Pulsed-wave Tissue Doppler Imaging Research Articles

Echocardiographic Assessment of Right Ventricular Function: How to Account for Tricuspid Regurgitation and Pulmonary Hypertension

Echocardiography is the usual initial test in dyspneic patients, but its application to right ventricular (RV) analysis is challenging. RV evaluation involves 3 steps, starting with quantification of afterload and pre-load. RV afterload is assessed by measurement of pulmonary artery systolic pressure (PASP) from tricuspid regurgitation (TR) velocity and right atrial pressure; pulmonary regurgitation velocity can also be used to assess pulmonary artery (PA) diastolic and mean PA pressure. Estimation of pulmonary vascular resistance (PVR) is useful if RV function is impaired. The second step is to assess the mechanism and severity of TR. For quantification of RV performance, we usually use 1 conventional (tricuspid annular plane systolic excursion [TAPSE], fractional area change [FAC], or right ventricular index of myocardial performance [RIMP]) and 1 novel method (pulsed wave or color Doppler tissue imaging systolic velocity [s'], or strain imaging). RV volumes may be measured using 3-dimensional echocardiography (Fig. 1, Table 1).

Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease

Coronary artery disease (CAD) is often silent in diabetic patients, and it is typically in advanced stages of development by the time it manifests. Various forms of stress testing have been investigated to detect obstructive CAD in diabetes mellitus. To assess the diagnostic value of dobutamine stress pulsed-wave Doppler tissue imaging (DTI) compared with standard wall motion analysis in detection of myocardial ischemia in diabetic patients with suspected CAD. The study comprised 46 diabetic patients with suspected CAD who underwent dobutamine stress echocardiography (DSE) with DTI within 4 weeks before coronary angiography (CA). Dobutamine infusion started at 5 μ/kg/min and increased up to 40 μ/kg/min with additional atropine during submaximal heart rate responses. In addition to wall-motion score index (WMSI) analysis, pulsed-wave DTI examination of basal and mid segments of posteroseptal, lateral, anterior, inferior and anteroseptal walls was performed. Myocardial velocities were measured at rest in the apical 4, 3 and 2-chamber views. The measurements were repeated at low dose (10–15 μ/kg/min) and at peak stress (40 μ/kg/min). DTI measurements included peak systolic velocity ( S ), peak early diastolic velocity ( E ) and peak late diastolic velocity ( A ) and the results were compared to WMSI analysis. Patients were classified into two groups according to CA results; group (I) diabetics with positive CA ( n = 27) and group (II) diabetics with negative CA ( n = 19). There was no significant difference between the two groups in duration of diabetes, global WMSI at rest or the Δ changes (stress-rest/rest) of WMSI ( p > .05). Global S and global E were significantly lower in group I compared to group II at peak stress (11.3 ± 3.7 cm/s vs. 14.5 ± 2.2 cm/s, p < 0.01) and (11.3 ± 1.6 cm/s vs. 13.1 ± 2.1 cm/s, p < 0.01) respectively. The cutoff points for global S and global E to detect obstructive CAD in diabetics were 11.3 cm/s and 11.2 cm/s respectively with 75.7%, 73.4% sensitivity and 94.7%, 89.47% specificity respectively. An increment (Δ changes) less than 0.56 in S or 0.26 in E from rest to peak stress identified CAD with 78.8%, 89.3% sensitivity and 94.7%, 90.7% specificity respectively. The accuracy of DTI parameters during peak stress was higher than WMSI analysis (sensitivity 74.1% vs. 59.3% and specificity 90% vs. 79%, p < 0.01 for each). In multivariate regression analysis, only Δ S and Δ E were independent predictors of obstructive CAD in diabetics (odd ratio: 36.16, 95% CI, 1.34–532.01 and 63.77, 95% CI, 3.19–721.47) respectively. Quantitative analysis, using DTI during DSE, adds new dimension in diagnosis of myocardial ischemia. It is more sensitive, specific, accurate and reproducible compared with standard wall motion analysis for recognition of significant CAD in diabetic patients.

