Myocardial Tissue Doppler Imaging Research Articles

Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study.

The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12h (D1) and 48-72h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e' was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e' (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography. Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure. What is Known: •Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension. What is New: •Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.

Use of strain rate imaging for early detection of epirubicin-induced cardiotoxicity in patients with breast cancer.

e12531 Background: Although epirubicin has improved outcome in breast cancer (BC) patients, its application is limited by its cardiotoxicity . Assessment of left ventricular (LV) ejection fraction (EF) is performed to demonstrate cardiac dysfunction. Changes in cardiac function induced by this therapy, however, are difficult to quantitate by conventional echocacardiography. Tissue Doppler myocardial imaging (TDI) derived wall motion velocity, and strain rate (SR) have been shown to sensitively quantify abnormalities in cardiac function. The aim of this study was to determine if sensitive indices of LV dysfunction, would be useful for addressing the early detection of cardiotoxic side effects of epirubicin. Methods: BC patients (N = 45 median age 60.2years) without cardiovascular risk factors were prospectively included. All patients received epirubicin. Twenty patients received further trastuzumab. Conventional and TDI echocardiography were obtained at baseline , every 2cycles of treatment and 3 months after chemotherapy. Segmental peak systolic longitudinal and radial velocity, SR and strain, were measured. Results: at baseline, median LV-EF was &gt; 55 %. There was no overall change in LV dimensions, EF and peak systolic velocity. In contrast, a significant reduction in longitudinal and radial SR and strain was found after 3 cycles (longitudinal strain -10.2% +/- 1.3 % vs baseline 22 +/- 4.1 %, P = .001; radial strain 26.1% +/-4,2% vs baseline 47.3% +/- 9.2 %, P &lt; .001). Changes in radial strain appeared earlier and were more pronounced than longitudinal strain. Conclusions: In this study we confirm the clinical use of TDI parameters for early detection of epirubicin mediated cardiac dysfunction. TDI detected subtle changes of LV function after 3 cycles of therapy. Use of Strain Rate Imaging detects subclinical LV dysfunction and can predict further changes in EF ,therefore can be used to monitor epirubicin-induced cardiotoxicity.

Ivabradine for Treatment of Heart Failure with Preserved Ejection Fraction

Aim To evaluate the effect of combination ivabradine-containing therapy for chronic heart failure (CHF) with preserved ejection fraction on quality of life (QoL) and the primary composite endpoint during a one-year follow-up.Material and methods This study included 160 patients aged 45 to 65 years with NYHA functional class (FC) II-III CHF with preserved left ventricular ejection fraction (CHF-PEF) and grade I and II diastolic dysfunction associated with FC III stable angina with sinus rhythm and a heart rate (HR) higher than 70 bpm. Presence of CHF-PEF was confirmed by results of echocardiography and myocardial tissue Doppler imaging. During one year of prospective observation, effects of bisoprolol and ivabradine as a part of the combination therapy on the primary composite endpoint, including death from cardiovascular complications (CVC) and hospitalizations for myocardial infarction (MI) or CHF, were evaluated in patients with CHF-PEF. Patients were randomized to three groups: A, bisoprolol with dose titration from 2.5 to 10 mg; В, combination of bisoprolol 2.5-10 mg and ivabradine 10-15 mg/day; and С, ivabradine 10-15 mg/day. All patients were on a chronic background therapy, including angiotensin-converting enzyme inhibitors (lisinopril) or, if not tolerated, angiotensin II receptor blockers (valsartan), antiaggregants, statins (atorvastatin, rosuvastatin), and short-acting nitrates as required. If edema developed diuretics were added. The follow-up duration was one year.Results After 12 weeks of follow-up, the achievement of goal HR in group A was associated with a tendency to increased distance in the 6-min walk test from 279±19 to 341±21 m (р&gt;0,05); in group B the distance increased from 243±25 to 319±29 m (р&lt;0.05); and in group C the distance increased from 268±21 to 323±22 m (р&lt;0.05). In the combination ivabradine and bisoprolol treatment group, results of the 24-h electrocardiogram monitoring showed a more pronounced anti-ischemic effect associated with a decrease in the number of myocardial ischemic episodes (p&lt;0.05). QoL was evaluated with the Minnesota questionnaire against the background of treatment. At 12 weeks of observation, the total score decreased from 44.5±2.6 to 38.4±2.1 in group A; from 45±2.9 to 38±2.2 in group B; and from 50.9±3.2 to 42.7±2.8 in group C (р&lt;0.05). The risk of acute MI and repeated hospitalization for CHF during the year of observation, as evaluated according to the Kaplan-Meier method, decreased in both bisoprolol and ivabradine combination treatment groups.Conclusion The inclusion of bisoprolol and ivabradine into the background therapy of CHF-PEF patients with stable IHD provided an improvement of QoL and a decrease in the risk of hospitalization for acute MI and CHF during the year of observation.

