Pulsed Tissue Doppler Imaging Research Articles

JS ISH-ESH-2 UPDATE ON THE DETECTION AND FOLLOW-UP OF EARLY HYPERTENSIVE HEART DISEASE

JS ISH-ESH-2 UPDATE ON THE DETECTION AND FOLLOW-UP OF EARLY HYPERTENSIVE HEART DISEASE

Immediate recovery of the left atrial and left ventricular diastolic function after transcatheter aortic valve implantation: A transesophageal echocardiography study.

Chronic increased afterload due to severe aortic stenosis (AS) results in com-pensatory concentric left ventricular (LV) hypertrophy and LV dysfunction. These in turn cause remodeling of the left heart. The aim of this study was to investigate the acute effect of transcatheter aortic valve implantation (TAVI) on left atrial (LA) mechanics and LV diastolic function. The study consisted of a total of 35 consecutive patients (mean age was 77.7 ± 5.0 years, 25 female) undergoing TAVI. All TAVI procedures have been performed under the transesophageal echocardiography (TEE) guidance. Before and 24 h after TAVI, all patients underwent transthoracic echocardiography (TTE) and mitral inflow velocities with pulsed-wave (PW) Doppler including early filling wave (E), late diastolic filling wave (A), and E/A ratio were obtained. LV diastolic function was also explored by pulsed tissue Doppler imaging (TDI). Early (E') and late (A') diastolic annular velocities, E'/A' ratio and E/E' ratio were obtained. In addition, during the procedure before and minutes after the valve implantation, the left atrial appendage-peak antegrade flow velocity (LAA-PAFV) was measured and recorded with TEE. Compared with baseline, the mean mitral E, septal E' and E'/A' ratio increased significantly after TAVI. In addition, the LAA-PAFV increased significantly within minutes of TAVI (32.45 ± 10.7 cm/s vs. 47.6 ± 12.6 cm/s, p < 0.001). TAVI improves LV diastolic function and LA performance immediately.

Evidence of Early Cardiomyopathy with Strain in Chagas Disease

Background: In Chagas’ disease, cardiomyopathy is the most severe affection produced by this parasitic disease; its slow progressionhas led to several investigations in search of parameters capable of detecting incipient myocardial damage. Currently, the incorporationof strain by speckle tracking echocardiography opens a new horizon.Objective: The aim of this study was to investigate the role of two-dimensional echocardiography in Chagas disease and in the detectionof incipient cardiomyopathy.Methods: A cross-sectional study was performed between December 2009 and March 2011, including 93 patients with Chagasdisease. Forty-five patients were men and mean age was 46±12 years. The patients were divided into three groups (G): G1 (n=40)without demonstrable heart disease), G2 (n=17) with abnormal electrocardiogram and G3 (n=36) with cardiomyopathy. A controlgroup consisted of 35 subjects; 19 were men and mean age was 40±10 years. Doppler echocardiography was performed to evaluateleft ventricular diameters, left atrial area, left ventricular ejection fraction (Simpson), mitral annular plane systolic excursion andtricuspid annular plane systolic excursion. Mitral inflow pattern evaluated E wave, A wave, mitral E wave deceleration time and E/Aratio. Pulsed tissue Doppler imaging was used to measure and compare velocities at the lateral mitral annulus and tricuspid annulus(E’ wave, A’ wave, E’/A’ ratio and S’ wave) and global and segmental longitudinal peak systolic strain.Results: Global longitudinal peak systolic strain correlated with mitral annular plane systolic excursion (r: 0.75) in the pool of patientswith Chagas disease. Segmental longitudinal peak systolic strain differentiated two or more abnormal segments (value below-12%) in 10 patients of the group without demonstrable heart disease. This subgroup (n=10) had lower values of global longitudinalpeak systolic strain (-19.78% vs. -22.28%; p=0.009), lower E’/A’ ratio in the mitral annulus (1.23±0.59; p=0.021) and tricuspid annulus(0.73±0.3; p=0.019), with inverted E’/A’ ratio in the tricuspid annulus compared with the rest of the group (n=30).Conclusions: Global longitudinal peak systolic strain correlated with mitral annular plane systolic excursion. Segmental longitudinalpeak systolic strain differentiated a subpopulation in the group without demonstrable heart disease with abnormal segments,low values of global longitudinal peak systolic strain and biventricular diastolic dysfunction by pulsed tissue Doppler imaging. Theclinical value of this finding requires longitudinal follow-up.