Prognostic Value of Tricuspid Annular Tissue Doppler Velocity in Heart Failure with Atrial Fibrillation

Right ventricular function is associated with long-term outcomes of heart failure (HF), particularly with atrial fibrillation (AF). The aim of this study was to evaluate the prognostic value of Doppler tissue imaging at the mitral and tricuspid annuli in patients with HF and AF. In this prospective observational study, 457 patients (mean age, 67 years; 283 men) referred for HF with AF were enrolled and underwent conventional echocardiography including pulsed-wave Doppler tissue imaging. Systolic (s') and early diastolic (e') velocities of the tricuspid and mitral annuli were recorded from the apical four-chamber view. The development of clinical adverse events during the follow-up period was defined as the composite of cardiac death and readmission for HF. During the follow-up period (median, 20 months), 37 patients reached the primary end point (nine deaths and 28 cases of HF). Patients with cardiac events were significantly older and more often had previous HF admissions and diuretic use, higher New York Heart Association classes, and greater average ratios of peak early diastolic mitral inflow to annular velocity. Additionally, Doppler tissue imaging of s' and e' at the tricuspid, septal, and lateral mitral annuli were all reduced. Multivariate analysis showed that tricuspid s' and septal e' remained significant predictors of cardiac events. By Kaplan-Meier analysis, the occurrence of cardiac events was more frequent when tricuspid s' was <9.0 cm/sec (P < .001) and when septal e' was <7.3 cm/sec (P < .001). In patients with HF and AF with a high risk for cardiac events, tricuspid s' and septal e' can be independent risk predictors of outcomes.

208: Ventricular functional responses to altered loading conditions in the fetal heart: a sheep study with acute fetal ductus arteriosus occlusion

loading conditions in the fetal heart: a sheep study with acute fetal ductus arteriosus occlusion Jason Hashima, David Sahn, Muhammad Ashraf, Vanessa Rogers, Stephen Langley, Lowell Davis, Roger Hohimer, Juha Rasanen Oregon Health and Science University, Obstetrics and Gynecology, Portland, OR, Oregon Health and Science University, Pediatric Cardiology, Portland, OR, Oregon Health and Science University, Pediatric Surgery, Portland, OR, Oregon Health & Science University, Maternal Fetal Medicine, Portland, OR OBJECTIVE: We hypothesized that during acute fetal ductus arteriosus (DA) occlusion (DO) left ventricular performance is improved by acutely increased preload, while an increase in right ventricular afterload has a negative impact on its function. STUDY DESIGN: Nine ewes with singleton pregnancies underwent surgery at 120-126 gestational days (term 145 days) for the placement of a vascular occluder around fetal DA. Fetal carotid artery and jugular vein were cannulated. After a 5-day recovery, fetal heart rate (FHR), right (RVSV) and left (LVSV) ventricular stroke volumes were measured by ultrasonography. Using pulsed-wave tissue Doppler imaging, left and right ventricular lateral wall longitudinal myocardial velocities were obtained at the level of mitral (MV) and tricuspid (TV) valve annuli. Ventricular systolic function was assessed by measuring isovolumic contraction velocity (IVCV) and its acceleration (loadindependent index of ventricular contractility) and diastolic function by measuring isovolumic relaxation velocity (IVRV) and its deceleration. From TV regurgitation jet, dP/dT was calculated to estimate right ventricular contractility. All the measurements were obtained at baseline, 15 and 60 minutes after DO, and 15 minutes after release of DO. RESULTS: All the data are presented as means (SD).* p 0.05, compared with baseline. CONCLUSION: Acute DO in fetal sheep increases LV preload and RV afterload. During DO, LVSV increased and RVSV decreased, respectively. The rise in LV preload did not affect LV contractility, however signs of diastolic dysfunction were observed. Right ventricle was able to maintain its systolic and diastolic function during an acute increase in afterload. These findings suggest that fetal LV could be more sensitive to acutely altered loading conditions than RV.