The Impact of Function-Flow Interaction on Left Ventricular Efficiency in Patients with Conduction Abnormalities: A Particle Image Velocimetry and Tissue Doppler Study

The aims of this study were to assess the influence of left bundle branch block (LBBB)-like conduction abnormalities on left ventricular (LV) blood flow patterns and to characterize their potential impact on LV efficiency by measuring the changes in vortex formation and energy dissipation in the left ventricle using echocardiographic particle image velocimetry. Thirty-six subjects were prospectively studied, including 20 patients with pacemakers, six patients with LBBB, and 10 healthy control subjects, all of whom had normal ejection fractions (>50%). In patients with pacemakers, data were acquired in both DDD and AAI modes. Standard grayscale, tissue Doppler myocardial imaging, and contrast-enhanced echocardiographic particle image velocimetric data were acquired, and LV flow patterns were analyzed using dedicated software. Dyssynchrony was quantified by measuring apical transverse motion. Apical transverse motion was significantly higher in patients with LBBB compared with normal control subjects (mean, 4.9±1.9 vs 1.0±0.7mm; P<.001). Quantitative measures of vortex energy dissipation (relative strength, vortex relative strength, and vortex pulsation correlation) were significantly higher in patients with LBBB (2.05±0.54, 0.53±0.13, and 0.87±0.47, respectively) compared with control subjects (1.48±0.28, 0.33±0.05, and 0.24±0.51, respectively) (P<.02 for all). Vortex duration time in relation to the entire cardiac cycle was shorter in patients with LBBB than in control subjects (28% vs 44%). All findings in both groups were comparable with DDD and AAI. LV flow pattern analysis by echocardiographic particle image velocimetry reveals that conduction delay due to LBBB or pacemaker stimulation in the right ventricle (DDD) disturbs the transfer of kinetic energy during the cardiac cycle and causes less efficient LV function. These data contribute to a better understanding of hemodynamic consequences of conduction delays and may help in the optimization of therapeutic approaches.

Tricuspid annular plane systolic excursion in evaluation of right heart systolic function of fetuses in second and late trimester with conventional M-mode and free angle M-mode echocardiography

Objective To evaluate the usefulness of free angle M-mode echocardiography (FAM) in obtaining tricuspid annular plane systolic excursion (TAPSE) for assessing the fetal right ventricular function, and to compare the results of measurements of TAPSE by conventional M-mode(CM) and FAM. Methods Two hundred and forty-three normal fetuses in second and late trimester were divided into 5 groups by gestational age(GA): 20-24 weeks, 24+ 1-28 weeks, 28+ 1-32 weeks, 32+ 1-36 weeks, 36+ 1-40 weeks. The TAPSE were measured by CM and FAM echocardiography, meanwhile multiple parameters for evaluating right ventricular function were obtained by using myocardial tissue Doppler imaging (TDI), and the correlation between TAPSE and other parameters were analyzed by linear correlation. ANOVA was used to compare CM-TAPSE, FAM-TAPSE, Em, Sm and right ventricular fractional shortening(RVFS) with different GA. Regression equation estimate was used to compare the relationship of FAM-TAPSE with GA. Independent sample t test was used to compare CM-TAPSE with FAM-TAPSE. Results There were significant differences in CM-TAPSE, FAM-TAPSE, Em, and Sm among 5 groups (P=0.000), the measured value of FAM-TAPSE was higher than that of CM-TAPSE (P=0.000). Both FAM-TPASE and CM-TAPSE showed significant positive correlations with GA, Em and Sm, but FAM-TAPSE demonstrated better correlation than CM-TAPSE. Conclusions By adjusting sample line of FAM, measuring the maximum displacement of tricuspid annular plane is feasible, and FAM may evaluate fetal right ventricular function more accurately and effectively. Key words: Ultrasonography, prenatal; Tricuspid annular plane systolic excursion; Ventricular function, right; Free angle M-mode echocardiography

