Interpretation of Annular Tissue Doppler Imaging

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Refer to the page 137-142 Diastolic dysfunction has become a more predominant form of heart failure (HF) than systolic dysfunction in the community. However, diastolic dysfunction is not always related to HF. Diastolic HF is defined as HF with preserved left ventricular (LV) systolic function, usually a LV ejection fraction (EF) of more than 50%, in the absence of valvular heart disease. The clinical importance of diastolic dysfunction has increased because its prevalence has increased with worsening morbidity and mortality, especially in the elderly and women. The standard criteria for LV diastolic dysfunction is characterized by impairment of LV relaxation during the isovolumic relaxation time (Tau) in cardiac catheterization. However, routine invasive cardiac catheterization is not always feasible, and therefore, we need simple noninvasive modalities to replace catheterization.1),2) The initial approach to assess diastolic function was the pulsed-wave Doppler of mitral inflow, based on the early filling (E) and atrial contraction (A) ratio and E-deceleration time. However, there were some limitations, first being its dependency on loading conditions and difficulty in differentiation between the normal and pseudonormal pattern. To overcome these limitations, mitral annular tissue Doppler imaging (TDI), with primary measurements of systolic (s'), early diastolic (e') and late diastolic velocity (a') has been widely used. TDI-derived velocities also have some limitations. The e' velocity can change with increase in age and it may not be useful in conditions of heavy mitral annular calcification, septal or lateral wall infarction, constrictive pericarditis, and severe mitral regurgitation. Despite these limitations, TDI is a sensitive and load-independent measure of LV relaxation, and has been a part of the most widely used and important echocardiographic parameter. A recent study by Baek et al.3) identified that when interpreting diastolic function in elderly subjects, different cut-off values should be considered according to TDI modality, annulus site, and gender. Study results have shown that spectral TDI has a somewhat higher e' than that of color-coded TDI, and the e' value in both these methods of tissue Doppler is lower in women as compared with men.