Estimation of Left Ventricular Diastolic Function in Gestational Hypertension during the Third Trimester Inbaghdad Teaching Hospital

Background: Gestational hypertension exerts a great challenge on the maternal cardiovascular system, in spite of this fact, there is lack of reports regarding the maternal diastolic function in gestational hypertension which precedes systolic dysfunction in any cardiovascular complications. Objectives: To evaluate the maternal left ventricular diastolic function in gestational hypertensive women in the third trimester by measuring the mitral inflow parameters with pulse wave Doppler and Tissue Doppler Imaging. Patients and Methods: This studywas conducted in Baghdad teaching hospital from November 2015 to June 2016. Sixty gestational hypertensive womenwith singleton pregnancy in the third trimester, aged 29.7 ± 5.9 year, gestational hypertension was defined as systolicblood pressure that is equal or more than 140 mmHg or diastolic bloodpressurethatequals or exceeds 90 mmHg and starts after 20 weeks of gestation without proteinuria were enrolled in this study. Another 50 Normal pregnant womenaged 28 ± 3.18year served as controls. The left ventricular diastolic function was studied using two transthoracic echocardiographic methods: Pulsed wave Doppler (PWD) to measure the transmitral flow velocity including the early maximum velocity of mitral inflow(E wave), the late maximum velocity of mitral inflow (A wave), and E/A ratio was recorded. Tissue Doppler imaging (TDI) to measure thelateralmitral annular velocity (lateral e), the septal mitral annular velocity (septal e) and their average (e) was calculated. The ratio of E/e was recorded. Results: Gestational hypertensive women hadsignificant lower E wave velocity compared tonormal pregnant women (P value was 0.001). “A”wave velocity was higher in gestational hypertensive women with statistical difference(P value 0.002) and E/A was significant low in gestational hypertension with P value <0.05. Tissue Doppler imaging showed significant difference in e velocity which was lowerin gestational hypertensive women (P value 0.001). E/ein gestational hypertension showed significantly higher value than controls with P value<0.05. Conclusion: Gestational hypertension puts the maternal heart under pressure and volume overload associated with impaired relaxation as manifested by the changes inthe left ventricular diastolic function measured by transthoracic echocardiography.

Early Changes in Atrial Electromechanical Coupling in Patients with Hypertension: Assessment by Tissue Doppler Imaging.

Background:Hypertension (HT) is associated with atrial electrophysiological abnormalities. Echocardiographic pulsed wave tissue Doppler imaging (TDI) is one of the noninvasive methods for evaluation of atrial electromechanical properties. The aims of our study were to investigate the early changes in atrial electromechanical conduction in patients with HT and to assess the parameters that affect atrial electromechanical conduction.Methods:Seventy-six patients with HT (41 males, mean age 52.6 ± 9.0 years) and 41 controls (22 males, mean age 49.8 ± 7.9 years) were included in the study. Atrial electromechanical coupling at the right (PRA), left (PLA), interatrial septum (PIS) were measured with TDI. Intra- (right: PIS-PRA, left: PLA-PIS) and inter-atrial (PLA-PRA) electromechanical delays were calculated. Maximum P-wave duration (Pmax) was calculated from 12-lead electrocardiogram.Results:Atrial electromechanical coupling at PLA (76.6 ± 14.1 ms vs. 82.9 ± 15.8 ms, P = 0.036), left intra-atrial (10.9 ± 5.0 ms vs. 14.0 ± 9.7 ms, P = 0.023), right intra-atrial (10.6 ± 7.8 ms vs. 14.5 ± 10.1 ms, P = 0.035), and interatrial electromechanical (21.4 ± 9.8 ms vs. 28.3 ± 12.7 ms, P = 0.003) delays were significantly longer in patients with HT. The linear regression analysis showed that left ventricular (LV) mass index and Pmax were significantly associated with PLA (P = 0.001 and P = 0.002, respectively), and the LV mass index was the only related factor for interatrial delay (P = 0.001).Conclusions:Intra- and interatrial electromechanical delay, PLA were significantly prolonged in hypertensive patients. LV mass index and Pmax were significantly associated with PLA, and the LV mass index was the only related factor for interatrial delay. The atrial TDI can be a valuable method to assess the early changes of atrial electromechanical conduction properties in those patients.