Transcatheter aortic valve implantation and intraoperative left ventricular function: a myocardial tissue Doppler imaging study.

Transcatheter aortic valve implantation in patients turned down for surgical aortic valve replacement is a high-risk procedure. Severe aortic stenosis is associated with impaired left ventricular longitudinal motion, and myocardial peak systolic velocity is a measure of left ventricular function in these patients. The present study aimed to quantify the acute changes in left ventricular function during the procedure by using myocardial tissue Doppler imaging and transthoracic cardiac output measurements. Prospective observational study. Tertiary care university hospital. 40 patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation. Transesophageal 4-chamber and 2-chamber echocardiograms were performed immediately before and ~15 minutes after valve implantation. Longitudinal myocardial peak systolic velocity was obtained by tissue Doppler imaging from 8 basal segments and averaged. Cardiac output was measured by the lithium dilution method, and systemic vascular resistance index and stroke volume were calculated. Longitudinal myocardial peak systolic velocity improved immediately after valve implantation, from -2.3±0.8 to -3.0±1.1 cm/sec (p<0.001); this represented an average increase of 31%±33%. Cardiac output increased from 3.2±0.8 L/min to 3.6±0.9 L/min (15%±33%; p = 0.04). This was due to increased heart rate (59±9 beats/min to 72±12 beats/min; p<0.001) and not to an improved stroke volume. Systemic vascular resistance index was reduced from 2,937±984 dynes*sec/cm(5)/m(2) to 2,436±730 dynes*sec/cm(5)/m(2) (p = 0.003). Intraoperative echocardiography tissue Doppler imaging detected immediate improvement in left ventricular long-axis motion after transcatheter aortic valve implantation. The method provided detailed information not obtainable by routine hemodynamic monitoring.

Echocardiographic evaluation of right ventricular function

Echocardiographic accurate assessment of right ventricular function due to complex three-dimensional morphology and different from left ventricular myocardial fibers orientation remains limited. Systolic function of right ventricle has been evaluated using several parameters — tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV FAC), right ventricle to left ventricle size comparison, myocardial Doppler tissue imaging (S’ velocity) and the Tei index as an expression of right ventricle impairment. Echocardiographic evaluation of right ventricle diastolic function has been evaluated using Doppler of the tricuspid inflow, tissue Doppler of the lateral tricuspid annulus, and measurements of inferior vena cava size and collapsibility.

Cardiovascular involvement in patients with pseudoexfoliation syndrome

Pseudoexfoliation (PEX) syndrome, diagnosed by ocular examination, is a common disorder of the extracellular matrix. Previous studies have demonstrated accumulation of PEX material in the walls of blood vessels and myocardium. We aimed to investigate whether PEX is associated with cardiovascular involvement using carotid ultrasound measurements and myocardial tissue Doppler imaging (TDI). Thirty-six PEX patients and 34 age-matched and sex-matched healthy controls who had no PEX material were included. Fasting blood samples were taken and the following data were obtained from all cases: myocardial TDI measurements, the mean carotid intima-media thickness (IMT), total carotid plaque area and number. There were no significant differences between the groups regarding clinical and biochemical data. The peak systolic TDI velocities at the septal (septal S) and lateral annuli (lateral S), and the isovolumic contraction velocity at the lateral annulus [lateral isovolumic contraction velocity (IVC)] were significantly lower in patients with PEX, than in controls (P = 0.001, <0.001 and 0.016, respectively) whereas IMT, total carotid plaque area and number were significantly higher (P = 0.002, 0.035 and 0.033, respectively). In a logistic regression analysis including age, septal S, lateral S, lateral IVC, IMT, total carotid plaque area and number, septal S, lateral S and IMT were significantly associated with PEX, (P = 0.035, 0.011 and 0.035, respectively). Peak systolic TDI velocities were significantly lower and IMT was significantly increased in patients with PEX. However, PEX was weakly associated with carotid plaque measurements.

