However, one-quarter of the young salt-loaded SHR developed cardiac failure with systolic and diastolic dysfunction associated with greater LV mass and ventricular fibrosis. They also had lower arterial pressure, decreased fractional shortening, and a restrictive pattern of mitral flow. Moreover, the shorter deceleration time of the E wave and increased V(E)/V(P), an index of LV filling pressure, indicated increased LV stiffness in these rats. These findings demonstrated that sodium sensitivity in SHR is manifested not only by further pressure elevation but also by significant LV functional impairment that most likely is related to enhanced ventricular fibrosis. Moreover, the SHR are more susceptible to cardiac damage when high dietary salt is introduced earlier in life.
Collapse
Affiliation(s)
- Jwari Ahn
- Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA
| | | | | | | | | |
Collapse
|
228
|
Hayashi SY, Brodin LA, Alvestrand A, Lind B, Stenvinkel P, Mazza do Nascimento M, Qureshi AR, Saha S, Lindholm B, Seeberger A. Improvement of cardiac function after haemodialysis. Quantitative evaluation by colour tissue velocity imaging. Nephrol Dial Transplant 2004; 19:1497-506. [PMID: 15034157 DOI: 10.1093/ndt/gfh205] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Overhydration and accumulation of uraemic toxins may influence the myocardial function in haemodialysis (HD) patients. To evaluate cardiac function and the effects of fluid and solute removal during a single session of HD, colour tissue velocity imaging (TVI) was used. This new technique, which is less load dependent than conventional echocardiography, allows an objective quantitative assessment of myocardial contractility, contraction and relaxation. METHODS Conventional echocardiographic and TVI images were recorded before and after a single HD session in 13 clinically stable HD patients (62+/-10 years, six males) and in 13 sex- and age-matched healthy controls. Myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E') and late (A') diastolic filling and strain rate (SR) were measured. RESULTS Left ventricular hypertrophy (LVH) was present in 12 patients. TVI gave additional information in comparison with conventional echocardiography. Before HD, PS (5.0+/-0.8 vs 6.0+/-1.2 cm/s, P<0.05), E' (5.7+/-1.7 vs 7.3+/-2.0 cm/s, P<0.05) and A' (6.6+/-1.7 vs. 8.3+/-2.9 cm/s, P<0.05) velocities were lower in the patients than in the controls, indicating systolic and diastolic dysfunction. The HD session increased IVCv (4.0+/-1.7 to 5.5+/-1.9 cm/s; P<0.001), PSv (5.0+/-0.8 to 5.7+/-0.8 cm/s; P<0.05) and SR (0.7+/-0.2 to 0.9+/-0.2 1/s; P < 0.05) and decreased E/E' (16.7+/-7.7 to 12.2+/-4.0, P<0.05), indicating improved systolic function and decreased LV filling pressure, respectively. Linear regression analysis demonstrated a dependency of systolic contraction (PSv) and contractility (IVCv) upon plasma levels of phosphate (r(2) = 0.70, P<0.005, r(2) = 0.33, P<0.01). CONCLUSIONS Using TVI, HD patients demonstrate myocardial dysfunction, which is found less frequently when using conventional echocardiography. The systolic function seems to be impaired by high plasma levels of phosphate and an increased Ca x P product. One single session of HD improved systolic function as indicated by increases in IVCv, PSv and SR. Further studies are needed to clarify if this effect of HD is due to the acute removal of fluid, the removal of solutes or both.
Collapse
Affiliation(s)
- Shirley Yumi Hayashi
- Division of Baxter Novum, Department of Clinical Science, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | |
Collapse
|
229
|
Eksik A, Gorgulu S, Eren M, Akyol A, Erdinler I, Oguz E, Gurkan K, Ulufer T, Tezel T. Sequential Evaluation of Left Ventricular Systolic and Diastolic Function After Radiofrequency Catheter Ablation. ACTA ACUST UNITED AC 2004; 45:429-40. [PMID: 15240963 DOI: 10.1536/jhj.45.429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Radiofrequency (RF) catheter ablation has become standard therapy for many types of arrhythmias. RF energy may cause deterioration in left ventricular function by damaging the myocardium. The aim of the present study was to assess the changes in left ventricular function after catheter ablation using various echocardiographic parameters. Forty patients (22 women), aged 37 +/- 14 years (range, 15-76 years), underwent catheter ablation for various tachycardias. Routine echocardiogaphic examination was done in all patients. Left ventricular systolic function was evaluated by the modified Simpson method and tissue Doppler. With regard to left ventricular diastolic function parameters, diastolic early (E) and late (A) transmitral filling velocities, deceleration time (DT), isovolumetric relaxation time (IVRT), and tissue Doppler parameters were assessed. All ventricular function parameters were assessed before, and 1 hour, 1 day, and 1 month after the catheter ablation procedure. To avoid any influence of heart rate on diastolic function parameters, the E/A ratio, DT, and IVRT were adjusted to heart rate (cE/A, cDT, cIVRT). No changes in left ventricular systolic function after the ablation were observed. After the ablation procedure (1 hour, 1 day, and 1 month) the cE/A ratio decreased from 1.42 +/- 0.43 to 1.19 +/- 0.40, 1.18 +/- 0.40, and 1.30 +/- 0.33 (P = 0.009), respectively. cDT increased from 210 +/- 54 to 272 +/- 64, 255 +/- 60, 240 +/- 64 (P = 0.001), respectively. Likewise cIVRT increased from 113 +/- 22 to 133 +/- 54, 123 +/- 27, 117 +/- 19 (P = 0.007), respectively. Significant changes were also observed concerning tissue Doppler parameters in assessing diastolic function. Although no significant changes were observed in systolic function after RF ablation, this procedure may have some detrimental effects on ventricular diastolic function para-meters.
