Myocardial Velocity Profile Research Articles

A pipeline to enable large-scale generation of diverse 2D cardiac synthetic ultrasound recordings corresponding to healthy and heart failure virtual patients

Simulated ultrasound (US) data are widely used in echocardiography to develop and validate rapidly growing convolutional neural networks (CNNs) based learning algorithms for image processing and analysis. In this context, a large and diverse database of synthetic US scans is considered vital for CNN training purposes, as clinical US data are scarce and difficult to access. Major hurdles in creating an extensive database are the long US simulation time and unstable heart models for extreme parameter settings. Here, we developed and implemented a cardiac US simulation pipeline that kinematically connects two state-of-the-art solutions in the field of US simulation (COLE) and cardiac modelling (CircAdapt), benefiting from the fast simulation time of the convolution-based ultrasound simulator and stability of the mechanical heart model to produce 2D synthetic cardiac US recordings. Furthermore, using our pipeline, we generated diverse set of 600 2D synthetic cardiac US recordings of healthy and heart failure virtual patients with variations in the shapes, motion patterns, and functions of the heart, along with their ground truth 2D myocardial velocity profiles and deformation curves. The resulting database is a potential tool for augmenting training databases of machine learning based US image processing algorithms. [Work funded by European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No. 860745.]

Myocardial Performance Index Determined by Tissue Doppler Imaging in Patients With Systolic Heart Failure Predicts Poor Long-Term Prognosis: An Observational Cohort Study

BackgroundMyocardial performance index (MPI) is an echocardiographic parameter that reflects left ventricular (LV) function. MPI determined by means of tissue Doppler imaging (TDI) at different LV sites (global MPI) and its long-term prognostic implications in congestive heart failure (HF) have not been evaluated. Methods and ResultsA total of 110 patients with HF during acute hospitalization were followed for a mean of 5.0 years for survivors. The myocardial velocities at 4 different LV sites near the mitral annulus from apical views were recorded with the use of pulsed-wave TDI. From myocardial velocity profiles, the MPI at each LV site was calculated: MPI = (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. The global MPI was calculated as the mean from the 4 LV sites. Mean ejection fraction was 25%. A total of 61 patients died during the study period. On multivariate analysis, only MPI emerged as an independent predictor of mortality. With a cutoff value of 0.67, the hazard ratio for cardiovascular mortality during the follow-up period was 13 (95% confidence interval 5.03–34.44; P < .001). A cutoff MPI value of ≥0.67 identified patient mortality during the study period with a sensitivity of 86% and a specificity of 79%. ConclusionGlobal TDI-derived MPI in patients with HF is a powerful predictor of cardiovascular mortality in patients with systolic HF.

Smoothed or not? How does temporal smoothing influence myocardial velocity profile in Doppler cardiosonography in the horse

Smoothed or not? How does temporal smoothing influence myocardial velocity profile in Doppler cardiosonography in the horse

Reference values for fetal tissue velocity imaging and a new approach to evaluate fetal myocardial function

ObjectivesMyocardial function can be evaluated using color-coded tissue velocity imaging (TVI) to analyze the longitudinal myocardial velocity profile, and by expressing the motion of the atrioventricular plane during a cardiac cycle as coordinated events in the cardiac state diagram (CSD). The objective of this study was to establish gestational age specific reference values for fetal TVI measurements and to introduce the CSD as a potential aid in fetal myocardial evaluation.MethodsTVI recordings from 125 healthy fetuses, at 18 to 42 weeks of gestation, were performed with the transducer perpendicular to the apex to provide a four-chamber view. The myocardial velocity data was extracted from the basal segment of septum as well as the left and right ventricular free wall for subsequent offline analysis.ResultsDuring a cardiac cycle the longitudinal peak velocities of septum increased with gestational age, as did the peak velocities of the left and right ventricular free wall, except for the peak velocity of post ejection. The duration of rapid filling and atrial contraction increased during pregnancy while the duration of post ejection decreased. The duration of pre ejection and ventricular ejection did not change significantly with gestational age.ConclusionEvaluating fetal systolic and diastolic performance using TVI together with CSD could contribute to increase the knowledge and understanding of fetal myocardial function and dysfunction. The pre and post ejection phases are the variables most likely to indicate fetuses with abnormal myocardial function.