Serial change in myocardial tissue Doppler imaging from fetus to neonate

BackgroundOur goal was to evaluate the serial change in myocardial performance from fetus to neonate using tissue Doppler imaging (TDI). Method and resultsThere were 37 term infants in the present study. The TDI sensor was placed at the level of the lateral mitral annulus (M-TDI), inter-ventricular septum (IVS-TDI) and the lateral tricuspid annulus (T-TDI). We measured TDI parameters from fetus to neonate. On univariate analysis, E′ (cm/s), A′ (cm/s), and S′ (cm/s) of three ventricular walls of TDI parameters excluding E′ IVS-TDI significantly decreased during the transition from fetal to neonatal circulation. E′/A′ ratio, E/E′ ratio and myocardial performance index (MPI) of three ventricular walls of TDI parameters excluding T-TDI MPI significantly increased during the transition from fetal to neonatal circulation. When multiple linear regression analysis with a step-wise procedure during the transition from fetus to neonate for TDI parameters was applied to variables, significant differences were noted for predicting decreases in M-TDI S′ (6.55 to 3.97, p<0.001) and IVS-TDI A′, (6.69 to 4.69, p<0.001), and increases in IVS-TDI E′/A′ ratio (0.77 to 1.02, p<0.001) and IVS-TDI E/E′ ratio (8.25 to 13.65, p<0.001). ConclusionIn conclusion, we found that the myocardial performances of both ventricles decreased during the transition from fetus to neonate using TDI parameters. In particular, left ventricular systolic performance was affected more than when fetal circulation changed to neonate circulation. Our findings suggest that serial change in TDI can give new information to estimate myocardial performance of the neonate.

DOPPLER TISSUE IMAGING: PRINCIPLES AND POSSIBILITIES OF THE METHOD (literature review)

Doppler tissue imaging is a group of regimes based on the Doppler effect and the qualitative and quantitative assessment of the global and segmental myocardial function. Doppler tissue imaging enables to evaluate quantitatively the functional state of not only the left, but also the right ventricle. The using of Doppler tissue imaging is informative for assessing the global and regional function of the left heart ventricle. The Doppler tissue imaging made it possible to assess the systolic and diastolic function of the various segments of the left and right ventricles. The review presents the information about the principles and possibilities of Doppler tissue imaging, the new technology of ultrasound heart examination in assessment of myocardial function. The review also covers the history of myocardial Doppler tissue imaging. The main attention is focused on the characterization of Doppler myocardial tissue imaging regimes.

Ratio of Right to Left Ventricular Ejection: A Pilot Study Using Doppler to Detect Interventricular Dyssynchrony

Chronic pulmonary hypertension (cPH) is known to delay maximal right ventricular (RV) deformation, causing mechanical dyssynchrony, which previously has been identified only through the use of myocardial tissue Doppler imaging. However, alterations between RV and left ventricular (LV) ejection should be easily identified during routine echocardiographic examinations. We hypothesized that assessment of differences in ejection fraction between left and right ventricles would be detected using pulsed Doppler. Standard echo and Doppler data were collected from 30 patients without PH (mean age, 53 ± 7 y; mean pulmonary artery systolic pressure [PASP], 31 ± 5 mm Hg) and from 40 patients with cPH (mean age, 53 ± 13 y, P not significant; mean PASP, 82 ± 24 mm Hg, P<0.00001). Temporal differences in the ejection of both ventricles were measured as the ratio of total duration of RV to LV outflow tract (RVOT and LVOT) pulsed Doppler signals. A ratio (<0.99) of RVOT to LVOT total duration of ejection was found not only to be the best Doppler parameter to identify an abnormal pulmonary artery systolic pressure, with a 90% sensitivity and 100% specificity (area under the curve 0.958, P = 0.0001), but also identified differences in the temporal ejection between the 2 ventricles, or dyssynchrony, as a result of cPH. The ratio of pulsed Doppler RV to LV total duration of ejection is easily obtainable and appears useful in identifying the presence of interventricular dyssynchrony in cPH patients. A prospective study is now required to determine if this Doppler ratio can identify minute changes in the ejection of both ventricles as a result of changes in disease status or response to PH therapy.

