Conventional Pulsed Wave Doppler Research Articles

The Significance of the Myocardial Performance Index and Fetal Doppler Abnormalities in Growth-Restricted Fetuses: A Systematic Review of the Literature

Introduction: This review aims to investigate the clinical implications of using the myocardial performance index (MPI), obtained through tissue Doppler imaging (TDI) and spectral Doppler, in assessing fetal cardiac function in growth-restricted fetuses. It explores the MPI’s potential in predicting adverse perinatal outcomes and its utility when combined with conventional pulsed-wave Doppler assessments for enhanced fetal well-being evaluations. Material and Methods: A systematic search of PubMed and Google Scholar databases spanning from 2004 to 2023 was conducted to identify pertinent articles on the MPI’s clinical application in managing growth-restricted fetuses. Inclusion criteria followed the Fetal Medicine Barcelona definition of fetal growth restriction (FGR) to mitigate study group heterogeneity. The research sources were PubMed and Google Scholar databases, and the review was conducted without any specific clinical or laboratory setting. Only articles meeting the inclusion criteria for FGR, as per the Fetal Medicine Barcelona definition, were considered. Six studies meeting these criteria were included in the review. The review analyzed the correlation between MPI values and conventional Doppler parameters, investigating the progression of myocardial function impairment and its association with the risk of fetal demise. The primary outcome measures included the relationship between MPI values, fetal well-being, and the potential for prenatal cardiac dysfunction in growth-restricted fetuses. Results: The findings indicate that as conventional Doppler parameters deteriorate, MPI values increase, suggesting progressive myocardial dysfunction. The MPI may cross the 95th percentile before abnormal flow in the ductus venosus and aortic isthmus, highlighting the potential for diastolic dysfunction preceding hypoxia in growth-restricted fetuses. Elevated MPI levels were observed in both growth-restricted and small-for-gestational-age (SGA) fetuses, indicating prenatal cardiac impairment. The strong association between an abnormal MPI and perinatal mortality has been shown for early FGR. Conclusions: MPI alterations appear to precede abnormal Doppler parameters in early- and late- onset FGR, potentially indicating diastolic dysfunction preceding hypoxia. Additionally, the MPI correlates with the risk of fetal demise. However, larger studies are needed to establish its sensitivity and specificity. Furthermore, the significance of prenatal cardiac impairment in some SGA fetuses raises questions about its potential impact on perinatal outcomes and cardiovascular programming.

Subclinical left ventricular structural and functional alterations in children with obesity: is body mass or insulin resistance the main issue?

Obesity is an independent risk factor for cardiovascular diseases. The study aims to assess the left ventricular structure and functions in children with obesity. This study included 29 patients with metabolic syndrome, 31 patients with obesity without metabolic syndrome, and 30 healthy children of similar age and gender. Demographic, anthropometric, and biochemical findings and left ventricular structure and functions evaluated by conventional pulsed wave Doppler and tissue Doppler echocardiography were compared. The left ventricular mass index and relative wall thickness were significantly higher in children with obesity compared to controls. The mean left ventricular mass index of children with metabolic syndrome was also higher than for those without it. Most children with obesity had normal left ventricular geometry; concentric hypertrophy (27.6%) was more common in children with metabolic syndrome, and eccentric hypertrophy (25.7%) was more common in those without. The early to late diastolic mitral annular velocity ratios obtained with conventional pulsed wave Doppler echocardiography and tissue Doppler echocardiography (E/A and Em/Am, respectively) were lower in children with obesity than controls. In addition, the ratio obtained by tissue Doppler echocardiography was lower in children with metabolic syndrome than without. The homeostatic model assessment of insulin resistance, systolic blood pressure, and body mass index has been identified as independent factors for left ventricular structures and functions. Obesity causes subclinical left ventricular hypertrophy and diastolic dysfunction. Additional metabolic syndrome-related risks lead to further deterioration of cardiac morphology and functions.

