Color M-mode Flow Propagation Velocity Research Articles

Comparison of early diastolic mitral annular velocity and flow propagation velocity in detection of mild to moderate left ventricular diastolic dysfunction

Background: Pulsed wave tissue Doppler echocardiography (PW-TDE) and color M-mode are new Doppler methods for left ventricular (LV) diastolic function assessment. To date, few studies have compared the data obtained by these methods in the same series of patients and compared them to the current clinical reference method of detecting LV diastolic function. Aims: To determine the utility of PW-TDE and color M-mode parameters in the assessment of LV diastolic function in the typical patient population encountered in daily clinical practice and to compare their discriminating power. Methods: Early diastolic septal mitral annular velocity ( Em ) determined by PW-TDE and color M-mode flow propagation velocity ( Vp ) were measured in 86 male patients and compared to LV filling patterns obtained using standard Doppler indices. Values of Em <0.08 m s −1 and Vp <0.5 m s −1 were considered as markers of abnormal LV diastolic function. Results: A value of Em <0.08 m s −1 distinguished mild to moderate LV diastolic dysfunction with higher sensitivity and specificity than Vp <0.5 m s −1 (96% and 87% vs. 73% and 84%, respectively). A comparison of receiver operating characteristic curves showed a significant difference for areas under the curve in favor of Em ( p <0.01). In a stepwise multiple logistic regression analysis, a pseudonormal filling pattern and an EF > 60% were identified as significant predictors of Vp false negative results ( p <0.05). Conclusions:Em appears to be superior to Vp in the detection of mild to moderate LV diastolic dysfunction. Vp failed to detect abnormal LV diastolic function in particular in patients with preserved LV systolic function and a pseudonormal filling pattern type.

The utility of newly derived Doppler echocardiographic variables in the diagnosis and management of patients with heart failure.

Doppler echocardiography, because of its noninvasive nature, is an ideal tool to evaluate patients with heart failure (HF), offering the potential to improve early identification and management of these patients. Although traditional Doppler indices have allowed characterization of diastolic filling abnormalities associated with various HF states, important limitations are recognized. More refined Doppler techniques such as analysis of color M-mode flow propagation velocity, tissue Doppler imaging, and strain parameters can add to the ability of the noninvasive laboratory to improve the identification and management of this group of patients. These newer techniques as well as the traditional Doppler assessment of transmitral left ventricular inflow and pulmonary venous inflow velocities are reviewed as methods to improve the diagnosis and management of patients with HF.

1016-156 Color M-mode Doppler flow propagation velocity is a new echocardiographic method for quantification of mitral regurgitation

1016-156 Color M-mode Doppler flow propagation velocity is a new echocardiographic method for quantification of mitral regurgitation

149 Familial dilated cardiomyopathy: an international registry

function FE>55%, but with left ventricular hypertrophy, and compared them 23 normal subjects (Group III). Before and after administration of sublingual trinitrine we measured color Mmode flow propagation velocity (Vp), peak early (E) and late (A) transmitral Doppler velocities, and calculated E/A ratio. Results: (See Table) In all three groups decrease of the E/A ratio after the administration of trinitrine was due to a significant decrease of the peak early velocity (E) by 28%. Color Mmode flow propagation velocity (Vp) was not affected after preload reduction in study groups. In normal subjects, heart rate (HR) increased after trinitrine by 10 ± 9 bmp, but Vp changes remained non-significant after correction for RR intervals (Vpc = Vp/root RR): Vpc = 2.4 (0.89) and Vpc NTG = 2.5 (0.9). Conclusion: Color Mmode flow propagation velocity, in contrast with Doppler indexes of transmitral filling, is relatively independent of preload changes. Vp might be an usefull index of assessing intrinsic changes in LV relaxation related to different drugs in various clinical conditions.