Myocardial tissue doppler imaging in studying of change in the longitudinal right ventricular function in patients with chronic obstructive pulmonary disease

The obstructive of paper was to study and match clinical symptoms of chronic obstructive pulmonary disease, laboratory and instrumental analyses data, and data obtained from myocardial Tissue Doppler Imaging. Sixty four patients four patients with chronic obstructive pulmonary disease were examined. It was discovered that information obtained through myocardial Tissue Doppler Imaging is in fact early evidence of pulmonary heart disease available at the pre-clinical stage (functional changes are observed before clinical symptoms).

Study on the clinical significance and fetal cardiac function of fetuses with intracardiac hyperechogenic foci using fetal echocardiography

Objective To evaluate the clinical significance and cardiac function of fetuses with intracardiac hyperechogenic focus(ICEF) by fetal echocardiography. Methods Fetal echocardiograms were performed on 1291 fetuses for evaluation of fetal heart structures and rhythms. Echocardiographic characteristics of ICEF were investigated. Fetal systolic and diastolic functions of 399 fetuses with an isolated ICEF were compared with 128 normal fetuses using conventional two-dimensional, M-mode, pulsed Doppler echocardiography and myocardial Doppler tissue imaging(DTI). Results The prevalence of ICEF was 34. 7% (448/1291). Twenty-four(5.4%) cases were found with cardiovascular malformations. There was 1 (0.22%) case of ICEF fetus associated with chromosomal abnormality (trisomy 21 ). Comprehensive fetal echocardiographic data analysis showed no significant differences in heart dimensions, global cardiac functions,and myocardial performances in the two groups( P ＞0.05). Conclusions An isolated ICEF in the fetal heart is not associated with increased risk for chromosome abnormalities. Fetuses with ICEF do not indicate impaired left ventricular systolic or diastolic function, therefore having no hemodynamic significance. Key words: Echocardiography; Fetus; Intracardiac hyperechogenic focus

Reproducibility of Doppler measures of ventricular function during maximal upright cycling

Echocardiographic measures of ventricular function during exercise may prove useful in assessing myocardial health. This study examined test-retest reproducibility of measurements of Doppler mitral flow velocity (E-wave) and myocardial tissue Doppler imaging (E'-, S-waves) during a progressive maximal upright cycle test in 12 healthy lean adolescent males. Measurements were taken as subjects pedalled to exhaustion with 35 watt work increments in two separate trials. We observed no significant differences in mean values at rest, submaximal (70 watts) exercise, or maximal exercise for all three variables. Coefficients of variation at maximal exercise were 5.3%, 7.4%, and 8.1% for mitral E, tissue Doppler-S, and tissue Doppler-E', respectively. These findings indicated acceptable levels of reproducibility of Doppler ultrasound techniques for assessing ventricular systolic and diastolic functional response to maximal exercise in young lean male subjects.