Effect of sample volume size and sampling method on feline longitudinal myocardial velocity profiles from color tissue Doppler imaging

ObjectivesThe aims of this study were to compare the effect of sample volume (SV) size settings and sampling method on measurement variability and peak systolic (s′), and early (e′) and late (a′) diastolic longitudinal myocardial velocities using color tissue Doppler imaging (cTDI) in cats. AnimalsTwenty cats with normal echocardiograms and 20 cats with hypertrophic cardiomyopathy. MethodsWe quantified and compared empirical variance and average absolute values of s′, e′ and a′ for three cardiac cycles using eight different SV settings (length 1,2,3 and 5 mm; width 1 and 2 mm) and three methods of sampling (end-diastolic sampling with manual tracking of the SV, end-systolic sampling without tracking, and random-frame sampling without tracking). ResultsNo significant difference in empirical variance could be demonstrated between most of the tested SVs. However, the two settings with a length of 1 mm resulted in a significantly higher variance compared with all settings where the SV length exceeded 2 mm (p < 0.001). There was an overall significant effect of sampling method on the variability of measurements (p = 0.003) and manual tracking obtained the lowest variance. No difference in average values of s′, e′ or a′ could be found between any of the SV settings or sampling methods. ConclusionWithin the tested range of SV settings, an SV length of 1 mm resulted in higher measurement variability compared with an SV length of 3 and 5 mm, and should therefore be avoided. Manual tracking of the sample volume is recommended.

Fetal cardiac muscle contractility decreases with gestational age: a color-coded tissue velocity imaging study

BackgroundPresent data regarding how the fetal heart works and develops throughout gestation is limited. However, the possibility to analyze the myocardial velocity profile provides new possibilities to gain further knowledge in this area. Thus, the objective of this study was to evaluate human fetal myocardial characteristics and deformation properties using color-coded tissue velocity imaging (TVI).MethodsTVI recordings from 55 healthy fetuses, at 18 to 42 weeks of gestation, were acquired at a frame rate of 201–273 frames/s for offline analysis using software enabling retrieval of the myocardial velocity curve and 2D anatomical information. The measurements were taken from an apical four-chamber view, and the acquired data was correlated using regression analysis.ResultsLeft ventricular length and width increased uniformly with gestational age. Atrioventricular plane displacement and the E’/A’ ratio also increased with gestational age, while a longitudinal shortening was demonstrated.ConclusionsFetal cardiac muscle contractility decreases with gestational age. As numerous fetal- and pregnancy-associated conditions directly influence the pumping function of the fetal heart, we believe that this new insight into the physiology of the human fetal cardiovascular system could contribute to make diagnosis and risk assessment easier and more accurate.

Assessment of left ventricular function in diabetes mellitus patients without complications by myocardial velocity gradient

Objective To evaluate the structure and function of left ventricle in diabetes mellitus (DM) patients without complications by myocardial velocity gradient (MVG) measured by myocardial velocity profile (MVP). Methods Thirty type 2 DM patients without complications and 30 healthy volunteers as controls were enrolled. The heart structure, systolic function and diastolic function of left ventricle were measured by echocardiography and the left ventricular mass index (LVMI) was calculated. Mitral annular systolic movement (Sm) , early rapid filling phase movement ( Em) and atrial contraction movement(Am) were measured by tissue Doppler image and the left ventricular MVG at diastole and systole in subendocardium and subepicardium (MVGs,MVGd) were measured by MVP. Results The diameter of left atria and left ventricle, thickness of interventricular septum and LVMI were higher in DM group than those of control group ( P <0. 05 or P <0. 01) , MVGs, MVGd, and Em were lower in DM group than those of control group( P <0. 05 or P <0. 01). There were no significant differences on E/A, Em/Am and E/Em between two groups. In addition, there were also no significant differences on Sm,left ventricular ejection fraction and left ventricular fraction shortening between two groups. Conclusions Structure and function of left ventricle have changed in patients of DM without complications. MVG measured by MVP is an accurate and sensitive index to assess left ventricular systolic and diastolic function. Key words: Echocardiography; Diabetes mellitus, type 2; Ventricular function, left; Myocardial velocity profile

Comparison of Pulsed Wave and Color Doppler Myocardial Velocity Imaging in Healthy Dogs