A new echocardiographic method for the assessment of the severity of aortic regurgitation: Color M-mode flow propagation velocity

Purpose: Echocardiographic Doppler methods widely used in assessment of the severity of aortic regurgitation (AR) are considered sensitive and reliable. However, they all have limitations for quantitation of AR. The color M-mode Doppler flow propagation velocity (FPV) method has been shown to provide useful insights in the evaluation of left ventricular diastolic function and appears to be minimally affected with preload changes. Clinical data regarding the value of FPV in the determination of the significance of valvular insuffiencies are lacking. The purpose of this study was to evaluate the use of FPV in measurement of the severity of AR and to compare its reliability with angiography and other echocardiographic methods. Methods: Twenty-nine patients (13 male, 16 female) who had cardiac catheterization for various reasons before echocardiographic evaluation were included. The mean age was 53.6 ± 13.4 years. At the time of cardiac catheterization, the degree of AR was assessed as mild in 10 patients, as moderate in 12, and as severe in 7. In all patients, FPV measurements of AR were obtained with color M-mode Doppler in the apical 5-chamber view. Regurgitation jet height and its ratio to left ventricular outflow obtained in the parasternal long axis with color flow Doppler, pressure half-time, and slope of AR obtained with continuous wave Doppler in apical 5-chamber view were other echocardiographic methods chosen for comparison. Results: The mean values of FPV were 93.1 ± 18.4 cm/s, 49.8 ± 8.0 cm/s, and 31.7 ± 4.9 cm/s in severe, moderate, and mild AR groups, respectively (P <.001). Significant correlation was observed between angiographic grades, FPV, pressure half-time, slope, and jet height and ratio to left ventricular outflow (P <.0001, r = 0.93; P <.0001, r = −0.81; P <.0001, r = 0.76; P <.0001, r = 0.92, respectively). Conclusion: FPV is a simple, practical, and reliable method for the quantification of AR. (J Am Soc Echocardiogr 2002;15:1453-60.)

Evaluation of left ventricular diastolic function from spectral and color M-mode Doppler in genetically altered mice

Doppler indices of transmitral flow are commonly used to assess noninvasively left ventricular (LV) diastolic function in species larger than mice. The objective of our study was to characterize patterns of LV diastolic function in 2 genetically altered mouse models using Doppler- and color M-mode echocardiography. Phospholamban (PLB) reversibly inhibits the sarcoplasmic reticulum Ca2+ ATPase (SERCA) and is a key regulator of myocardial relaxation. Twelve-week-old PLB knockout mice (PLB/KO) were examined in parallel with age-matched transgenic mice expressing a mutant form of PLB (PLB/N27A) that exhibited superinhibition of SERCA. Transmitral Doppler flow indexes, including isovolumic relaxation time, the ratio of peak early-to-late filling velocities, and deceleration time of peak early transmitral velocity indicate impaired diastolic filling in the PLB/N27A mutants, but improved LV diastolic function in the PLB/KO mice. In addition, a relatively load-independent parameter of LV relaxation measured by color M-mode Doppler, the propagation velocity of early flow into the LV cavity confirmed the observed differences. We conclude that transmitral filling patterns and color M-mode flow propagation velocity reflect changes in myocardial relaxation in mice with genetically altered levels of PLB and may be useful tools to characterize LV diastolic function in other mouse models of disease. (J Am Soc Echocardiogr 2002;15:1065-73.)

Color M-mode flow propagation velocity versus conventional Doppler indices in the assessment of diastolic left ventricular function in patients on chronic hemodialysis.

Color M-mode flow propagation velocity (Vp) has been reported as a preload-independent measure of diastolic function. To study the effects of loading conditions on diastolic function assessment in patients on chronic hemodialysis, we measured Vp and conventional Doppler indices pre- and posthemodialysis. Twenty hemodialysis patients with normal systolic function underwent measurement of Vp, early filling velocity (E), its deceleration time (DT), atrial contraction velocity (A), isovolumic relaxation time (IVRT), and pulmonary atrial flow reversal velocity (PFR) pre- and posthemodialysis. Twelve healthy controls underwent these same measurements. Hemodialysis patients had significantly slower Vp at baseline than normal controls, while E/A, DT, IVRT, and pulmonary flow reversal were not significantly different. E, IVRT, and PFR were affected by hemodialysis, while color M-mode flow propagation velocities, A, and DT were not. Color M-mode flow propagation velocity seems to be a preload-independent measure of diastolic function in chronic hemodialysis patients in whom isolated diastolic dysfunction appears prevalent.