Right Ventricular Function in Patients With Different Infarction Sites After a First Acute Myocardial Infarction

IntroductionTo investigate the effect of different infarction sites on right ventricular (RV) functional changes in patients with a first acute ST-elevation myocardial infarction without concomitant RV infarction. MethodsSixty consecutive patients underwent conventional echocardiography and pulsed-wave tissue Doppler imaging for RV function evaluation after successful primary percutaneous coronary intervention. They were divided into 2 groups according to infarct location based on the electrocardiographic findings: group I consisted of 35 patients with anterior (including anteroseptal) wall infarction and group II included 25 patients with inferior (including inferoposterior) wall infarction. Ten healthy individuals served as the control group. ResultsThe tricuspid annular plane systolic excursion was significantly lower in group I compared with that in the controls (20.3 ± 3.8 versus 23.9 ± 2.4mm, P < 0.05). The ratio of transtricuspid peak early filling velocity to tricuspid annular early diastolic velocity (E/Em) was comparable between group I and group II, whereas it was higher in group II than in the controls (6.10 ± 1.37 versus 4.33 ± 1.17, P < 0.05). The RV myocardial performance index determined by tissue Doppler imaging was significantly higher in group I than in group II (0.48 ± 0.25 versus 0.32 ± 0.10, P < 0.05) and the healthy controls (0.48 ± 0.25 versus 0.27 ± 0.08, P < 0.05). ConclusionsIn patients with a first, acute reperfused ST-elevation myocardial infarction without associated RV infarction, RV function may be affected discrepantly depending on the different infarction sites. In patients with inferior infarction without concomitant RV infarction, only regional RV diastolic dysfunction is observed, whereas the alteration of global RV function is more pronounced in patients with anterior wall infarction.

Study of quantitative assessment of left ventricular systolic function by tissue motion annular displacement in heart failure patients

ObjectiveTo evaluate the ability of tissue motion annular displacement (TMAD) for assessment of global left ventricular systolic function in heart failure patients.MethodsThe HF group and the control group were composed...

Assessment of mitral annular velocities by Doppler tissue imaging in predicting left ventricular thrombus formation after first anterior acute myocardial infarction

Abstract Introduction This study was carried out in cardiology department, Zagazig University from August 2005 to December 2006. This study included 60 patients with first acute anterior myocardial infarction. These patients were 36 male (72%) and 14 female (28%). Aim of the work The aim of this study is to determine whether early assessment of mitral annular velocities by pulsed wave tissue Doppler imaging predicts left ventricular thrombus formation after first acute anterior myocardial infarction or not. Patients and methods Patients included in our study represented by first time anterior wall acute myocardial infarction who met the following criteria; chest pain lasting more than 30 min, ST segment elevation greater than 2 mm in two consecutive anterior electrographic leads and transient elevation of biochemical cardiac markers. Patients were excluded if they had evidence of previous anterior myocardial infarction, valvular heart disease, patients with poor Echo window and conduction abnormalities. All patients were subjected to the following: complete history taking, thorough physical examination, laboratory tests, 12-lead surface ECG, determination if the patient was received thrombolytic therapy or not and echocardiographic evaluation (M-mode, two-dimensional and DTI assessment) was performed for all patients within 24 h of arrival to CCU to evaluate LV function and to measure mitral annular velocities then two-dimensional echocardiography to determine thrombus was formed on days 7 and 30. Patients were divided into two groups: group (1); patients with LV thrombus (19 patients “31.6%”) and group (2); patients without LV thrombus (41 patients “68.4%”). Results There was no significant difference between the two groups as regards age, gender, diabetes mellitus, hypertension, heart rate, peak CPK and whether patients received thrombolytic therapy or not. LVESV and LVEDV were higher in group (1) than in group (2) while EF was lower in group (1) than in group (2). As regards WMSI is higher in group (1) than in group (2). E wave velocity was higher in group (1) than in group (2), while A wave velocity was lower in group (1) than in group (2) and E/A ratio is higher in group (1) than in group (2). Deceleration time of E wave was shorter in group (1) than in group (2) and IVRT were lower in group (1) than in group (2). Em wave velocity was lower in group (1) than in group (2), Am wave velocity had no significant difference between the two groups while Em/Am ratio was lower in group (1) than in group (2) and E/Em ratio was higher in group (1) than in group (2). Sm wave velocity was lower in group (1) than in group (2). From previous data and correlation of TDE finding with other echocardiographic data, we found that systolic and diastolic functions were impaired in patients of group (1) than in group (2) but Sm velocity and WMSI had higher sensitivity and higher specificity (94.7% sensitivity, 95.1% specificity for Sm wave velocity and 94.2% sensitivity, 90.2% specificity for WMSI). Conclusion From our study, we can conclude that TDE can be used for estimation of systolic and diastolic functions of LV and hence identification of patients at high risk for LV thrombus formation after first time acute anterior myocardial infarction and we recommend more studies to support our results about the importance of the role of oral anticoagulant after AMI.

