Pulsed-wave Tissue Doppler Imaging Research Articles

The efficacy of tissue Doppler imaging in predicting myocardial iron load in patients with beta-thalassemia major: correlation with T2* cardiovascular magnetic resonance

Tissue Doppler imaging (TDI) can detect myocardial dysfunction related to iron load in patients with beta-thalassemia major (TM). We aimed to assess the efficacy of pulsed-wave TDI (PW-TDI) in predicting myocardial iron load in patients with TM using T2* magnetic resonance (MR) as the gold-standard non-invasive diagnostic test. 33 asymptomatic TM patients, mean aged 18 +/- 6 years (6-31) with normal left ventricular (LV) global systolic function were evaluated by conventional echocardiography and PW-TDI. Results were compared with 20 age and sex-matched controls. TDI measures included myocardial systolic (Sm), early (Em) and late (Am) diastolic velocities at basal and middle segments of septal and lateral LV wall. Myocardial iron deposition were measured in 29/33 patients by T2* MR. TM patients were also subgrouped according to those with iron load (T2* <or= 20 ms) and those without (T2* > 20 ms). Mean T2* was 12.3 +/- 7.8 ms (4-31.3). Abnormal myocardial iron load (T2* < 20 ms) was found in 25/29 (86%) patients. The following TDI measures were lower in patients than in controls: basal septal Em (P < 0.001) and Am (P < 0.05), mid-septal Am (P < 0.05), mid-lateral LV wall Sm (P < 0.05) and Am (P < 0.05). Regional myocardial dysfunction were more prominent in patients with T2* <or= 20 ms. Mid-septal Sm and Em significantly correlated with mid-septal T2*(r = 0.44, P = 0.023 and r = 0.54, P = 0.004, respectively). The PW-TDI parameters and the cut-off values for predicting presence of myocardial iron load were determined. PW-TDI technique was found both sensitive and specific in predicting presence of myocardial iron load in TM patients with normal LV global systolic function. Therefore, it can be used for screening of TM patients.

Tricuspid Annular Velocity Assessed by Doppler Tissue Imaging as a Marker of Right Ventricular Involvement in the Acute and Late Phase after a First ST Elevation Myocardial Infarction

Right ventricular (RV) involvement in patients with ST elevation myocardial infarction (STEMI) is a clinically important problem. The aim of this study was to evaluate the use of tricuspid annular velocity assessed by Doppler tissue imaging (DTI) as a marker of RV involvement in patients with a first STEMI. Seventy-one patients with a first STEMI were examined by echocardiography before discharge and after 6 months. The patients were compared to 31 healthy subjects (HS). The diagnosis of RV infarction was based on the presence of >or= 1 mm ST elevation in the right precordial ECG lead V4R. Tricuspid annular systolic and diastolic velocities using pulsed-wave DTI were recorded at the RV free wall. At day 1, tricuspid annular velocities were significantly reduced in patients with, compared to those without, ST elevation in V4R (11.1 vs. 13.7 cm/sec, 9.4 vs. 13.1 cm/sec and 14.1 vs. 15.9 cm/sec for systolic, early, and late diastolic velocities, respectively; P < 0.01). With a cutoff value for a tricuspid annular systolic velocity of 13 cm/sec, sensitivity and specificity for identifying patients with ST elevation in V4R were 89% and 71%, respectively. After 6 months, both tricuspid annular systolic and diastolic velocities in patients with RV infarction had increased significantly, but only tricuspid annular systolic velocity was still reduced compared to HS (12.3 vs. 14.7 cm/sec; P < 0.01). Tricuspid annular velocities assessed by DTI may be used as a marker of RV involvement in the acute and the late phase after a first STEMI.

