Pulsed tissue Doppler imaging of left ventricular systolic and diastolic wall motion velocities to evaluate differences between long and short axes in healthy subjects.

Our objective was to evaluate in healthy subjects the left ventricular (LV) wall motion velocities along the long and short axes by means of pulsed tissue Doppler imaging (TDI) to clarify the differences in the LV systolic and diastolic function between both axes. Wall motion velocities were recorded at the mid-wall portion of the middle site of the LV posterior wall in the parasternal long-axis view, and at the subendocardial portion of the middle site of the LV posterior wall in the apical long-axis view by pulsed TDI in 35 healthy subjects (mean age 26 +/- 10 years, mean heart rate 72 +/- 7 bpm). In all subjects, the LV pressure curve, its first derivative (dP/dt), the LV wall motion velocity, the phonocardiogram, and the electrocardiogram were simultaneously recorded. The systolic wave of the LV posterior wall motion velocity exhibited 2 peaks: the first and second systolic waves (Swl and Sw2, respectively). The diastolic wave also exhibited 2 peaks, the early diastolic and atrial systolic waves. The Swl along the long axis was greater than either the Sw1 and Sw2 along the short axis or the Sw2 along the long axis. The peak Sw1 along the long axis coincided with the peak dP/dt and was slightly earlier than the peak Swl along the short axis. The onset of Sw1 along the long axis coincided with the onset of the first heart sound. The Sw2 along the short axis was greater than that along the long axis. The early diastolic wave along the short axis was greater than that along the long axis, whereas the atrial systolic wave along the long axis was greater than that along the short axis. Thus, in healthy subjects, shortening of the longitudinal fibers predominated over that of the circumferential fibers during early systole, whereas shortening of the circumferential fibers predominated over the longitudinal fibers during the ejection phase. During diastole, the circumferential fibers predominated in the LV wall expansion at early diastole, whereas the longitudinal fibers predominated at atrial systole. In conclusion, pulsed TDI provided information that is useful in understanding the characteristics of LV wall motion along the long and short axes.     

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.     

心肌速度梯度对肥厚型心肌病左室局部收缩功能的研究

目的应用心肌速度梯度对肥厚型心肌病左室短轴方向局部收缩功能进行评价.方法应用定量组织速度成像技术分析16例HCM患者和15例正常人室间隔左室面、右室面下与左室后壁内、外膜面下心肌短轴方向的速度曲线,测量收缩期峰值运动速度(Vs)、收缩期心肌速度梯度(MVGs)等参数.结果 HCM组室间隔左、右室面下与左室后壁内、外膜面下心肌短轴方向Vs与正常人相比较无显著性差异,但其室间隔与左室后壁短轴方向MVGs明显低于正常对照组;室间隔收缩期峰值速度梯度与IVS/PW之间显著相关,而左室射血分数与IVS/PW比值之间相关性差.结论 HCM左室短轴方向局部收缩功能是降低的;心肌速度梯度能够精确反应室壁局部收缩功能,定量组织速度成像为我们提供了一种测量心肌速度梯度的新方法.     

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.     

Influence of preload alterations on parameters of systolic left ventricular long-axis function: a Doppler tissue study.

The study examined the influence of preload alterations on parameters of left ventricular (LV) long-axis function during systole. Doppler tissue echocardiography was performed in 32 healthy volunteers at rest who were placed in the Trendelenburg position after administration of 0.8 mg of nitroglycerin sublingually. In a 16-segment LV model, long-axis myocardial strain and systolic velocities were assessed. Isovolumic acceleration was assessed in the lateral mitral annulus. Mean LV strain and systolic velocity were unchanged during the different load conditions. In the mitral annulus, strain was also uninfluenced by preload alterations, whereas the peak systolic velocities seemed influenced by preload reduction. The isovolumic acceleration of the mitral annulus was found to be load dependent (enhanced preload 1.38 +/- 0.50 vs baseline 1.6 m/s2 +/- 0.60, P <.01; and preload reduction 2.18 +/- 0.65 m/s2, P <.01). In conclusion, LV long-axis strain and systolic velocities were not significantly influenced by load alterations, whereas myocardial systolic velocities and isovolumic acceleration in the lateral mitral annulus were significantly load dependent.     

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.     

Acute regional myocardial ischemia identified by 2-dimensional multiregion tissue Doppler imaging technique.