Improved diastolic function in type 2 diabetes after a six month liraglutide treatment

AimsTo investigate whether liraglutide improves diastolic function in type 2 diabetes. MethodsThirty-seven patients with type 2 diabetes who began liraglutide therapy between June 2013 and May 2014 were enrolled in this observational, prospective study. 26 patients received liraglutide therapy for at least 6months. The remaining 11 patients withdrew from liraglutide therapy during the first month, were started on other hypoglycaemic therapies and formed the control group. Anthropometric, metabolic and echocardiographic parameters including pulsed wave tissue Doppler imaging were evaluated at baseline and at 6months. ResultsIn the liraglutide group the early diastolic mitral annulus velocity on the lateral (e-lat) and medial (e-med) sides of the mitral annulus increased from 9.2±3.4 to 11.6±4.7cm/s (p<0.001) and from 6.9±1.7 to 8.4±2.6cm/s (p<0.003), respectively. The ratio of early-to-late velocities on the lateral and medial sides of the mitral annulus increased from 0.7±0.3 to 0.9±0.4 (p<0.001) and from 0.5±0.1 to 0.6±0.1 (p<0.02), respectively. The ratio of early diastolic mitral inflow velocity to early diastolic myocardial relaxation velocity decreased from 10.7±4.3 to 8.5±2.5 (p<0.005). No improvements in diastolic function was detected in the control group. Glucose control improved similarly in both groups: HA1bc −1.5% (−17mmol/mol) vs −1.3% (−14mmol/mol), p=0.67. ConclusionsIn patients with type 2 diabetes, 6months liraglutide treatment was associated with a significant improvement in diastolic function.

Does ketogenic diet have any negative effect on cardiac systolic and diastolic functions in children with intractable epilepsy?: One-year follow-up results

ObjectiveThe ketogenic diet (KD) has been referred to as an “effective therapy with side effects” for children with intractable epilepsy. Among the most recognized adverse effects, there are cardiac conduction abnormalities, vascular and myocardial dysfunction. However, very limited and controversial data are available regarding the effects of the KD on cardiac functions. We sought to analyze the mid-term effect of ketogenic diet on cardiac functions in patients with intractable epilepsy who received a ketogenic diet for at least 12months using conventional and relatively new imaging techniques. MethodsThis prospective study included 61 patients with intractable epilepsy who received ketogenic diet for at least 12months. Clinical examinations, serum carnitine and selenium levels as well as electrocardiographic and echocardiographic examinations were scheduled prior to the procedure and at 1, 3, 6 and 12months. We utilized two-dimensional, M-mode, colored Doppler, spectral Doppler and pulsed wave tissue Doppler imaging techniques to investigate ventricular systolic and diastolic functions of this subgroup of patients. ResultsIn our study, there was no significant difference after 1year of KD therapy compared to baseline values—except a significantly decreased A wave velocity—in terms of pulse wave Doppler echocardiographic measurements of the diastolic function. The tissue Doppler measurements obtained from the lateral wall of tricuspide and mitral annuli were not different at baseline and at month 12 of the treatment, as well. ConclusionThe ketogenic diet appears to have no disturbing effect on ventricular functions in epileptic children in the midterm.

Impaired right and left ventricular mechanics in adults with pulmonary hypertension and congenital shunts.

To assess left ventricle mechanics in Eisenmenger physiology patients with congenital shunts, and their relationship with the right ventricle, and to consider the clinical usefulness of this information. The study involved 28 patients with pulmonary artery hypertension (PAH) and congenital shunt, matched with 28 healthy participants. Standard echocardiography and pulsed wave tissue Doppler imaging were employed to analyze systolic and diastolic ventricular function, the myocardial performance index (MPI) of ventricles, and the strain and strain rate along the left ventricle lateral wall, septum, and right ventricle free wall. The left ventricle ejection fraction was similar in the two groups. However, despite normal standard left ventricle measures, patients presented parameters of defective myocardial mechanics: mitral peak systolic velocity (S') (cm/s) (8.6 (7.6-10.9) vs. 10.7 (8.6-12.5); P = 0.002) was higher, whereas left ventricle-MPI was lower (0.54 ± 01 vs. 0.32 ± 0.07, P < 0.001). Right ventricle-MPI and right ventricle global strain were correlated significantly with left ventricle-MPI and left ventricle global strain (r = 0.74, P < 0.001; r = 0.442, P < 0.001, respectively). Clinically, the six-minute walking test results were correlated negatively with left ventricle-MPI (r = -0.69, P < 0.001), whereas the functional class was positively correlated (r = 0.36, P < 0.001). In conclusion, left ventricle mechanics and geometry are impaired in Eisenmenger syndrome patients, although conventional evaluation is in the normal range. Our results highlight the significance of ventricular interdependence in PAH and provide a useful tool for improving the clinical management of these patients.

