Assessment of left ventricular function using mitral annular velocities in patients with congestive heart failure with or without the presence of significant mitral regurgitation.

Myocardial velocities in patients with congestive heart failure (CHF) were studied using pulsed wave Doppler tissue imaging. Velocities were recorded at the mitral and tricuspid annulus. Four sites at the mitral annuli were selected corresponding to the septal, lateral, inferior, and anterior walls of the left ventricle from apical 4- and 2-chamber views. A mean value from the above 4 sites was selected to describe the mitral annular velocities. Only one site of the tricuspid annulus was selected, corresponding to the right ventricular free wall. Three different annular velocities were recorded: the peak systolic, and the peak early and late diastolic velocities. A total of 96 patients were compared with 12 age-matched healthy participants. Patients with CHF had significantly decreased mitral and tricuspid systolic velocities compared with healthy participants (4.9 vs 9.3 cm/s, P <.001, for the mitral annulus and 10.4 vs 14.6 cm/s, P <.001, for the tricuspid annulus). The early diastolic velocity was also reduced in patients compared with healthy participants (5.9 vs 10.9 cm/s, P <.001, for the mitral annulus and 8.6 vs 12.9 cm/s, P <.001, for the tricuspid annulus). Patients with CHF had a severely depressed left ventricular ejection fraction (EF) (27%). The correlation the between systolic mitral annular velocity and EF was relatively good (r = 0.59 and P <.001). The patients with CHF were divided into 2 subgroups depending on the presence or absence of significant mitral regurgitation. There was a correlation between EF and the systolic mitral annular velocity both in patients with (r = 0.61, P <.001) and without (r = 0.59, P <.001) significant mitral regurgitation. In conclusion, compared with healthy participants, the mitral and tricuspid annular velocities are significantly decreased in patients with CHF. The correlation between EF and the systolic mitral annular velocity is relatively good irrespective of the presence or absence of significant mitral regurgitation. Measurements of annular velocities constitute a simple and useful method for evaluating patients with CHF.     

Effects of first myocardial infarction on left ventricular systolic and diastolic function with the use of mitral annular velocity determined by pulsed wave doppler tissue imaging.

This study was undertaken to assess the effect of a first myocardial infarction (MI) on the systolic and diastolic velocity profiles of the mitral annulus determined by pulsed wave Doppler tissue imaging and thereby evaluate left ventricular (LV) function after MI. Seventy-eight patients with a first MI were examined before discharge. Peak systolic, peak early diastolic, and peak late diastolic velocities were recorded at 4 different sites on the mitral annulus corresponding to the septum, anterior, lateral, and inferior sites of the left ventricle. In addition, the amplitude of mitral annular motion at the 4 above LV sites, the ejection fraction, and conventional Doppler diastolic parameters were recorded. Nineteen age-matched healthy subjects served as controls. Compared with healthy subjects, the MI patients had a significantly reduced peak systolic velocity at the mitral annulus, especially at the infarction sites. A relatively good linear correlation was found between the ejection fraction and the mean systolic velocity from the 4 LV sites (r = 0.74, P <.001). The correlation was also good when the mean peak systolic mitral annular velocity was tested against the magnitude of the mean mitral annular motion (r = 0.77, P <.001). When the patients were divided into 2 different groups with respect to an ejection fraction > or =0.50 or <0.50, a cutoff point of mean systolic mitral annular velocity of > or =7.5 cm/s had a sensitivity of 79% and a specificity of 88% in predicting a preserved global LV systolic function. Similar to systolic velocities, the early diastolic velocity was also reduced, especially at the infarction sites. The peak mitral annular early diastolic velocity correlated well with both LV ejection fraction (r =.66, P <.001) and mean systolic mitral annular motion (r = 0.68, P <.001). However, no correlation existed between the early diastolic velocity and conventional diastolic Doppler parameters. The reduced peak systolic mitral annular velocity seems to be an expression of regionally reduced systolic function. The peak early diastolic velocity is also reduced, especially at the infarction sites, and reflects regional diastolic dysfunction. Thus, quantification of myocardial velocity by Doppler tissue imaging opens up a new possibility of assessing LV function along its long axis.     