BACKGROUND AND OBJECTIVE: Tissue Doppler echocardiography (TDE) is a promising method for the assessment of regional myocardial function, but pulsed TDE does not provide quantitative data from multiple regions simultaneously. This feature is important for the objective assessment of regional differences in myocardial function. In the present study, we investigated a new off-line TDE method that provides quantitative pulsed velocity data from an unlimited number of regions selected within a 2-dimensional (2D) image. The goal of the study was to determine the ability of this new approach to quantify regional myocardial function during acute myocardial ischemia induced by balloon angioplasty. METHODS: Twenty-two patients undergoing angioplasty of the left anterior descending coronary artery (LAD) were studied. Left ventricular longitudinal wall motion was assessed by 2D TDE from the apical 4-chamber view before, during, and after angioplasty. Images were sampled at a rate of 69 +/- 15 frames/s, and the off-line analysis allowed simultaneous measurement of velocities in multiple myocardial segments. RESULTS: There were 3 major alterations in the systolic velocity pattern during LAD occlusion. Peak early systolic velocities along the apical septum were significantly reduced during LAD occlusion (2.8 +/- 1.2 cm/s to 0.6 +/- 1.7 cm/s, P <.001). Myocardial velocities in mid systole suggested paradoxical wall motion (1.0 +/- 1.2 cm/s to -0.8 +/- 0.9 cm/s, P <.001). When comparing the ischemic regions of the left ventricle with the nonischemic regions, each patient demonstrated lower myocardial systolic velocities in the ischemic region. Furthermore, during early diastole, the wall motion of the ischemic segments showed a postsystolic contraction pattern with velocities changing from -0.9 +/- 1.0 cm/s to 1.9 +/- 1.3 cm/s (P <.001). CONCLUSION: This new 2D TDE approach is able to quantify detailed myocardial velocity profiles from multiple regions simultaneously. Single-beat comparisons of ischemic and nonischemic regions might enhance the sensitivity for diagnosing ischemic heart disease. Reversed systolic wall motion during midsystole and marked positive velocity during early diastole might be new and important markers of myocardial wall ischemia.     

Acute effects of hemodialysis on left ventricular function evaluated by tissue Doppler imaging.

Evidence exists that left ventricular function is impaired in chronic uremic patients. During hemodialysis (HD) treatment, myocardium undergoes electrolyte, hemodynamic and neuro-humoral stress; however, data about the acute changes on ventricular function are controversial. Aim of the present study was to evaluate the effect of a single hemodialysis session on left ventricular (LV) systolic and diastolic function using pulsed tissue Doppler imaging (TDI) sampled by echocardiography. The study group included 20 uremic patients (17 males, aged 51+/-13 yrs) on maintenance HD, free from clinically overt cardiac dysfunction who underwent echocardiography with pulsed TDI 30 min prior and 30 min after a HD session. TDI was performed by placing the sample volume in the center of the basal lateral segment and the basal interventricular septum in the apical four-chamber view. Myocardial systolic wave (S(m)) and early (E(m)) and atrial (A(m)) diastolic waves were measured. On standard sonography examination, no significant changes in LV systolic function parameters were observed after HD, but the indices for LV diastolic function deteriorated significantly (peak E, 75.4+/-11.2 vs. 58.8+/-12.5 cm/s, P<0.01; E/A ratio, 1.0+/-0.3 vs. 0.8+/-0.2, P<0.01). However, regarding TDI measures following HD, the patients exhibited a lower S(m) peak (septum: 7.6+/-1.1 vs. 5.9+/-0.8 cm/s; lateral wall: 7.7+/-1.7 vs. 6.8+/-1.2 cm/s, P<0.001), a lower E(m) peak (septum: 8.3+/-1.6 vs. 6.3+/-1.7 cm/s; lateral wall: 10.2+/-2.4 vs. 7.1+/-1.9 cm/s, P<0.001), and a reduced E(m)/A(m) ratio (septum: 1.0+/-0.4 vs. 0.7+/-0.2; lateral wall: 1.2+/-0.5 vs. 0.7+/-0.2, P<0.001, respectively), as compared to pre-HD parameters. Of interest, peak E(m), and E(m)/A(m) ratio of the lateral wall were negatively related to ultrafiltration rate (r = -0.60, P<0.05 and -0.69, P<0.01, respectively). Our data indicate that a single hemodialysis session is associated with acute deterioration of diastolic and systolic parameters of myocardial function, as assessed by TDI. These reversible changes could be considered as a cardiac stunning that seems to be related to the ultrafiltration rate and then to the interdialysis weight gain. These findings suggest that low ultrafiltration volume and/or limited interdialytic weight gain are cardioprotective measures in hemodialysis patients.     

