Pulsed-wave Tissue Doppler Imaging Research Articles

Left ventricular performance and dyssynchrony in heart failure and normal ejection fraction: assessment by stress echocardiography

Purpose: We evaluated the left ventricular (LV) performance and dyssynchrony in patients with heart failure and normal ejection fraction (HFNEF) during exercise as compared to those with heart failure and reduced ejection fraction (HFREF) and healthy subjects. Methods: All subjects received echocardiographic (Vivid7) examination with symptom-limited (fatigue or dyspnea) exercise testing on a semi-recumbent and tilting bicycle ergometer. The exercise images for two-dimensional (2D) speckle tracking were acquired with submaximal heart rate of 90-100bpm, while M-mode and tissue Doppler Imaging (TDI) exercise images were stored with attainment of >85% of maximal age-predicted heart rate response. Results: Stress echocardiography exams were performed in 40 HFNEF (aged 65±9 years; 53% male), 40 HFREF (aged 62±9 years; 90% male) and 30 normals (aged 56±5 years; 33% male). Trends of progressive decline in 2D global circumferential and radial strains (GCS & GRS), global longitudinal strains (2D GLS & GLS_TDI), pulsed-wave TDI systolic velocity (septal S') and M-mode mitral annular plane systolic excursion (MAPSE) were observed from control, HFNEF to HFREF groups (all p<0.05). LV twist was preserved in HFNEF but reduced in HFREF patients as compared to normals (p<0.001). Diastolic function measured by spetal e' progressively decreased from controls to HFNEF followed by HFREF (all p<0.05). LV filling pressure (septal E/e'), stroke volume and cardiac indices (LVSI & LVCI) were preserved in HFNEF but deteriorated in HFREF than controls. LV dyssynchrony parameters (standard deviation of time to peak systolic velocity, Ts-SD) were similar in all groups. Conclusions: This study provides the reference values of LV performance and dyssynchrony during exercise in HFNEF and knowledge about these changes provide important insights for future clinical studies.

GW24-e3081 Evaluation of right ventricular systolic function of patients with pulmonary hypertension by pulse wave tissue Doppler imaging

ObjectivesThe study purpose is to investigate the value of pulse wave tissue Doppler imaging (PW-TDI) in evaluating right ventricular systolic function of patients with pulmonary hypertension.Methods78 patients with pulmonary hypertension...

Right Ventricular and Septal Function in Patients with Pulmonary Hypertension

Pulmonary hypertension (PHT) exacerbates the functions of both ventricles. This prospective, randomised study was planned to investigate the effects of PHT on kinetics of both ventricles and the septum. Twenty-five patients were randomly selected among the patients who had been planned to undergo mitral valve replacement (MVR) because of isolated mitral stenosis and divided into two groups according to their preoperative pulmonary artery pressure (PAP) values. Blood pool gated single photon emission tomography (BPGS) and transthoracic echocardiography were performed. Ventricles' regional, global and functional parameters were also assessed by using pulsed wave Doppler tissue imaging (DTI). Preoperative and postoperative PAP of the group 1 (PAP < 50 mmHg) were 40.0 ± 2.8 and 30.0 ± 2.6 mmHg (p = 0.03), group 2 (PAP ≥ 50 mmHg) were 71.9 ± 4.7 and 50.6 ± 3.5 mmHg (p < 0.05). The global right and left ventricle scores were decreased after the operation. The decrement was only significant in group 2. Considering the septal kinetics, right ventricle septal score was decreased from 7.6 to 3.3 (p < 0.05) in group 1, from 3.8 to 1.6 (p < 0.05) in group 2 postoperatively. Following MVR, a decrement in PAP values, and an improvement in ventricular function, especially in the right ventricular and septal kinetics were achieved. Furthermore, it was found that both DTI and BPGS techniques are beneficial to investigate the functional changes postoperatively and in the follow-up period of the patients who undergo mitral valve surgery.