Collapse
Affiliation(s)
- Abdurrahman Eksik
- Cardiology Department, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Instanbul, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
230
|
Fukuda N, Shinohara H, Sakabe K, Nada T, Wakayama K, Tamura Y. Effect of Regurgitant jet Direction on Left Ventricular Diastolic Performance in Patients With Aortic Regurgitation. J Echocardiogr 2004. [DOI: 10.2303/jecho.2.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
231
|
Baykan M, Yilmaz R, Celik S, Orem C, Kaplan S, Erdol C. Assessment of left ventricular systolic and diastolic function by doppler tissue imaging in patients with preinfarction angina. J Am Soc Echocardiogr 2003; 16:1024-30. [PMID: 14566294 DOI: 10.1016/s0894-7317(03)00552-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was assessment of left ventricular (LV) systolic and diastolic function by pulsed wave Doppler tissue imaging (DTI) in patients with or without preinfarction angina in acute myocardial infarction. METHODS We prospectively evaluated 31 consecutive patients (4 women, 27 men; age 58 +/- 10 years) with a first acute myocardial infarction. LV systolic and diastolic function was assessed by classic methods and DTI on the third day during acute myocardial infarction. Patients were divided into 2 groups according to the presence (group 1; n = 10) or absence (group 2; n = 21) of preinfarction angina. Mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, the ratio of early diastolic mitral inflow velocity (E) to Em, and myocardial performance index were calculated by DTI. RESULTS Group 1 had significantly higher Em and Em/Am than group 2 (11.3 +/- 3.34 cm/s vs 7.4 +/- 2.07 cm/s, P <.0001; 1.01 +/- 0.38 cm/s vs 0.6 +/- 0.2 cm/s, P =.001, respectively). The E/Em ratio and myocardial performance index were significantly lower in group 1 than in group 2 (5.1 +/- 2.92 vs 8.10 +/- 3.15, P=.018; 0.49 +/- 0.15 vs 0.65 +/- 0.24, P =.042, respectively). Wall-motion score index was lower in those with preinfarction angina than in those without (1.6 +/- 0.36 vs 1.9 +/- 0.39; P =.04, respectively). Peak systolic mitral annular velocity and Am were not statistically different between groups (9.4 +/- 1.84 vs 8.3 +/- 2.03, P =.172; 11.7 +/- 3.07 vs 12.1 +/- 3.34, P =.72, respectively). There were no significant differences between the 2 groups regarding transmitral E velocity, atrial contraction mitral inflow velocity (A), E/A ratio, isovolumetric relaxation time, and deceleration time of the mitral E wave (P =.91, P =.08, P =.58, P =.81, and P =.71, respectively). CONCLUSION LV diastolic function was better in patients with preinfarction angina than in patients without. This condition could not be detected by conventional mitral inflow Doppler velocities, but could be detected by DTI. This preliminary evidence shows that DTI is better than conventional mitral Doppler indices in the assessment of a favorable LV diastolic function in patients with preinfarction angina.
Collapse
Affiliation(s)
- Merih Baykan
- Department of Cardiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
| | | | | | | | | | | |
Collapse
|
232
|
Rivas-Gotz C, Khoury DS, Manolios M, Rao L, Kopelen HA, Nagueh SF. Time interval between onset of mitral inflow and onset of early diastolic velocity by tissue Doppler: a novel index of left ventricular relaxation. J Am Coll Cardiol 2003; 42:1463-70. [PMID: 14563593 DOI: 10.1016/s0735-1097(03)01034-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The goal of this study was to examine the diagnostic utility of the time to onset of early (Ea) diastolic velocity of the mitral annulus by tissue Doppler (TD) in comparison with the time to onset of mitral inflow (T(Ea-E)) for the assessment of left ventricular (LV) relaxation. BACKGROUND Tissue Doppler imaging of the mitral annulus provides useful information about myocardial function. So far, studies have focused on the measurement of peak Ea, but have not evaluated the diagnostic utility of the time to onset of Ea. METHODS Simultaneous left heart catheterization and Doppler echocardiography (DE) were performed in 10 dogs. Left atrial pressures and LV volumes and pressures were measured before and after constriction of the circumflex (cx) coronary artery. The delay in Ea was next examined in 60 consecutive patients, undergoing simultaneous right heart catheterization and DE. Furthermore, (T(Ea-E)) was used to predict filling pressures in a prospective group of 33 patients. RESULTS In canine studies, significant prolongation in the time interval (T(Ea-E)) was noted after cx constriction, which had a significant relation with tau (tau) (r = 0.93, p < 0.01). In human studies, Ea was significantly delayed in patients with impaired relaxation and pseudonormal LV filling in comparison with age-matched controls. In the prospective group, pulmonary capillary wedge pressure (PCWP) derived as: PCWP(Doppler) = LV(end-systolic pressure) x e(-IVRT/(T(Ea-E))), where IVRT is isovolumetric relaxation time; PCWP(Doppler) related well to PCWP(catheter) (r = 0.84, p < 0.001). CONCLUSIONS T(Ea-E) is a useful novel index of LV relaxation. It can be used to identify patients with diastolic dysfunction and predict PCWP.