Spectral pulsed-wave tissue Doppler imaging lateral-to-septal delay fails to predict clinical or echocardiographic outcome after cardiac resynchronization therapy

The current study sought to assess if pre-implantation lateral-to-septal delay (LSD) > or =60 ms assessed by spectral pulsed-wave myocardial tissue Doppler imaging (PW-TDI) could predict successful long-term outcome after cardiac resynchronization therapy (CRT). Sixty patients (72% males, mean age 59 +/- 10 years) who were referred for CRT according to the ACC/ESC guidelines were enrolled in the study. All patients underwent spectral PW-TDI before and 1 year after CRT. Two left ventricular (LV) dyssynchrony time intervals, T(O) and T(P) (time to onset and peak of LV myocardial velocity, respectively), LSD were recorded. Left ventricular dyssynchrony was defined as LSD > or =60 ms. Clinical response was defined as an improvement in >1 NYHA class plus improvement in 6-min walk distance (6MWD) > or =25%, echocardiographic response was defined as a > or =15% reduction in LV end-systolic volume (LV-ESV). One year after CRT, 50 patients (83%) were clinical responders and 47 patients (78%) were echocardiographic responders. Both T(O) and T(P) LV dyssynchrony indices failed to predict echocardiographic CRT outcome. In addition, there were no significant differences between 'synchronous' and 'dyssynchronous' patient populations at baseline or follow-up in either clinical (NYHA class and 6MWD) or echocardiographic (LV ejection fraction, LV end-diastolic, and end-systolic) variables. The great majority of patients referred for CRT benefit clinically from it. However, spectral PW-TDI failed to predict CRT outcome. When PW-TDI dyssynchrony was applied for selection of proper CRT patients, up to 80-86% of the patients with synchronous LSD that had proven clinical and echocardiographic benefit from CRT would have been denied CRT.

Myocardial tissue doppler imaging: Does successful surgery of the aortic root unmask a new threat for Marfan patients?

Myocardial tissue doppler imaging: Does successful surgery of the aortic root unmask a new threat for Marfan patients?

Pulmonary Embolism and Right Heart Function: Insights from Myocardial Doppler Tissue Imaging

Acute pulmonary embolism (PE) has significant impact in right heart function. We assess the difference of Doppler tissue parameters among control subjects, patients with pulmonary hypertension, and patients with acute PE. After optimal treatment, the changes of Doppler tissue parameters in patients with PE were assessed. A total of 50 patients with acute PE, confirmed by multidetector-row chest computed tomography, were enrolled. Another 70 patients with pulmonary hypertension, but no evidence of PE found by computed tomography, were also enrolled. A total of 100 healthy people without signs of cardiopulmonary dysfunction served as a control group. We assessed left and right ventricular (RV) ejection fraction by Simpson's rule. Doppler tissue parameters were obtained from lateral sides of tricuspid and mitral annulus, and interventricular septum. Myocardial performance index (MPI) of RV was estimated from lateral tricuspid annulus by Doppler tissue imaging, MPI of left ventricle from lateral mitral annulus. The left ventricular and RV ejection fractions in patients with pulmonary hypertension were lower than for the control group and patients with PE. But the RV-MPI in patients with PE was the lowest as a result of significant prolongation of isovolumic relaxation time (IVRT). One month after anticoagulant treatment, the IVRT and RV-MPI recovered in patients with PE. There was no significant correlation between IVRT and pulmonary artery systolic pressure. By bivariate correlation analysis, the most significant factor correlated to pulmonary artery systolic pressure was peak late diastolic velocity of tricuspid annulus with r 0.67, r(2) 0.45, and P less than .0001. Acute PE has significant impact in systolic and diastolic function of RV. The higher RV-MPI implies that condition. However, optimal anticoagulant treatment corrects RV dysfunction in patients with PE. After a 1-month course of anticoagulant treatment, RV-MPI diminishes as the result of RV-IVRT reduction.