Tissue velocity imaging (TVI) is increasingly used in small animal cardiology. Tissue velocity of the myocardial wall can be measured by pulsed wave (PW) or color Doppler (CD) imaging methods. Currently, the same reference ranges are used for PW TVI and CD TVI methods. However, if and how both methods correlate, and whether they can be used interchangeably, have not been assessed in small animals. To compare the results of PW TVI and CD TVI measurements. Seventy-one healthy dogs. Longitudinal myocardial velocity profiles were recorded from the 4-chamber left apical view. Peak maximal systolic (S), early (E), and late diastolic (A) velocities were measured off-line in a blinded fashion in the septal and lateral left ventricular wall by PW TVI and CD TVI. Differences between peak PW TVI and CD TVI waves were analyzed by a paired t-test. Regression analysis and Bland-Altman difference plots also were used to assess agreement between methods. There was a significant correlation between PW TVI and CD TVI (P < .001). However, S, E, and A waves measured by PW TVI were significantly higher than the CD TVI values (P < .001). Peak systolic and diastolic PW velocities were approximately 2.20 cm/s higher than corresponding mean CD TVI velocities. PW TVI measurements are significantly higher compared with CD TVI measurements. Theses differences are clinically relevant. These methods should not be used interchangeably, and different reference ranges for PW TVI and CD TVI should be used.

Pulsed-wave Doppler tissue imaging velocities in normal geriatric cats and geriatric cats with primary or systemic diseases linked to specific cardiomyopathies in humans, and the influence of age and heart rate upon these velocities.

Pulsed-wave Doppler tissue imaging (pw-DTI) techniques allow the non-invasive assessment of myocardial dynamics. pw-DTI has demonstrated regional and global diastolic impairment in various forms of human and feline cardiomyopathy. We hypothesise that in geriatric cats with systemic diseases that have been linked to specific cardiomyopathies in human beings, the myocardial velocity profile will be altered when compared to either normal or hypertrophic cardiomyopathy (HCM) cats; and that both age and heart rate have a significant affect upon pw-DTI velocities. The aims of this study were to determine whether the feline M-mode or myocardial velocity profile is altered in geriatric cats with disease states that have been linked to specific cardiomyopathies in humans when compared to normal geriatric cats or geriatric cats with HCM and to determine whether age or heart rate has a significant effect upon pw-DTI velocities within these groups of cats. Sixty-six cats aged 8 years or above were included in the study, and were divided as follows: Unaffected (n=8), basilar septal bulge (BSB) (17), HCM (14), hyperthyroid (HiT(4)) (12) and chronic renal failure (CRF) (15). Systolic blood pressure was normal in all the cats. pw-DTI systolic (S'), early (E') and late diastolic (A') velocities were assessed from standardised sites within the myocardium, and the relationships between these and disease group, age and heart rate were then assessed. In cats with HCM, the E' velocity was decreased at various sites. Conversely, the HiT(4) cats demonstrated increased S' velocities. The only site at which the age of the cat was significantly related to myocardial velocities was the S' velocity from the apical mid-septum. There were also significant positive relationships between heart rate and the magnitude of myocardial S', E' and A' velocities of radial motion and S' and A' velocities of longitudinal motion. pw-DTI detected diastolic dysfunction in untreated cats with HCM and increased systolic function in HiT(4) cats. The age of the cat was of little significance, whereas heart rate significantly influenced myocardial velocity profiles.

Opposing Wall Mechanics Are Significantly Influenced by Longitudinal Cardiac Rotation in the Assessment of Ventricular Dyssynchrony

This study sought to assess whether longitudinal rotation (LR) affects myocardial systolic velocity profiles and to compare velocity-based measures of dyssynchrony with LR for predicting cardiac resynchronization therapy (CRT) response. Longitudinal rotation, a rocking motion often seen when the dilated left ventricle (LV) is imaged in its horizontal long-axis plane, is a recently recognized phenomenon and a new predictor of response to CRT. One hundred patients with CRT implants and suitable baseline echocardiograms were identified. Longitudinal rotation was assessed in the apical 4-chamber view by speckle-tracking techniques and myocardial systolic velocities for basal septum, and lateral LV were analyzed from tissue Doppler images. The quartiles of LR distribution were analyzed for differences in their systolic velocities. Correlation between measurements and reduction in LV end-systolic volume (ESV) at follow-up was performed. Quartile 1 had a mean LR of -6.8 +/- 2.3 degrees ; quartile 4 showed a mean LR of 2.3 +/- 1.6 degrees . A depressed peak velocity of lateral wall, when compared with the septum, was found for quartile 1 (p = 0.01), whereas the converse was noted in quartile 4 (p = 0.0001). The difference in amplitude of peak velocity between septal and lateral walls was found to correlate with the pattern of LR and with percentage reduction in LV ESV at follow-up in nonischemic patients. Septal-lateral delay was not correlated with the presence of LR, nor was it predictive of reduction in LV ESV. Patients with prominent clockwise LR have depressed long-axis systolic velocities of the lateral wall, whereas the patients with counterclockwise LR have depressed septal wall velocities. The difference in peak amplitude of basal septal and lateral systolic velocities is predictive of LR, and in the nonischemic subgroup correlates with quantitative LV reverse remodeling at follow-up. Velocity time-based measures, including septal-lateral delay were not predictive of CRT response.