Tissue cardiovascular magnetic resonance demonstrates regional diastolic dysfunction in remote tissue early after inferior myocardial infarction.

PURPOSE: To investigate regional diastolic and systolic function using tissue cardiovascular magnetic resonance (CMR), early after transmural myocardial infarction of the inferior wall due to single proximal right coronary artery disease. MATERIALS AND METHODS: Velocity encoded CMR was used to measure early diastolic transmitral flow velocity (E), and regional, longitudinal, myocardial systolic (Sa) and early diastolic (Ea) velocities (tissue CMR) in 15 patients with a recent transmural inferior myocardial infarction and in 15 age and LV-mass index matched control subjects. An unpaired two-tailed t test was used to assess significance of continuous variables. RESULTS: Global systolic (ejection fraction 46 +/- 7% versus 57 +/- 4%, p = 0.000052) and global diastolic LV function (average Ea of infarcted or inferior, remote or anterior, adjacent or septal and lateral myocardium 6.8 +/- 1.7 cm/s versus 10.4 +/- 1.5 cm/s, p = 0.0000012) were impaired in patients as compared to controls. Regional systolic and diastolic LV velocities were impaired in infarcted and adjacent tissue in patients. However, in remote or anterior tissue, systolic velocities were preserved (Sa 6.6 +/- 2.0 cm/s versus 6.8 +/- 1.4 cm/s, p = 0.70), but diastolic velocities were impaired in patients as compared to controls (Ea 7.2 +/- 2.3 cm/s versus 10.2 +/- 2.5 cm/s, p = 0.0026). CONCLUSIONS: Regional diastolic velocities early after inferior myocardial infarction are impaired in the infarcted, adjacent and remote tissue, but regional systolic velocities are preserved in remote tissue.     

Assessment of regional systolic and diastolic wall motion velocities in highly trained athletes by pulsed wave Doppler tissue imaging.

We studied the relationship between left ventricular (LV) function and the increased LV mass in 18 highly trained rowing athletes (14 men, 4 women; mean age 20.7 +/- 4.5 years) using pulsed wave Doppler tissue imaging (PWDTI). Thirteen untrained volunteers, matched for age and body mass index, acted as control participants. Peak systolic, early diastolic (Ev), and late diastolic (Av) myocardial velocities (cm/s); Ev/Av ratio; and isovolumic relaxation time (ms) were measured at the level of basal lateral wall and basal posterior interventricular septum (bas-IVS) segments. In comparison with control participants, athletes showed a greater LV cavity size (P <.05), wall thickness (IVS, P <.001; posterior wall, P <.01), and mass index (P <.001). In athletes, systolic velocity of bas-IVS had increased (P <.001) and was positively correlated with IVS thickness (r = 0.66, P <.005) and LV mass index (r = 0.71, P <.001). Of the PWDTI-measured diastolic indexes, Ev/Av ratio significantly increased in athletes in comparison with control participants in both the examined segments (bas-IVS, P <.05; basal lateral wall, P <.05). When Ev and Av were separately considered, a different behavior was found in the 2 segments: Ev significantly increased in the basal lateral wall (P <.005); Av significantly decreased in the bas-IVS. The increase in the systolic velocity of bas-IVS suggests that septum greatly contributes to the longitudinal LV systolic shortening and increase of stroke volume in athletes compared with untrained participants. Moreover, the behavior of PWDTI diastolic velocities suggests a more effective relaxation activity in the longitudinal axis at the level of lateral wall. This study suggests therefore the usefulness of PWDTI in the assessment of functional properties of "athlete's heart" and differentiation from pathologic cardiac conditions.     

Influence of aging on systolic left ventricular wall motion velocities along the long and short axes in clinically normal patients determined by pulsed tissue doppler imaging.