#2280 Kidney elastometry, X-flow algorithms to interrogate adult and pediatric number of nephrons

Abstract Background and Aims Standard ultrasound mainly provides information about structural changes in the kidney, whereas parenchymal Doppler ultrasound provides the renal resistance index (RI), which correlates with plasma creatinine levels. Unfortunately, in the case of isolated proteinuria and normal renal function/creatinine levels, these two classical approaches do not show any changes. Recent advances in ultrasound analysis, allowing the measure of kidney stiffness (sharewave elastometry) and the imaging of ultralow-flow vessels up glomeruli (such as X-Flow), might be helpful to identify kidney alterations in case of proteinuria with normal creatinine. We hypothesize that proteinuria with intact glomerular filtration may induce a measurable change in kidney stiffness and the size of low-flow microcircle, with different effects in acute and chronic conditions. We also verify whether the mismatch between creatinine, resistance index, and kidney size may suggest a specific nephrological disease. Method We conducted a transversal study on 301 patients with chronic kidney disease (CKD) and 160 kidney transplant patients (Tx), comparable for age, gender, and eGFR. For all patients, we retrieved the resistance indices of both the kidney and the spleen, clinical variables, shear wave elastrometry, and the X-Flow algorithm (Esaote) to detect the microcircle. We compared Conventional pulsed wave Doppler techniques (resistance index, RI) and ultrasensitive Doppler algorithm (Xflow, Esaote, Genoa, GE, Italy) to study the perfusion pattern and smaller angio-architecture of kidney's cortical vessels. X-Flow is a high-resolution and high-definition Doppler technology, which, with a new algorithm, makes better spatial resolution possible and maximizes Doppler signal penetration capabilities. We also identify a mismatch between creatinine and the renal RI, calculating the renal mismatch index (correlation between renal resistance index and creatinine level). The connection between the resistance index and the kidney size was tested as a significant marker of chronicity. Results The eGFR was best predicted by renal RI in Tx patients (Pearson −0.4, p < 0.01). At variance, the RI is a poor predictor of eGFR in CKD patients: in these subjects, the kidney longitudinal size was a better predictor of eGFR (Pearson's coefficient 0.39, p < 0.01). Using a large dataset from a previous study, we estimated the total number of nephrons using the following approximation: nephron number = (5270*total cortical volume – 61612)*number of kidneys. This formula is only valid for chronic patients and cannot be applied to polycystic patients. We speculated that while eGFR was proportional to the number of active glomeruli in CKD patients (thus correlating with kidney size), in TX patients, the local microcircle better explained the changes in eGFR. The consequence is that the eGFR has different meaning in CKD and Tx patients. Patients deviating from this pattern are identified as having an increased renal dissimilarity index. The multiple regression analysis revealed that RI also depended on age and cholesterol levels. The spleen resistance index correlated with cholesterol levels. The kidney mismatch index defined a subgroup of patients with tubular microcirculation abnormalities. Shearwave stiffness correlated with Resistance index (Pearson −0.3, p = 0.04) and, limited to Tx patients, to the cortical volume (Pearson = −0.446, p < 0.05) and number of nephrons (Pearson −0.44, p < 0.05), but was not associated with creatinine or eGFR. The extent of microcircle measured on X-flow images was altered in chronic forms of proteinuria with normal creatinine levels. Conclusion Kidney elastometry and kidney X-flow indices might show more sources of profitable information that can be collected from ultrasound approaches that allow the identification of a diseased kidney, even in the presence of regular architecture and average resistance index. The X-flow algorithm should be used to study the smaller vascular tree not visualizable with Doppler, such as the afferent arteriole.

Impact of Asthma Phenotypes on Myocardial Performance and Pulmonary Hypertension in Children and Adolescents With Moderate to Severe Persistent Asthma.