Collapse
Affiliation(s)
- Carlos Rivas-Gotz
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | |
Collapse
|
233
|
De Boeck BWL, Cramer MJM, Oh JK, van der Aa RPLM, Jaarsma W. Spectral pulsed tissue Doppler imaging in diastole: a tool to increase our insight in and assessment of diastolic relaxation of the left ventricle. Am Heart J 2003; 146:411-9. [PMID: 12947357 DOI: 10.1016/s0002-8703(03)00322-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Conventional Doppler echocardiography offers an indirect assessment of left ventricular (LV) diastolic function, hampered by preload dependency. Tissue Doppler imaging (TDI) is a tool to study diastolic function in a more direct and less preload-dependent manner. METHODS The Medline database has been searched for literature on TDI for the analysis of diastolic function. A secondary search reviewed the relevant references related to TDI or diastolic function in general. RESULTS TDI measures myocardial velocities with a high temporal and velocity resolution but lacks spatial information. In particular, the velocity of early diastolic wall motion (E(m)) and its timing are promising indices of local myocardial relaxation. E(m) at the mitral annulus offers fair estimates of ventricular relaxation, relatively independent of preload and systolic function. Combined with early transmitral flow velocity (E), detection of pseudo-normalized filling patterns and estimation of filling pressures are enhanced by E/E(m). CONCLUSION TDI has an emerging role in the study and assessment of diastolic function. However, TDI-derived information needs to be integrated with other echocardiographic data because single diagnostic accuracy remains unsatisfactory.
Collapse
Affiliation(s)
- Bart W l De Boeck
- Department of Non-invasive Cardiac Imaging, University Medical Centre, Utrecht, The Netherlands
| | | | | | | | | |
Collapse
|
234
|
Border WL, Michelfelder EC, Glascock BJ, Witt SA, Spicer RL, Beekman RH, Kimball TR. Color M-mode and Doppler tissue evaluation of diastolic function in children: simultaneous correlation with invasive indices. J Am Soc Echocardiogr 2003; 16:988-94. [PMID: 12931112 DOI: 10.1016/s0894-7317(03)00511-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the validity of diastolic indices derived from color M-mode Doppler and Doppler tissue imaging in a heterogeneous group of pediatric patients by comparing them with simultaneously obtained invasive indices of diastolic function. METHODS A total of 20 children undergoing left heart catheterization had echocardiographic images recorded simultaneously with high-fidelity left ventricular (LV) pressure tracings. Transmitral Doppler, pulmonary vein Doppler, Doppler tissue imaging, and color M-mode Doppler flow propagation velocity were recorded. LV peak negative dP/dt, the time constant of isovolumic relaxation, and LV end-diastolic pressure were compared with the echocardiographic indices. RESULTS The ratio of peak E-wave mitral velocity/propagation velocity correlated significantly with LV end-diastolic pressure (r = 0.71; P <.001). Propagation velocity correlated with the time constant of isovolumic relaxation (r = -0.56; P =.01) and peak negative dP/dt (r = 0.50; P <.03). Septal mitral annular myocardial velocity correlated significantly with the time constant of isovolumic relaxation (r = -0.58, P =.01). CONCLUSION The newer diastolic indices derived from color M-mode Doppler and Doppler tissue imaging appear to be a helpful adjunct in the noninvasive assessment of diastolic function in children.
Collapse
MESH Headings
- Adolescent
- Adult
- Aortic Valve/abnormalities
- Aortic Valve/diagnostic imaging
- Aortic Valve/physiopathology
- Cardiac Catheterization
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/physiopathology
- Child
- Child Welfare
- Child, Preschool
- Diastole/physiology
- Echocardiography
- Echocardiography, Doppler, Color
- Echocardiography, Doppler, Pulsed
- Female
- Heart Atria/abnormalities
- Heart Atria/diagnostic imaging
- Heart Atria/physiopathology
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Rate/physiology
- Heart Ventricles/abnormalities
- Heart Ventricles/diagnostic imaging
- Heart Ventricles/physiopathology
- Humans
- Infant
- Infant Welfare
- Infant, Newborn
- Male
- Mucocutaneous Lymph Node Syndrome/diagnosis
- Mucocutaneous Lymph Node Syndrome/physiopathology
- Observer Variation
- Ohio
- Pulmonary Veins/abnormalities
- Pulmonary Veins/diagnostic imaging
- Pulmonary Veins/physiopathology
- Reproducibility of Results
- Statistics as Topic
- Stroke Volume/physiology
Collapse
Affiliation(s)
- William L Border
- Cincinnati Children's Hospital Medical Center, OH 45229-3039, USA.