Our objective was to evaluate the influence of aging on left ventricular (LV) regional systolic function along the long and short axes in clinically normal patients. We recorded LV wall motion velocity patterns at the mid-wall portion of the middle of the LV posterior wall in the parasternal long-axis view (short-axis direction) and at the endocardial portion of the middle of the LV posterior wall in the apical long-axis view (long-axis direction) with pulsed tissue Doppler imaging in 80 normal patients (age range 15 to 78 years). In all patients the LV pressure curve and its first derivative (dP/dt) were recorded. The systolic wave of the LV posterior wall motion velocity pattern exhibited 2 peaks, the first (Sw(1)) and second (Sw(2)) systolic waves. No significant changes were seen with aging in the percent LV fractional shortening determined by M-mode echocardiography, LV ejection fraction determined by left ventriculography, the peak Sw(1) and Sw(2) along the short axis, the peak Sw(2) along the long axis, and the peak dP/dt. The peak Sw(1) along the long axis correlated inversely with age (P <.0001) but did not correlate significantly with the peak dP/dt. These results suggest that shortening of the longitudinal fibers in early systole is impaired with increased age in healthy individuals. This impairment results in insufficient spherical change in the LV cavity, although global LV pump function and myocardial contractility are maintained.     

Evaluation of abnormal motion of interventricular septum after coronary artery bypass grafting operation: assessment by ultrasonic strain rate imaging.

We investigated whether strain rate imaging by echocardiography can quantify abnormal motion of interventricular septum (IVS) after coronary artery bypass grafting operation (CABG). Strain rate imaging was performed in 12 patients with angina pectoris treated by CABG; 12 patients with angina pectoris treated medically, with catheter intervention, or both (non-CABG); and 10 patients with previous anterior myocardial infarction. Peak systolic Doppler tissue velocity of mid-IVS was significantly lower in the CABG group than in the non-CABG group (2.15 +/- 0.58 cm/s vs 3.37 +/- 1.15 cm/s; P <.05). However, there was no significant difference in peak systolic strain (PSS) rate and PSS of mid-IVS between CABG and non-CABG groups. PSS rate and PSS of mid-IVS were significantly lower in the anterior myocardial infarction group than in the non-CABG group (-0.45 +/- 0.25/s vs -1.22 +/- 0.28/s and -5.8 +/- 4.9% vs -17.2 +/- 3.4%, respectively; P <.0001). Strain rate imaging can quantify accurate left ventricular function in cases of apparently reduced cardiac motion.     

Effect of aging on diastolic left ventricular myocardial velocities measured by pulsed tissue Doppler imaging in healthy subjects.

We evaluated the effect of aging on diastolic left ventricular (LV) wall motion velocity in 80 healthy persons with the use of pulsed tissue Doppler imaging. The wall motion velocity patterns were recorded at the middle regions of the LV posterior wall and ventricular septum in the parasternal (along the short axis) and apical (along the long axis) LV long-axis views. In the posterior wall, the peak early diastolic wall motion velocities (Ews) along both axes correlated inversely with age (long axis: r = -0.61, P <. 0001; short axis: r = -0.55, P <.0001), and the peak atrial systolic wall motion velocities(Aws) along both axes correlated directly with age (long axis: r = 0.59, P <.0001; short axis: r = 0.65, P <.0001). In the ventricular septum, the Ew along the long axis correlated inversely with age (r = -0.51, P <.0001), and the Aws along both axes correlated directly with age (long axis: r = 0.57, P <.0001; short axis: r = 0.53, P <.0001). The Ews along both axes at the posterior wall correlated directly with the peak early diastolic transmitral flow velocity. The Aws along both axes at the ventricular septum and posterior wall correlated directly with the peak atrial systolic transmitral flow velocity. The times from the second heart sound to the peak of the early diastolic waves of the ventricular septum and posterior wall along both axes significantly increased with age. The times from the aortic component of the second heart sound to the peak of the early diastolic motion velocities along both axes were significantly longer at the ventricular septum than at the posterior wall. Pulsed tissue Doppler imaging may be useful for evaluating the effect of aging on diastolic LV function in healthy persons.     