Asthma is characterized by chronic inflammation and remodeling of pulmonary vessels and airway wall resulting in pulmonary hypertension (PH). Increased afterload on right ventricle (RV) myocardium leads to RV diastolic dysfunction (RVDD). Echocardiography is an excellent tool to detect these changes early. Using echocardiography, we assessed the impact of clinical asthma phenotypes on myocardial performance and PH in children with asthma. Sixty children with moderate or severe persistent asthma and 60 age and gender-matched healthy controls were enrolled. As per clinical phenotypes, children with asthma were classified into early wheezers (n = 30) and late wheezers (n = 30). Pulmonary function tests (PFT) and echocardiography, both conventional and pulse wave (PW), were performed. Children with asthma had significant RVDD and higher incidence (33%) of PH. Myocardial performance index (MPI) was poor in asthmatics, 0.41 (0.04) compared to controls, 0.38 (0.03). Measures for PH such as tricuspid regurgitation (TR) gradient, TR velocity, and pulmonary artery pressure (PAP) were significantly higher in cases. Among clinical asthma phenotypes, there was no difference in left ventricular ejection fraction (LVEF) between early 64.3% (4.6) and late wheezers 65.6% (4.4). MPI was better in late wheezers at 0.41 (0.05) than in early wheezers at 0.40 (0.03). TR gradient, TR velocity, and PAP were significantly higher in early wheezers. The odds ratio for the development of PH was 0.74 (CI 0.25 - 2.17), and for the development of RVDD was 3.2 (CI 0.77 - 13.8), both in favor of early wheezers. Children with asthma, particularly early-onset wheezers are at increased risk of developing PH and RVDD. We suggest annual screening by conventional echocardiography and pulse wave Doppler imaging for early diagnosis and timely initiation of management.

How Automated Techniques Ease Functional Assessment of the Fetal Heart: Applicability of MPI+™ for Direct Quantification of the Modified Myocardial Performance Index.

(1) Objectives: In utero functional cardiac assessments using echocardiography have become increasingly important. The myocardial performance index (MPI, Tei index) is currently used to evaluate fetal cardiac anatomy, hemodynamics and function. An ultrasound examination is highly examiner-dependent, and training is of enormous significance in terms of proper application and subsequent interpretation. Future experts will progressively be guided by applications of artificial intelligence, on whose algorithms prenatal diagnostics will rely on increasingly. The objective of this study was to demonstrate the feasibility of whether less experienced operators might benefit from an automated tool of MPI quantification in the clinical routine. (2) Methods: In this study, a total of 85 unselected, normal, singleton, second- and third-trimester fetuses with normofrequent heart rates were examined by a targeted ultrasound. The modified right ventricular MPI (RV-Mod-MPI) was measured, both by a beginner and an expert. A calculation was performed semiautomatically using a Samsung Hera W10 ultrasound system (MPI+™, Samsung Healthcare, Gangwon-do, South Korea) by taking separate recordings of the right ventricle's in- and outflow using a conventional pulsed-wave Doppler. The measured RV-Mod-MPI values were assigned to gestational age. The data were compared between the beginner and the expert using a Bland-Altman plot to test the agreement between both operators, and the intraclass correlation was calculated. (3) Results: The mean maternal age was 32 years (19 to 42 years), and the mean maternal pre-pregnancy body mass index was 24.85 kg/m2 (ranging from 17.11 to 44.08 kg/m2). The mean gestational age was 24.44 weeks (ranging from 19.29 to 36.43 weeks). The averaged RV-Mod-MPI value of the beginner was 0.513 ± 0.09, and that of the expert was 0.501 ± 0.08. Between the beginner and the expert, the measured RV-Mod-MPI values indicated a similar distribution. The statistical analysis showed a Bland-Altman bias of 0.01136 (95% limits of agreement from -0.1674 to 0.1902). The intraclass correlation coefficient was 0.624 (95% confidence interval from 0.423 to 0.755). (4) Conclusions: For experts as well as for beginners, the RV-Mod-MPI is an excellent diagnostic tool for the assessment of fetal cardiac function. It is a time-saving procedure, offers an intuitive user interface and is easy to learn. There is no additional effort required to measure the RV-Mod-MPI. In times of reduced resources, such assisted systems of fast value acquisition represent clear added value. The establishment of the automated measurement of the RV-Mod-MPI in clinical routine should be the next level in cardiac function assessment.