多普勒组织成像评价小儿心脏移植术后心功能

目的用超声心动图二维、M型、彩色多普勒及脉冲多普勒组织成像(PW-DTI)等方法对小儿心脏移植术后非排异期心脏的结构、形态、血流、功能等状态进行综合评价，重点探讨PW-DTI对小儿心脏移植术后非排异期心功能评价的意义。方法移植组和对照组各36例，应用超声心动图、PW-DTI测量左室舒张末期内径，室间隔厚度，左室后壁厚度，左室质量，左室短轴缩短率，二、三尖瓣前向血流舒张早、晚期峰值速率及心率；将PW-DTI取样容积置于二尖瓣瓣环水平左室侧壁、室间隔及三尖瓣环水平右室壁采样，获取收缩期和舒张早、晚期PW-DTI运动速度曲线。结果移植组的所有PW-DTI速度曲线参数均较对照组低。二尖瓣瓣环水平左室侧壁舒张早期峰值速率，室间隔及三尖瓣环收缩期峰值速率，舒张早、晚期峰值速率与对照组差异有显著性意义；而其他指标移植组与对照组基本相同。结论PW-DTI速度曲线参数的结果提示心脏移植术后非排异期患儿在常用的心功能指标测值正常时，已存在右室收缩、舒张功能及左室舒张功能的减低，以右心功能减低为明显。PW-DTI是一种敏感、简便的测量小儿心脏移植后左、右心功能的方法．     

Effects of percutaneous mitral commissurotomy on longitudinal left ventricular dynamics in mitral stenosis: quantitative assessment by tissue velocity imaging.

OBJECTIVE: We hypothesized that mitral annular velocities would improve immediately after relief of mitral stenosis and that serial assessment could be used as an index for quantifying functional changes after percutaneous mitral commissurotomy (PMC). METHODS: Longitudinal left ventricular annular velocities were quantified by spectral pulsed wave Doppler tissue velocity imaging in 25 patients (16 women; mean age [+/-SD], 29.2 +/- 8.6 years) who had isolated mitral stenosis and were in sinus rhythm, and were compared with 30 age- and sex-matched control subjects. Echocardiography was performed 1 to 24 hours before PMC and 48 to 72 hours after, and changes in velocities from the lateral and septal corners of the mitral annulus in early diastole, late diastole, isovolumic contraction, and ejection were recorded. RESULTS: Systolic and diastolic mitral annular velocities were significantly less in patients with mitral stenosis than in control subjects. After PMC, peak annular velocity of systolic excursion in ejection and peak annular velocity in early diastole showed significant improvement. The change in peak annular velocity in early diastole in the lateral wall correlated well with improvement in the mitral valve orifice area by planimetry (ratio of mitral valve orifice area, 1.92 +/- 0.42; ratio of peak annular velocity in early diastole, 1.36 +/- 0.22; r = 0.65; P <.001). CONCLUSION: Serial evaluation of changes in mitral annular velocities by Doppler tissue imaging aids clinical assessment of immediate improvement in left ventricular function after PMC.     

Comparison between aortic, mitral and tricuspid annular velocities measured with quantitative two-dimensional color Doppler tissue imaging in healthy subjects

OBJECTIVES: To compare the systolic, early and late diastolic velocities of the aortic, mitral and tricuspid annuli in healthy subjects and to study the intraobserver and interobserver reproducibility (IIOR) of measuring the velocities at the aortic annulus. METHODS: Twenty healthy subjects with mean age 28 years were investigated with quantitative two-dimensional color Doppler tissue imaging and the systolic, early and late diastolic velocities were measured at the aortic, mitral and tricuspid annuli. RESULTS: The mitral annulus had significant higher systolic velocity and early diastolic velocity than the aortic annulus. The late diastolic velocity was significant lower at the aortic annulus compared with the both other annuli. At the different sites of the annuli the highest systolic velocity and early diastolic velocity were measured at the lateral site of the mitral annulus, whereas the lowest systolic velocity was measured at the septal site of the same annulus. The lowest early diastolic velocity was found at the septal site of the aortic annulus. The highest late diastolic velocity was measured at the lateral site of the tricuspid annulus and the lowest at the lateral site of the aortic annulus. CONCLUSIONS: The mitral annulus has statistical significant higher systolic and early diastolic velocities than the aortic annulus. There are significant differences in velocities between several of the different sites of the annuli. IIOR of measuring the systolic and early diastolic velocities of the aortic annulus is good.     