| | | | | | | | | | | | | |
Collapse
|
235
|
Nikitin NP, Witte KKA, Thackray SDR, de Silva R, Clark AL, Cleland JGF. Longitudinal ventricular function: normal values of atrioventricular annular and myocardial velocities measured with quantitative two-dimensional color Doppler tissue imaging. J Am Soc Echocardiogr 2003; 16:906-21. [PMID: 12931102 DOI: 10.1016/s0894-7317(03)00279-7] [Citation(s) in RCA: 192] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Quantitative 2-dimensional color Doppler tissue imaging is a new method to reveal impairment of left ventricular (LV) and right ventricular (RV) longitudinal function, which is a potential marker of early myocardial disease. The aim of this study was to obtain normal values for atrioventricular annular and regional myocardial velocities using this method. METHODS A total of 123 healthy patients (age range: 22 to 89 years) underwent echocardiography including color Doppler tissue imaging using a scanner (Vivid 5, GE Vingmed, Horten, Norway) with postprocessing analysis (Echopac 6.3, GE Vingmed). Regional myocardial velocities were measured at 12 LV segments in 3 apical views and 2 segments of the free RV wall. Mitral annular velocities from 6 sites, and tricuspid annular velocities at its lateral site, were also assessed. At each site, systolic (S(m)), early diastolic (E(m)), and late diastolic (A(m)) velocities were measured, and the E(m)/A(m) ratio was calculated. RESULTS Patients were classified into 4 groups aged 20 to 39, 40 to 59, 60 to 79, and >/=80 years. Mitral annular velocity and regional LV myocardial S(m) and E(m) progressively decreased with age. A(m), whereas low in the youngest age group, increased significantly in patients more than 40 years of age. The E(m)/A(m) ratio gradually declined with aging. There were no differences between age groups in S(m) measured at the tricuspid annulus and free RV wall, but the pattern of age-related changes of diastolic velocities and E(m)/A(m) ratio was the same as in the LV. Slight but significant sex-related differences were observed in middle-aged groups. The intraobserver and interobserver reproducibility was highest for atrioventricular annular velocities. CONCLUSIONS A progressive decrease in S(m) reveals a decline in longitudinal systolic LV function with age, whereas systolic RV function remains unaffected. Atrioventricular annular velocity and regional E(m) decrease with aging in both ventricles, suggesting a deterioration in the diastolic properties of the myocardium, whereas A(m) increases from middle age implying a compensatory augmentation of atrial function. The study results can be used as reference data for the quantitative assessment of longitudinal LV and RV function in patients with cardiac disease.
Collapse
Affiliation(s)
- Nikolay P Nikitin
- Department of Cardiology, University of Hull School of Medicine, Cottingham, Kingston upon Hull, United Kingdom.
| | | | | | | | | | | |
Collapse
|
236
|
Abstract
The aging process is a major factor that contributes to changes seen in the cardiovascular system in older people. Stiffening of the arterial tree alters afterload and left ventricular geometry and although resting left ventricular systolic function is maintained, left ventricular diastolic function changes substantially. Cardiovascular function in older people during exercise is also significantly altered but can be modified by exercise training in older adults or genetic modification in animals. Age-related changes in cardiovascular structure and function also lower the threshold at which cardiac diseases become apparent. This review describes the changes in cardiovascular structure and function at rest and during exercise in older people and highlights their consequences.
Collapse
Affiliation(s)
- Helen Oxenham
- Department of Cardiology, Royal Infirmary of Edinburgh, Lauriston Place, Scotland, EH3 9QW, Edinburgh, UK.
| | | |
Collapse
|
237
|
Müller S, Bartel T, Koopman J, Pandian NG, Erbel R, Pachinger O. Tissue Doppler analysis is hindered in abnormal wall motion and changes in afterload. Int J Cardiol 2003; 90:81-90. [PMID: 12821223 DOI: 10.1016/s0167-5273(02)00536-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tissue Doppler (TD) analysis is used to estimate contractility. However, interference with hemodynamics has not been investigated. OBJECTIVE To evaluate the effect of hemodynamic conditions and wall motion abnormalities on TD indices. METHODS TD indices were obtained in 16 dogs and correlated with hemodynamics and wall thickening. RESULTS An inverse relation between TD indices and systemic vascular resistance was observed when afterload-related parameters were included in the analysis (early systolic subendocardial velocity: r((multiple regression))=0.82, P<0.0001 vs. r((simple regression))=0.57, P=0.0002). Early systolic TD data were more closely related to hemodynamics than those derived from the entire systole. TD data did not correspond to the hyperkinesia of the contralateral wall in myocardial infarction, whereas the increase of gradient parameters reflected hypercontractility (P<0.05). CONCLUSION TD indices are directly related to contractility and inversely to afterload. They do not reflect wall motion of those segments not involved in regional ischemia.