Right Ventricular Function in Patients with Pulmonary Hypertension: Correlation between Myocardial Performance Index measured by Conventional Pulsed Wave Doppler and Tissue Doppler Imaging

Right Ventricular Function in Patients with Pulmonary Hypertension: Correlation between Myocardial Performance Index measured by Conventional Pulsed Wave Doppler and Tissue Doppler Imaging

Emerging Technology: Ultrasound Vector Flow Imaging—A Novel Approach to Arterial Hemodynamic Quantification

Accurate, reliable, and easily obtainable quantification of peripheral arterial hemodynamic states has long been a holy grail of vascular ultrasound. While conventional Doppler modalities have been relied upon for decades to provide velocity, directionality, and flow volume data for integration into patient management schema, they carry limitations in accurately and reproducibly quantifying complex arterial hemodynamic patterns. Advances in ultrasound imaging architecture, such as virtual beamforming, integration of “big data” capabilities, and the use of enhanced digital signal processing methods have opened the door for a novel approach to arterial hemodynamic mapping and quantification—ultrasound vector flow imaging (VFI). This article presents an overview of the technological underpinnings of VFI, compares it with conventional pulsed wave and color Doppler methods, and describes the potential clinical benefits of this emerging vascular ultrasound modality.

Evolution of echocardiography in adult congenital heart disease: from pulsed-wave Doppler to fusion imaging.

The number of patients with adult congenital heart disease (ACHD) has been dramatically increasing and adults with congenital heart disease now outnumber children with congenital heart disease. However, patients with ACHD are still at increased risk of morbidity and mortality due to residua and sequelae. Although echocardiography is an indispensable imaging modality in the comprehensive assessment of ACHD, accurate echocardiographic assessment of ACHD is challenging especially for physicians or sonographers who are not familiar with ACHD because of its complex morphology, physiology, and hemodynamics. A recently developed fusion imaging technology can provide synchronized display of real-time echocardiographic images and multiplanar reconstruction images of computed tomography or magnetic resonance imaging corresponding to the image plane of real-time echocardiography. We have reported the clinical utility of this fusion imaging technology for the precise evaluation of complex ACHD. On the other hand, conventional echocardiographic technology also plays an important role in assessing unique ACHD pathophysiology. For example, restrictive right ventricular physiology is a common finding after tetralogy of Fallot or pulmonary stenosis repair and can be evaluated by conventional pulsed-wave Doppler. In this review, we discuss the clinical usefulness of modern and conventional echocardiographic technologies for the evaluation of ACHD by presenting a case series.

Does breathing technique improve diastolic function of left ventricular?

Abstract Funding Acknowledgements Type of funding sources: None. Background. Diastolic heart failure (HF) is an important clinical disorder mainly seen in the elderly patients with hypertensive heart disease. Early recognition and appropriate therapy of diastolic dysfunction is advisable to prevent further progression of the illness. There is no specific therapy to improve diastolic function directly. Mechanisms by which yoga may improve cardiac function and reduce myocardial stress are speculated at this time. Purpose. The study’s purpose was to analyze the effects of full yogic breathing on diastolic function of left ventricular in patients with HF. Methods. One hundred and two patients with chronic HF (males, 62%; mean age, 68.2 ± 4.5 years) were randomly assigned to full yogic breathing training plus standard therapy (n = 48) or standard therapy alone (n = 54). Patients in both groups were assessed at baseline and 6 months after randomization. Echocardiographic evaluation of diastolic function has been performed by measurement of transmitral flow parameters including the early (E) and late (A) diastolic filling velocities, the E/A ratio, and the E deceleration time (DT) with conventional pulsed wave Doppler. The medial and lateral early diastolic mitral annular velocities, and the E/Ea ratio were also assessed by tissue Doppler imaging. Results. There were no significant differences in demographic and baseline characteristics between participants. By the end of the observation period significant diastolic function improvements were observed in yogic breathing group. E/A ratio (from 1.02 ± 0.9 to 1.13 ± 0.7; from 1.01 ± 0.7 to 1.08 ± 0.8) was increased, whereas E DT (from 238 ± 16 to 216 ± 17 ms; from 229 ± 20 to 221 ± 19 ms) and E/Ea ratio (from 9.87 ± 1.34 to 8.71 ± 0.79; from 9.77 ± 1.26 to 9.36 ± 0.68) were decreased in yogic breathing group compared with standard therapy alone group. Conclusion. Yoga breathing practice for 6 months showed a significant improvement in diastolic function of left ventricular.