Assessment of right ventricular function by myocardial performance index in diabetic patients

Abstract Background Assessment of right ventricular (RV) function remains difficult because of the RV complex shape. Data regarding RV performance in patients with diabetes are incomplete The aim of this study was to assess the feasibility of pulsed wave tissue Doppler imaging and myocardial performance index (MPI) for the assessment of right ventricular function in diabetic patients without coronary artery disease. Methods The study included 20 diabetic patients, 20 diabetic hypertensive and 20 gender and age matched healthy subjects underwent standard echocardiography with tissue Doppler imaging (TDI) to assess RV function. Patients with myocardial ischemia, impaired left ventricular systolic function, valvular heart disease or other diseases which could alter the right ventricular performance were excluded. Results Myocardial performance index was significantly higher in diabetes compared to control group (0.41 ± 0.05 versus 0.27 ± 0.04, p = 0.001). Peak myocardial systolic velocity (Sa), early diastolic myocardial velocity (Ea), and late diastolic myocardial velocity (Aa) were significantly lower in patients with diabetes mellitus (DM) compared to the control group (p = 0.0001). Isovolumetric relaxation time (IVRT) was significantly higher in DM group compared to control group (p = 0.003). MPI was significantly higher in diabetic hypertensive group versus DM alone group (0.46 ± 0.050 versus 0.41 ± 0.05, p = 0.01). There was no correlation between MPI and blood glucose level and duration of diabetes. Conclusion Myocardial performance index is a useful noninvasive tool for the detection of early right ventricular systolic and diastolic dysfunction in diabetic patients, regardless of coexisting hypertension.

Evaluation of a novel index by tissue Doppler imaging in patients with advanced heart failure: relation to functional class and prognosis

Despite the ability of tissue Doppler imaging (TDI) to detect left ventricular (LV) systolic and diastolic myocardial functions in patients with heart failure, the added value of TDI to clinical variables and conventional echocardiography in predicting the symptoms and outcome of advanced heart failure has not been clearly defined. Two hundred and thirty adult patients diagnosed with congestive heart failure were assigned to study groups based on the New York Heart Association functional classes. Pulsed-wave TDI (PWTDI), including average of peak systolic (Sm), early (Em) and late diastolic (Am) velocities from six mitral annular sites was evaluated. PWTDI was also calculated to create a combined index (EAS index) of diastolic and systolic performances. All patients were followed up for cardiac-related death and hospitalisation as a result of heart failure. Patients with functional class III-IV had a significantly higher EAS index (0.21 ± 0.19 vs. 0.13 ± 0.08, p < 0.05) than those with class I-II and the control (0.10 ± 0.04, p < 0.05). Except for Sm and Em, all conventional echocardiographic Doppler parameters and TDI variables significantly correlated with functional class. Moreover, according to multiple stepwise analysis, EAS index and percentage of chronic renal insufficiency (CRF) were the only two independent predictors of functional class (EAS index, p = 0.006; CRF, p = 0.019). During follow-up (median, 30 months), 93 participants had cardiac events. EAS index, LV mass index and CRF were significant predictors of cardiac mortality and hospitalisation [EAS index, hazard ratio (HR) 4.962, p = 0.006; LV mass index, HR 1.007, p = 0.003; CRF, HR 1.616, p = 0.040]. The EAS index, which reflects systolic and diastolic performances, is a highly effective means of differentiating between patients with functional class I-II and those with III-IV. The index also correlates with cardiac mortality and hospitalisation for worsening heart failure, thus providing additional value to conventional echocardiographic measures.

Pulsed-wave tissue Doppler imaging of the myocardium of cats with induced thyrotoxicosis

Left ventricular myocardial motion was quantified using pulsed-wave tissue Doppler imaging (PW-TDI) in nine adult cats before and after thyrotoxicosis induction. In order to induce thyrotoxicosis, all cats were given 150µg kg-1 of levothyroxine sodium as a single oral dose each day for 10 weeks. PW-TDI examinations were performed immediately before the induction and by the end of the experimental protocol. An increase in myocardial motion velocity was documented at the interventricular septum level, demonstrated by an elevation in systolic (Sa), and early (Ea) and late (Aa) diastolic waves (P&lt;0.05). However, no alteration in Sa, Ea and Aa values was seen at the lateral mitral annulus. Heart rate increased significantly between the experimental stages, and three of the animals presented fused Ea and Aa waves at the end of the experiment. The experimental protocol used in this study caused alterations in left ventricular myocardial motion velocity, but did not impair left ventricular diastolic function.