Age-related changes in diastolic atrioventricular annular velocity: Studies using pulsed Doppler tissue imaging

Age-related changes in the diastolic velocity of the mitral and tricuspid annuli were studied in 67 healthy subjects aged 15 to 79 years. Ventricular inflow velocities were recorded by pulsed Doppler echocardiography with sample volumes at the mitral and tricuspid orifices in the apical four-chamber view, and peak early (E) and late (A) diastolic velocities were measured. Atrioventricular annular velocities were recorded by Doppler tissue imaging with sample volume set on the lateral portion of each annulus in the same view, and peak early (Ea) and late (Aa) diastolic velocities were determined. E and Ea correlated inversely with age, while A and Aa correlated directly with age in both ventricles. E/A and Ea/Aa ratios correlated inversely with age in both ventricles. Coefficients of correlation of these variables with age were higher for annular velocity than for inflow velocity. The E/A ratio at the tricuspid orifice was higher than that at the mitral orifice in all decades. An E/A ratio of less than 1 was observed at the mitral orifice in the sixth decade, but at the tricuspid orifice in the seventh decade. The Ea/Aa ratio at the tricuspid annulus was lower than that at the mitral annulus in all decades. The Ea/Aa ratio was less than 1 at the mitral annulus in the fifth decade and at the tricuspid annulus in the fourth decade. Diastolic function of both ventricles thus deteriorates with age, and diastolic annular velocity reflects ventricular diastolic function more accurately than ventricular inflow velocity.     

Assessment of left ventricular systolic and diastolic function by Doppler tissue imaging in patients with preinfarction angina.

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.     

Analysis of the myocardial velocities in patients with mitral stenosis

BACKGROUND: Pure mitral stenosis (MS) affects left-ventricular performance as a result of myocardial and functional factors. We planned this study to evaluate the effect of MS on right- and left-ventricular functions using Doppler tissue imaging (DTI). METHODS: A total of 46 patients with an established diagnosis of MS (mean age: 41 +/- 11 years), and 40 age-matched healthy individuals (mean age: 40 +/- 9 years) were included in this study. Echocardiography equipped with DTI function was performed on each participant. The mitral valve area was measured. Myocardial velocities were recorded at 4 different sites (septum, lateral, anterior, and inferior) of the left ventricle, and the right-ventricular free wall annulus by DTI. The positive systolic velocity when the mitral and tricuspid ring moved toward the cardiac apex, and 2 negative diastolic velocities when the mitral annulus moved toward the base away from the apex (1 during the early phase of diastole and another in the late phase of diastole [A(m)]) were measured. The early diastolic velocity/A(m) ratio was calculated for each wall. The mean of systolic and diastolic myocardial velocities of the left ventricle was calculated. Patients with pure MS were compared with healthy participants, and the relationship of DTI variables with mitral valve area was evaluated. RESULTS: The myocardial velocities of the left ventricle indicating left-ventricular function were found to be significantly lower in patients with pure MS. Right-ventricular annulus velocities, on the other hand, were similar in both groups. A significant positive correlation could be established between mitral valve area and mean positive systolic velocity, A(m) of the left ventricle, and right-ventricular A(m) (r = 0.50, P <.001; r = 0.48, P =.001; r = 0.45, P =.002, respectively), whereas a significant negative correlation (r = -0.42, P =.004) was established for right-ventricular early diastolic velocity/A(m) ratio. CONCLUSION: This first study where pure MS was evaluated by DTI shows that MS affects left-ventricular performance on long axis. The results indicate that the decrease in left-ventricular performance is caused by both functional and myocardial factors.     

Normal regional right ventricular function and its change with age: a Doppler myocardial imaging study.