Cardiac functions in children with steroid-sensitive nephrotic syndrome.

The aim of the present study was to evaluate the presence of cardiac systolic and diastolic dysfunction in pediatric patients with steroid-sensitive nephrotic syndrome (NS). The study population consisted of 19 patients with debut-relapse of NS aged 1-18years and 30 sex and age-matched healthy controls. Blood and urine samples, two M-mode conventional echocardiograms and tissue Doppler velocity imaging were evaluated in both attack and remission periods. With regard to conventional pulse wave Doppler (cPWD), steroid-sensitive NS patients (both in debut / relapse and in remission periods) had a higher peak of late diastolic flow velocities (A peak), and patients in debut / relapse had a lower E/A ratio than the control group, indicating diastolic dysfunction (overall P = 0.003 and P = 0.006, respectively). Based on tissue Doppler velocity imaging echocardiography results, patients in debut/relapse had a higher A' and a lower E'/A' ratio (overall P < 0.001 and P = 0.001, respectively). There was also a significant difference in the cPWD E/TDI E' ratio between the patients showing an increased cPWD E/TDI E' ratio in remission periods compared to in debut/relapse periods (P = 0.09). The albumin levels were positively correlated with E'/A' and E/ E' ratio (r = 0.609; P = 0.007, r = 0.472; P = 0.041 respectively). Systolic cardiac functions are preserved but diastolic functions are affected in steroid-sensitive NS patients both in debut/relapse and in remission periods in a relatively short time. The persistence of left ventricular (LV) dysfunction during the remission period requires special attention during the follow up for early detection of cardiac abnormalities.

Assessment of cardiac diastolic function in infants of diabetic mothers using tissue Doppler echocardiography

BackgroundLimited number of studies evaluated cardiac diastolic function in infants of diabetic mothers using tissue Doppler imaging. The aim of this study was to evaluate diastolic parameters in full-term infants of diabetic mothers compared to healthy full-term neonates using both conventional echocardiography and tissue Doppler imaging. This study is a comparative study. Fifty consecutive infants of diabetic mothers (cases) in the first 3 days of life: 25 neonates with poor maternal glycemic control (Hemoglobin A1c > 7.5 g/dl) and 25 neonates with good maternal glycemic control (Hemoglobin A1c ≤ 7.5 g/dl). Thirty healthy full-term infants of non-diabetic mothers with age and sex matching were included as controls. The studied groups were assessed by conventional pulsed wave Doppler and tissue Doppler imaging.ResultsAmong pulsed wave Doppler parameters, cases had lower values than controls as regards mitral E velocity, mitral E/A ratio, tricuspid E velocity, and tricuspid E/A ratio, while neonates with poor maternal glycemic control had lower values than those with good maternal glycemic control as regards mitral E/A ratio, tricuspid E velocity, and tricuspid E/A ratio as well as higher mitral A velocity (denoting more diastolic dysfunction). Similarly, among tissue Doppler parameters, cases had lower values than controls as regards septal E' velocity, E'/A' ratio, left ventricular E' velocity, E'/A' ratio, and right ventricular E' velocity as well as higher septal A' velocity, left ventricular A' velocity, and right ventricular A' velocity, while neonates with poor maternal glycemic control had lower values than those with good maternal glycemic control as regards septal E' velocity, E'/A' ratio, left ventricular E' velocity, E'/A' ratio, and right ventricular E' velocity, as well as higher left ventricular A' velocity (denoting more diastolic dysfunction). Tissue Doppler was able to detect higher number of neonates with left ventricular diastolic dysfunction than conventional pulsed wave Doppler.ConclusionsTissue Doppler imaging was found to be able to detect diastolic dysfunction early in infants of diabetic mothers specifically as regards the left ventricle. Tissue Doppler imaging should be considered an integral part of cardiac function assessment in infants of diabetic mothers.