The Association between Left Ventricular Diastolic Dysfunction and Increased Aortic Stiffness Can Be Explained by Possible Neurohumoral Mechanisms

In our study, we tried to find an answer to the question "How could the association between left ventricular diastolic dysfunction (LVDDF) and increased aortic stiffness (IAS) be explained?" Cases without coronary artery disease (CAD) were divided into three groups according to their left ventricular (LV) inflow patterns and their LV basal-lateral annulus pulsed-wave tissue Doppler imaging (pw-TDI). Group 1 (n = 38) represented the normal LV inflow pattern while Group 2 (n = 54) represented impaired LV relaxation and Group 3 (n = 18) represented pseudonormalization. Aortic diameters were measured by using M-mode at a level that is 3 cm above the aortic valve. Aortic strain (AS) and aortic distensibility (AD) were calculated by using aortic diameters and pulse pressure. In Group 3, AS was lower compared to Groups 1 and 2 (respectively P < 0.001, P = 0.040). AS was also lower in Group 2 compared to Group 1 (P = 0.012). AD was higher in Group 1 compared to Groups 2 and 3 (respectively P = 0.01, P < 0.001). Early diastolic velocity of aortic pw-TDI was higher in normal LV inflow compared to Groups 2 and 3 (respectively P = 0.022, P = 0.050). Unfortunately, none of echocardiographic parameters that evaluate LV and aortic functions together (stroke volume, pulse pressure/stroke volume, pulse pressure/stroke volume index) were different among the groups. The results of our study clearly showed the association between LVDDF and IAS in cases without CAD. Additionally, it was concluded that this togetherness could be explained not by hemodynamic factors but by possible neurohumeral mechanisms.

Function of the left ventricular myocardium in patients with systemic sclerosis

Deposits of myocardial fibrosis are the principal cause of myocardial dysfunction and poor prognosis in the patients with systemic sclerosis. Our aim was to assess whether there are changes in regional function of the left ventricular myocardium in female patients with systemic sclerosis without clinical signs and symptoms of cardiovascular disease. The study included 23 female patients with systemic sclerosis (without cardiovascular disease and with normal global systolic and diastolic function of the left ventricle) and 21 healthy female controls. In both groups, pulsed wave tissue Doppler imaging was done at rest and during exercise stress test echocardiography. The myocardial function was assessed from the basal segments in systola and diastola. The level achieved and duration of exercise tests were significantly reduced in the patients with systemic sclerosis compared to the controls (P < 0.001 for both). The patients had significantly lower baseline regional systolic (P < 0.02) and diastolic (P < 0.001) myocardial functions, which became even more evident after the exercise test. During the test, those with systemic sclerosis demonstrated a smaller increase of systolic (20.6%) and diastolic (6.5%) function compared to the controls (systolic by 32.3% and diastolic by 25.0%). Quantification of regional function of the left ventricular myocardium using pulsed wave tissue Doppler imaging demonstrated an impaired systolic and diastolic myocardial function in the female patients with systemic sclerosis who had no clinical signs and symptoms of a cardiovascular disease.

Evaluation of Subclinical Right Ventricular Dysfunction in Obstructive Sleep Apnea Patients Using Velocity Vector Imaging

The aims of this study were to evaluate subclinical regional right ventricular (RV) dysfunction in newly diagnosed obstructive sleep apnea (OSA) patients without systemic and pulmonary arterial (PA) hypertension, and to correlate OSA severity to RV dysfunction, using both velocity vector imaging (VVI)-derived strain imaging and tissue Doppler imaging (TDI). The OSA group consisted of 27 patients and the control group consisted of 26 healthy participants. All participants underwent 24-h ambulatory blood pressure monitoring. Peak systolic myocardial velocities, strain, and strain rate (SR) were determined at the basal and mid segments of the RV free wall by VVI. Additionally, RV myocardial velocities were assessed by pulsed-wave TDI. Patients with OSA had significantly impaired VVI-derived peak systolic myocardial velocities, strain, and SR (P<0.0001 for all). RV isovolumic acceleration (IVA) was the only TDI-derived parameter that was significantly impaired (P<0.0001). RV IVA (r=-0.512, P<0.0001), RV mid free wall strain (r=0.568, P<0.0001) and SR (r=0.519, P<0.0001) revealed the best correlations with apnea hypopnea index (AHI). Subclinical RV dysfunction is present in OSA patients despite normal systemic and PA pressures. Tissue Doppler-derived RV IVA and VVI-derived RV deformation can accurately recognize and quantify RV function abnormalities in this subgroup of patients.