Evaluation of impaired left ventricular relaxation with normal ejection fraction by kinetic energy of blood flow in early diastole

Objective To evaluate the left ventricular(LV) impaired relaxation(IR) by kinetic energy of blood flow in early diastole (Ek) in patients with normal ejection fraction(EF).Methods 42 patients with impaired LV relaxation while normal EF (IR group) and 38 controls volunteers with normal LV relaxation (NR group) underwent conventional echocardiography and real-time three-dimensional echocardiography (RT-3DE).Pulsed-wave (PW) Doppler imaging and PW tissue Doppler imaging (PWTDI) were performed in all the subjects.PW Doppler imaging indices included peak E velocities (VE),peak A velocities (VA) and VE/VA.PW-TDI indices included velocities of septal and lateral sides of the mitral annulus in early diastole Se',Le'),then the average of Se' and Le' described as e') were calculated.RT3DE indices included end diastolic volume EDV),ejection fraction EF) and flow volume of peak E QE).Results There were significant difference between Ek of two groups P ＜0.05).There were significant positive correlation between Ek and e' in both the two groups P ＜0.05).And Ek was less influenced by age or systolic blood pressure.Area under curve of the ROC of Ek was 0.654,sensitivity was 63.2 ％ and specificity was 61.9％,respectively.And the specificity of Ek was higher than that of e' and VE/VA.Conclusions Ek was less influenced by age or afterload,which can be used to detect impaired LV relaxation. Key words: Echocardiography, real-time three-dimensional; Ventricular function,left ; Kinetic energy; Impaired relaxation

Tissue Doppler Imaging and Two-Dimensional Speckle Tracking of Left Ventricular Function in Healthy Horses After Clenbuterol Application

The cardiac effects of high dosages of the ß2-adrenergic agent clenbuterol have been the focus of several histological, biochemical and echocardiographic studies in the past. Possible effects of a therapeutic dosage on myocardial contractility and velocities have not been evaluated using tissue Doppler imaging (TDI) and two-dimensional speckle tracking (2DST) in equine medicine. Twenty-five healthy horses were treated over 14 days with clenbuterol in a normal dosage (0.8 μg/kg every 12 hours). Before and after the treatment, an echocardiographic examination was performed using B-mode, M-mode, color flow Doppler, and tissue Doppler imaging (TDI). In all horses, the radial and circumferential myocardial functions were recorded in the right parasternal short-axis view (SAX). Pulsed-wave (PW) and color TDI were used for evaluation of peak and mean myocardial velocities; myocardial deformation was documented in 2DST. An improvement of diastolic function after clenbuterol treatment was demonstrated by a significant increase of the early diastolic radial wall motion velocity (Em) in all myocardial sections except the right ventricular free wall (RVFW) in TDI, as well as an increase of the E/A quotient in the left ventricular free wall (LVFW) and the interventricular septum (IVS). Shortened time intervals, in particular in the LVFW and a tendency of increase of all deformation parameters showed improved relaxation characteristics of the cardiac muscle after treatment. The results can be interpreted as beginning physiologic cardiac hypertrophy due to clenbuterol treatment. No signs of increased rigidity or reduced compliance of the heart muscle could be found at the applied dosage. This study demonstrates the sensitivity of TDI and 2DST in equine cardiology to detect myocardial remodeling before the appearance of obvious findings in conventional echocardiographic techniques. This technique can be used to detect pharmacologic effects on myocardial function.

Non-invasive assessment of cardiac function in a mouse model of renovascular hypertension

Hypertension continues to be a significant cause of morbidity and mortality, underscoring the need to better understand its early effects on the myocardium. The aim of this study is to determine the feasibility of in vivo longitudinal assessment of cardiac function, particularly diastolic function, in a mouse model of renovascular hypertension. Renovascular hypertension (RVH) was induced in 129S1/SvImJ male mice (n=9). To assess left ventricular (LV) systolic and diastolic function, M-mode echocardiography, pulsed-wave Doppler echocardiography and tissue Doppler imaging were performed at baseline, 2 and 4 weeks after the induction of renal artery stenosis. Myocardial tissue was collected to assess cellular morphology, fibrosis, extracellular matrix remodeling and inflammation ex vivo. RVH led to a significant increase in systolic blood pressure after 2 and 4 weeks (baseline: 99.26±1.09 mm Hg; 2 weeks: 140.90±7.64 mm Hg; 4 weeks: 147.52±5.91 mm Hg, P<0.05), resulting in a significant decrease in LV end-diastolic volume, associated with a significant elevation in ejection fraction and preserved cardiac output. Furthermore, the animals developed an abnormal diastolic function profile, with a shortening in the E velocity deceleration time as well as increases in the E/e' and the E/A ratio. The ex vivo analysis revealed a significant increase in myocyte size and deposition of extracellular matrix. Non-invasive high-resolution ultrasonography allowed assessment of the diastolic function profile in a small animal model of renovascular hypertension.

