多普勒组织成像检测肥厚型心肌病与高血压性心脏病的参数比较

目的初步探讨多普勒组织成像技术（TDI）对肥厚型心肌病（HCM）与高血压性心脏病鉴别诊断的临床价值。方法应用TDI技术对HCM患者、高血压性心脏病患者及正常人分别测量二尖瓣环收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）及舒张晚期峰值速度（Va）。常规超声检查测得左室射血分数（LVEF）、左室短轴缩短率（FS）、二尖瓣口血流峰值速度E、A,计算E/A。结果HCM组、高血压性心脏病组各峰值速度均减低,与正常组比较差异有显著性意义（P<0.05）;HCM组部分心肌节段峰值速度与高血压性心脏病组比较有显著性差异（P<0.05）。结论TDI技术对HCM与高血压性心脏病鉴别诊断提供可行、实用的信息。     

肥厚型心肌病左室局部与整体舒张功能研究新方法定量组织多普勒速度成像技术

目的　探讨定量组织多普勒速度成像技术(QTVI)评价肥厚型心肌病 (HCM )患者左室局部与整体心肌舒张功能的价值。方法　应用QTVI获取 36例正常人和 4 2例HCM患者左室长轴方向不同室壁心肌多普勒速度曲线。离线分析正常人与HCM患者不同室壁舒张期心肌多普勒运动速度。测量的快速充盈期和心房收缩期速度 (Ve和Va)、Ve/Va比值反映左室局部舒张功能 ,脉冲多普勒测量二尖瓣舒张期血流频谱E/A值、左室等容舒张期 (IRT)反映左室整体功能 ,常规超声心动图测量室壁厚度。结果　①HCM患者肥厚室间隔节段Ve、Va、Ve/Va的测值及二尖瓣血流频谱E/A值均比正常人测值明显降低 ,IRT比正常人明显延长(P <0 0 5 ) ;②HCM患者肥厚室间隔节段Ve、Va、Ve/Va的测值比其他左室节段明显降低 ;③E/A比值异常的HCM患者Ve/Va与E/A有相关关系 (r =0 70 4 )。④非梗阻型HCM患者肥厚室间隔厚度IVSt与Ve/Va有负相关关系 (r =- 0 6 14 )。结论　QTVI定量评价HCM患者左室局部心肌舒张功能以及局部与整体心肌舒张功能关系 ,为进一步了解HCM心肌舒张功能的变化提供较为敏感、精确的方法。     

定量组织速度成像测量二尖瓣环运动速度评价肥厚型心肌病患者左室舒张功能

目的 :应用定量组织速度成像 (QTVI)测量二尖瓣环运动速度评价肥厚型心肌病 (HCM )患者左室舒张功能。方法 :QTVI测量 31例HCM患者 (HCM组 )和 2 0例正常人 (对照组 )二尖瓣环 6个节段 (后间隔和侧壁、前间隔和后壁、前壁和下壁 )舒张早期峰值速度 (Ve)、左房收缩期峰值速度 (Va) ,计算平均Ve、Va和Ve/Va比值。多普勒超声心动图测量二尖瓣口血流快速充盈速度E峰、左房收缩充盈速度A峰 ,计算E/A值和E与平均Ve的比值 (E/Ve)。结果 :HCM患者平均Ve和Ve/Va较对照组明显减低 [(Ve:(3.6 4± 1.4 1)cm/s∶(8.2 1±1.6 9)cm/s,P <0 .0 1;Ve/Va:(0 .92± 0 .5 1)∶(1.5 7± 0 .5 0 ) ,P <0 .0 1;E和E/A较对照组减低 [E :(74 .73±2 6 .5 5 )cm/s∶(84 .0 0± 14 .5 7)cm/s ,P =0 .14 2 ;E/A :(1.12± 0 .4 9)∶(1.6 8± 0 .4 1) ,P <0 .0 1;E/Ve较对照组明显增高 [(2 3.0 3± 7.73)∶(10 .5 3± 2 .6 7) ,P <0 .0 1]。E/A <1者 14例 (4 5 .2 % ) ,Ve/Va <1者 2 0例 (6 4 .5 % ) ;E/A >1的HCM患者其Ve和Ve/Va亦较对照组明显减低 ,E/Ve明显增高。结论 :HCM患者二尖瓣口多普勒血流信号E、A受前负荷和左房收缩性等因素的影响 ,而QTVI测量二尖瓣环运动速度能准确评价HCM患者左室舒张功能。     