Mitral Annular Systolic Velocity: Clinical Determinants and Relationship to Diastolic Function in Population-based Subjects

Background: Systolic mitral annular velocity (Sm), a marker of longitudinal left ventricular (LV) systolic function, has been shown to be reduced in subjects with LV diastolic dysfunction (DD) despite “normal” LV ejection fraction (EF). However, there are limited data to evaluate the clinical determinants of Sm and independent effects of DD on Sm in unselected populations. Aim: To assess the clinical and echocardiographic determinants of Sm in a population-based sample of older adults. Methods: A total of 463 participants of a longitudinal cohort study (mean age 75.5 ± 5.9 years, 52% men) were examined by echocardiography. Sm at the lateral (Smlat) and septal (Smsep) annulus was assessed by pulse-wave tissue Doppler imaging. Results: Smlat was higher than Smsep (0.074 m/s vs. 0.064 m/s, p < 0.001) with a modest correlation between sites (ρ = 0.5; p < 0.001). Smlat was higher in men (0.077 m/s vs. 0.071 m/s; p = 0.005) and lower in those with a history of myocardial infarction and atrial fibrillation (p = 0.003 for both). Sm had a modest correlation with markers of DD (for Smlat: e’: ρ = 0.34; p < 0.001; E/e’: ρ = −0.41;p < 0.001) and was reduced according to DD severity (Table). There was only weak correlation with EF (ρ = 0.14; p = 0.003); LV mass index (ρ = −0.20; p < 0.001); age (ρ = −0.13; p = 0.006); heart rate (ρ = 0.11; p = 0.015); and systolic blood pressure (ρ = −0.15; p < 0.001). In multivariable analysis, DD remained a strong independent predictor of Sm (p < 0.001). Conclusions: In an unselected population of older adults, the relationship between Sm and DD is independent of the effects of other echo-clinical factors. Sm is reduced according to the severity of DD. Normal, n = 155

Left Ventricular Function in Children and Adolescents With Type 1 Diabetes Mellitus

Background and ObjectivesAdult studies have reported that patients with diabetes mellitus (DM) show ultrastructural and functional myocardial deterioration. The aim of this study was to assess whether cardiac functional deterioration can be detected in pediatric patients with type I DM and whether or not a relatively short duration of DM and hyperglycemia influences cardiac function.Subjects and MethodsForty-seven children and adolescents with DM and 38 healthy subjects (control group) were enrolled. Glycosylated hemoglobin (HbA1c), DM-induced complications, and left ventricular (LV) function as assessed using conventional and unconventional echocardiography {tissue Doppler imaging (TDI) and vector velocity imaging (VVI)} were evaluated.ResultsThe conventional echocardiographic parameters, with the exception of early peak mitral inflow velocity, the findings of pulsed wave TDI at the annular level, and regional ventricular function by VVI, were not significantly different between the two groups. Using the conventional and unconventional indices of systolic and diastolic function, no significant relationship was found between the duration of DM and the echocardiographic parameters. The deceleration time (DT) and E'/A' had an inverse correlation with HbA1c (p=0.042 and p=0.016, respectively).ConclusionPatients with DM in childhood and early adolescence rarely have insight on the significance of DM, and their diet is difficult to control. An alteration of myocardial function induced by DM may begin earlier than generally thought, and these changes are accelerated when glycemic control is poor. We recommend the early institution of close observation of patients with diabetes for alterations in cardiac function, in addition to other diabetic complications.