BACKGROUND: Doppler Myocardial Imaging (DMI) is a new technique currently being studied for the assessment of regional systolic and diastolic left ventricular (LV) function. No normal values or data on age-related changes in regional myocardial right ventricular (RV) velocities are available. METHODS AND RESULTS: Color DMI was used in 32 healthy volunteers (aged 16-76 years) to derive regional velocities from basal, medial, and apical segments of the RV free wall in the apical 4-chamber view, and from distal segments as well as from the tricuspid annulus in the parasternal long-axis view. Both mitral annular and regional LV velocities (4-chamber, long-axis parasternal view) were also recorded and compared with corresponding RV regional velocities. The M-mode displacement of the cardiac base was measured. Corresponding RV and LV DMI data sets were compared. For longitudinal function, RV free wall systolic velocities were consistently higher than velocities recorded in corresponding LV segments (analysis of variance, P <.05). Older subjects (40-76 years; 13 men, 2 women) had lower RV long-axis regional velocities than younger subjects (16-39 years; 15 men, 2 women), but had higher short-axis RV systolic velocities. For diastolic velocities, a negative correlation between age and the ratio of regional early diastolic to late diastolic velocity was shown for all RV free wall segments (eg, basal segment: r = -0.63, P <.0001). CONCLUSIONS: The right ventricle has higher long-axis regional velocities, a greater excursion of its lateral atrioventricular valve ring, and reduced circumferential shortening velocities compared with the left ventricle. Right ventricular longitudinal shortening is dominant over short-axis function in healthy young subjects. Normal age-related changes of diastolic velocities for each segment of the normal RV free wall have been defined.     

多普勒组织成像评价高血压病患者左室舒张功能

目的　探讨应用多普勒组织成像 (DTI)技术检测二尖瓣环运动速度评估原发性高血压病左室舒张功能的应用价值。方法　应用DTI技术 ,对 5 6例原发性高血压病患者和 5 0例正常对照者二尖瓣环运动速度进行测定 ,并与常规多普勒超声心动图检查结果对照分析。结果　与正常组相比 ,高血压病患者收缩期DTI速度峰值 (S)差异无显著性意义 ,舒张早期DTI速度峰值 (Ve)显著减低 (P <0 .0 5 ) ,舒张晚期DTI速度峰值 (Va)无显著变化 ,舒张早期与舒张晚期DTI速度峰值的比值 (Ve Va)显著减低 (P <0 .0 5 )。Ve Va值与二尖瓣血流频谱E A值之间存在高度相关性。结论　DTI技术检测二尖瓣环舒张期运动速度参数可用于无创评价原发性高血压病左室舒张功能。     

Association of newer diastolic function parameters with age in healthy subjects: a population-based study.

OBJECTIVES: We sought to determine if newer Doppler diastolic function parameters are associated with age and to define age-stratified reference ranges for these parameters in a population-based setting. BACKGROUND: Although newer Doppler parameters aid in the evaluation of diastolic function and filling pressures, age-specific reference ranges are poorly described. METHODS: Randomly selected residents of Olmsted County, Minn, age >/= 45 years were studied (n = 2042) prospectively. Those without a history of cardiovascular disease or abnormal 2-dimensional echocardiograms were selected. Measured parameters included the transmitral early (E) and late (A) filling velocities at rest and with Valsalva, A duration, pulmonary venous atrial reversal duration, lateral and septal early diastolic mitral annular velocities, E/lateral early diastolic mitral annular velocity, E/septal early diastolic mitral annular velocity, and the index of left ventricular myocardial performance. RESULTS: A total of 1012 subjects met the inclusion criteria. Both A duration (r = 0.18, P <.001) and pulmonary venous atrial reversal duration (r = 0.28, P <.001) were longer in older subjects, whereas their difference showed a marginal correlation with age (r = 0.07, P =.036). The E/A ratio at peak Valsalva correlated with age (r = -0.54, P <.001) whereas the change in E/A with Valsalva (corrected for E-A fusion) showed a marginal correlation with age (r = 0.08, P =.032). Both E/lateral early diastolic mitral annular velocity (r = 0.39, P <.001) and E/septal early diastolic mitral annular velocity (r = 0.27, P <.001) increased with age. Left ventricular myocardial performance showed a marginal correlation with age (r = 0.08, P =.014). Age specific reference ranges (median, 5th and 95th percentiles) for all parameters are provided. CONCLUSIONS: All newer Doppler diastolic function parameters showed a variable but significant correlation with age. Age-specific reference values will aid in the interpretation of diastolic function parameters.     

应用多普勒组织成像记录二尖瓣环运动速度评价心肌梗塞后

目的　探讨多普勒组织成像 (DTI)记录二尖瓣环运动速度评价心肌梗塞后左室收缩功能和舒张功能的价值。方法　急性心肌梗塞 3 8例 ,年龄匹配的健康者 2 0例 ,于心尖位四腔观、心尖位二腔观二尖瓣环相对应的室间隔、左室前壁、侧壁和后壁记录收缩期峰值速度 (VS)、舒张早期峰值速度 (VE)、舒张晚期峰值速度 (VL)。结果　二尖瓣环收缩期峰值速度、舒张早期峰值速度均降低。结论　多普勒组织成像测定二尖瓣环运动速度开辟了评价心肌梗塞后左室收缩功能和舒张功能的新途径。     

Prognostic importance of various echocardiographic right ventricular functional parameters in patients with symptomatic heart failure.