Reproducibility and observer variability of tissue phase mapping for the quantification of regional myocardial velocities

To systematically investigate the reproducibility of global and segmental left ventricular (LV) velocities derived from tissue phase mapping (TPM). Breath held and ECG synchronized TPM data (spatial/temporal resolution?=?2?×?2 mm²/20.8 ms) were acquired in 18 healthy volunteers. To analyze scan–rescan variability, TPM was repeated in all subjects during a second visit separated by 16?±?5 days. Data analysis included LV segmentation, and quantification of global and regional (AHA 16-segment modal) metrics of LV function [velocity–time curves, systolic and diastolic peak and time-to-peak (TTP) velocities] for radial (Vr), long-axis (Vz) and circumferential (VΦ) LV velocities. Mean velocity time curves in basal, mid-ventricular, and apical locations showed highly similar LV motion patterns for all three velocity components (Vr, VΦ, Vz) for scan and rescan. No significant differences for both systolic and diastolic peak and TTP myocardial velocities were observed. Segmental analysis revealed similar regional peak Vr and Vz during both systole and diastole except for three LV segments (p?=?0.045, p?=?0.033, and p?=?0.009). Excellent (p?<?0.001) correlations between scans and rescan for peak Vr (R²?=?0.92), peak Vz (R²?=?0.90), radial TTP (R²?=?0.91) and long-axis TTP (R²?=?0.88) confirmed good agreement. Bland–Altman analysis demonstrated excellent intra-observer and good inter-observer analysis agreement but increased variability for long axis peak velocities. TPM based analysis of global and regional myocardial velocities can be performed with good reproducibility. Robustness of regional quantification of long-axis velocities was limited but spatial velocity distributions across the LV could reliably be replicated.     

Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects.

Assessment of myocardial velocities by Doppler tissue imaging is gaining in importance. However, generally accepted reference values are still missing. In this study we examined 62 consecutive healthy subjects (mean age 46, range 22-82 years) by pulsed wave Doppler tissue imaging to characterize the systolic and diastolic velocity profiles of the left and right ventricles. The subjects were divided into 3 different age-groups: group I, younger than 40 years; group II, 40 to 59 years; and group III, 60 years and older. Recordings were made along the long axis in the apical 4- and 2-chamber views by using 4 sites (septal, anterior, lateral, and inferior) at the mitral annulus and 1 site at the tricuspid annulus. Systolic mitral annular velocity (10.3 +/- 1.4 cm/s) correlated strongly with global left ventricular function determined by M-mode echocardiographic mitral annular displacement (r = 0.70, P <.001). The systolic velocity was significantly lower in group III than in group I (9.6 vs 10.8 cm/s, P <.01). A relatively weak, but significant, correlation was found between systolic velocity and the age of the subjects (r = -0.43, P <.001). Mitral annular early diastolic velocity was also lower in group III compared with group I (11.3 vs 17.7 cm/s, P <.001), with a strong correlation with age (r = -0.81, P <.001) and other conventional Doppler diastolic parameters. Both the systolic and early diastolic mitral annular velocities at the septum were lower than at other left ventricular sites. Tricuspid annular systolic velocity (15.2 +/- 1.9 cm/s) was higher than mitral annular systolic velocity (P <.001). Unlike mitral annular velocity, systolic tricuspid annular velocity was not correlated with age. However, the diastolic tricuspid annular velocities correlated well with transtricuspid Doppler diastolic parameters. The method of recording the annular velocities was feasible in all subjects, simple and highly reproducible.     

心肌组织多普勒显像技术在心血管疾病中的应用

目的：通过正常组与疾病组室壁运动速度的对比分析,以验证该技术的准确性,为定量评价局部室壁运动提供新方法。方法：分别对２８例正常组与１５例陈旧性前间壁心肌梗塞组、２０例扩张型心肌病组（ＤＣＭ）前间隔及左室后壁运动速度进行测量,并同时将二维图像作对比分析。结果：陈旧性心肌梗塞组室间隔收缩期峰值速度明显低于正常对照组Ｐ＜０．００１;ＤＣＭ组前间隔与后壁收缩期峰值速度明显低于正常对照组Ｐ＜０．００１。２ＤＥ－ＴＤＩ显像中,正常组收缩中期前间隔与左室后壁以明亮的蓝色及红黄色编码,疾病组彩色编码暗淡或消失。结论：ＴＤＩ将Ｍ型与多普勒超声技术结合起来,不仅可以评价心脏整体功能,而且还能够对局部室壁的运动速度进行分析,是一有价值的显像技术,值得进一步研究。     