多普勒组织成像评价肥厚型心肌病左室舒张功能

目的应用多普勒组织成像脉冲技术测量二尖瓣环舒张速度,以评价肥厚型心肌病左室舒张功能.方法对90例肥厚型心肌病患者及50例正常人进行常规超声心电图及多普勒组织成像检查,测量各房室内径,室壁厚度,射血分数及二尖瓣环各点舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa).两组指标比较采用成组t检验.结果肥厚型心肌病患者室间隔厚度(25.5±6.6)mm,左室后壁厚度(9.9±2.3)mm,左室内径(42.9±5.9)mm,左房内径(39.9±4.7)mm,LVEF(71.9±4.3)%,二尖瓣血流E/A为1.42±0.7.肥厚型心肌病患者Ea较正常人减低.Aa无明显差异.结论肥厚型心肌病左室长轴主动松弛功能较正常人减低.     

组织多普勒评价原发性高血压不同左心室构型患者右心室舒张功能

目的:应用多普勒组织成像(DTI)技术检测原发性高血压(EH)不同左心室构型患者三尖瓣环脉冲组织多普勒(PW-DTI)频谱,评价其右心室舒张功能.方法:EH患者80例,按照Ganau分类方法,以左心室质量指数(LVMI)和相对室壁厚度(RWT)分为:正常左心室构型组(EH1组),向心性重构组(EH2组),向心性肥厚组(EH 3组)及离心性肥厚组(EH 4组);另入选20例健康体检者作为正常对照组.取标准心尖四腔切面,用PW-DTI技术测量各组的三尖瓣瓣环舒张早期峰值速度(E),舒张晚期峰值速度(A)及E/A值.结果:与正常对照组比较:EH1、2、3、4组E峰逐渐减低,A峰逐渐增高,E/A比值逐渐减低(P<0.05);EH各组间比较:平均E峰逐渐减低且随左心室构型改变呈下降趋势(P<0.05);平均A峰逐渐增高且随左心室构型改变呈上升趋势(P<0.05).结论:①EH患者早期左心室构型正常时已存在右心室舒张功能减低;②EH患者的右心室舒张功能在不同左心室构型中根据恶化程度呈下降趋势;③DTI技术可用于评价EH患者右心室舒张功能.     

Combined thallium-201 and dynamic iodine-123 iodophenylpentadecanoic acid single-photon emission computed tomography in patients after acute myocardial infarction with effective reperfusion

BACKGROUND: Considerable derangements of energy metabolism are to be expected during ischemia and reperfusion. In ischemic myocardium, the oxidative degradation of carbohydrates is shifted toward the anaerobic production of lactate and the oxidation of fatty acids is suppressed. HYPOTHESIS: The aim of this study was to examine the uptake and metabolism of iodine-123 (123I) iodophenylpentadecanoic acid (IPPA) in stunned myocardium. METHODS: In 15 patients, SPECT with 201Tl and 123I IPPA as well as echocardiography with low-dose dobutamine stimulation were performed 12 +/- 5 days after myocardial infarction with reperfusion. Follow-up echocardiography was carried out 24 +/- 8 days later for documentation of functional improvement. Uptake of 201Tl and 123I IPPA were obtained in five left ventricular segments, and dynamic SPECT imaging was used for calculation of the fast and the slow components of the biexponential myocardial 123I IPPA clearance. RESULTS: Wall motion improved in 14 of 26 dysfunctional segments (54%). Stunned segments were characterized by a reduced 123I IPPA extraction, a shorter half-life of the fast, and a longer half-life of the slow clearance component. All parameters of the combined 201Tl/123I IPPA study predicted functional recovery with similar accuracies (area under the receiver operator characteristic curves between 0.68 and 0.76; p = NS). Analysis of 201Tl uptake alone could not predict functional recovery in this study. CONCLUSIONS: Stunned myocardium is characterized by a disturbance of fatty acid metabolism. For prediction of functional improvement, 123I IPPA imaging added significant diagnostic information.     