Collapse
Affiliation(s)
- Silvana Müller
- Department of Cardiology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | | | | | | | | | | |
Collapse
|
238
|
Adsett M, West MJ, Galbraith A, Duhig E, Lange A, Palka P. Eosinophilic heart: marked left ventricular wall thickening and myocardial dysfunction improving with corticosteroid therapy. Echocardiography 2003; 20:369-74. [PMID: 12848881 DOI: 10.1046/j.1540-8175.2003.03043.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of a 34-year-old male with acute severe heart failure associated with marked concentric left ventricular wall thickening and biopsy evidence of eosinophilic myocardial infiltrate. This appears to be an unusual description of this degree of concentric myocardial thickening in eosinophilic myocarditis coupled with Doppler tissue echocardiography. Following high-dose corticosteroid treatment, wall thickness, systolic and diastolic left ventricular function normalized and the patient experienced a dramatic clinical improvement.
Collapse
|
239
|
Fujimoto S, Oki T, Tabata T, Tanaka H, Yamada H, Oishi Y, Ishimoto T, Ito S, Abe Y, Kanda R. Novel approach to the quantitation of regional left ventricular systolic and diastolic function using tissue Doppler imaging to create a myocardial velocity profile and gradient. Circ J 2003; 67:416-22. [PMID: 12736480 DOI: 10.1253/circj.67.416] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The myocardial velocity profile (MVP) and gradient (MVG) between the endocardium and epicardium of the left ventricular (LV) wall measured by color-coded tissue Doppler imaging (TDI) are new indices for evaluating regional LV myocardial function. However, accurate recording and measurement of the MVP is difficult using conventional methodology because of the stochastic nature of the ultrasound signal; that is, the effect of speckled noise. The aim of this study was to validate the accuracy and establish the validity of a newly developed method for measuring the MVP and MVG using 10 clinically normal controls and 10 patients with a hypertensive hypertrophied LV posterior wall. A non-isotropic, averaging algorithm was developed that was capable of obtaining a stable MVP (averaged MVP). Averaged MVP was recorded using parasternal, LV short-axis, color-coded TDI, placing regions of interest along the LV posterior wall with the reference point for angle-correction being at the center of LV contraction. The velocity from epicardium to endocardium within the region of interest was automatically angle-corrected to calculate the velocity component radially relative to the LV cavity and was spatially averaged along the circumference within the region of interest. Inter- and intraobserber variabilities of measurements were lower in the averaged MVP and MVG than in the conventional MVP and MVG. The correlation coefficients of the linear regression lines of systolic and early diastolic MVPs in the LV posterior wall were higher in all controls and hypertensive patients with the averaged method than with the conventional TDI procedures. The mean peak systolic and early diastolic MVGs were lower in the hypertensive group than in the controls. In conclusion, the newly developed averaged MVP provides a stable and reproducible index for the quantitative assessment of regional LV myocardial function.
Collapse
Affiliation(s)
- Sayuri Fujimoto
- Cardiovascular Section, National Higashi Tokushima Hospital, Tokushima, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
240
|
Pellerin D, Larrazet F, Cohen L, Witchitz S, Veyrat C. Myocardial time intervals preceding left ventricular filling in chronic coronary artery disease: value of a decreased septal ejection time. Int J Cardiol 2003; 89:33-44. [PMID: 12727003 DOI: 10.1016/s0167-5273(02)00422-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim was to assess the capabilities of a two-segment myocardial recording to recognize patients with an underlying chronic ischemic process as a fast screening from controls, prior to the usual segment-to-segment tissue Doppler echocardiographic assessment of ischemia. Ischemia generates systolic and relaxation abnormalities. A flow Doppler index of global systolic and diastolic myocardial performance was recently drawn from time durations studied by coupling isovolumic relaxation (IR) to preejection (PEP)/ejection (ET) ratio (PEP/ET). We derived a similar tissue Doppler approach to the period preceding the left ventricular filling: PEP', the ejectional inward wall motion representing ET' and the prefilling (PreFg) period ranging from the end of ET' to the onset of the outward wall motion approximating IR, were measured and ratios calculated between variables. Spectral tissue Doppler was applied to septal and posterior walls of 28 patients with proven chronic coronary artery disease and preserved left ventricular function and of 12 age-matched controls. Data were compared with global flow data. Global information did not differentiate both groups, save for IR (sensitivity 32%, specificity 57%). In patients, tissue Doppler mean values of single variables (P=0.004-0.0006) and ratios (P=0.03-0.002) significantly differed from controls. Moreover, septal ET' differentiated 13 patients with one-vessel (219+/-34 ms) from 10 with two-vessel disease (158+/-70 ms, P=0.01). Sensitivity and specificity of a septal ET'<190 ms for a two-vessel disease were 80%. The two-segment tissue Doppler echocardiographic study provided a rapid screening of patients versus controls and helped to predict the number of diseased vessels.