Early Left Ventricular Mechanics Abnormalities in Prehypertension: A Two-Dimensional Strain Echocardiography Study

Prehypertension predicts established hypertension. In this study, the aim was to analyze left ventricular (LV) mechanics in borderline prehypertensive (pre-HT) and hypertensive (HT) subjects through two-dimensional (2D)-strain echocardiography and then evaluate possible relations between cardiac parameters and insulin metabolism (homeostasis model assessment of insulin resistance (HOMA(IR)). Seventy-four consecutive newly diagnosed, untreated HT were divided, on the basis of their office blood pressure (BP) measurements, confirmed by ambulatory BP monitoring (ABPM), in 41 borderline pre-HT (ABPM: 122.5 +/- 6.7/76.2 +/- 5.2 mm Hg) and 33 never-treated mild HT (ABPM: 138.3 +/- 7.3/87.6 +/- 7.1 mm Hg). Thirty-three healthy normotensive (NT) controls (ABPM: 114.8 +/- 6.3/73.1 +/- 6.1 mm Hg) (P < 0.0001) were also studied (NT). All subjects performed 2D color Doppler and pulsed-wave tissue Doppler imaging (PW-TDI). Left ventricular mass (LVM) was significantly higher in pre-HT (39.2 +/- 8.7 g/m(2.7)) and in HT (43.6 +/- 8.5 g/m(2.7)) compared with NT (30.9 +/- 7.4 g/m(2.7)) (P < 0.0001). A mild LV diastolic dysfunction was found both with Doppler mitral flow velocity and PW-TDI at mitral annulus level analysis. Longitudinal 2D strain in pre-HT (-18.9% +/- 3.4) and in HT (-18.0% +/- 3.3) was significantly lower than in NT (-23.9% +/- 3.0) (P < 0.002). These LV abnormalities were associated with systolic ABPM, LVM, and HOMA(IR). Early abnormalities of LV longitudinal systolic deformation were found both in pre-HT and HT, together with a mild LV diastolic dysfunction. In both groups this early cardiac systolic and diastolic dysfunction is associated to insulin resistance, systolic pressure load, and cardiac remodeling.

Speckle myocardial imaging modalities for early detection of myocardial impairment in isolated left ventricular non-compaction

ObjectiveTo examine the hypothesis that speckle myocardial imaging (SMI) modalities, including longitudinal, radial and circumferential systolic (s) and diastolic (d) myocardial velocity imaging, displacement (D), strain rate (SR) and strain...

Assessment of right ventricle function during exercise echocardiography by using tissue Doppler imaging in patients with coronary artery disease

Assessing right ventricle (RV) function is difficult primarily because of its complex shape. Worsening RV function or dilatation during stress tests in patients with coronary artery disease may indicate proximal right coronary artery (RCA) narrowing. The aim of this study was to obtain quantitative diagnostic criteria for impaired RV function by tissue Doppler imaging (TDI) during exercise echocardiography, which could detect a significant lesion of the RCA in patients with coronary artery disease. We evaluated regional systolic and diastolic function using pulsed-wave TDI in two myocardial segments of the RV free wall during exercise stress tests in 160 patients with suspected coronary artery disease. The diagnostic criteria were obtained by comparing TDI and coronary angiography data. The accuracy, sensitivity, and specificity of the TDI diagnostic model for RCA disease were 81.1, 88.0, and 72.3%, respectively. TDI is a highly accurate method for the detection of RV dysfunction and RCA disease at rest and during exercise stress echocardiography in group of patients with known or suspected coronary artery disease.