Tissue Doppler imaging versus conventional echocardiography in assessment of cardiac diastolic function in full term neonates with perinatal asphyxia

Background and objective Limited number of studies evaluated cardiac diastolic function in neonates with perinatal asphyxia using tissue Doppler imaging. The aim of this study was to evaluate the echocardiographic parameters in full-term neonates with perinatal asphyxia compared to healthy full-term neonates. Diagnostic value of echocardiographic parameters of diastolic dysfunction in predicting mortality in asphyxiated neonates was assessed. Setting Neonatal intensive care unit at the Obstetric and Gynecology Hospital, Cairo University, Egypt (a tertiary care center). Patients and methods This study included 20 neonates with perinatal asphyxia (cases) and 20 healthy full-term nonasphyxiated neonates (as controls). The studied groups were assessed by conventional pulsed wave Doppler and tissue Doppler imaging. Results Among pulsed wave Doppler parameters, cases had statistically significant lower values (denoting more diastolic dysfunction) than controls as regards mitral E velocity (p = .04) and mitral E/A ratio (p = .04). Similarly, among tissue Doppler parameters, cases had statistically significant lower values (denoting more diastolic dysfunction) than controls as regards septal E′/A′ ratio (p = .019), left ventricular E′ velocity (p = .001), and E′/A′ ratio (p < .001). Septal E′/A′ ratio and right ventricular E′/A′ ratio were significantly lower (p = .012 and p = .025, respectively) among nonsurvivors (denoting more diastolic dysfunction) compared to survivors. Moreover, cases had statistically significant higher values (denoting more diastolic dysfunction) than controls as regards septal (p < .001), left ventricular (p < .001), and right ventricular (p < .001) tissue Doppler-based myocardial performance indices. Asphyxiated neonates showed statistically significant higher evidence of left ventricular diastolic dysfunction than controls in both pulsed wave Doppler and tissue Doppler with p < .001 and p = .001, respectively; while there was no difference as regards right ventricular diastolic dysfunction. Tissue Doppler was able to detect higher number of neonates with left ventricular diastolic dysfunction than conventional pulsed wave Doppler. Conclusions Tissue Doppler imaging was found to be able to detect diastolic dysfunction early in neonates with perinatal asphyxia specifically as regards the left ventricle. Assessment of myocardial function is important in asphyxiated neonates. Tissue Doppler imaging should be considered an integral part of assessment of cardiac function in asphyxiated neonates.

Quantitative Ultrasound Measurements of Blood Flow Velocity and Turbulence

The paper described the hemodynamics of blood flow based on fluid mechanics and its corresponding formulas, and revealed the limitation of blood flow velocity measurement for non-laminar flow when using the conventional pulse wave Doppler. The paper demonstrated the calculation of turbulence for blood flow based on velocity directions and quantified the turbulence according to the presented formulas. Two methods were introduced and the simulated results were analyzed. An example using real data based on ultrasound vector flow imaging for calculating the turbulence of blood flow was presented in the end.

Role of Tissue Doppler Tei Index in Evaluating Myocardial Performance after Coronary Revascularization

Background: Tei index expresses the overall systolic and diastolic myocardial function in a single number. The use of tissue Doppler instead of conventional pulsed wave Doppler enables us to measure Tei index in a single scan. It also has many advantages for the assessment of myocardial function with coronary revascularization in IHD patients. Methods: We included 47 chronic ischemic heart disease patients with LV dysfunction (EF<50%) who were subjected to coronary revascularization with either CABG or PCI. They were divided into 2 groups according to the improvement of EF after revascularization. Group I: Included 35 patients who had an increase ≥ 5% in LV EF at follow up. Group II: Included 12 patients who had an increase <5% increase in LV EF at follow up. Echocardiography including tissue Doppler Tei index (tdTei) was done twice; just before and at least 4 months after coronary revascularization. Results: Following revascularization; improvement of ejection fraction correlated well with tdTei improvement (r=0.67, p<0.001) and was associated with improvement of wall motion score index (p<0.001) and diastolic function parameters including E`/A` (p<0.05) and E/E` (p<0.001). Using ROC curve, we found that the tdTei index at cut-off point 72.9; can predict patients who are expected to have ejection fraction improvement from coronary revascularization with high sensitivity (83.3%) and specifity (80%). It also correlated well to TIMI score (p<0.05). Conclusion: Tissue Doppler Tei index is a promising technique allowing accurate quantitative description of the effect of ischemia on myocardium including both diastolic and systolic dysfunction in a single number. Baseline tdTei index can predict patients who are expected to have improvement of myocardial function (both diastolic and systolic) after coronary revascularization.