Cardiac incoordination induced by left bundle branch block: its relation with left ventricular systolic function in patients with and without cardiomyopathy

BackgroundAlthough left bundle branch block (LBBB) alters the electrical activation of the heart, it is unknown how it might change the process of myocardial coordination (MC) and how it may affect the left ventricular (LV) systolic function. The present study assessed the effects of LBBB on MC in patients with LBBB with and without dilated (DCMP) or ischemic cardiomyopathy (ICMP).MethodsTissue Doppler echocardiography (TDE) was performed in 86 individuals: 21 with isolated LBBB, 26 patients with DCMP + LBBB, 19 patients with ICMP + LBBB and in 20 healthy individuals (Controls). MC was assessed analyzing the myocardial velocity profiles obtained from six basal segments of the LV using TDE. The LV systolic function was assessed by standard two-dimensional echocardiography and by TDE.ResultsSevere alterations in MC were observed in subjects with LBBB as compared with controls (P < 0.01 for all comparisons); these derangements were even worse in patients with DCMP and ICMP (P < 0.001 for comparisons with Controls and P < 0.01 for comparison with individuals with isolated LBBB). Some parameters of MC differed significantly between DCMP and ICMP (P < 0.01). A good or very good correlation coefficient was found between variables of MC and variables of LV systolic function.ConclusionLBBB induces severe derangement in the process of MC that are more pronounced in patients with cardiomyopathies and that significantly correlates with the LV systolic function. The assessment of MC may help in the evaluation of the etiology of dilated cardiomyopathy.

Pulsed doppler tissue imaging in the early diagnosis of coronary artery disease

Cardiovascular diseases are the leading cause of death in the majority of well-developed countries. Early diagnosis of coronary artery disease is difficult due to blood vessels remodeling, late manifestations of reduced maximal and normal coronary blood flow, and negative correlation between stenosis and plaque burden. Pulsed Doppler tissue imaging is used for assessment of myocardial velocity, whereas classical Doppler imaging is used for measurement of blood flow velocity. Systolic myocardial velocity profile During the systolic phase only a single myocardial motion is registered--S wave. There are early and late myocardial relaxation velocities. Impact of coronary artery disease on myocardial velocities Early to late myocardial relaxation velocity ratio is influenced by coronary artery disease. This paper provides practical guidelines for using pulsed doppler tissue imaging. Pulsed Doppler tissue imaging is an excellent procedure for early diagnosis of coronary artery disease.

2273: Initial exploring regional left ventricular systolic function in patients with hypertrophic cardiomyopathy by TDI myocardial velocity profile

2273: Initial exploring regional left ventricular systolic function in patients with hypertrophic cardiomyopathy by TDI myocardial velocity profile

Left Ventricular Geometry and Myocardial Contractility in Patients with Essential Hypertension Evaluated by Myocardial Velocity Profile

Left ventricular (LV) systolic function in the hypertensive heart has been evaluated considering geometric differences. The maximal systolic myocardial velocity gradient (Gmax) obtained from myocardial velocity profile can evaluate regional myocardial contractility. The purpose of this study was to assess LV myocardial contractility in the hypertensive heart using Gmax regarding geometric differences. The study included 93 patients with essential hypertension. Gmax was correlated with relative wall thickness and LV mass index. LV myocardial contractility was assessed by classifying patients into normal geometry, concentric remodeling (CR), eccentric hypertrophy, and concentric hypertrophy (CH). Gmax has shown significant negative relationship with LV end-diastolic dimension. LV end-diastolic dimension in CH and eccentric hypertrophy groups was significantly greater than that in normal geometry and CR groups (CH vs CR, 4.9 vs 4.2 cm, P < .001). LV mass index was significantly greater in CH and eccentric hypertrophy groups than in the other groups (CH vs CR, 196 vs 122 g/m2, P < .001). Although there was no difference in relative wall thickness between CH and CR groups, Gmax was significantly smaller in CH than in CR group (1.8 vs 2.8 s(-1), P < .05). In patients with essential hypertension, LV myocardial contractility worsened corresponding to increase in LV dimension with similar wall thickness. Gmax obtained from myocardial velocity profile detected depressed myocardial contractility in patients with increased LV dimension.