Subclinical Regional Left Ventricular Dysfunction in Obese Patients With and Without Hypertension or Hypertrophy

We investigated the impact of obesity on the abnormalities of systolic and diastolic regional left ventricular (LV) function in patients with or without hypertension or hypertrophy, and without heart failure. We studied 120 individuals divided into 6 groups of 20 patients (42 ± 6 years, 60 females) using standard and pulsed-wave tissue Doppler imaging (TDI) echocardiography, and heterogeneity index (HI): nonobese (I: no hypertension, no hypertrophy, control group; II: hypertension, no hypertrophy; III: hypertension and hypertrophy) and obese (IV: no hypertension, no hypertrophy; V: hypertension, no hypertrophy; VI: hypertension and hypertrophy). The criterion for obesity was BMI ≥30 kg/m2, for hypertension was blood pressure ≥ 140/90 mm Hg, for hypertrophy in nonobese was LV mass/body surface area (BSA) >134 g/m(2) (men) and >110 mg/m2 (women), and in obese was LV mass/height(2.7) >50 (men) and >40 (women). Obese groups had normal LV ejection fraction compared with nonobese groups, but decreased longitudinal and radial systolic myocardial peak velocities (S'), and early diastolic myocardial peak velocity (E'). Also, a great variability of E' and late diastolic myocardial peak velocity (A') from the longitudinal basal region was observed in obese groups (E'basal nonobese: 11 ± 7 vs. obese 19 ± 11, P < 0.001, A'basal nonobese: 7 ± 4 vs. obese 11 ± 7, P < 0.001). Our findings were more evident when comparing groups IV with V and VI, with the latter having concentric hypertrophy and obvious segmental systolic and diastolic dysfunctions. Subclinical myocardial alterations and increased variability of the velocities were observed in obese groups, especially with hypertension and hypertrophy, reflecting impaired regional LV relaxation, segmental atrial, and systolic dysfunctions.

Myocardial function in offspring 5–8 years after pregnancy complicated by preeclampsia

Introduction Preeclampsia and diabetic pregnancies share pathophysiological features suggested to influence epigenetic changes during foetal life with importance for later development and metabolic and cardiovascular diseases. Aim Our objective was to study the myocardium in offspring after pregnancy complications. Methods Forty-five children (age 5–8 years) delivered from pregnancies complicated by preeclampsia (n = 25), diabetes mellitus type 1 (n = 8) or gestational diabetes mellitus (n = 12) were included. Fifteen children from uneventful pregnancies served as controls. Myocardial functions of right and left ventricle were examined by conventional Doppler and tissue Doppler imaging (TDI). Results No major differences were found in the myocardial function between offspring of pregnancy complications and control group. However, the preeclampsia group had smaller hearts, increased heart rate and increased late diastolic velocity (A′-wave) at mitral valve attachments shown by both pulsed wave and colour TDI compared to the control and diabetic groups together (p ≤ 0.01). Conclusion Children born after preeclampsia may show effects of a negative impact on the heart already at the age of 5 to 8 years. The numbers of examined children were, however, limited.

Cardiac Functions in Children With Growth Hormone Deficiency Before and During Growth Hormone–Replacement Therapy