Ocena funkcji systemowej prawej komory z wykorzystaniem tkankowej echokardiografii doplerowskiej u dzieci z zespołem niedorozwoju lewego serca po operacji metodą Fontana — wyniki wstępne

Introduction. Difficulties in the echocardiographic assessment of single ventricle function, particularly with right ventricular morphology, prompt to use different available echocardiographic techniques. Echocardiographic evaluation of the degree of hemodynamic disturbances affecting systemic ventricular function not only allows better investigation of the cardiovascular system but also helps determine prognostic factors to guide further therapeutic decisions. The role of tissue Doppler imaging (TDI) in paediatric patients with univentricular heart has been highlighted but only few studies evaluated the utility of this method in the evaluation of systemic ventricle systolic and diastolic function after the Fontan procedure. The aim of the study was to assess the relationship between conventional echocardiographic and TDI parameters in the evaluation of the performance of a functional single right ventricle in children with hypoplastic left heart syndrome (HLHS) after the Fontan procedure. Material and methods. A total of 34 patients with HLHS after staged surgical treatment culminating in the Fontan procedure underwent evaluation, including medical interview, physical examination, electrocardiography, and transthoracic echocardiography in standard views using M-mode, two-dimensional imaging, continuous and pulsed wave Doppler, colour Doppler, and TDI. The effect of demographic and perioperative factors on selected parameters of the echocardiographic evaluation of systemic ventricular function was analysed. In addition, we evaluated relations between conventional echocardiographic and TDI parameters in the evaluation of single right ventricular function in children after Fontan procedure. Results. Statistical analysis showed no significant correlation between TDI parameters of systolic and diastolic function (E’, E’/A’) and standard echocardiographic indices (E, A, E/A). Likewise, no significant correlation was found between the myocardial performance index (MPI) obtained from TDI and conventional MPI. A significant correlation was found between the E/E’ ratio and MPI. Conclusions. No significant correlation found in children after Fontan procedure between diastolic function parameters and right ventricular MPI measured using TDI and conventional echocardiographic parameters indicates that TDI is a technique complementary to conventional echocardiography in the evaluation of single right ventricle function in children. In addition, TDI does not depend on preload, and thus it can be speculated that this technique may identify ventricular dysfunction (mostly diastolic) at a stage when conventional echocardiographic parameters are still normal. Further studies in a larger number of patients are needed to support these conclusions.

Assessment of atrial electromechanical interval using echocardiography after catheter ablation in patients with persistent atrial fibrillation.

We sought to investigate variation of atrial electromechanical interval after catheter ablation procedure in patients with persistent atrial fibrillation using pulse Doppler (PW) and pulse tissue Doppler imaging (PW-TDI). A total of 25 consecutive in-patients with persistent atrial fibrillation, who restored sinus rhythm after ablation procedure, were recruited in our cardiac center. Echocardiography was performed on each patient at 2 hours, 1 day, 5 days, 1 month and 3 months after the ablation therapy, and atrial electromechanical delay was measured simultaneously by PW and PW-TDI. There was no significant difference between PW and TDI in measuring atrial electromechanical delay. However, at postoperative 2 hours, peak A detection rates were mathematically but nonsignificantly greater by PW-TDI than by PW. Second, there was a significant decreasing trend in atrial electromechanical interval from postoperative 2 hours to 3 months, but only postoperative 2-hour atrial electromechanical interval was significantly greater than atrial electromechanical interval at other time. Lastly, patients without postoperative 2-hour atrial electromechanical interval had a significantly longer duration of atrial fibrillation as compared to those with postoperative 2-hour atrial electromechanical interval, by the PW or by PW-TDI, respectively. In patients with persistent atrial fibrillation, atrial electromechanical interval may decrease significantly within the first 24 hours after ablation but remain consistent later, and was significantly related to patients’ duration of atrial fibrillation. Atrial electromechanical interval, as a potential predicted factor, is recommended to be measured by either PW or TDI after 24 hours, when patients had recovered sinus rhythm by radiofrequency ablation.