Little is known about the prognostic importance of right ventricular (RV) systolic and diastolic function. The purpose of this study was to determine the prognostic power of systolic and diastolic RV functional parameters derived from Doppler tissue imaging of tricuspid annular motion and to assess whether their combination might improve the risk stratification of patients with heart failure. In all, 140 patients with symptomatic heart failure and left ventricular ejection fraction of 40% or less underwent standard echocardiography, Doppler tissue imaging of tricuspid annular motion, and right heart catheterization. They were followed up for a mean period of 17 months for cardiac-related death and nonfatal cardiac events including the implantation of cardioverter-defibrillator and hospitalization for heart failure decompensation. A total of 48 cardiac events occurred; 19 patients died, 26 were hospitalized for heart failure decompensation, and 3 because of the need for implantation of a cardioverter-defibrillator. The peak tricuspid annular velocity during systolic ejection of 10.8 cm/s or less, peak early diastolic tricuspid annular velocity of 8.9 cm/s or less, tricuspid annular acceleration during isovolumic contraction of 2.52 m/s 2 or less, and Doppler RV index (Tei index) of 1.20 or more were found to significantly worsen survival or event-free survival. However, their combination significantly exceeded the predictive potential of individual parameters. The worst survival was predicted by the combination of peak tricuspid annular velocity during systolic ejection of 10.8 cm/s or less plus peak early diastolic tricuspid annular velocity of 8.9 cm/s or less plus tricuspid annular acceleration during isovolumic contraction of 2.52 m/s 2 or less (relative risk 6.17, P < .001), whereas the worst event-free survival was identified by the combination of peak tricuspid annular velocity during systolic ejection of 10.8 cm/s or less plus peak early diastolic tricuspid annular velocity of 8.9 cm/s or less plus Doppler RV index (Tei index) of 1.20 or more (relative risk 3.62, P < .001). In conclusion, the combination of RV systolic and diastolic functional parameters represents a very powerful tool for risk stratification of patients with symptomatic heart failure.     

An evaluation of the use of new Doppler methods for detecting longitudinal function abnormalities in a pacing-induced heart failure model.

BACKGROUND: Doppler tissue echocardiography and color M-mode Doppler flow propagation velocity have proven useful in evaluating cross-sections of patients with left ventricular (LV) dysfunction, but experience with serial changes is limited. Purpose and methods: We tested their use by evaluating the temporal changes of LV function in a pacing-induced congestive heart failure model. Rapid ventricular pacing was initiated and maintained in 20 dogs for 4 weeks. Echocardiography was performed at baseline and weekly during brief pacing cessation. RESULTS: With rapid pacing, LV volume significantly increased and ejection fraction (57%-28%), stroke volume (37-18 mL), and mitral annulus systolic velocity (16.1-6.6 cm/s) by Doppler tissue echocardiography significantly decreased, with ejection fraction and mitral annulus systolic velocity closely correlated (r = 0.706, P <.0001). In contrast to the mitral inflow velocities, mitral annulus early diastolic velocity decreased steadily (12.3-7.3 cm/s) resulting in a dramatic decrease in mitral annulus early/late (1.22-0.57) diastolic velocity with no tendency toward pseudonormalization. The color M-mode Doppler flow propagation velocity also showed significant steady decrease (57-24 cm/s) throughout the pacing period. Multiple regression analysis chose mitral annulus systolic velocity (r = 0.895, P <.0001) and propagation velocity (r = 0.782, P <.0001) for the most important factor predicting LV systolic and diastolic function, respectively. CONCLUSIONS: Doppler tissue echocardiography and color M-mode Doppler flow could evaluate the serial deterioration in LV dysfunction throughout the pacing period. These were more useful in quantifying progressive LV dysfunction than conventional ehocardiographic techniques, and were probably relatively independent of preload. These techniques could be suitable for longitudinal evaluation in addition to the cross-sectional study.     