Childhood growth hormone deficiency (GHD) decreases left-ventricular (LV) mass, but impairment of cardiac function has never been documented. The objective of this study was to assess the cardiac effects of GHD and recombinant human growth hormone (rhGH) treatment using conventional echocardiography and tissue Doppler imaging. Complete two-dimensional, M-mode, pulse-wave Doppler echocardiography and pulse-wave tissue Doppler imaging were performed in 12 children (6 male and 6 female patients) with GHD at baseline and at 5.86 ± 1.61 months after rhGH therapy. Recombinant human growth hormone treatment was associated with a significant increase in LV mass index (63.8 ± 27.1 to 79.3 ± 30.3 g/m(2); P < 0.01) and LV internal dimensions (21.4 ± 2.63 to 24.0 ± 4.13 mm in systole [P = 0.03] and 36.5 ± 3.90 to 39.5 ± 4.94 mm in diastole [P < 0.01]). There were statistical differences of parameters, such as deceleration time of early peak velocity of mitral, isovolumic relaxation time, and myocardial performance index (103 ± 15.4 to 139 ± 21.2 ms [P < 0.01], 55.5 ± 9.24 to 69.2 ± 3.74 ms [P < 0.01], and 37.8 ± 4.46 to 44.9 ± 5.44% [P < 0.01], respectively). Before and during rhGH therapy, there were no significant differences in fractional shortening of the left ventricle, peak mitral, and tricuspid wave velocities with ratios determined using conventional echocardiography and tissue Doppler imaging. In children, GHD affects heart morphology by inducing a decrease in cardiac size, but it does not modify cardiac function. Recombinant human growth hormone treatment increases cardiac mass, deceleration time of early peak velocity of the mitral valve, isovolumic relaxation time, and myocardial performance index, but it does not make a difference in other parameters of conventional echocardiography and tissue Doppler imaging.

568 Tissue Doppler Imaging Findings Associated with Moderate Rejection in Young Heart Transplant Recipients

Myocardial biopsies to monitor acute rejection after heart transplantation are invasive. Acute decrease in pulse wave tissue Doppler imaging (TDI) velocities has been used for rejection monitoring in adults, but not in children. The purpose of this study was to evaluate TDI findings during biopsy-proven rejection in young heart transplant recipients.

Characterization of fetal cardiac structure and function detected by echocardiography in women with normal pregnancy and gestational diabetes mellitus

To assess fetal cardiac structure and function in normal pregnancy and in the presence of gestational diabetes mellitus (GDM) using echocardiography measurements. We studied fetal cardiac structure and function in 169 uncomplicated singleton pregnancies and in 92 complicated by GDM. Maternal glycemic control was deemed adequate in 75 women and inadequate in 17. Fetal two-dimensional ultrasound, pulsed wave Doppler and tissue Doppler imaging (TDI) were used to assess cardiac walls thickness and cardiac function, both systolic [with ejection fraction (EF)] and diastolic [using early diastolic peak flow velocity (E)/late peak of diastolic velocity (A) and early diastolic peak velocity at the annulus (Ea)/late diastolic peak velocity at the annulus (Aa) ratios]. In normal pregnancies, fetal ventricular walls and interventricular septum thickness increased progressively with advancing gestation and were significantly thicker in the presence of GDM (P < 0.001) independently of maternal glycemic control. Fetal cardiac systolic function indicated by EF did not change during normal pregnancy, but was significantly increased (P < 0.001) in the presence of GDM independently of maternal glycemic control. Both pulsed wave Doppler and TDI indicators of fetal diastolic cardiac function increased during normal pregnancy, reaching a maximum at 36 to 40 weeks of gestation (P < 0.001). The presence of GDM did not affect pulsed wave Doppler indicators of diastolic function [ratio of early/late diastolic peak flow velocity (E/A ratio)], whereas TDI indices [ratio of early/late diastolic peak velocity at the annulus (Ea/Aa ratio)] were significantly lower after adjustment for gestational age and estimated fetal weight (EFW); and such changes were independent of maternal diabetic control (P < 0.001). Fetal cardiac wall thickness, cardiac systolic and diastolic functions are affected by GDM independently of glycemic control.

Conventional and segmental myocardial Tei indices measurement in patients with acute ST-segment elevation myocardial infarction: Is there a relation?