Left Ventricular Function by Echocardiography, Tissue Doppler Imaging, and Carotid Intima-Media Thickness in Obese Adolescents With Nonalcoholic Fatty Liver Disease

The aims of this study were to evaluate left ventricular (LV) systolic and diastolic function in obese adolescents with nonalcoholic fatty liver disease (NAFLD) using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate the relations between LV function and carotid intima-media thickness (CIMT). LV remodeling, tissue Doppler-derived LV velocities, and cardiovascular risk profiles in obese adolescents with NAFLD were also studied. One hundred eighty obese adolescents and 68 healthy controls were enrolled in the study. LV end-diastolic and end-systolic and left atrial diameters and LV mass were higher in the 2 obese groups compared with controls. By pulsed-wave Doppler echocardiography and pulsed-wave tissue Doppler imaging, the NAFLD group had normal LV systolic function, impaired diastolic function, and altered global systolic and diastolic myocardial performance. In patients with NAFLD, LV mass was positively correlated with homeostasis model assessment of insulin resistance and serum alanine aminotransferase. CIMT was positively correlated with homeostasis model assessment of insulin resistance, alanine aminotransferase, and LV mass. By multiple stepwise regression analysis, alanine aminotransferase (β = 0.124, p = 0.026), homeostasis model assessment of insulin resistance (β = 0.243, p = 0.0001), LV mass (β = 0.874, p = 0.0001) were independent parameters associated with increased CIMT. In conclusion, insulin resistance has a significant independent impact on CIMT and LV remodeling in the absence of diabetes in patients with NAFLD. Pulsed-wave tissue Doppler imaging is suggested to detect LV dysfunction at an earlier stage in obese adolescents with NAFLD for careful monitoring of cardiovascular risk.

Usefulness of Pulsed Wave Tissue Doppler Imaging in Assessment of Left Ventricular Functions in Children with Beta-Thalassemia Major

To evaluate the changes in the LV systolic and diastolic function in children with beta-thalassemia major (β-TM) using pulsed wave tissue doppler (TD) echocardiography. Clinical, conventional echo doppler and pulsed wave tissue doppler imaging parameters were compared in 40 beta-thalassemia major patients (mean age, 6.52 ± 3.5 y) and 25 age and sex matched normal subjects (mean age, 6.5 ± 2.7 y). There were no significant statistical differences between mean fractional shortening (FS) and ejection fraction (EF) of left ventricle (LV) of the patients and control group. Children with beta-thalassemia had significantly lower E' wave velocities measured at the left ventricular septal annulus (8.1 ± 3.3 vs. 13 ± 2.5, P < 0.001), lateral margin of the mitral annulus (9.1 ± 5.4 vs. 13.3 ± 2.5, P < 0.001) and lateral margin of the tricuspid annulus (9.3 ± 3.9 vs. 13.3 ± 2.5, P < 0.001) when compared to the control group. Furthermore children with beta-thalassemia had significantly lower E'/A' wave ratio at the left ventricular septal annulus (0.76 ± 0.34 vs. 1.36 ± 0.23), lateral margin of the mitral annulus (0.83 ± 0.17 vs. 1.28 ± 0.22), and lateral margin of the tricuspid annulus ((0.90 ± 0.27 vs. 1.26 ± 0.23, (P < 0.05) when compared to the control group. This study showed that patients with beta-thalassemia major and normal conventional echo doppler parameters had statistically significant changes detected by pulsed wave tissue doppler imaging.

Correlates of Impaired Global Right Ventricular Function in Patients With a Reperfused Acute Myocardial Infarction and Without Right Ventricular Infarction

BackgroundThe frequency and clinical correlates of global right ventricular (RV) dysfunction in patients treated with primary percutaneous coronary intervention for a first acute ST-elevation myocardial infarction (STEMI) without a coexisting...