三尖瓣环运动速度多普勒组织成像评价下壁心肌梗塞后右室功能

目的 探讨多普勒组织成像(DTI)记录三尖瓣环运动速度评价下壁心肌梗塞后右室功能的价值。方法 急性下壁心肌梗塞病人28例，年龄匹配的健康者20例，于心尖四腔观三尖瓣环相对应的右室游离壁记录收缩期峰值速度(VS)，舒张早期峰值速度(VE)，舒张晚期峰值速度(VA)。结果 急性下壁心肌梗塞组三尖瓣环收缩期峰值速度、舒张早期峰值速度均降低。结论 多普勒组织成像测定三尖瓣环运动速度可作为评价下壁心肌梗塞后右室功能的新方法。     

心室功能评估中房室瓣环组织多普勒波形的测定

在诸多无创性评估心室功能的检测手段和方法中,多普勒组织成像(DTI)正得到临床的广泛应用,房室瓣环组织多普勒波形改变对心室功能的提示意义也逐渐受到重视.房室瓣环的运动代表了心肌纤维由基底部向心尖的运动,瓣环运动速度的测定可提供心室收缩期到舒张早期运动状态的信息.DTI获得的二尖瓣环收缩期运动速度波形可反映心梗缺血壁段引起的左室壁不协调性,并可用这些参数评价左室的整体收缩功能.三尖瓣环的DTI运动速度可以用于评价与下壁心梗相关的右室功能.因受前负荷变化的影响小,二尖瓣环DTI有助于鉴别二尖瓣的假阴性血流频谱,有助于无创性评估左室充盈压.一些影响房室瓣环DTI运动速度测定的因素目前难以消除,需结合其他多普勒参数和临床表现来分析.     

Effect of preload reduction by haemodialysis on new indices of diastolic function

Assessment of mitral annular motion diastolic velocities by M-mode or tissue Doppler imaging and the propagation velocity of early diastolic filling (Vp) by colour M-mode have been proposed as preload-independent indices of diastolic function. The aim of the present study was to determine the effects of preload reduction by haemodialysis on these new echocardiographic indices and to assess the relationship between these indices. The study group comprised 17 patients with chronic renal failure in sinus rhythm with normal left ventricular systolic function who underwent echocardiography 30 min prior to and 30 min following haemodialysis. Following dialysis there were significant reductions in weight (P<0.001), left atrial diameter (P=0.001), the peak Doppler velocity of early diastolic transmitral flow (P=0.005) and the ratio of Doppler velocities of early to late diastolic transmitral flow (P=0.02), consistent with a reduction in intravascular volume. There was no change after dialysis in early diastolic mitral annular velocity using M-mode (P=0.19) or tissue Doppler imaging from either the septal or lateral walls (P=0.88 and P=0.15 respectively), but there was a reduction in Vp after dialysis (55 to 49 cm/s; P=0.04). There were only weak correlations between Vp and the early diastolic mitral annular velocities (r<0.6 for all). We conclude that the assessment of diastolic function by the mitral annular early diastolic velocity appears to be preload-independent, that Vp may be affected by preload and that there is only a weak relationship between Vp and the early diastolic mitral annular velocity.     

Doppler tissue analysis of mitral annular velocities: evidence for systolic abnormalities in patients with diastolic heart failure.

BACKGROUND: The presence of signs and symptoms of heart failure (HF), abnormal diastolic function and an ejection fraction > 45%, have been defined as diastolic HF (DHF). However, a cut-off value of 45% for ejection fraction seems arbitrary as mild systolic dysfunction may be overlooked. It was the goal of this study to assess the additive information derived from Doppler tissue imaging for patients with DHF. METHODS: As a measure of left ventricular (LV) long-axis function, systolic and diastolic velocities of the mitral annulus (peak, peak early, and peak late) derived from pulsed Doppler tissue imaging were assessed in 36 asymptomatic control subjects, 36 patients with DHF, and 35 patients with systolic HF (SHF). As a measure of overall LV performance, the Tei index (isovolumic contraction time and isovolumic relaxation time divided by ejection time) was assessed. RESULTS: In the DHF group, peak systolic annular velocity was reduced (7.1 +/- 1.2 cm/s) as compared with the control group (9.0 +/- 1.2 cm/s, P <.05), and was even lower in the SHF group (5.0 +/- 0.7 cm/s, P <.01 SHF group vs DHF/control groups). The Tei index was increased in the DHF group (0.53 +/- 0.14) in comparison with the control group (0.39 +/- 0.07, P <.05), and was highest in the SHF group (0.94 +/- 0.43, P <.01 SHF group vs control/DHF groups). Using peak systolic annular velocity < 7.95 cm/s as a cut-off value (derived from receiver operating characteristic curve analysis), patients with DHF were separated from control subjects with a sensitivity of 83% and a specificity of 83%. A Tei index > 0.43 separated patients with DHF and control subjects with a sensitivity of 79% and a specificity of 72%. CONCLUSION: Systolic long-axis LV function is also impaired in patients with DHF, resulting in feasible diagnosis of DHF by Doppler tissue imaging analysis of LV long-axis function and overall LV function with the Tei index.     