Background: Myocardial infarction (MI) results in impairment of left ventricular (LV) systolic and diastolic functions to various degrees. The tissue Doppler image derived Tei index (TDI-Tei index) has recently been used to assess LV function, and like the conventional Tei index, it was also found to be useful for global function. There are a small number of studies which apply TDI-Tei index to assess regional function and whether it varies according to the degree of changes in wall motion in various LV segments. Objectives: This study was conducted to assess the changes of segmental myocardial Tei index by TDI according to the degree of changes of wall motion in the patient with acute ST-segment elevation myocardial infarction (STEMI) and its correlation with Tei index derived by conventional Doppler. Patients and methods: This study was carried out on thirty patients with acute STEMI selected from Coronary Care Unit, Cardiology Department, Mansoura Specialized Hospital, Mansoura University, Egypt. The study group was subjected to clinical assessment, electrocardiography (ECG), routine laboratory profile and Doppler echocardiography (conventional and pulsed wave tissue Doppler imaging “PW-TDI”). Tei index was calculated from the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT), divided by ejection time (ET) which were measured from pulsed wave Doppler imaging of the trans-mitral inflow and LV outflow tracts. Myocardial velocities and TDI-Tei index were measured at basal and mid-segments of LV walts from apical 4, 2 and 5-chamber views using 16-segment model. Average values of myocardial velocities and TDI-Tei indices were obtained from normal, hypokinetic and akinetic segments then compared. Results: The mean values of left ventricular ejection fraction (LVEF), mitral E/A ratio and conventional Tei index were 51.83 ± 5.15%, 1.18 ± 0.15 and 0.63 ± 0.07 ms, respectively. Segmental myocardial TDI-Tei index was correlated positively with conventional Tei index ( r = 0.648, P < 0.001). TDI-Tei indices were significantly higher in akinetic and hypokinetic segments than those of normal segments (0.70 ± 0.09, 0.64 ± 0.05 vs 0.63 ± 0.05, P < 0.001). Conclusions: Tei index (either conventional or TDI) is superior to EF in evaluation of LV performance in patients with acute STEMI. Tei index derived by myocardial segments by TDI is correlated with conventional Tei index. Segmental TDI-Tei index values differ according to the grade of dysfunctional wall motion.

Advantages of deformation indices over systolic velocities in assessment of longitudinal systolic function in patients with heart failure and normal ejection fraction

Tissue Doppler imaging (TDI) systolic velocities have been used to detect impaired systolic function in patients with heart failure and normal ejection fraction (HFnEF). However, many patients do not show alterations by this technique, and furthermore, myocardial systolic velocities can be affected by tethering, translation, and loading conditions. Thus, uncertainties remain about the detection of abnormal systolic function in HFnEF patients. The aim of this study was, therefore, to compare systolic velocities vs. TDI-derived deformation indices for detection of possible abnormalities of systolic function in HFnEF patients, taking into account loading conditions. We studied 40 patients with systolic heart failure (SHF: EF ≤ 40%), 47 HFnEF patients, and 50 controls (C). Systolic velocities of the mitral annulus (pulsed-wave TDI) were measured at four sites and averaged; concomitantly, peak negative TDI-derived strain and strain rate of the four walls were measured in apical, four-, and two-chamber views. Ejection fraction was 65 ± 6% in C, 62 ± 7% in HFnEF, and 29 ± 7% in SHF (P< 0.001 vs. both). In HFnEF patients, systolic velocities and peak negative global longitudinal strain rate and strain were higher than in SHF (P< 0.0001 for all), but lower than in C (P< 0.0001 for all). After controlling for age, left ventricular mass index, end-diastolic volume index, and circumferential end-systolic stress, differences between groups remained significant for deformation indices but not for TDI velocities. By velocity/strain-stress relationship analysis, peak global longitudinal strain was more sensitive than peak systolic motion in detecting systolic dysfunction in HFnEF patients (64 vs. 40%, P< 0.05). In patients with HFnEF, TDI-derived deformation indices may more accurately detect abnormal systolic function than myocardial velocities.

Atrial Dilation and Altered Function Are Mediated by Age and Diastolic Function But Not Before the Eighth Decade