肥厚型心肌病左心室局部及整体舒张功能的研究

目的探讨肥厚型心肌病（HCM）患者左心室局部及整体舒张功能的变化。方法以40例肥厚型心肌病患者和40名健康人为研究对象,脉冲多普勒（PWD）测量二尖瓣口血流E峰、A峰,组织多普勒（TDI）测量二尖瓣环的前间隔、后间隔、前壁、下壁、后壁及侧壁6个位点的舒张早期峰值速度（Em）、舒张晚期峰值速度（Am）,计算E／A、Em／Am、E／Em,对各组参数之间的差异、Em与室壁厚度的相关性分别进行分析。结果HCM组二尖瓣瓣环各位点Em分别为前壁（0．053±0．019）m／s、后壁（0．055±0．016）m／s、前间隔（0．038±0．017）m／s、后间隔（0．049±0．015）m／s、侧壁（0．052±0．018）m／s、下壁（0．056±0．015）m／s;对照组二尖瓣环各位点Em分别为前壁（0．144-±0．031）m／s、后壁（0．139±0．033）m／s、前间隔（0．136±0．029）m／s、后间隔（0．143±0．028）m／s、侧壁（0．138±0．025）m／s、下壁（0．139±0．030）m／s,HCM组二尖瓣环各位点Em较对照组明显降低（P〈0．05）,但各位点间仅室壁增厚明显的前、后间隔瓣环位点与其他位点Em差异有统计学意义（P〈0．05）。HCM组E／Em为15．876±6．579,对照组E／Em为5．949-±1．283,二者比较差异有统计学意义（P〈0．05）。Em与心室壁厚度成线性负相关（r=-0．535,P〈0．05）,随着心室壁厚度增加而降低。结论HCM患者左心室局部及整体舒张功能明显降低,左室壁局部舒张功能降低与室壁厚度相关。     

Effects of verapamil on left ventricular diastolic function at rest and during isometric exercise in patients with hypertrophic cardiomyopathy

Ten patients with hypertrophic cardiomyopathy were examined with echocardiography before and during verapamil treatment to evaluate short-term and long-term effects of verapamil on left ventricular diastolic function. All patients were in sinus rhythm and in NYHA functional class I. Effects on filling and myocardial relaxation were documented by digitized echocardiography obtained at rest and during isometric exercise before treatment, after two weeks (short-term) and four months (long-term) treatment, respectively. At rest a significant decrease of the myocardial relaxation time was found during verapamil treatment. A few patients, however, returned to almost baseline conditions after an initial improvement. A small increase in the peak rate of dimension change, a parameter of filling, reached statistical significance at the end of the long-term treatment period. Isometric exercise did not induce any changes in the diastolic parameters during verapamil treatment. A positive effect of verapamil was thus seen on both myocardial relaxation and left ventricular filling, but only in resting conditions.     

Effect of disopyramide on left ventricular diastolic function in patients with hypertrophic cardiomyopathy: Comparison with diltiazem

Summary Left ventricular diatolic function before and after the administration of disopyramide (100 mg) or diltiazem (30 mg) was assessed in 10 patients with nonobstructive-type hypertrophic cardiomyopathy. Left ventricular diastolic function was assessed by Doppler echocardiography. The peak early (E) and late (A) diatolic flow velocities and E/A ratio (E/A) were measured. Three hours after the administration of disopyramide, blood pressure did not significantly change, but heart rate was decreased significantly (p<0.01). Disopyramide increased the E velocity and E/A ratio from 43.8±15.0 cm/sec to 51.3±16.1 cm/sec and from 0.71±0.20 to 1.00±0.24 (each p<0.01), respectively, and decreased the A velocity from 63.9±18.5 cm/sec to 52.1±14.9 cm/sec (p<0.01). Diltiazem increased the E velocity and E/A ratio from 42.8±12.5 cm/sec to 46.4±13.4 cm/sec (p<0.05) and from 0.74±0.21 to 0.96±0.28 (p<0.01), respectively, and decreased the A velocity from 60.6±16.4 cm/sec to 50.2±15.6 cm/sec (p<0.01). These results indicate that disopyramide improved left ventricular diastolic filling in hypertrophic cardiomyopathy, and its effect was similar to that of diltiazem.     