Early Detection of Diastolic Dysfunction in Diabetic Patients (Single Center Cross Sectional Study)

Background: Left ventricular diastolic dysfunction in asymptomatic patients with diabetes mellitus may represent the early stage of diabetic cardiomyopathy even in patients without structural cardiac disease or systemic hypertension and have a preserved left ventricular systolic function. Objectives: To determine the prevalence of left ventricular diastolic dysfunction in asymptomatic patients with diabetes mellitus. Methods: A cross sectional study was carried out on 86 diabetics and compared with 65 age and sex matched controls. Detailed history, physical examination , specific investigations and transthoracic echocardiography study (including conventional pulse wave Doppler and tissue Doppler imaging) were done to assess the diastolic function. Results: Left ventricular diastolic dysfunction is more prevalent in diabetic patients comparing with control group (62.3% versus 12.8%, p<0.05) and this correlated independently with increasing age, duration of the disease and glycated hemoglobin level. Conclusion: Diastolic dysfunction can occur in diabetic patients even in young patients and those with shorter duration of disease. Tissue Doppler imaging, left atrial size and peak tricuspid regurgitation velocity are sensitive indices of LV diastolic dysfunction.

Left ventricular dysfunction by conventional and tissue Doppler echocardiography in pediatric hemodialysis patients: relation with plasma brain natriuretic peptide levels.

IntroductionTissue Doppler imaging (TDI) is a relatively new echocardiography method in children with chronic kidney disease (CKD). The aims of this study were to evaluate left ventricular (LV) diastolic function in pediatric CKD patients using conventional pulsed-wave Doppler echocardiography (cPWD) and TDI methods and correlate them with BNP levels.Material and methodsThirty children on regular hemodialysis (HD) were included. Left ventricular systolic and diastolic indices and BNP levels were measured immediately before and after HD.ResultsAfter HD, LV and left atrium diameters were significantly decreased (p < 0.001 and p < 0.001, respectively). Transmitral E velocity and E/A ratio decreased (p < 0.001 and p < 0.001, respectively). Also, there were significant decreases in the early diastolic velocity E’ of LV wall, septal wall, and anterior wall (p = 0.001, p = 0.004 and p < 0.001, respectively). Mean E/E’ ratio and ratios of septal and lateral walls were decreased significantly (p = 0.004, p = 0.002 and p = 0.017, respectively). BNP levels decreased significantly during HD when comparing concentrations before and after HD (p < 0.001). BNP strongly correlated with LV diastolic function indices (before HD: mean E/E’ (r = 0.401, p = 0.028), lateral E/E” (r = 0.291, p = 0.025), septal E’(r = –0.398, p = 0.029), lateral wall E’ (r = –0.452, p = 0.012) and mean E’ (r = –0.469, p = 0.009), after HD: mean E/E’ (r = 0.38, p = 0.038) and lateral E/E” (r = 0.474, p = 0.008) and lateral wall E’ (r = –0.270, p = 0.037)).ConclusionsThe cPWD and TDI-derived LV indices are influenced by HD. The diagnostic utility of BNP in the presence of deteriorating renal function may be compromised to some extent.

Differential approach to the evaluation of right ventricular systolic function by pulsed wave Doppler ultrasound

A method for diagnostics of systolic function of the right ventricle of the heart in patients with cardiovascular disease is proposed. Its application expands possibilities for detecting disorders of the discharge RV function using a conventional pulsed wave Doppler ultrasonography.