Atrial interaction in the form of ‘cross talk’ in patients with ventricular outflow tract obstruction

The Bernheim 'a' wave in the jugular venous pulse of patients with left ventricular hypertrophy has been shown to reflect accentuated right atrial activity. To study possible atrial interaction in patients with right and left ventricular outflow tract obstruction due to significant pulmonary (PS) and aortic valvular stenosis (AS) respectively. We studied 41 PS patients (age 36 ± 10 year) and 41 AS patients (age 35 ± 12 year) and their results were compared with those of 27 controls (age 30 ± 7 year). RV and LV filling were recorded by conventional PW Doppler. Biventricular segmental function was studied using the PW tissue Doppler imaging (TDI) and M-mode techniques. The 2 patient groups had similar degree of ventricular outflow tract obstruction. Long axis function was impaired while global systolic function was preserved in the pressure-overloaded ventricle. Patients had higher peak late filling (A wave) and TDI late diastolic (Aa) velocities recorded in the disease-free ventricles despite having similar peak early filling velocities (E wave), E wave deceleration time and E/Ea ratios were not different from controls (p > 0.05 for all). Such accentuation of atrial activity (A wave) was moderately correlated with the degree of contralateral ventricular outflow tract obstruction (p < 0.001 for both). Long axis function is more sensitive than global function in revealing myocardial dysfunction in the pressure-overloaded ventricles. The increased contralateral atrial systolic activity suggests an evidence for atrial interaction in the form of 'cross talk'.

Abstract 4897: Right Ventricular Diastolic Dysfunction in Upper-normal and Mildly Hypertensives: A Tissue Doppler Imaging Study

Background: Systemic hypertension is known to affect the right ventricle in addition to its wide-ranging effects on left ventricular structure and function. Whether upper-normal increments in systemic blood pressure (BP), sampled by ABPM, exert any effect on right ventricular function is, however, unknown at this point. Methods: Left (LV) and right ventricular (RV) diastolic longitudinal function were assessed by pulsed-wave TDI sampled at mitral (early:Em MIT and late:Am MIT ) and tricuspid (Em TRIC and Am TRIC ) annular level in a group of 98 (37F/61M, age: 46 ± 14yrs) otherwise normal subjects with office BP values ranging from the optimal (&lt; 120/80 mmHg) to the mild hypertensive (140–160/90–100 mmHg) range. RV free wall (FWT) and interventricular septum thickness (IVST), LV ejection fraction (EF), TRIC annulus plane systolic excursion (TAPSE, an index of RV systolic function), LV mass index (MI, g/m 2.7 ) were evaluated by standard methods. The sample was stratified by ascending 24-hr systolic(S) BP tertiles (cutoffs:117 and 130 mmHg, I:110 ± 7/68 ± 7, II:125 ± 4/77 ± 7, III:139 ± 7/87 ± 8 mmHg) and analyzed accordingly. Results : Em TRIC decreased significantly at each increasing 24-hr SBP stratum (I:15.9 ± 2.8, II:12. ± 3.1, III:10.9 ± 3.6 cm/sec, I vs II p &lt; 0.01, II vs III p &lt; 0.01) in parallel with consensual reductions in Em MIT (I:11.1 ± 2.8, II:8.7 ± 2.9, III:8.3 ± 2.6 cm/sec, I vs II &amp; III p &lt; 0.001). RVFWT (I:3.5 ± 0.6, II:4.0 ± 1.1, III:3.6 ± 0.9 mm, NS) and LVMI (I:38.6 ± 8.3, II: 41.3 ± 6.6, III: 43.0 ± 9.1 g/m 2.7 , NS) did not change in contrast to the graded, BP-related thickeness of IVS (I: 7.9 ± 1.1, II: 9.3 ± 1.25, III: 10.3 ± 1.34 mm, I vs II: p = 0.001, II vs III: p = 0.001). Intra-individually (n = 98), Em TRIC associated with 24-hr SBP (r =−0.52, p &lt; 0.001), IVST (r = −0.63, p &lt; 0.001) and Em MIT (r = 0.41, p &lt; 0.001) but only the two latter (IVST: t = 5.5, p &lt; 0.0001; Em MIT : t = 2.8, p = 0.006) were independent predictors of Em TRIC when entered in a multiple regression model. Conclusions : Systemic BP increments still within the normal range associate with echocardiographic evidence of RV diastolic longitudinal dysfunction. Interventricular septum thickening appears to be the main determinant of that behavior, possibly as an expression on interventricular dependence.