Collapse
Affiliation(s)
- Denis Pellerin
- Department of Cardiology, University Hospital Bicêtre, Paris-Sud Medical School, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France
| | | | | | | | | |
Collapse
|
241
|
Abstract
Despite diastolic dysfunction is recognized to play a major role in the pathophysiology of heart failure, the importance of an accurate diagnosis and treatment of this syndrome in clinical practice is poorly established. Recent publications suggest that diastolic dysfunction is the primary cause of heart failure in 30-50% of patients. Several studies also show that, in a significant number of patients with systolic dysfunction, diastolic function is the major determinant of their symptomatic status, their response to treatment and their outcome. Other preliminary data suggest that diastolic dysfunction is an important cause of exercise intolerance in patients with chronic hypertension. This paper discusses the most recent concepts related to the mechanisms, the diagnosis and the treatment of diastolic dysfunction based on diagnostic imaging techniques.
Collapse
Affiliation(s)
- Mario Jorge García
- Laboratorio de Ecografía. Departamento de Cardiología. Fundación Cleveland Clinic. Cleveland. OH 44195, USA.
| |
Collapse
|
242
|
Yamamoto T, Oki T, Yamada H, Tanaka H, Ishimoto T, Wakatsuki T, Tabata T, Ito S. Prognostic value of the atrial systolic mitral annular motion velocity in patients with left ventricular systolic dysfunction. J Am Soc Echocardiogr 2003; 16:333-9. [PMID: 12712015 DOI: 10.1016/s0894-7317(02)74537-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transmitral flow velocity variables are powerful predictors of poor prognosis in patients with left ventricular (LV) systolic dysfunction. However, these variables may not accurately reflect the severity of pulmonary congestion. This study was designed to determine whether the peak atrial systolic mitral annular motion velocity (MA-Aw) measured by pulsed Doppler tissue imaging can predict cardiac death or hospitalization for worsening heart failure in patients with LV systolic dysfunction. METHODS MA-Aw was recorded in 96 patients with LV systolic dysfunction who were followed up for 29 +/- 10 months. All patients underwent Doppler echocardiography on entry into the study, and cardiac catheterization was performed in 45 patients. Patients were divided into 3 groups on the basis of the ratio of early (E) to late (A) diastolic filling (E/A) of the transmitral flow velocity: group 1 (n=31; E/A < 1); group 2 (n=37; 1 < or = E/A < 2); and group 3 (n=28; E/A > or = 2). RESULTS During follow-up, 36 patients (38%) died of cardiac causes and 34 (35%) were hospitalized for worsening heart failure. There were 2 cardiac deaths (6%) in group 1, 14 (39%) in group 2, and 20 (56%) in group 3. The MA-Aw correlated closely with the mean pulmonary capillary wedge pressure. Univariate Cox model analysis showed that MA-Aw < or = 5 cm/s was the most powerful predictor of cardiac death or hospitalization for worsening heart failure compared with clinical, hemodynamic, and the other echocardiographic variables. Furthermore, MA-Aw < or = 5 cm/s was clearly discernible as a good predictor of cardiac mortality on multivariate Cox model and as assessed by Kaplan-Meier method. CONCLUSION The MA-Aw obtained by pulsed Doppler tissue imaging is a sensitive index of pulmonary congestion in patients with LV systolic dysfunction. It is a simple and noninvasive outcome measure and can be used to monitor treatment.
Collapse
Affiliation(s)
- Takashi Yamamoto
- Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Japan
| | | | | | | | | | | | | | | |
Collapse
|
243
|
Sitges M, Shiota T, Lever HM, Qin JX, Bauer F, Drinko JK, Agler DA, Martin MG, Greenberg NL, Smedira NG, Lytle BW, Tuzcu EM, Garcia MJ, Thomas JD. Comparison of left ventricular diastolic function in obstructive hypertrophic cardiomyopathy in patients undergoing percutaneous septal alcohol ablation versus surgical myotomy/myectomy. Am J Cardiol 2003; 91:817-21. [PMID: 12667567 DOI: 10.1016/s0002-9149(03)00016-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Both percutaneous transcoronary alcohol septal reduction (ASR) and surgical myectomy are effective treatments to relieve left ventricular (LV) outflow tract obstruction in obstructive hypertrophic cardiomyopathy (HC). LV diastolic function was assessed by echocardiography in 57 patients with obstructive HC at baseline and 5 +/- 4 months after ASR (n = 37) or surgical myectomy (n = 20). LV outflow tract pressure gradient decreased from 65 +/- 40 to 23 +/- 21 mm Hg (p <0.01) after treatment. The ratio of the early-to-late peak diastolic LV inflow velocities, and the ratio of the early peak diastolic LV inflow velocity to the lateral mitral annulus early diastolic velocity determined by tissue Doppler imaging significantly decreased after the procedures (1.6 +/- 1.7 vs 1.0 +/- 0.7 and 15 +/- 8 vs 11 +/- 5, respectively), whereas LV inflow propagation velocity significantly increased (60 +/- 24 vs 71 +/- 36 cm/s). Left atrial size decreased from 29 +/- 7 to 25 +/- 6 cm(2) (p <0.05). Patients had a significant improvement in New York Heart Association functional class and in exercise performance. When comparing ASR with myectomy, no difference was found in the degree of change in any parameter of diastolic function. Thus, diastolic function indexes obtained by echocardiography changed after septal reduction interventions in patients with obstructive HC; this change was similar to that after surgical myectomy and ASR.