Development and validation of a quantitative measurement of the biomechanical marker of arterial disease, wall shear stress, using contrast enhanced high-frame rate plane-wave Doppler ultrasound

The development of arterial disease in the renal arteries is of clinical interest as it is associated with increased risk of conditions such as heart failure, hypertension, diabetes mellitus and cerebrovascular disease (Ganz and Hsue, 2013) [1] . A biomechanical marker of this damage is Wall Shear Stress (WSS), which plays a significant role in maintaining proper arterial functioning, and is linked to arterial wall stiffening and the formation of atherosclerotic plaques, and also contributes to the initiation and possibly the progression of atherosclerotic disease (Ganz and Hsue, 2013) [1] , (Zalunardo and Tuttle, 2004) [2] and (Chien et al., 1998) [3] . The effect of WSS on haemodynamic flow, is hence of considerable scientific and clinical interest. This poster will firstly, present an overview of wall shear stress and then critically review the different attempts which have been made to measure WSS, namely, magnetic resonance imaging and conventional pulsed-wave Doppler ultrasound techniques. The main limitations associated with both of these techniques are their inability to detect low blood velocity and also their poor velocity resolution, both of which are critical for accurate WSS measurements (Katritsis et al., 2007) [4] and (Torii et al., 2009) [5] . One approach which can be potentially implemented to improve the SNR and velocity resolution of pulsed-wave Doppler ultrasound is ultrasound microbubble contrast agents. However, ultrasound contrast agents have been used with limited success to improve the quality of the velocity information from blood and the main results from these studies will be discussed in this poster. Finally, the concluding aspect of this review will be a discussion of whether the determination of wall shear stress can be achieved using commercially available ultrasound systems.

Growth-differentiation Factor-15 and Tissue Doppler Imaging in Detection of Anthracycline-induced Cardiomyopathy During Therapy of Childhood Cancers.

The aim of this study was to evaluate the importance of growth-differentiation factor-15 (GDF-15) levels and tissue Doppler imaging (TDI) in the early detection of anthracycline-induced cardiomyopathy during the treatment of childhood cancers. Twenty patients (13 males and 7 females) newly diagnosed with childhood cancer whose treatment protocol included anthracycline were included in the study. Echocardiography, including M-mode, pulse Doppler, and TDI, was performed after the first anthracycline treatment at cumulative doses of 100, 200, and 300 mg/m and at least 6 months after the last treatment. GDF-15 and troponin-I were also measured at these time points. The median age of the patients was 14 years (range, 3 to 18 y). The median cumulative anthracycline dose was 220 mg/m (range, 60 to 400 mg/m). Conventional pulse wave and pulse wave tissue Doppler methods revealed significant differences in the right ventricular myocardial performance indices of the patients who received cumulative anthracycline doses of 300 mg/m compared with their indices at least 6 months after the last treatment. The serum GDF-15 levels after the cumulative anthracycline dose of 200 mg/m were also higher than the patients' pretreatment levels. Doppler/TDI and GDF-15 levels may be used in the early determination of anthracycline-induced cardiomyopathy during the treatment of childhood cancers.

Assessment of left ventricular function by tissue Doppler echocardiography in pediatric chronic kidney disease

Background: Cardiovascular (CV) disease remains the most common cause of mortality in chronic kidney disease (CKD). Methods: In this cross-sectional study, 43 pediatric patients with CKD were divided into two groups according to their estimated glomerular filtration rate (eGFR): groups 1 and 2 (eGR; 29–75 and 15–29 mL/min/1.73 m2, respectively). M – mode, conventional pulsed wave Doppler (cPWD) echocardiography and tissue Doppler imaging (TDI) were performed in all patients and 16 healthy controls. Maximal early (E wave) and late (A wave) diastolic flow velocities were assessed by cPWD. Using TDI, the early (E′) and late (A′) diastolic filling velocities were recorded. Early and late diastoles were evaluated using E′ values and E/E′ ratios, respectively. Results: Left ventricular hypertrophy (LVH) was determined in 19/43 (44.2%) patients. The E/E′ ratio was significantly higher in group 2 than in group 1 and controls. E/E′ was found to be positively correlated with left ventricular mass (LVM) index, and negatively with hemoglobin (Hb) levels. Low Hb levels were only independent predictor of E/E′ (p = 0.001, β: −0.470, 95% CI: −0.764; −0.196). E′ ratio was significantly lower in both patient groups compared to the controls. Conclusions: LVH and diastolic dysfunction are already present in early stages of CKD. Treatment of risk factors, such as anemia, is important to improve the clinical outcome.