Tissue Doppler Imaging can be useful to distinguish pathological from physiological left ventricular hypertrophy: a study in master athletes and mild hypertensive subjects

BackgroundTransthoracic echocardiography left ventricular wall thickness is often increased in master athletes and it results by intense physical training. Left Ventricular Hypertrophy can also be due to a constant pressure overload. Conventional Pulsed Wave (PW) Doppler analysis of diastolic function sometimes fails to distinguish physiological from pathological LVH.The aim of this study is to evaluate the role of Pulsed Wave Tissue Doppler Imaging in differentiating pathological from physiological LVH in the middle-aged population.Methodswe selected a group of 80 master athletes, a group of 80 sedentary subjects with essential hypertension and an apparent normal diastolic function at standard PW Doppler analysis. The two groups were comparable for increased left ventricular wall thickness and mass index (134.4 ± 19.7 vs 134.5 ± 22.1 gr/m2; p > .05). Diastolic function indexes using the PW technique were in the normal range for both.ResultsPulsed Wave TDI study of diastolic function immediately distinguished the two groups. While in master athletes the diastolic TDI-derived parameters remained within normal range (E' 9.4 ± 3.1 cm/sec; E/E' 7.8 ± 2.1), in the hypertensive group these parameters were found to be constantly altered, with mean values and variation ranges always outside normal validated limits (E' 7.2 ± 2.4 cm/sec; E/E' 10.6 ± 3.2), and with E' and E/E' statistically different in the two groups (p < .001).ConclusionOur study showed that the TDI technique can be an easy and validated method to assess diastolic function in differentiating normal from pseudonormal diastolic patterns and it can distinguish physiological from pathological LVH emphasizing the eligibility certification required by legal medical legislation as in Italy.

Analysis of Left Ventricular Regional Dyssynchrony: Comparison between Real Time 3D Echocardiography and Tissue Doppler Imaging

There is a paucity of information concerning left ventricular (LV) dyssynchrony assessment by real time three-dimensional (3D) echocardiography (RT3DE) versus tissue Doppler imaging (TDI). To compare RT3DE and TDI LV dyssynchrony assessment. A prospective study of 92 individuals (56 men, age 47 +/- 10 years), 32 with dilated cardiomyopathy (CMP), and 60 healthy individuals. By RT3DE, we measured the LV% dyssynchrony index (DI) of 6, 12, and 16 segments (SDI). By pulsed-wave TDI, we measured the QS electromechanical interval in the basal segments of the mitral valve annulus of the septum, the lateral, anterior and inferior walls, and the TDI% DI. In the normal group, the 3D DI was 1.1 +/- 0.8%, 1.4 +/- 1.3%, 1.8 +/- 1.7%, for 6 segments, 12 segments, and SDI, respectively. The correlation coefficient (Pearson's r) for the TDI DI and SDI was r = 0.2381 (P = 0.0470). In CMP group, the 3D DI was 4.6 +/- 5.4%, 7.9 +/- 7.1%, 11.1 +/- 7.1%, for 6 segments, 12 segments, and SDI, respectively. The correlation coefficient for TDI DI and SDI was r = 0.7838 (P < 0.0001). We observed a good correlation between RT3DE and tissue Doppler LV dyssynchrony assessment in patients with advanced heart failure.