Tissue Doppler Is More Sensitive and Reproducible than Spectral Pulsed-Wave Doppler for Fetal Right Ventricle Myocardial Performance Index Determination in Normal and Diabetic Pregnancies

The aim of this study was to compare the reproducibility, agreement, and sensitivity of pulsed-wave Doppler tissue imaging (DTI) versus spectral Doppler assessment of right ventricular (RV) myocardial performance index (MPI) in midgestation fetuses in both a normal and a disease state. RV MPI was calculated using pulsed-wave DTI and spectral Doppler in normal pregnancies (n= 69) and in women with pregestational diabetes (n= 51). Intraobserver and interobserver variability and agreement were evaluated using Bland-Altman analysis. Student's t tests were used for comparisons of differences. In normal fetuses, RV MPI derived by the two methods showed no statistical difference, were interchangeable (DTI, 0.51 ± 0.10; spectral Doppler, 0.50 ± 0.12; P= .686), and were in agreement by Bland-Altman analysis. However, in fetuses of mothers with diabetes, the two methods produced different RV MPI measurements (DTI, 0.56 ± 0.10; spectral Doppler, 0.51 ± 0.12; P < .001). Intraobserver and interobserver bias was lower for DTI. The DTI method of measuring fetal RV MPI is more sensitive, has less variability and more precision, and is better able to demonstrate subtle abnormalities in cardiac function than the spectral Doppler method in diabetic versus normal pregnancies.

The Effects of Prolonged Acute Hypobaric Hypoxia on Novel Measures of Biventricular Performance

There are limited data on the effects of prolonged acute hypoxia on individual and global measures of biventricular function. The aim of this study was to assess its effects on conventional and novel measures of biventricular function, including the recently defined E'/(A'×S') (EAS) index, obtained using pulsed-wave tissue Doppler Imaging (PWTDI) and associated blood brain natriuretic peptide (BNP) levels. In this study, 14 healthy subjects aged 30.5 years were assessed at baseline and at >150 minutes following hypobaric hypoxia (HH) to the equivalent altitude of 4800 m for a total of 180 minutes. The combined EAS index (E'/(A' × S')) was calculated at the mitral and tricuspid annulus using data from the peak systolic (S') early (E') and late (A') diastolic filling. It was seen that HH increased resting heart rate (63.4 ± 8.4 vs. 85.2 ± 10.2/min; P < 0.0001), cardiac output (4.6 ± 0.7 L/min vs. 6.1 ± 1.2 L/min; P < 0.0001), peak pulmonary artery systolic pressure (PASP) (26.3 ± 2.0 mmHg vs. 37.2 ± 6.3 mmHg; P < 0.0001), and reduced SpO2 (98.5 ± 1.1 vs. 72.9 ± 8.1%; P < 0.0001). There was a significant reduction in mitral (0.19 ± 0.06 vs. 0.11 ± 0.03; P < 0.0001) and tricuspid (0.12 ± 0.04 vs. 0.09 ± 0.03; P = 0.03) EAS indices, but no change in left or right ventricular myocardial performance (Tei) indices, global left ventricular (LV) longitudinal systolic strain, BNP levels, or estimated filling pressures (E/E'). Only reducing SpO2 remained as an independent predictor of PASP on multivariate analysis (overall R(2) = 0.77; P < 0.0001). The right and LV EAS indices were significantly correlated (r = 0.45; 95% CI: 0.07-0.7; P = 0.02). The conclusion from this study was that acute prolonged HH does not adversely affect resting global biventricular function and there is evidence of linked right and LV responses.