Diastolic dysfunction, infarct size, and exercise capacity in remote myocardial infarction: a combined approach of mitral E-wave deceleration time and color M-mode flow propagation velocity

In normal subjects, exercise capacity is related to diastolic filling.1 However, in patients with previous myocardial infarction, the association between exercise capacity and diastolic filling is less clear2,3 and might be influenced by other determinants, such as infarct size and left ventricular ejection fraction (LVEF). The present study compares exercise capacity in remote myocardial infarction, between patients with normal versus abnormal LV filling patterns, stratified for infarct size and LVEF. Transmitral inflow deceleration time (DT) of the early diastolic peak velocity and color M-mode derived flow propagation velocity (Vp) of the left ventricle were used to classify LV filling patterns.4

Color M-mode and pulsed wave tissue Doppler echocardiography: Powerful predictors of cardiac events after first myocardial infarction

To assess the association between color M-mode flow propagation velocity and the early diastolic mitral annular velocity (Em) obtained with tissue Doppler echocardiography and to assess the prognostic implications of the indexes, echocardiography was performed on days 1 and 5, and 1 and 3 months after a first myocardial infarction in 67 consecutive patients. Flow propagation velocity correlated well with Em (r = 0.72, P <.0001). The ratio of peak E-wave velocity (E) to flow propagation velocity also correlated well with E/Em (r = 0.87, P <.0001). The positive predictive value of E/FPV ≥1.5 to identify patients with Killip class ≥II was 90%, and the negative predictive value 92%. The corresponding values for E/Em ≥10 were 70% and 90%. Cox proportional hazards analysis identified E/flow propagation velocity ≥1.5 (relative risk, 12.4 [95% confidence interval, 4.1-37.3]), E/Em ≥10 (relative risk, 11.5 [95% confidence interval, 3.8-34.7]), and Killip class ≥II (relative risk, 7.8 [95% confidence interval, 1.6-40.4]) to be predictors of the composite end point of cardiac death and readmission because of heart failure. Thus flow propagation velocity and Em are closely related after myocardial infarction and appear to have similar prognostic information. (J Am Soc Echocardiogr 2001;14:757-63.)

Evaluation of beat-to-beat change in left ventricular diastolic function during atrial fibrillation by color M-mode (CMM) flow propagation velocity Peggy K. Han, Tomotsugu Tabata, Junko Watanabe, Benjamin Cheong, Neil L. Greenberg, Allan L. Klein, James D. Thomas, Richard A. Grimm. The Cleveland Clinic Foundation, Cleveland, OH

Evaluation of beat-to-beat change in left ventricular diastolic function during atrial fibrillation by color M-mode (CMM) flow propagation velocity Peggy K. Han, Tomotsugu Tabata, Junko Watanabe, Benjamin Cheong, Neil L. Greenberg, Allan L. Klein, James D. Thomas, Richard A. Grimm. The Cleveland Clinic Foundation, Cleveland, OH

Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first myocardial infarction: a serial color M-mode doppler echocardiographic study