Abnormal Left Ventricular Longitudinal Functional Reserve Assessed by Exercise Pulsed Wave Tissue Doppler Imaging in Patients with Subclinical Hypothyroidism

Response of systolic and diastolic velocities of mitral annulus to exercise in patients with subclinical hypothyroidism (SCH) has not been explored previously. We sought to investigate whether SCH is associated with abnormal left ventricular (LV) longitudinal function reserve to exercise. Mitral annular systolic (S') and early diastolic (E') velocities were measured at rest and during supine bicycle exercise using tissue Doppler echocardiography (TDE) in 23 patients with newly diagnosed SCH and 25 controls. LV diastolic and systolic longitudinal function reserve indices were calculated. There were no significant differences in mitral inflow velocities at rest between groups except for LV end-diastolic dimension and LV end-systolic dimension, which were higher in the control group. E' and S' at rest were also similar between the groups. However, S' (9.8 +/- 1.5 vs. 11.3 +/- 1.5 cm/sec at 25 W, P = 0.001; and 11.3 +/- 1.8 vs. 13.1 +/- 1.8 cm/sec at 50 W, P = 0.001) and E' (13.8 +/- 1.4 vs. 15.7 +/- 1.6 cm/sec at 25 W, P < 0.001; and 15.6 +/- 1.6 vs. 18.2 +/- 1.5 cm/sec at 50 W, P < 0.001) during exercise were significantly lower in patients with SCH. Longitudinal systolic and diastolic function reserve indices were significantly lower in patients with SCH (systolic index, 1.4 +/- 0.9 vs. 2.5 +/- 0.9 cm/sec at 25 W, P = 0.001; and 2.7 +/- 1.3 vs. 4.1 +/- 1.2 cm/sec at 50 W, P = 0.001; diastolic index, 2.3 +/- 1.3 vs. 3.6 +/- 1.5 cm/sec at 25 W, P = 0.003; and 3.9 +/- 1.6 vs. 5.9 +/- 1.3 cm/sec at 50 W, P < 0.001). Assessment of LV longitudinal functional reserve with exercise using TDE appears to be helpful in identifying early myocardial dysfunction in SCH.

Methods and Reliability of Tissue Doppler Imaging for Assessment of Left Ventricular Radial Wall Motion in Horses

Noninvasive assessment of left ventricular (LV) function is incompletely studied in horses. The goals of this study were to investigate the feasibility, techniques, and reliability of tissue Doppler imaging (TDI) for characterization of LV radial wall motion in healthy horses. Three Standardbreds, 3 Thoroughbreds; age 8-14 years; body weight 517-606 kg. Repeated echocardiographic examinations were performed by 2 observers in unsedated horses using TDI. Test reliability was determined by estimating measurement variability, within-day interobserver variability, and between-day interobserver and intraobserver variability of all echocardiographic variables. Variability was expressed as coefficient of variation (CV) and the absolute value below which the difference between 2 measurements will lie with 95% probability. Assessment of LV radial wall motion by TDI was feasible in all horses. Measurement variabilities were very low (CV < 5%) to low (CV 5-15%) for most variables. Within-day interobserver variability as well as between-day interobserver and intraobserver variabilities were low to moderate (CV 16-25%) for most variables. All pulsed-wave TDI variables of systolic LV function showed very low to low variability, whereas some of the variables of LV diastolic and LA function showed moderate to high (CV > 25%) variability. Pulsed-wave TDI variables appeared more reliable than color TDI variables. Measurement of TDI indices of LV function is feasible and reliable in adult Standardbred and Thoroughbred horses. The clinical relevance of LV function assessment by TDI remains to be determined.

Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy

In patients with ischaemic left ventricular (LV) dysfunction and viable myocardium, revascularization improves systolic function. Diastolic dysfunction is also present in such patients; however, whether revascularization improves diastolic function also is largely unknown. Twenty-six patients with chronic ischaemic cardiomyopathy [ejection fraction (EF) 32 +/- 6%, wall motion score index (WMSI) 2.45 +/- 0.33] and viable myocardium (low-dose dobutamine echocardiography) were examined at baseline and > or =4 months after revascularization. Diastolic function was assessed by transmitral pulsed-wave Doppler and tissue Doppler imaging (TDI) at the mitral annulus. At baseline, 62% of patients showed non-restrictive filling (non-RF) pattern, and 38% restrictive filling (RF) pattern. After revascularization, along with improvement in systolic function (EF 43 +/- 10%, WMSI 1.78 +/- 0.47, P = 0.0002 for both), diastolic filling improved in most patients, with only three patients still exhibiting RF pattern (P = 0.016); furthermore, E' velocity increased (32 +/- 42%, P = 0.0028) and E/E' decreased (-19 +/- 31%, P = 0.0378) compared with baseline. Left ventricular filling pressure also decreased, from 17.5 +/- 6.8 to 13.1 +/- 6.5 mmHg (P = 0.005). Improvement of diastolic function by TDI was related to the extent of viability at baseline (P = 0.0098) and to LV reverse remodelling after revascularization (P = 0.0092). In patients with ischaemic cardiomyopathy, LV diastolic filling may largely improve after revascularization. Improvement of diastolic dysfunction is related to the amount of viable tissue and it may represent an additional advantage of revascularizing dyssinergic but viable myocardium.