Detection of left ventricular dysfunction by Doppler tissue imaging in patients with complete recovery of visual wall motion abnormalities 6 months after a first ST-elevation myocardial infarction

AIMS: The aim of this study was to assess left ventricular (LV) systolic and diastolic function, using Doppler tissue imaging (DTI), in patients with complete recovery of visual wall motion abnormalities six months after a first ST-elevation myocardial infarction (STEMI). METHODS: Out of 90 patients presenting with a STEMI, 68 patients without a history of heart disease were examined by echocardiography before discharge and after 6 months. The patients were compared to 41 age matched healthy subjects (HS). LV function was assessed by visual wall motion and mitral annular velocities using pulsed wave DTI. RESULTS: Sixty-eight patients had visual wall motion abnormalities at baseline. Of these, 19 patients showed complete recovery of wall motion at 6-months follow-up. Patients with complete recovery of wall motion abnormalities had significantly reduced peak systolic and peak early diastolic mitral annular velocities compared to HS at 6 months (8.3 cm s(-1) versus 9.9 cm s(-1), P<0.001 for systolic velocity and 9.3 cm s(-1) versus 13.1 cm s(-1), P<0.001 for diastolic velocity, respectively). CONCLUSION: In patients presenting with a first STEMI, mitral annular systolic and early diastolic velocities assessed by DTI at 6-months follow-up are significantly reduced compared to HS, despite normal standard echocardiographic parameters of LV function. This probably reflects a residual subendocardial damage not detected by conventional echocardiographic methods.     

Acute effects of smoking on diastolic function in healthy participants: Studies by conventional doppler echocardiography and doppler tissue imaging

The acute effects of smoking on left ventricular (LV) function were studied in 36 healthy participants (mean age 38 ± 10 years). The studies were made before and immediately and 30 minutes after smoking a cigarette. From apical 4- and 2-chamber views, the mitral annular velocities, determined by pulsed wave Doppler tissue imaging, were measured at 4 LV sites corresponding to the septum and the anterior, lateral, and inferior walls. A mean value from the 4 sites was used to assess LV function. The peak systolic, early diastolic, late diastolic, and the ratio of early to late diastolic velocities were recorded. In addition, other conventional Doppler echocardiographic diastolic parameters were also determined. Heart rate was increased immediately after smoking (from 67 ± 8 to 74 ± 10 bpm, P < .001). There was no change in systolic mitral annular velocity. Diastolic LV function was changed significantly immediately after smoking. The transmitral A wave increased (0.55 ± 0.1 vs 0.7 ± 0.1 m/s, P < .001), the transmitral E/A ratio decreased (1.5 ± 0.6 vs 1.1 ± 0.3, P < .001), and the transmitral E-wave deceleration time increased (186 ± 42 vs 211 ± 44 ms, P < .05). The diastolic myocardial velocity at the mitral annulus also changed significantly: the early diastolic velocity decreased (16 ± 3 vs 15 ± 3 cm/s, P < .001), the late diastolic velocity increased (10.9 ± 2.2 vs 12 ± 2.4 cm/s, P < .001), and the ratio of early to late diastolic annular velocities decreased (1.5 ± 0.5 vs 1.2 ± 0.4, P < .001). The changes in the transmitral flow velocities remained unaltered even 30 minutes afterward, although the heart rate returned to normal. The results were similar in both smokers and nonsmokers. Acute smoking of a cigarette influences LV diastolic function in healthy participants. The mechanism behind this effect cannot be explained only by changes in the heart rate or loading conditions. The mechanism is probably more complex. (J Am Soc Echocardiogr 2002;15:1232-7.)