Nomograms for mitral inflow Doppler and tissue Doppler velocities in Caucasian children

BackgroundPediatric echocardiographic nomograms for systolic/diastolic functional indices are limited by small sample size and inconsistent methodologies. Our aim was to establish pediatric nomograms for mitral valve (MV) pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI) velocities. MethodsWe performed PWD/TDI measurements of MV velocities and generated models testing for linear/logarithmic/exponential/square root relationships. Heteroscedasticity was accounted for by White test or Breusch-Pagan test. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. ResultsIn all, 904 Caucasian Italian healthy children (age 0 days–17 years; 45.5% females; BSA 0.12–2.12m2) were prospectively studied. No individual variable provided equations with an acceptable coefficient of determination (R2) and even the inclusion of multiple variables in the model resulted in only a partial amelioration of the R2. Higher R2 were obtained for PWD-E deceleration time (0.53), septal (Se′) and lateral (Le′) MV-TDI e′ velocity (Se′: 0.54; Le′: 0.55). Variability was higher at lower age and BSA. In older children patterns were more reproducible; however, the exclusion of neonates did not substantially improve the final models. The low R2 hampered building of z-scores and calculation of estimated percentiles. Thus normative data have been presented as observed percentile according to age for all measurements. ConclusionsWe report normal ranges for PWD and TDI mitral velocities derived from a large population of Caucasian children. Variability of diastolic patterns especially at lower ages needs to be taken into account.

Dual gate Doppler法がもたらす可能性について

Dual gate Doppler analysis is one of the most useful methods developed in recent years. This technology allows us to assess two different regions of interest simultaneously. It facilitates the diagnosis of fetal arrhythmia. Furthermore, two different techniques, such as pulsed wave Doppler and tissue Doppler imaging, can be employed simultaneously. We hope dual gate Doppler analysis will allow us to investigate fetal circulation and/ or fetal condition.

Short-Time Impact of Laser Ablation of Placental Anastomoses on Myocardial Function in Monochorionic Twins with Twin-to-Twin Transfusion Syndrome.

Purpose To evaluate pre- and post-procedure myocardial function in monochorionic twins with TTTS who underwent laser ablation of placental anastomoses using pulsed wave tissue Doppler imaging (pw TDI). Materials and Methods 20 monochorionic twin gestations with TTTS were included and underwent laser ablation at our center between 2011 and 2014. Prior to and after the intervention, cardiac function was assessed by measuring the mitral annular plane systolic excursion (MAPSE), the tricuspid annular plane systolic excursion (TAPSE), Tei index, isovolumetric contraction time (ICT), ejection time (ET), isovolumetric relaxation time (IRT) for the left ventricle in pulsed wave Doppler (pw D) ultrasound as well as ICT, ET, IRT and Tei index in pw TDI for the left and right ventricle. E-, A-, E´- and A´-wave peak velocity and the systolic downward motion (S´) were measured for both ventricles and the E/A, E/E´ and E´/A´ ratios were calculated. In a mean of 1.3 (SD 0.6) days after laser ablation, this measurement protocol was repeated. Results Pre-intervention recipients had longer ICT, ET and IRT in pw D and pw TDI compared to donors not reaching statistical significance for most parameters. Statistically significant were prolonged ICT in pw D (p 0.01) and ET (p 0.01) in pw TDI in recipients. In donor fetuses preoperative myocardial function did not differ significantly from postoperative myocardial function except in increased left ventricular ejection time of the left ventricle in pw TDI (p 0.04) and an increased E´/A´ratio (p 0.01). After laser coagulation, myocardial function was slightly altered in recipients as ICT and IRT shortened and Tei indices decreased but only reaching statistical significance in shortened IRTs in pw TDI for both ventricles. Conclusion Laser ablation of placental anastomoses in TTTS might influence myocardial function in the postoperative period. Shortened IRT intervals may reflect an improvement of diastolic function in recipients.

Echocardiographic Evaluation of Cardiovascular Function in Cloned Dogs

Ju-Hwan Yeo, Jae-Hwan Kim, So-Young Kim, Seung-Jun Lee, Noh-Won Park, Hyun-Ju Oh, Min-Jung Kim, Geon-A Kim, Young-Kwang Jo, Byeong-Chun Lee and Kidong Eom. J Vet Clin 2015;32:301-7. https://doi.org/10.17555/jvc.2015.08.32.4.301

The Diagnostic Value of Pulsed Wave Tissue Doppler Imaging in Asymptomatic Beta- Thalassemia Major Children and Young Adults; Relation to Chemical Biomarkers of Left Ventricular Function and Iron Overload.