Doppler Tissue Imaging Provides an Estimate of Pulmonary Arterial Pressure in Children with Pulmonary Hypertension Due to Congenital Intracardiac Shunts

The aim of this study is to determine the relationship between the cardiac catheterization findings and pulsed-wave (PW) Doppler and Doppler tissue imaging (DTI) in pulmonary arterial hypertension patients with congenital heart disease with intracardiac shunts. The present study aims to determine the relationship between the cardiac catheterization findings and PW Doppler and Doppler tissue imaging (DTI) in patients who have pulmonary arterial hypertension patients due to congenital heart disease with intracardiac shunts. Echocardiographic measurements were performed at the catheter angiography laboratory with concurrent catheterization. Left and right ventricle inflow velocities were recorded with PW Doppler and DTI studies. Maximum tricuspid regurgitation velocity (TS) was recorded in cases with measurable levels by continuous-wave Doppler. Moreover, the correlations among the echocardiographic values and invasive hemodynamic measures such as systolic pulmonary arterial pressure (PAPsystolic), mean pulmonary arterial pressure (PAPmean), diastolic pulmonary arterial pressure (PAPdiastolic) and pulmonary vascular resistance index (PVRI) were evaluated. A negative correlation was found between TE'/TA' and PAPsystolic, PAPdiastolic and PAPmean (P = 0.008, r = -0.480; P = 0.001, r = -0.584; P = 0.001, r = -0.567, respectively). ME/ME' was also found to be negatively correlated with PAPdiastolic, PAPmean and PVRI (P = 0.002, r = -0.556; P = 0.005, r = -0.502; P = 0.027, r = -0.411, respectively). The concurrent use of TE'/TA' (cut-off value <2.6) and TS had a sensitivity of 79% and a specificity of 93% for distinguishing between patients with healthy controls. When used in conjunction with conventional methods, TE'/TA' has the highest sensitivity and specificity in distinguishing between patients and healthy controls.

Association of left ventricular motion and central augmentation index in healthy young men

Central blood pressure is a determinant of cardiovascular outcome; however, it can be described by parameters other than systolic and diastolic pressure with central augmentation index (AIx) often utilized. Although generally considered as determined by peripheral pressure wave reflection, not all data are consistent with this interpretation of AIx. We hypothesized that the motion of the heart during systole may influence central pressure waveform morphology, including the AIx. We studied the carotid pressure waveform, aortic stiffness and endothelial function in 20 healthy young men (full data available in 19). Arterial stiffness was measured by carotid femoral pulse wave velocity (cfPWV), endothelial function by peripheral arterial plethysmography (PAPl) and central blood pressure waveform by carotid applanation tonometry. Basal cardiac motion was assessed with pulsed wave tissue Doppler imaging of the septal mitral annulus. Carotid AIx decreased after the administration of glyceryl trinitrate by 11.3 ± (sem) 4.6% (P = 0.02); however, time to the inflection point (Ti) did not change. During systolic contraction at both baseline and after glyceryl trinitrate, time to peak annular systolic velocity was directly related to, and always preceded, carotid Ti (R(2) = 0.81; P < 0.01). Carotid Ti and AIx were not related to cfPWV or endothelial function. In fit young men, rather than only being a consequence of arterial properties Ti, and therefore central AIx, may be substantially determined by left ventricular systolic function. These findings question the interpretation of central AIx as a measure of pressure wave reflection and aortic stiffness and potentially impact its interpretation in diagnosis and treatment of cardiovascular risk.

Mitral annular systolic velocity as a marker of preclinical systolic dysfunction among patients with arterial hypertension

BackgroundThe aim of this study was to investigate early changes in left ventricular longitudinal systolic function in patients with hypertension (HTN) with and without concomitant diastolic dysfunction (DD) and the clinical implications of these findings.MethodWe enrolled 299 patients with HTN and 297 age-matched patients with HTN and DD and compared both groups with an age-matched control group consisting of 100 healthy subjects. The long axis systolic function was investigated by determining the average peak systolic velocity of the septal and lateral mitral sites (Smavg) using spectral pulsed wave tissue Doppler imaging (TDI).ResultsWe found a strong negative trend toward the reduction of velocity, which is dependent on the grade of HTN, on the magnitude of DD, and also on the gender and age of the subjects (r=−0.891/-0.580; p<0.0001). The data showed that the beginning and evolution of HTN are related to a slight but significant reduction in the long axis systolic function (10.2-10.0 cm/s; p<0.0001), and DD worsens this initial finding (9.8-8.8 cm/s; p<0.0001).ConclusionThe strength of the study is the analysis of incremental changes in longitudinal contraction in patients with different stage of HTN but not so many the classification of the degree of systolic dysfunction. The importance of our results lies in the fact that these initial changes in systolic contraction could be used as an early sign that should prompt optimization of the treatment of HTN.