Effect of regional myocardial perfusion abnormalities on regional myocardial early diastolic function in patients with hypertrophic cardiomyopathy

Summary Nonuniform hypertrophy of the left ventricle is an important factor in regional diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM). However, the effect of myocardial perfusion abnormalities on regional diastolic dysfunction has not been established in patients with HCM. We investigated the relationship between regional myocardial perfusion abnormalities and regional early diastolic function in 31 patients with HCM and 8 control patients. Short-axis images of the left ventricle recorded by cine magnetic resonance imaging were divided into ten blocks. The time-to-peak-wall-thickness-thinning rate (TPWR) and the wall thickness were measured in each block. Of the 310 blocks from the patients with HCM, 242 (78%) showed normal thallium-201 uptake (group 1), 40 (13%) showed slightly decreased uptake (group 2), and 28 (9%) showed markedly decreased uptake (group 3). There was no difference in the regional wall thickness among the three groups. The TPWR was longer in patients with HCM than in control patients. It was significantly longer in group 3 (190±45ms) than in group 1 (167±36ms) and group 2 (160±31ms). (P<0.01). The linear regression slope of the relationship between the TPWR and the regional wall thickness was significantly steeper in group 3 than in groups 1 and 2 (P<0.05). In conclusion, abnormalities in regional myocardial perfusion, in addition to regional hypertrophy, contributed to the regional early diastolic dysfunction in patients with HCM.     

Prognostic value of pulsed tissue Doppler imaging for the assessment of left ventricular systolic function in patients with nonischemic dilated cardiomyopathy

There is still some debate regarding the prognostic significance of left ventricular longitudinal systolic dysfunction as assessed by tissue Doppler (TD) imaging in patients with chronic heart failure (HF), since previous studies have included patients with postischemic wall motion abnormalities. Thus, this study was designed to ascertain whether TD-derived longitudinal systolic dysfunction may influence the outcome of patients with nonischemic chronic HF. In 200 consecutive patients with chronic HF secondary to dilated cardiomyopathy and no history of ischemic heart disease, peak systolic mitral annular velocity (S(m) ) was measured by pulsed TD at the septal and lateral annular sites. The end points were cardiac death or hospitalization for worsening HF. Mean follow-up duration was 30 months. In a time independent analysis, averaged S(m) calculated as the average of septal and lateral S(m) , resulted to be a significant predictor of outcome in the study population (area under receiver-operator characteristic curve: cardiovascular death, 0.69, P < 0.0001; cardiovascular events, 0.64, P = 0.0005). In a time-dependent analysis, average S(m) was associated with both cardiovascular death (hazard ratio 0.832, P = 0.0019) and cardiovascular events (hazard ratio 0.904, P = 0.039), independently of other clinical risk factors and echocardiographic parameters of systolic function. Septal S(m) but not lateral S(m) was independently associated with the outcome measures. In conclusion, the assessment of systolic mitral annular velocity by pulsed TD is a useful indicator for prognostic stratification of patients with nonischemic dilated cardiomyopathy and chronic HF.     

心肌组织多普勒评价急性下壁心肌梗死的右心功能

目的　应用心肌组织多谱勒技术 (TDI)结合 M型超声评价急性下壁心肌梗死 (AIWMI)患者右心室整体功能。方法　正常对照组 2 0例 ,AIWMI2 0例 ,在标准心尖四腔心切面 ,采用 M超记录三尖瓣环右心室游离壁处运动曲线 ,测量右心室收缩期、舒张早期与晚期最大运动幅度 (SD、DED、DAD)及其平均速度 (SV、DEV、DAV ) ,求出舒张早期和舒张晚期最大运动幅度比值 (DED/ DAD)。应用 TDI技术测量上述各期峰值运动速度 (Sm、Em和 Am ) ,求出舒张早期峰值运动速度 (Em)和舒张晚期峰值运动速度 (Am )的比值 (Em / Am )。结果　与对照组相比 ,AIWMI组 SD、DED、SV、DEV、DED/ DAD均显著降低 ,Sm、Em及 Em/ Am比值也显著降低。结论　 TDI可以评价心肌梗死后右心室整体功能     

Alterations in left ventricular structure and diastolic function in professional football players: assessment by tissue Doppler imaging and left ventricular flow propagation velocity