This study investigated changes in left atrial (LA) volumes and phasic atrial function, by deciles, with normal aging. LA volume increase is a sensitive independent marker for cardiovascular disease and adverse outcomes. To use this variable more effectively as a marker of pathology and a gauge of outcome, physiological changes due to aging alone need to be quantitated. A detailed transthoracic echocardiogram was performed in 220 normal subjects; 89 (41%) were male and their age ranged from 20 to 80 years (mean 45 ± 17 years). Maximum (end-ventricular systole), minimum (end-ventricular diastole), and pre-a-wave volumes were measured using the biplane method of disks. LA filling, passive emptying, conduit and active emptying volumes, and fractions were calculated. Transmitral inflow, pulmonary vein flow, and pulsed-wave Doppler tissue imaging parameters were measured as expressions of left ventricular diastolic function. For purposes of analysis, subjects were divided by age deciles. LA indexed maximum (0.05 ml/m(2) per year) and minimum (0.06 ml/m(2) per year) volume increased with age but only became significant in the eighth decade (26.0 ± 6.3 ml/m(2), p = 0.02, and 13.5 ± 3.9 ml/m(2), respectively; p < 0.001). Impaired left ventricular diastolic relaxation was apparent in decade 6 and was associated with a shift in phasic LA volumes so that LA expansion index and passive emptying decreased with increasing age, whereas active emptying volume increased. In normal healthy subjects, LA indexed volumes remain nearly stable until the eighth decade when they increase significantly. Therefore, an increase in LA size that occurs before the eighth decade is likely to represent a pathological change. Changes in phasic atrial volumes develop earlier consequent to age-related alteration in LV diastolic relaxation.

Utility of Doppler Myocardial Imaging, Cardiac Biomarkers, and Clonal Immunoglobulin Genes to Assess Left Ventricular Performance and Stratify Risk Following Peripheral Blood Stem Cell Transplantation in Patients with Systemic Light Chain Amyloidosis (AL)

Cardiac dysfunction is a well-recognized complication of light chain amyloidosis (AL). Autologous stem cell transplant (auto-SCT) has emerged as a successful treatment modality for AL patients. In this study, we examined the effect of clonal immunoglobulin light chain genes (VL), which encodes the immunoglobulin light chain protein that ultimately forms amyloid, on cardiac function, in the context of auto-SCT and its impact on overall survival. Longitudinal Doppler myocardial imaging parameters along with cardiac biomarkers were used to assess for cardiac function pre and post auto-SCT. VL gene analysis revealed that Vl genes, in particular VlVI, were associated with worse cardiac function parameters than Vk genes. Clonal VL genes appeared to have an impact on left ventricular (LV) function post-transplant and also influenced mortality, with specific VL gene families associated with lower survival. Another key predictor of mortality in this report was change in tricuspid regurgitant flow velocity following auto-SCT. Correlations were also observed between systolic strain rate, systolic strain and VL genes associated with amyloid formation. Clonal VL gene usage influences global cardiac function in AL, with patients having VlVI and VlII-III-associated amyloid more severely affected than those having Vk or VlI amyloid. Pulsed wave tissue Doppler imaging along with immunoglobulin gene analysis offers novel insights into prediction of mortality and cardiac dysfunction in AL after auto-SCT.

Echokardiografische Gewebedoppleranalyse der Mitralringgeschwindigkeiten bei Patienten mit hypertropher Kardiomyopathie und bei Hochleistungssportlern

Echocardiographic Tissue Doppler Imaging (TDI) has been proposed for the differentiation of pathological left ventricular hypertrophy (e.g. hypertrophic cardiomyopathy, HCM) and physiologic left ventricular hypertrophy (athlete's heart). The aim of this study was the TDI analysis of the systolic (S') and early diastolic (E') velocities in patients (pts.) with non-obstructive hypertrophic cardiomyopathy (HCM) and in top-level athletes in consideration of the previously published cut-off values (S'<9cm/s, E'<9cm/s). Pulsed-wave TDI of the systolic and early-diastolic velocities was performed at the lateral and septal mitral annulus in the four-chamber view in 17HCM pts (12 men; mean age 44±16 years) and 80 consecutive athletes (80 men; mean age 26±5 years). Pts with HCM showed significantly decreased systolic velocities of the septal (S' septal: 5.1±1.2cm/s versus 9.5±1.5cm/s, p<0.001) and lateral mitral annulus (S' lateral: 6.4±2.0cm/s vs. 10.5±2.1cm/s, p<0.001). The early diastolic velocity of the mitral annulus E' was significantly decreased in HCM, too (E' septal: 5.9±2.2cm/s vs. 13.1±2.9cm/s, p<0.001; E' lateral: 8.2±3.0cm/s vs. 16.5±3.4cm/s, p<0.001). Tissue Doppler Imaging of the systolic and early diastolic velocity of the mitral annulus might be helpful as a promising additional method for the echocardiographic differentiation between pathological and physiologic left ventricular hypertrophy.