Abstract 19355: Tissue Doppler Imaging For Rejection Surveillance in Pediatric Heart Transplant Recipients

Conventional echocardiography is not considered reliable for rejection-surveillance in pediatric heart transplant (HT) recipients. Pulse-wave tissue Doppler imaging (TDI) is geometry-independent and more sensitive than conventional imaging to evaluate bi-ventricular function. The purpose of this study was to assess TDI findings during biopsy-proven rejection in pediatric HT recipients and to develop TDI criteria for absence of rejection with high predictive accuracy. Methods: All HT recipients in follow-up at our center were included (N=122, median age at transplant 8.7 yrs, range 2 weeks-22 yrs). We identified all echocardiograms with TDI imaging performed within 24 hrs of an endomyocardial biopsy during 2005-2011. Rejection was defined as ISHLT Grade ≥2R cellular rejection or antibody-mediated rejection. Paired comparisons of TDI velocities were made using each patient’s baseline TDI as control. Results: Overall, 650 biopsy-pairs were identified where there was no rejection by biopsy at baseline (median duration between paired biopsies 4.3 mo, 25th-75th percentile 1-8.7 mo). In 25 of these pairs, the second biopsy demonstrated cellular or antibody mediated rejection. Rejection was associated with 27±17 % decline in LV S’ (P&lt;0.001), 17±25 % decline in RV S’ (P&lt;0.001) and a 16±18 % decline in septal S’ velocity (P&lt;0.001). Using a receiver-operating characteristic curve, &lt;24% decline in LV S’, &lt;15% decline in RV S’ and &lt;12% decline in septal S’ were all individually associated with a negative predictive value (NPV) of 98% for rejection. When all three criteria were met, the NPV was 98.5% (95% CI 96.9%, 99.4%) for rejection. Overall, 83% of biopsy pairs met criteria of 98.5% NPV for rejection. Conclusions: Biopsy-proven rejection in pediatric HT recipients is associated with significant and easily measured changes in ventricular function using TDI echocardiography. Using well-defined TDI criteria to predict absence of rejection, over 80% of planned biopsies may be deferred or avoided at minimal risk to pediatric HT recipients.

Assessment of left ventricular geometry, functions and mass in patients with metabolic syndrome

Background and aims The frequent coexistence of obesity, arterial hypertension, and lipid and carbohydrate disorders is well known. Although these conditions have been identified as independent risk factors for impaired left ventricular diastolic function, there is a paucity of data on the dysfunction among patients with metabolic syndrome (MS). The aim of this study was to determine the impact of metabolic syndrome on left ventricular systolic and diastolic functions, mass and geometry by using conventional echocardiography and pulsed wave tissue Doppler imaging in individuals with MS compared to healthy subjects. Methods The study included 120 subjects divided by half into control and case group: 60 subjects (30 males and 20 females) with MS (diagnosed according to consensus statement from the International Diabetes Federation (platinum standard)) aged 54.4 ± 9.5 years and 60 healthy subjects (32 males and 28 females) aged 50.3 ± 13.7 years. Left ventricular ejection fraction (LVEF) was measured with the Tiech method in the short axis parasternal view by averaging measurements from five consecutive cardiac cycles. The LV diastolic function was estimated with Doppler measurement of transmitral blood flow and determination of the maximal rates for E and A peaks, E/A ratio, delay time (DT) for early diastolic filling rate, E′, A′ and E′/A′ ratio according to criteria of the European Study Group on diastolic heart failure. IMP was be calculated as the sum of IVRT and IVCT divided by ventricular ET (IMP = IVRT + IVCT/ET). LV mass was determined using the corrected cube formula as (0.80 × {1.04 × [(septal thickness + LV internal diameter + posterior wall thickness) 3 − (LV internal diameter) 3 ]} + 0.6). Results The assessed parameters using conventional and tissue Doppler echocardiography showing that those with metabolic syndrome had greater LV mass and significantly lower E/A ratio; increased LVH and significantly higher IMP, indicating impaired global left ventricular functions in patients with MS compared with control subjects without MS. There were no statistically significant difference in EF percentage. Conclusions Our results demonstrate that LV functions are impaired in patients with metabolic syndrome using IMP and E/A ratio. LVH incidence are higher in metabolic syndrome patients. To conclude metabolic syndrome are associated with significant cardiac functions deterioration and should be prevented and treated in proper manner.