Analysis of athletes’ heart by tissue Doppler and strain/strain rate imaging

After regular and prolonged training, some physical and structural changes occur in the heart. Strain (S) imaging and Strain Rate (SR) imaging are new and effective techniques derived from tissue Doppler imaging (TDI) which examine systolic and diastolic functions. The aim of the present study was to evaluate left ventricular TDI and S/SR imaging properties in athletes and sedentary controls. The study population consisted of 26 highly trained athletes (group I) and age, sex and body mass index (BMI) adjusted 23 control subjects (group II) who had no pathological conditions. Using standard transthoracic and Doppler echocardiographical measurements and reconstructed spectral pulsed wave tissue Doppler velocities, the S/SR imaging of six different myocardial regions were evaluated. There was a significant increase in left ventricular systolic (LVSD) and diastolic (LVDD) diameter, inter-ventricular septum (IVS), left ventricular mass (LVm), left atrial diameter (LA), and transmitral Doppler peak E velocity (flow velocity in early diastole) between group I and group II in the case of echocardiographic findings. In athletes, TDI analysis showed a significantly increased mitral annulus lateral TDI peak early diastolic (E) velocity (18.8 ± 4.1 cm/s vs. 15 ± 3.5 cm/s, P < 0.01), septal TDI peak E velocity (15.8 ± 2.8 cm/s vs. 12.8 ± 2.4 P < 0.001). There were no significant differences in myocardial velocity imaging parameters between group I and group II. Peak systolic strain/strain rates of septal and lateral walls in group I were significantly higher than group II. This study demonstrates that left ventricular S/SR imaging was higher in athletes than in healthy subjects. In addition to traditional echocardiographic parameters, SI/SRI could be utilised as a useful echocardiographic method for cardiac functions of athletes.     

Effect of an acute increase in afterload on left ventricular regional wall motion velocity in healthy subjects.

We recorded left ventricular (LV) wall motion velocities before and after angiotensin II infusion by pulsed tissue Doppler imaging in 20 healthy subjects, and evaluated the responses of systolic and diastolic LV function along the long and short axes during an acute increase in afterload. Angiotensin II was administered intravenously to obtain a 30% increase in mean blood pressure. After angiotensin II infusion, LV end-systolic dimension and end-systolic circumferential wall stress increased significantly, and the percentage of LV fractional shortening decreased significantly. Peak first systolic LV wall motion velocity (Sw1 ) along the long axis decreased markedly compared with that along the short axis, and peak second systolic LV wall motion velocity (Sw2 ) along the short axis decreased significantly compared with that along the long axis. Early diastolic LV wall motion velocities along both the long and short axes decreased significantly, whereas atrial systolic LV wall motion velocity did not change. In conclusion, an acute increase in afterload caused a significant decrease in longitudinal fiber shortening during the isovolumic contraction phase (Sw1 along the long axis), circumferential fiber shortening during the ejection phase (Sw2 along the short axis), and LV relaxation during early diastole (early diastolic LV wall motion velocities along both axes) in healthy subjects. Pulsed tissue Doppler imaging may be useful for detecting the effect of various loading conditions on LV wall motion velocities along the long and short axes.     

Impact of flow level on coronary flow velocity pattern. A doppler flow study in patients with first acute myocardial infarction

Analysis of coronary flow velocity pattern has been used to assess microvascular function post acute myocardial infarction (AMI). This study sought to analyze whether the flow level has an impact on parameters of coronary flow velocity pattern. Parameters of coronary flow velocity pattern were determined at baseline and during increased flow due to maximal hyperemia induced by adenosine in 25 patients after PTCA for first AMI using Doppler flow wires. Patients were divided into those with depressed (global wall motion index (GWMI) > or = 1.5; n = 14) and those with preserved (GWMI < 1.5; n = 11) left ventricular (LV) function at 4 weeks. Coronary flow velocity pattern at rest was different between patients with depressed and patients with preserved LV function at follow-up. A difference in flow pattern between the groups remained at increased flow level. However, increase of flow altered parameters of flow pattern. Diastolic deceleration rate (DSR) increased for patients with preserved LV function (53.7+/-25.6 at baseline vs. 67.0+/-29.8 cm/s2 with adenosine) and depressed LV function (95.3+/-58.6 vs. 110.7+/-61.4 cm/s2, respectively, p = 0.0012). Induction of hyperemia resulted also in increased systolic and diastolic peak flow velocity and diastolic deceleration time (DDT). Higher flow had no impact on early systolic retrograde flow, systolic flow duration and diastolic-systolic velocity ratio (DSVR). The coronary flow velocity pattern allows prediction of LV function at 4 weeks after AMI. However, it should be considered that some parameters of the flow velocity pattern are affected by the coronary flow level.