BACKGROUND: Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler imaging (TDI) and ventricular early flow propagation velocity (Vp) are new tolls in the evaluation of myocardial function. We sought to compare TDI and Vp findings in professional football players and age-adjusted sedentary controls to assess the effect of regular athletic training on myocardial function. METHODS: Twenty-four professional football players and age-, sex-, and weight-adjusted 20 control subjects underwent standard Doppler echocardiography pulsed TDI, performed parasternal four-chamber views by placing sample volume septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were obtained by measuring the slope delineated by first aliasing velocity from the mitral tips toward the apex by using apical four-chamber color M-mode Doppler images. RESULTS: Age, body surface area, blood pressure, and heart rate were comparable between two groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter, and decreased transmitral diastolic late velocity. In athletes TDI analysis showed significantly increased mitral annulus septal DTI peak early diastolic (e) velocity (0.22 +/- 0.04 vs 0.19 +/- 0.04, P < 0.05), lateral DTI peak e velocity (0.19 +/- 0.03 vs 0.16 +/- 0.02, P < 0.05) and lateral DTI e/a peak velocity ratio (1.96 +/- 0.41 and 1.66 +/- 0.23, P < 0.05). The ratio of transmitral peak early diastolic velocity (E) to e in both lateral (4.72 +/- 1.20 vs 5.95 +/- 1.38, P = 0.007) and septal (3.90 +/- 0.80 vs 5.25 +/- 1.50, P = 0.002) side of mitral annulus were significantly lower in athletes. In Vp evaluation, we found higher Vp values (60.52 +/- 6.95 in athletes and 56.56 +/- 4.24 in controls, P = 0.03) in football players. CONCLUSIONS: Professional football playing is associated with morphologic alteration in left ventricle and left atrium and improvement in left ventricle diastolic function that can be detected by TDI and Vp. These techniques may be new tools to define and quantitate the degree of LV diastolic adaptations to endurance exercise.     

Assessment of left ventricular systolic function by tissue Doppler imaging in controlled versus uncontrolled type 2 diabetic patients

Aim

To detect and quantify early subtle left ventricular (LV) systolic dysfunction using Tissue Doppler Imaging in type 2 diabetic patients with apparently normal LV ejection fraction.

Quantitative systolic and diastolic transmyocardial velocity gradients assessed by M-mode colour Doppler tissue imaging as reliable indicators of regional left ventricular function after acute myocardial infarction.

AIMS: The aim of this study was to determine whether myocardial velocity gradients assessed by M-mode colour Doppler tissue imaging could be of clinical relevance and represent reliable indicators of regional left ventricular function after acute myocardial infarction. METHODS AND RESULTS: Among 64 consecutive patients with a first acute myocardial infarction, in 50 who had a marked asynergy in the parasternal short-axis view at the mid-papillary muscle level, myocardial velocities and velocity gradients were assessed in the anteroseptum and posterior wall by M-mode Doppler tissue imaging. Similar measurements were obtained in 11 matched healthy volunteers who served as a control group. In patients with anterior myocardial infarction, the peak myocardial velocity gradient in the anteroseptum was significantly lower when compared with controls (mean +/- [SD] 0.0 +/- 0.5 vs 1.1 +/- 0.7 s-1 during systole, P < 0.01; and 0.3 +/- 0.6 vs 2.0 +/- 0.5 s-1 during diastole, P < 0.01). Conversely, the peak systolic myocardial velocity gradient in the posterior wall was significantly higher than in controls (2.6 +/- 1.2 vs 1.8 +/- 1.2 s-1, P < 0.05). In patients with inferior myocardial infarction, the peak velocity gradient in the posterior wall was significantly lower when compared with healthy subjects (0.9 +/- 0.6 vs 1.8 +/- 1.2 s-1 during systole and 1.4 +/- 1.4 vs 4.9 +/- 1.2 s-1 during diastole, both P < 0.01). The peak systolic tissue velocity gradient in the anteroseptum was significantly higher than in controls (2.1 +/- 1.0 vs 1.1 +/- 0.7 s-1, P < 0.01). CONCLUSION: The present study indicates that myocardial velocity gradients assessed by M-mode Doppler tissue imaging are of clinical relevance for the characterization of ischaemic myocardial dysfunction after infarction and may provide quantitative assessment of segmental left ventricular function in this clinical setting.     

The effect of successful electrical cardioversion on left ventricular diastolic function in patients with persistent atrial fibrillation: a tissue Doppler study

BACKGROUND: Changes in mitral inflow and pulmonary venous flow after electrical cardioversion (ECV) in patients with persistent atrial fibrillation (AF) were showed in many former studies. In our study we investigated the effects of ECV on diastolic parameters by using tissue Doppler imaging (TDI) in patients with persistent AF. METHODS: Forty-one (24 women) consecutive patients underwent successful elective ECV for nonvalvular persistent AF, and maintained sinus rhythm for 1 month were enrolled to the study. Transthoracic echocardiography was applied to all patients before, 24 hours after and 1 month after ECV. Mitral annular TDI parameters were also measured with mitral inflow, pulmonary venous flow, and other standard echocardiographic measurements. RESULTS: No differences in peak myocardial early velocity (Em), deceleration time of Em, and myocardial isovolumic relaxation time measured from mitral lateral annulus before, 24 hours after, and one month after ECV were found. Peak myocardial late velocity measured 24 hours after ECV increased significantly at the end of 1 month. CONCLUSION: There were not any changes in LV diastolic function except restoration of atrial mechanical contraction following ECV in patients with persistent AF.     