Subtle Systolic Dysfunction May Be Associated with the Tendency to Develop Diastolic Heart Failure in Patients with Preserved Left Ventricular Ejection Fraction

We looked for an answer to the question of whether diastolic heart failure (DHF) is a reality or all heart failures are systolic. 300 cases (hypertensive, aged, obese, etc.), not being diagnosed DHF, with preserved left ventricular (LV) ejection fraction (EF) but having the tendency to develop DHF in future were examined. One hundred and eighty cases without exclusion criteria were selected. Cases were assigned to three groups according to noninvasively obtained pulmonary capillary wedge pressure (PCWP). In cases with higher PCWP (>10 mmHg), transmitral A velocity was increased (P < 0.001) and among the pulsed wave tissue Doppler imaging (pw-TDI) parameters Ea velocity was decreased (P < 0.001) and Ea-dt was prolonged (P < 0.005). In cases with lower PCWP (<8 mmHg), transmitral E velocity was higher (P< 0.001). Furthermore, a more meaningful relationship was found between PCWP and systolic pw-TDI parameters. In all the groups, it was observed that Sa velocity was progressively decreased and Q-Sa interval was progressively prolonged as PCWP increased (for all the groups P < 0.046). The question whether DHF is a reality or all heart failures are systolic may be answered as follows. Subtle systolic dysfunction may be associated with the tendency to develop DHF in patients with preserved LV ejection fraction. As in systolic heart failure (EF < 45%), in patients with preserved systolic function (EF > or = 45%), systolic and diastolic functions may impair together. The pw-TDI method may be more sensitive than standard echocardiography parameters in detection of systolic dysfunction in cases with preserved EF.

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.

Influence of left ventricular diastolic function on pulmonary function in healthy individuals

The aim of this study was to determine if left ventricular (LV) diastolic function influences pulmonary function (PF) in healthy subjects and to determine if they are independently related after accounting for age, gender, BMI and blood pressure (BP). Echocardiograms and PF tests were performed in 103 healthy subjects (22‐76 yr). The ratio of peak early (E) and late (A) mitral inflow velocities and the ratio of peak early (E') and late (A') mitral annular velocities were obtained by pulsed wave Doppler and tissue Doppler imaging. The first stage of diastolic dysfunction, often observed in healthy aging, is characterized by reduced E and E', and greater A and A' resulting in a reversal of E/A and E'/A'. PF measures included forced vital capacity (FVC), carbon monoxide diffusing capacity (DLCO) and forced mid‐expiratory flow (FEF25‐75). Age, gender and BMI accounted for &gt;60% of the interindividual variation between diastolic function and PF. After accounting for age, gender, BMI and BP, E' was positively associated with FVC (additional R2=0.03, P&lt;0.01). A was negatively and A' positively associated with DLCO (additional R2=0.03, R2=0.01, P&lt;0.05) and FVC (additional R2=0.03, R2=0.03, P&lt;0.01). E/A was positively associated with DLCO (additional R2=0.02, P&lt;0.01). In conclusion, LV diastolic function may influence PF in healthy subjects, with the greatest interactions being observed in older males. NIH HL71478