Comparison of left and right atrial appendages anatomy and function in patients with mitral stenosis and sinus rhythm

Abstract Background The left atrial appendage (LAA) has been considered a relatively significant portion of the cardiac anatomy. Transesophageal echocardiography (TEE) is a technique that makes clear imaging of the LAA possible, so that its shape and function can be assessed. Tissue Doppler imaging (TDI) was used recently for the assessment of the contractile function of the left atrial appendage (LAA) and right atrial appendage (RAA). Patients and methods Forty-three patients with pure mitral stenosis (MS) in sinus rhythm were compared to 12 normal individuals only patients with mild and severe mitral stenosis were included. Patients with moderate mitral stenosis were excluded. A transthoracic and a transesophageal echo were performed in all patients. We assessed the LAA anatomy (neck width, length, area). Assessment of LAA function was done by the recording of LAA emptying velocity. Pulsed-wave tissue Doppler imaging (TDI) was positioned at the tip of the LAA and the tip of the RAA to obtain atrial peak systolic (Sm) and diastolic myocardial velocities. Results Patients with MS (severe and mild) had a larger left atrial diameter and area than the control {50.5 ± 3.8 & 46.2 ± 4.5 vs 35.4 ± 1.8, and 31.2 ± 3.3 & 26 ± 2.3 vs 19.9 ± 1.4} P-value 0.0001 & 0.0001, respectively and patients with MS (severe and mild) had a higher PASP than the control {50.9 ± 10.5 & 30 ± 7 vs 25.2 ± 1.6} P-value 0.0001. TEE data of patients with MS (severe and mild) had a larger left atrial appendage length, base, and area than the control {(49.8 ± 6.38 & 42 ± 2.5 vs 37.8 ± 2.2), (27.7 ± 3.8 & 23.2 ± 3.1 vs 18 ± 2.5), and (7.6 ± 0.6 & 6.5 ± 0.5 vs 4.6 ± 0.7} P-value 0.0001. Patients with MS (severe and mild) had a significant decrease in atrial peak systolic flow velocities (S wave) than the control (16.1 ± 3.7 & 26.5 ± 0.7 vs 70 ± 13), P-value 0.0001.Also patients with MS (severe and mild) had significant decrease in atrial peak systolic myocardial velocities (Sm wave) of the LAA compared with the control (6.1 ± 1.7 & 12.6 ± 0.3 vs 18.8 ± 1.9), P-value 0.0001. (TDI) flow of the RAA myocardial velocity, patients with mitral stenosis (severe and mild) had a significant decrease in atrial peak systolic myocardial velocities (Sm wave) of the RAA compared with the control (16.5 ± 2.9 & 17.7 ± 1.6 vs 20.1 ± 2.6), P-value 0.0001. SEC was detected in the LAA in 17 patients of the 43 patients with mitral stenosis which represents 39.5% of the patients. All patients with SEC were with severe MS. Patients with SEC had a significant increase in Fc, mean transmitral gradient, PASP, Sm LAA, Sm RAA, LAA area and peak S velocity LAA than patients without SEC. No patient had SEC in the RAA cavity. Conclusion LAA and RAA dysfunction occurred in patients with MS and sinus rhythm due to increase of atrial afterload presented by a decrease in atrial myocardial velocities.