Systolic myocardial mechanics in patients with Anderson-Fabry disease with and without left ventricular hypertrophy and in comparison to nonobstructive hypertrophic cardiomyopathy

Objectives: Anderson–Fabry disease (AFD) is a lysosomal storage disease, which can involve the heart, mimicking hypertrophic cardiomyopathy (HCM). The underlying mechanism of disease in AFD is an infiltrative, diffuse process, whereas HCM is a primary heart muscle condition with patchy distribution, which may prompt differences in myocardial mechanics. The aim of this study was to assess myocardial mechanics in AFD according to the presence of left ventricular hypertrophy (LVH) compared to nonobstructive HCM (NHCM) and healthy controls. Methods and Results: We carried out a single‐center, retrospective study in a small, genetically confirmed AFD cohort, which was divided into a subgroup with LVH (LVH+, n = 19), and without LVH (LVH–, n = 21). Comparison groups were healthy controls (n = 40) and NHCM patients (n = 19). Vector Velocity Imaging was applied to two‐dimensional echocardiography studies for assessment of longitudinal strain (LS), circumferential strain (CS), and base‐to‐apex CS gradients. AFD LVH+ patients had lower global LS than AFD LVH– patients (–14 ± 4% vs –17 ± 3%, P < 0.05), but similarly lowered global CS (–24 ± 5% vs –22 ± 5%, P = ns). AFD LVH+ and NHCM had similarly lowered global LS compared to normals, but significantly lower global CS was observed in AFD LVH+ (–24 ± 5% vs –28 ± 4%, P < 0.05), whereas it was significantly increased in NHCM (–31 ± 2% vs –28 ± 4%, P < 0.05). Unlike NHCM, in both AFD subgroups, patients lost their normal base‐to‐apex CS gradient. Conclusions: AFD patients without LVH already show abnormal systolic myocardial mechanics. Relevant differences in myocardial mechanics between AFD patients with LVH compared to NHCM reflect the different underlying mechanisms of disease.     

Evaluation of left ventricular systolic and diastolic global function: peak positive and negative myocardial velocity gradients in M-mode Doppler tissue imaging

OBJECTIVES: To evaluate a new indicator of left ventricular global function: Myocardial velocity gradient (MVG) M-mode Doppler tissue imaging (DTI). BACKGROUND: MVG is a new indicator of regional left ventricular function and global left ventricular diastolic function. However, it is unclear whether MVG also is an indicator of left ventricular global function in comparison with invasive indices. METHODS: We performed conventional imaging and M-mode DTI in 85 subjects and calculated MVG at the posterior wall. We obtained satisfactory images in 65 subjects, who we divided into three groups: Noninvasive study group, invasive study group, and hemodialysis group. The noninvasive study group was divided into three subgroups (a younger normal subgroup, an older normal subgroup, and a cardiomyopathy subgroup), and MVG was compared with indices of conventional imaging. In the invasive study group, we compared MVG and indices of conventional imaging with hemodynamic data (peak positive and negative dp/dt, and the time constant T) using a high fidelity micromanometer-tipped catheter. In the hemodialysis group, we compared indices before hemodialysis with those after hemodialysis. RESULTS: Peak positive MVG correlated well with peak positive dp/dt (r = 0.79), and this did not change with hemodialysis (P = 0.87). Peak negative MVG also correlated well with peak positive dp/dt and the time constant T (r = 0.88 and r = 0.80), and this did not change with hemodialysis (P = 0.97). CONCLUSIONS: Peak positive and negative MVG are sensitive and load-insensitive indicators of left ventricular function.     

Regional myocardial function in an arrhythmogenic milieu: tissue velocity and strain rate imaging in a patient who had hypertrophic cardiomyopathy with recurrent ventricular tachycardia.

We report the use of tissue velocity and strain rate imaging for detecting marked segmental variations and asynchrony in left ventricular systolic and diastolic functions of a 40-year-old patient with hypertrophic obstructive cardiomyopathy who died of an intractable ventricular tachycardia. These newer techniques have advantages for identifying heterogeneity in regional myocardial function in hypertrophic cardiomyopathy.