OBJECTIVESWe sought to assess the prognostic value of left ventricular (LV) filling patterns, as determined by mitral E-wave deceleration time (DT) and color M-mode flow propagation velocity (Vp), on cardiac death and serial changes in LV volumes after a first myocardial infarction (MI).BACKGROUNDCombined assessment of DT and Vp allows separation of the effects of compliance and relaxation on LV filling, thereby allowing identification of pseudonormal filling. This may be valuable after MI, where abnormal LV filling is frequently present.METHODSEchocardiography was performed within 24 h, five days and one and three months after MI in 125 unselected consecutive patients. Normal filling was defined as DT 140 to 240 ms and Vp ≥45 cm/s; impaired relaxation as DT ≥240 ms; pseudonormal filling as DT 140 to 240 ms and Vp <45 cm/s; and restrictive filling as DT <140 ms.RESULTSLeft ventricular filling was normal in 38 patients; impaired relaxation in 38; pseudonormal in 23; and restrictive in 26. End-systolic and end-diastolic volume indexes were significantly increased during the first three months after MI in patients with pseudonormal or restrictive filling (37 ± 15 vs. 47 ± 19 ml/m2, p < 0.0005 and 71 ± 20 vs. 88 ± 24 ml/m2, p < 0.0005, respectively). During a follow-up period of 12 ± 7 months, 33 patients died. Mortality was significantly higher in patients with impaired relaxation (p = 0.02), pseudonormal filling (p < 0.00005) and restrictive filling (p < 0.00005), compared with patients with normal filling. On Cox analysis, restrictive filling (p = 0.003), pseudonormal filling (p = 0.006) and Killip class ≥II (p = 0.008) independently predicted cardiac death, compared with clinical and echocardiographic variables.CONCLUSIONSPseudonormal or restrictive filling patterns are related to progressive LV dilation and predict cardiac death after a first MI.

Preload dependence of color M-Mode Doppler flow propagation velocity in controls and in patients with left ventricular dysfunction

The purpose of this study was to assess the effects of preload alterations on color M-mode flow propagation velocity (Vp) in volunteers with normal left ventricular (LV) function and in patients with depressed LV function. Color M-mode Doppler echocardiography was performed during Valsalva maneuver, passive leg lifting, and after administration of nitroglycerin in 30 healthy volunteers and in 30 age- and sex-matched patients with previous myocardial infarction (MI). Mean Vp in controls was 74 ± 15 cm/s at baseline and 46 ± 15 cm/s in MI patients (P <.0005). In both groups, minor changes in Vp were seen during preload alterations; however, these were not significant (control P =.72, MI P =.31). In both groups, peak E-wave velocity (P <.0005), ratio of early-to-late peak velocities (P <.0005), and E-wave deceleration time (P <.0005) were found to change during preload alterations. In conclusion, we found that in controls and patients with previous MI, the color M-mode flow propagation velocity is not affected significantly by preload. (J Am Soc Echocardiogr 2000;13:902-9.)

Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation.

Although Doppler echocardiography can be used to estimate left ventricular filling pressures (LVFPs) in patients in sinus rhythm, its utility in atrial fibrillation is unknown. An initial training population of 30 patients (17 men, 13 women: mean age, 69 +/- 9 years; range, 48 to 87 years) was studied. Measurements of LVFP were obtained simultaneously with pulsed Doppler recordings of mitral and pulmonary venous flow velocities and color M-mode recording of the flow propagation velocity of the mitral inflow. Measurements were averaged over 10 cardiac cycles. In addition, left atrial volume was derived from the apical four-chamber view. Significant relations were observed between LVFP and several parameters derived from the transmitral and pulmonary venous velocity and left atrial volume. The best relations were observed with the peak acceleration (PkAcc) of the mitral velocity (r = .84), isovolumic relaxation time (IVRT) (r = .76), mean early (E) velocity (r = .6), and the ratio of peak E velocity to color M-mode flow propagation velocity (r = .65). The best model obtained by multilinear regression analysis (r = .88) included PkAcc and IVRT. The equation LVFP = 22+0.005 (PkAcc)-0.183(IVRT) was tested in 30 additional patients (12 women and 18 men: mean age, 65 +/- 10.6 years; range, 43 to 87 years) with similar results (r = .87). When all 60 patients were combined, the mean +/- ISD difference between predicted and observed pressure was -0.88 +/- 3.6 mm Hg. LVFPs can be estimated with Doppler echocardiography in patients with atrial fibrillation.