Characteristics of Left Ventricular Diastolic Function in Patients with Systolic Heart Failure: A Doppler Tissue Imaging Study

Our aim was to characterize myocardial velocity profiles in different types of diastolic dysfunction for patients with severely decreased left ventricular (LV) systolic function. A total of 126 patients with congestive heart failure and an LV ejection fraction of 35% or less were included. Patients underwent an echocardiographic Doppler examination, with measurement of the transmitral inflow pattern, and Doppler tissue imaging of the mitral annulus. Compared with age-matched control subjects, the patients had decreased systolic (9.5 vs 4.9 cm/s, P < .001) and early diastolic (11.6 vs 5.6 cm/s, P < .001) mitral annular velocities. According to the transmitral inflow pattern, 56 patients had signs of a LV restrictive pattern, 36 had a pseudonormalization pattern, and 34 had an abnormal relaxation pattern. The peak systolic and early diastolic mitral annular velocities were quite similarly reduced in different diastolic groups (systolic velocities of 4.6, 5.0, and 5.3 cm/s, and early diastolic velocities of 5.7, 5.8, and 5.1 cm/s at restrictive, pseudonormal, and abnormal relaxation, respectively). The ratio of the transmitral early wave and mitral annular early velocity, an expression of LV filling pressure, was highest in the restrictive group compared with other groups (17.0, 14.6, and 11.7 in the above 3 groups, respectively, P < .001 among groups). The ratio of the transmitral early wave and mitral annular early velocity was also higher in the pseudonormal group than in a control group of patients with ejection fraction of 35% or more with signs of a normal/pseudonormal pattern (14.6 vs 9.0, P < .001). Doppler tissue imaging may enhance the estimates of diastolic dysfunction in patients with decreased LV systolic function, and help to disclose abnormal diastolic function especially in a pseudonormal group.

Losartan improves regional left ventricular systolic and diastolic function in patients with hypertension: accurate evaluation using a newly developed color-coded tissue doppler imaging technique

BackgroundAngiotensin II receptor antagonists have recently been accepted as antihypertensive therapy. Tissue Doppler imaging (TDI) has been developed as a noninvasive tool to assess quantitatively regional myocardial motion abnormalities. This study was designed to determine whether our newly developed technique of color-coded TDI may be a useful means of quantifying the improvement in regional left ventricular (LV) myocardial contractility and relaxation after treatment with losartan in patients with hypertension. Methods and resultsLosartan (50 to 100 mg) was administered for 6 months to 37 previously untreated patients with essential hypertension. Averaged myocardial velocity profiles (MVPs) for color-coded TDI were recorded in the ventricular septum and LV posterior wall before and after treatment. Peak myocardial velocities and peak myocardial velocity gradients (MVGs) in the LV walls were determined during systole and early diastole. The plasma concentration of transforming growth factor (TGF)-β1 also was measured in all patients. Blood pressure and plasma TGF-β1 level decreased after initiation of losartan therapy. The LV mass index and LV meridional end-systolic wall stress also decreased after treatment with losartan. LV geometry changed from a pattern consistent with concentric hypertrophy to normal geometry in 10 patients and to a pattern consistent with concentric remodeling in 5 patients, and from concentric remodeling to normal geometry in 5 patients after treatment with losartan. The ratio of early to late diastolic filling for the transmitral flow velocity increased after losartan treatment. The peak systolic and early diastolic myocardial velocities and MVGs in the ventricular septum and LV posterior wall increased after treatment with losartan, although the values 6 months after treatment with losartan were still lower than those in normal individuals. There were good correlations between changes in plasma TGF-β1 level and changes in systolic and early diastolic MVGs 6 months after losartan. However, there were no significant correlations between changes in the systolic blood pressure and LV end-systolic wall stress and changes in the TDI parameters. ConclusionLosartan improves regional LV function in patients with hypertension. Our newly developed averaged MVP and MVG measurements may be useful for accurately evaluating regional LV myocardial contractility and relaxation in these patients.

Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function

On the basis of color Doppler myocardial motion data, 1-dimensional regional natural strain rate and strain curves can now be calculated by comparing local myocardial velocity profiles. Such deformation data sets may be an important, new, and more sensitive approach to quantifying both regional radial and long-axis function of the left or right ventricle in both acquired and congenital heart disease. The normal ranges of regional velocity, strain rate, and strain values have already been determined in both adults and children. This review will focus both on the potential clinical applications of these new ultrasound-based deformation parameters and the current limitations inherent in implementing the technique in everyday practice.

Diagnosis of cardiac amyloidosis based on the myocardial velocity profile in the hypertrophied left ventricular wall

The myocardial velocity profile (MVP), derived from color-coded tissue Doppler imaging (TDI), can identify transmural heterogeneity based on the physiology and pathology of the myocardium. This study sought to clarify whether the MVP can differentiate cardiac amyloidosis from other causes of left ventricular hypertrophy. We recorded the MVP and determined its myocardial velocity gradient (MVG) in the ventricular septum and left ventricular posterior wall using color-coded TDI in 10 patients with cardiac amyloidosis, in 25 patients with hypertensive hypertrophied left ventricular wall, in 25 patients with asymmetric septal hypertrophy of hypertrophic cardiomyopathy, and in 20 clinically normal controls. End-diastolic ventricular septal thickness was similar among the cardiac amyloidosis, hypertension, and hypertrophic cardiomyopathy groups. Percent systolic thickening of the ventricular septum and left ventricular posterior wall calculated from M-mode left ventricular echocardiograms was lower in the cardiac amyloidosis group than in the hypertension, hypertrophic cardiomyopathy, or control group. Peak MVGs during systole and early diastole were lowest in the cardiac amyloidosis group, followed, in order, by the control, hypertension, and hypertrophic cardiomyopathy groups. The systolic and early diastolic MVPs in the ventricular septum and left ventricular posterior wall showed a characteristic serrated pattern in all patients with cardiac amyloidosis, but not in any other patient groups. In conclusion, MVPs in the ventricular septum and left ventricular posterior wall show a distinctive serrated pattern that may be related to amyloid deposition in the myocardium. Myocardial tissue characterization using color-coded TDI provides diagnostic information in patients with cardiac amyloidosis.

1041-97 Assessment of transmyocardial velocity distribution during high dose dobutamine stress echocardiography using myocardial velocity profile

1041-97 Assessment of transmyocardial velocity distribution during high dose dobutamine stress echocardiography using myocardial velocity profile

Novel approach to the quantitation of regional left ventricular systolic and diastolic function using tissue Doppler imaging to create a myocardial velocity profile and gradient.

The myocardial velocity profile (MVP) and gradient (MVG) between the endocardium and epicardium of the left ventricular (LV) wall measured by color-coded tissue Doppler imaging (TDI) are new indices for evaluating regional LV myocardial function. However, accurate recording and measurement of the MVP is difficult using conventional methodology because of the stochastic nature of the ultrasound signal; that is, the effect of speckled noise. The aim of this study was to validate the accuracy and establish the validity of a newly developed method for measuring the MVP and MVG using 10 clinically normal controls and 10 patients with a hypertensive hypertrophied LV posterior wall. A non-isotropic, averaging algorithm was developed that was capable of obtaining a stable MVP (averaged MVP). Averaged MVP was recorded using parasternal, LV short-axis, color-coded TDI, placing regions of interest along the LV posterior wall with the reference point for angle-correction being at the center of LV contraction. The velocity from epicardium to endocardium within the region of interest was automatically angle-corrected to calculate the velocity component radially relative to the LV cavity and was spatially averaged along the circumference within the region of interest. Inter- and intraobserber variabilities of measurements were lower in the averaged MVP and MVG than in the conventional MVP and MVG. The correlation coefficients of the linear regression lines of systolic and early diastolic MVPs in the LV posterior wall were higher in all controls and hypertensive patients with the averaged method than with the conventional TDI procedures. The mean peak systolic and early diastolic MVGs were lower in the hypertensive group than in the controls. In conclusion, the newly developed averaged MVP provides a stable and reproducible index for the quantitative assessment of regional LV myocardial function.