Collapse
Affiliation(s)
- Marta Sitges
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
244
|
Rivas-Gotz C, Manolios M, Thohan V, Nagueh SF. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol 2003; 91:780-4. [PMID: 12633827 DOI: 10.1016/s0002-9149(02)03433-1] [Citation(s) in RCA: 272] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Carlos Rivas-Gotz
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | |
Collapse
|
245
|
Wang M, Yip GWK, Wang AYM, Zhang Y, Ho PY, Tse MK, Lam PKW, Sanderson JE. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol 2003; 41:820-6. [PMID: 12628728 DOI: 10.1016/s0735-1097(02)02921-2] [Citation(s) in RCA: 304] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The aim of this study was to ascertain if left ventricular mitral annulus velocities measured by tissue Doppler imaging (TDI) are more powerful predictors of outcome compared with clinical data and standard Doppler-echocardiographic parameters. BACKGROUND Tissue Doppler imaging of basal or mitral annulus velocities provides rapid assessment of ventricular long axis function. But it is not known if TDI-derived velocities in systole and diastole add incremental value and are superior to the standard Doppler-echocardiographic measurements as a predictor of outcome. METHODS The study population consisted of 518 subjects, 353 with cardiac disease and 165 normal subjects who had full Doppler two-dimensional-echocardiographic studies with measurement of mitral inflow velocities in early and late diastole, E-wave deceleration time (DT), peak systolic mitral annular velocity (Sm) early and late diastolic mitral annular velocity (Em and Am) by TDI, early diastolic flow propagation velocity, and standard chamber dimensions. All subjects were followed up for two years. The end point was cardiac death. RESULTS Tissue Doppler imaging mitral annulus systolic and diastolic velocities were all significantly lower in the non-survivors (all p < 0.05) as was DT (p = 0.024). In the Cox model the best predictors of mortality were Em, Sm, Am, left ventricular ejection fraction, left ventricular mass, and left atrial diameter in systole (LADs). By backward stepwise analysis Em and LADs were the strongest predictors. After forcing the TDI measurements into the covariate model with clinical and mitral DT <0.16 s, Em provided significant incremental value for predicting cardiac mortality (p = 0.004). CONCLUSIONS Mitral annulus velocity measured by TDI in early diastole gives incremental predictive power for cardiac mortality compared to clinical data and standard echocardiographic measurements. This easily available measurement adds significant value in the clinical management of cardiac patients.
Collapse
Affiliation(s)
- Mei Wang
- Division of Cardiology, Department of Medicine and Therapeutics, Hong Kong SAR, China
| | | | | | | | | | | | | | | |
Collapse
|
246
|
Yang H, Sun JP, Lever HM, Popovic ZB, Drinko JK, Greenberg NL, Shiota T, Thomas JD, Garcia MJ. Use of strain imaging in detecting segmental dysfunction in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2003; 16:233-9. [PMID: 12618731 DOI: 10.1067/mje.2003.60] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The distribution and magnitude of left ventricular hypertrophy are not uniform in patients with hypertrophic cardiomyopathy (HCM). Previous echocardiographic studies have focused on global left ventricular function. Recently, myocardial Doppler strain (epsilon) imaging, a newly developed technique, has allowed the quantification of regional myocardial motion. The aim of this study was to characterize regional left ventricular systolic function by myocardial Doppler epsilon imaging in patients with HCM. METHODS Included in this study were 31 patients with asymmetric septal hypertrophy and HCM, and 41 age-matched healthy patients. Regional longitudinal axial systolic epsilon was assessed at the basal, mid, and apical segments of the septal and lateral walls and compared between both groups. RESULTS Patients with HCM had reduced epsilon at the ventricular septum (-10.3 +/- 5.7%) compared with control patients (-19.4 +/- 3.3%, P <.001). In the HCM group, epsilon in the midseptum (-1.3 +/- 8.2%) was significantly less than at the basal (-12.2 +/- 8.7%, P <.01) and apical septum (-17.3 +/- 10.4%, P <.01), and was also less than at the midlateral wall (-9.4 +/- 5.3%, P <.05). There was a significant correlation between midseptal epsilon and intraventricular septum to posterior wall thickness ratio (r = 0.81, P <.001). CONCLUSION Midseptal longitudinal epsilon was markedly decreased, even reversed in patients with HCM (paradoxic longitudinal systolic expansion), which was directly related to the degree of septal hypertrophy. Myocardial Doppler epsilon imaging could offer a unique approach to quantify regional systolic dysfunction in these patients.