BackgroundCardiac iron toxicity is the leading cause of death among β-halassaemia major (TM) patients. Once heart failure becomes overt, it is difficult to reverse.ObjectivesTo investigate non-overt cardiac dysfunctions in TM patients using pulsed wave Tissue Doppler Imaging (TD I) and its relation to iron overload and brain natriuretic peptide (BNP).MethodsThorough clinical, conventional echo and pulsed wave TDI parameters were compared between asymptomatic 25 β-TM patients and 20 age and gender matched individuals. Serum ferritin and plasma BNP levels were assayed by ELISA.ResultsTM patients had significant higher mitral inflow early diastolic (E) wave and non significant other conventional echo parameters. In the patient group, pulsed wave TDI revealed systolic dysfunctions, in the form of significant higher isovolumetric contraction time (ICT), and lower ejection time (E T), with diastolic dysfunction in the form of higher isovolumetric relaxation time (IRT), and lower mitral annulus early diastolic velocity E′ (12.07 ±2.06 vs 15.04±2.65, P= 0.003) compared to the controls. Plasma BNP was higher in patients compared to the controls. Plasma BNP and serum ferritin had a significant correlation with each other and with pulsed wave conventional and TDI indices of systolic and diastolic functions. Patients with E/E′ ≥ 8 had significant higher serum ferritin and plasma BNP levels compared to those with ratio < 8 without a difference in Hb levels.ConclusionPulsed wave TDI is an important diagnostic tool for latent cardiac dysfunction in iron-loaded TM patients and is related to iron overload and BNP.

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.

Myocardial function in Saudi adolescents with vitamin D deficiency: Tissue Doppler imaging study

Vitamin D deficiency is a common health problem in Saudi Arabia especially in children and adolescents. Many studies have reported the relation between low 25-Hydroxyvitamin D (25(OH)D) levels with cardiovascular diseases risk factors as well as cardiovascular events, including stroke, myocardial infarction, and congestive heart failure. This study was conducted to evaluate the effect of 25(OH)D deficiency on the myocardial function and other echocardiographic variables in adolescent, using tissue Doppler imaging (TDI) and to correlate these parameters with 25(OH)D level. The study included 84 healthy adolescents, consecutively selected from adolescents attending the outpatient clinic of Saad Specialist Hospital, KSA between September 2013 and October 2014. The study population was classified into two groups; vitamin D deficient group with 25(OH)D level less than 20ng/mL and normal vitamin D (control group) with 25(OH)D equal or more than 30ng/mL. Both groups were subjected to measuring hemoglobin level, serum albumin, creatinine, total calcium, Phosphorous, intact parathyroid hormone (iPTH), B-type natriuretic peptide (BNP), and 25(OH)D levels. Both conventional and pulsed wave TDI were done for all participants. TDI measurements showed significant higher LV Tei Index and RV Tei index when compared to the control group (0.61±0.11 Vs 0.32±0.05 p<0.0001), (0.54±0.14 Vs 0.40±0.06 p<0.0001) respectively. Mitral and tricuspid annular systolic velocities were significantly lower in vitamin D deficient group (6.99±1.92 Vs 10.69±0.31cm/sec p<0.0001 and 12.30±2.14 Vs 13.89±0.29 p<0.0001 respectively). The mitral and tricuspid E/Em ratio was significantly higher in vitamin D deficient group than control group (p<0.0001, p 0.005) respectively. Left ventricular internal diameter at end-diastole (LVIDd) was significantly higher in vitamin D deficient group (44.72±6.33 Vs 40.36±6.21 p 0.003). Serum 25(OH)D level showed significant negative correlation with LV Tei index (r=−0.668, p<0.0001), RV Tei index (r=−0.421, p<0.0001). Vitamin D deficiency is associated with subtle systolic and diastolic myocardial dysfunction in Saudi adolescents. TDI is a useful tool for detecting early changes in the myocardium in this particular group.