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Allograft dysfunction is a common finding early after heart transplant (HT). We sought to assess the recovery of left (LV) and right ventricular (RV) function during the first year after HT in children and young adults using pulsed-wave tissue Doppler imaging. We analyzed serially performed echocardiography in 44 pediatric HT recipients (median age: 7.3 years at HT) who remained rejection-free during the first year post-transplant. Age-based normative values for systolic (S'), early-diastolic (E'), and late-diastolic (A') velocities obtained using pulsed-wave tissue Doppler imaging in 380 healthy children were used to transform patient data into z scores. Pulsed-wave tissue Doppler imaging studies ≤10 days post-HT demonstrated biventricular systolic and diastolic dysfunction with most prominent impairment in RV systolic function (S' z score -2.7±0.8), RV early-diastolic filling (E' z score -2.3±1.1), and LV early-diastolic filling (E' z score -2.3±1.1). LV systolic function (S' z score) and late-diastolic filling (A' z score) improved to normal in 11 to 30 days, LV early-diastolic filling (E' z score) in 4 to 6 months, and RV early-diastolic filling in 6 to 9 months (P<0.001 for all on longitudinal analysis). However, RV systolic function (RV S' z score -1.2±1.1) remained impaired 1-year post-transplant. Analysis of serial cardiac catheterization studies showed that RV and LV filling pressures were elevated early post-HT and declined gradually during the first year post-transplant. Pediatric HT recipients have biventricular dysfunction using pulsed-wave tissue Doppler imaging early after HT with most significant impairment in RV systolic function and RV and LV early-diastolic filling. Although other aspects of LV and RV function normalize in 6 to 9 months, RV systolic function remains abnormal 1 year-post-transplant.

Quantitative study of left ventricular function in the normal fetuses by mitral annular displacement

Objective To measure mitral annual displacement (MAD) by M-mode echocardiography in normal second and third trimester fetuses,and assess relationships between MAD and gestational age and routine echocardiographic parameters for evaluation of left ventricular function.Methods One hundred fifty-five normal fetuses from 19 to 38 weeks of gestation were recruited in the study.MVD and tricuspid annual displacement (TAD) were measured.Early diastolic inflow velocities (E) of the atrioventricular valves were assessed by pulsed-wave Doppler(PW),and early diastolic velocities (Em) of the mitral annular were estimated by pulsed-wave tissue Doppler imaging (TDI).The ratio of E/Em was calculated.Results In normal fetuses,the MAD was (7.05 ± 1.17) mm.There was significant positive correlation between the fetal MAD and advancing gestational age ( r =0.82,P ＜0.01 ),and between MAD and E,A,Em,Am or Sm ( r =0.25,0.24,0.32,0.29 and 0.40 respectively,P ＜0.01).There was no correlation between fetal MAD and E/A,E/Em,LVEF or LVFS.The left MAD was significantly lower than the right TAD ( P ＜0.01 ).Conclusions MAD of fetuses from 19 to 38 weeks of gestation can be quantitatively measured by Mmode echocardiogram.The measurement of MAD provides a reliable quantitative standard to estimate long axis ventricular function of fetuses,which may be clinically useful in prenatal detecting early cardiac failure. Key words: Echocardiography; Fetus; Ventricular function, left

Fetal tissue Doppler imaging in pregnancies complicated with preeclampsia with or without intrauterine growth restriction

This study's aim was to evaluate the effect of preeclampsia and intrauterine growth restriction (IUGR) on fetal cardiac function, and the relationship of the latter with adverse pregnancy outcomes. We did a cross-sectional study of 132 women with uncomplicated singleton pregnancies, 34 with preeclampsia without IUGR, and 12 with preeclampsia and IUGR. Fetal cardiac structure and function were evaluated using fetal two-dimension ultrasound, pulsed wave Doppler and tissue Doppler imaging (TDI). Data were analyzed by t-tests, ANOVA, Chi-square tests, or Wilcoxon rank-sum test. Compared with the normal pregnancy group, mitral/tricuspid early systolic peak velocity of annulus/late diastolic peak velocity of annulus (Sa) and left ventricular (LV)/right ventricular (RV) early diastolic peak velocity at the annulus (Ea) in TDI decreased in preeclampsia with or without IUGR (P < 0.05). LV/RV Ea underwent a gestational decrease in preeclampsia with or without IUGR (P < 0.05). The changes in mitral/tricuspid Sa and LV Sa associated with preeclampsia were even more pronounced with preterm delivery at less than 34 gestational weeks and stillbirth (P < 0.05). Intrauterine growth restriction influences fetal cardiac function in the presence of preeclampsia, and TDI may be a sensitive and preferable method to detect such changes. Fetal LV/RV Ea is a potential marker for early fetal cardiac diastolic impairment, and mitral/tricuspid Sa and LV Sa may be predictors for adverse pregnancy outcomes.