Right Heart Function in Scleroderma: Insights from Myocardial Doppler Tissue Imaging

To use Doppler tissue imaging to evaluate heart function and to predict rehospitalization rate in progressive systemic sclerosis, we studied 40 patients (limited in 24 patients, diffuse in 16 patients) with chest roentgenography, pulmonary function test, routine echocardiography, and myocardial Doppler tissue. Another 45 volunteers without any sign of heart failure served as the control group. Significant difference of echocardiographic parameters was found in peak transmitral early diastolic velocity, right ventricular (RV) ejection fraction (EF) (RVEF), pulmonary artery systolic pressure, and Doppler tissue parameters of the RV and septum (peak transmitral early diastolic velocity, P = .012; RVEF, P < .0001; pulmonary artery systolic pressure, P < .0001). The parameters derived by pulsed wave Doppler tissue decreased in RV, including peak systolic myocardial velocity (Sm), early diastolic velocity, late diastolic velocity, and myocardial performance index. RVEF and left ventricular EF were estimated by Simpson's method. RV-Sm could be used to identify RV failure. Receiver operating characteristic area under the curve for RV-Sm was 0.935. RV-Sm less than 11 cm/s indicted RVEF less than 40% with sensitivity of 87% and specificity of 86%. Contrary to expectation, pulmonary artery systolic pressure was not so well correlated with RV function. The frequency of admission was reverse correlated with decrement of RV-Sm in patients with RV-Sm less than 12 cm/s. We conclude that in progressive systemic sclerosis, RV systolic dysfunction is common and appears to be a result of pulmonary hypertension, disturbance of myocardial microcirculation, and myocardial fibrosis. Pulmonary hypertension was not well correlated with RV dysfunction; it suggested pulmonary hypertension was not the only cause of RV failure. Primary right heart involvement was the other possible cause. By myocardial Doppler tissue imaging, we can predict the frequency of hospitalization; it suggests simultaneous involvement of heart, skin, lung, and other organs. RV-Sm more than 12 cm/s predicted a decreased likelihood of readmission to the hospital.

Right Heart Function in Systemic Lupus Erythematosus: Insights from Myocardial Doppler Tissue Imaging

The purpose of this study was to use Doppler tissue imaging to evaluate heart function and to investigate the correlation between Doppler imaging and pulmonary artery systolic pressure (PASP) and right ventricular (RV) ejection fraction (EF) in patients with systemic lupus erythematosus (SLE). Standard echocardiography and 2-dimensional and color Doppler imaging were used to assess cardiac function in patients given the diagnosis of SLE (n = 40) and healthy control subjects (n = 45). Half of the patients with SLE also presented with pulmonary hypertension (PH). Significant differences in PASP and RV EF (RVEF) were found between the control and SLE groups. The peak systolic velocity of tricuspid annulus was significantly lower in patients with SLE than in the control group. The calculated myocardial performance index of the RV, septum, and left ventricular lateral wall were significantly higher in patients with SLE than in the control group. Bivariate correlation analysis revealed a significant correlation among PASP, RVEF, and systolic tricuspid annular velocity. There was a significant correlation between each of these 3 parameters and the 6-minute walk distance in patients with SLE. Patients with SLE and PH had a significantly shorter 6-minute walk distance than patients with SLE without PH. Furthermore, in patients with SLE and PH, RVEF and systolic tricuspid annular velocity were lower than in the control subjects and patients with SLE without PH. Patients with SLE and PH had a longer isovolumic relaxation time and a higher myocardial performance index of RV than those without PH. Finally, by simple linear regression analysis, we found a significant positive relation between RVEF and systolic tricuspid annular velocity, but a negative relationship between PASP and systolic tricuspid annular velocity. These findings demonstrate that in patients with SLE, systolic tricuspid annular velocity determined by echocardiography and Doppler imaging can be used to assess RV function and PASP. Furthermore, systolic tricuspid annular velocity reflects exercise tolerance in patients with SLE and the length of the isovolumic relaxation time represents the progression of PH.

Effect of Transcatheter Atrial Septal Defect Closure in Children on Left Ventricular Diastolic Function

The acute impact of transcatheter atrial septal defect (ASD) closure on left ventricular (LV) diastolic function was assessed in 15 consecutive children, and pre- and postclosure data were compared with those in a matched group of controls. The data indicate that transcatheter ASD closure leads to an immediate improvement in LV diastolic function as assessed by septal myocardial Doppler tissue imaging and LV inflow velocity propagation. The improvement in LV diastolic properties correlates with the degree of right ventricular volume overload.