Effect of food intake on left and right ventricular systolic tissue Doppler measurements

Systolic tissue Doppler measurements (s') have been used to measure the velocity in myocardial motion and are a valuable tool for evaluating the systolic function of the left and right ventricles. Digestion of food is known to significantly alter hemodynamics and may therefore affect s'. The effect of food intake on s' parameters has not yet been studied. We assessed whether s' is affected by food intake. Nineteen healthy subjects aged 26·2±4·2years were investigated. s' was measured with pulsed tissue Doppler imaging in the right and left ventricles before the subjects ate a standardized meal and also 30 and 110min after the meal. Three measurements were taken in each projection, and a mean value was calculated for each. s' increased significantly (P<0·05) from fasting to 30min after food intake in every measured site except in the left inferolateral wall (P=0·15, NS). Several, but not all, variables returned to base value 110min after food intake. This study shows that food intake affects the tissue Doppler variables used to evaluate systolic heart function. Further studies are needed in older healthy subjects and older subjects with various cardiovascular diseases.

Aortic biomechanics in hypertrophic cardiomyopathy

Background: Ventricular-vascular coupling is an important phenomenon in many cardiovascular diseases. The association between aortic mechanical dysfunction and left ventricular (LV) dysfunction is well characterized in many disease entities, but no data are available on how these changes are related in hypertrophic cardiomyopathy (HCM). Aim of the work: This study examined whether HCM alone is associated with an impaired aortic mechanical function in patients without cardiovascular risk factors and the relation of these changes, if any, to LV deformation and cardiac phenotype. Methods: 141 patients with HCM were recruited and compared to 66 age- and sex-matched healthy subjects as control group. Pulse pressure, aortic strain, stiffness and distensibility were calculated from the aortic diameters measured by M-mode echocardiography and blood pressure obtained by sphygmomanometer. Aortic wall systolic and diastolic velocities were measured using pulsed wave Doppler tissue imaging (DTI). Cardiac assessment included geometric parameters and myocardial deformation (strain and strain rate) and mechanical dyssynchrony. Results: The pulsatile change in the aortic diameter, distensibility and aortic wall systolic velocity (AWS') were significantly decreased and aortic stiffness index was increased in HCM compared to control (P < .001) In HCM AWS' was inversely correlated to age(r = − .32, P < .0001), MWT (r = − .22, P < .008), LVMI (r = − .20, P < .02), E/Ea (r = − .16, P < .03) LVOT gradient (r = − 19, P < .02) and severity of mitral regurg (r = − .18, P < .03) but not to the concealed LV deformation abnormalities or mechanical dyssynchrony. On multivariate analysis, the key determinant of aortic stiffness was LV mass index and LVOT obstruction while the role LV dysfunction in aortic stiffness is not evident in this population. Conclusion: HCM is associated with abnormal aortic mechanical properties. The severity of cardiac phenotype, not LV deformation, is interrelated to aortic stiffness in patients with HCM. The increased aortic stiffness seems to be promising module that can be added as clinical risk parameter in HCM.

Reference values for pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography.

In pediatric echocardiography, pulse wave Doppler, and tissue Doppler imaging velocities are widely used to assess cardiac function. Current reference values and Z scores, allowing adjustment for growth are limited by inconsistent methodologies and small sample size. Using a standardized approach for parametric modeling and Z score quality assessment, we propose new pediatric reference values and Z score equations for most left ventricular pulse wave Doppler and tissue Doppler imaging measurements. Two hundred thirty-three healthy pediatric subjects 1 to 18 years of age were prospectively recruited. Thirteen pulse wave Doppler and 14 tissue Doppler imaging measurements were recorded. Normalization for growth was done via a complete and standardized approach for parametric nonlinear regression modeling. Several analyses were performed to ensure adequate Z score distribution and to detect potential residual associations with growth or residual heteroscedasticity. Most measurements adopted a nonlinear relationship with growth and displayed significant heteroscedasticity. Compared with age, height, and weight, normalization for body surface area was most efficient in removing the effect of growth. Generally, polynomial and allometric models yielded adequate goodness-of-fit. Residual values for several measurements had significant departure from the normal distribution, which could be corrected using logarithmic or reciprocal transformation. Overall, weighted parametric nonlinear models allowed us to compute Z score equations with adequate normal distribution and without residual association with growth. We present Z scores for normalized pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Further studies are needed to define the threshold beyond which health becomes a disease by integrating other important factors such as ventricular morphology, loading conditions, and heart rate.