Collapse
Affiliation(s)
- Hua Yang
- Department of Cardiology, The Cleveland Clinic Foundation, Clevelnad OH 44195, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
247
|
Gökçe M, Karahan B, Erdöl C, Kasap H, Ozdemirci S. Left ventricular diastolic function assessment by tissue Doppler echocardiography in relation to hormonal replacement therapy in postmenopausal women with diastolic dysfunction. Am J Ther 2003; 10:104-11. [PMID: 12629588 DOI: 10.1097/00045391-200303000-00005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to evaluate the effect of hormone replacement therapy (HRT) regimens on left ventricular diastolic function by using mitral pulsed wave Doppler (MPWD) and tissue Doppler velocities (TDE). Seventy-eight postmenopausal women with normotensive and impaired diastolic left ventricular filling were included in the study. All the patients began a six-cycle HRT course. This formulation consisted of E2 valerate plus Medroxy progesterone acetate (MPA). Left ventricular diastolic function at rest was evaluated by M-mode, two-dimensional, MPWD and TDE in 78 postmenopausal women with normal blood pressure before the treatment for 6 months of HRT. The M-mode, two-dimensional, and MPWD parameters assessed were heart rate, systolic blood pressure, diastolic blood pressure, left ventricular mass index, ejection fraction of the left ventricle (EF), septal (IVS) and posterior wall (PW) thickness, left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) diameter, left atrial diameter, peak early diastolic velocity (E), peak atrial velocity (A), E/A ratio, E acceleration time, E deceleration time, diastolic filling period, and isovolumic relaxation time (IVRT). The TDE parameters assessed were peak early diastolic velocity (E'), peak late diastolic velocity (A'), peak systolic velocity, E'/A' ratio, E' acceleration time, E' deceleration time, IVRT', and E/E' ratio. Quantitative data were analyzed using Student t test. Among the MPWD parameters, peak A velocity, E deceleration time, and IVRT significantly decreased, while peak E velocity and E/A ratio increased after a 6-month treatment. From the point of TDE parameters, E' velocity and E'/A' ratio increased, while A' velocity, E' deceleration time, E/E' ratio and IVRT' decreased. Some MPWD and TDE parameters were partially reversed after HRT. TDE velocities and especially E/E' ratio may provide better and true information of the diastolic function. TDE parameters were independent from the preload and did not produce pseudonormal pattern. HRT may cause increase in the blood volume and produce pseudonormal pattern in transmitral flow. In that case, TDE may be a beneficial method for evaluation of diastolic function.
Collapse
Affiliation(s)
- Mustafa Gökçe
- Department of Cardiology, Medical Faculty of Karadeniz Technical University, 61080 Trabzon, Turkey.
| | | | | | | | | |
Collapse
|
248
|
Affiliation(s)
- Derek G Gibson
- Department of Echocardiography, Royal Brompton Hospital, London, UK Heart Function Unit, Royal Brompton Hospital, London, UK
| | | |
Collapse
|
249
|
Oki T. The Role of Tissue Doppler Imaging as a New Diagnostic Option in Evaluating Left Ventricular Function. J Echocardiogr 2003. [DOI: 10.2303/jecho.1.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
250
|
Minamihaba O, Takeishi Y, Hirono O, Yamauchi S, Arimoto T, Fukui A, Okuyama M, Nozaki N, Akiyama H, Fatema K, Miyamoto T, Takahashi H, Fujiwara S, Okada A, Takahashi K, Kubota I. Pulsed Doppler tissue imaging for the assessment of myocardial viability: comparison with 99mTc sestamibi perfusion imaging. Nucl Med Commun 2002; 23:1197-204. [PMID: 12464785 DOI: 10.1097/00006231-200212000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to examine whether Doppler tissue imaging demonstrated comparable diagnostic performance for the detection of viable myocardium compared to myocardial perfusion imaging with Tc hexakis-2-methoxyisobutylisonitrile (MIBI). We studied 30 patients with old myocardial infarction who underwent percutaneous transluminal coronary angioplasty (PTCA). Myocardial single photon emission computed tomography (SPECT) with Tc-MIBI and two-dimensional echocardiography were carried out within 7 days before PTCA. We measured regional Tc-MIBI uptake for each myocardial segment from SPECT and peak systolic velocity and a ratio of regional pre-ejection period to regional ejection time (PEP/ET) from pulsed Doppler tissue imaging. Biplane left ventriculography was performed before interventional procedures and repeated 3 months after PTCA. Myocardial viability was determined when wall motion was improved at least one grade after PTCA. The peak systolic velocity was positively correlated with regional Tc-MIBI uptake (R =0.59, P<0.01). The PEP/ET demonstrated inverse correlation with Tc-MIBI uptake ( R=-0.59, P<0.01). Peak systolic velocity of viable segments was higher than that of non-viable segments ( P<0.05). The PEP/ET was lower in viable segments than in non-viable segments ( P<0.05). Peak systolic velocity and PEP/ET demonstrated high diagnostic accuracy for detecting viable myocardium compared with Tc-MIBI perfusion imaging (80% and 79% vs 90%). These data indicate that measurements of regional peak systolic velocity and PEP/ET by Doppler tissue imaging are useful for evaluating myocardial viability quantitatively and provide helpful information for a clinical judgment in an interventional strategy.
Collapse
Affiliation(s)
- O Minamihaba
- The First Department of Internal Medicine, and Diagnostic Radiology & Radiation Center, Yamagata University Hospital, Yamagata University School of Medicine, Yamagata, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|