Role Of Tissue Doppler Imaging Research Articles

The assessment of treatment outcomes in patients with acute viral myocarditis by speckle tracking and tissue Doppler methods.

The aim was to evaluate the role of tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE), to identify myocardial dysfunction, and to evaluate myocardial segmental deformation in acute viral myocarditis. Twenty-one patients and twelve healthy children were studied prospectively. The TDI and STE were performed before and after treatment. The myocardial velocities (Sm , Em , and Am ) and time intervals (isovolumic contraction, isovolumic relaxation, and ejection times [ET]) at interventricular septum (IVS), left, and right ventricular basal segments were examined by TDI. The left ventricular global longitudinal strain (LVGLS) and strain rate (LVGLSR), left ventricular global circumferential strain (LVGCS) and strain rate (LVGCSR), and right ventricular global longitudinal strain (RVGLS) and strain rate (RVGLSR) were examined by STE. Sm and Em at IVS and at LV, ET at IVS, ET at RV, ET at LV were significantly lower in patients before treatment than controls. LVGLS, LVGLSR, LVGCS, LVGCSR, RVGLS, RVGLSR were significantly decreased in patients before treatment than controls. There was significant improvement for LVGLS, LVGLSR, LVGCS, LVGCSR, and RVGLS in patients after treatment. Sm , Em , and Am at LV were significantly lower in patients before treatment than in patients after treatment. In spite of improvements, Sm , Em , and ET at IVS, LVGLS, LVGLSR, LVGCS, LVGCSR were significantly lower in patients after treatment than controls. The TDI and STE were useful methods for detection of early myocardial dysfunction and evaluation of treatment outcomes in acute viral myocarditis.

Assessing Myocardial Function in Infants with Pulmonary Hypertension: The Role of Tissue Doppler Imaging and Tricuspid Annular Plane Systolic Excursion.

Transthoracic echocardiography is the most common noninvasive method of evaluating pulmonary hypertension (PH) in infants. Identification of reliable, quantitative indices of myocardial function may enhance the diagnostic value of echocardiography in this population. We hypothesized that pulsed wave tissue Doppler imaging (TDI) and tricuspid annular plane systolic excursion (TAPSE) would be reproducible measurements and would suggest decreased ventricular function, in infants with PH. This retrospective case-control study involved subjects diagnosed clinically and echocardiographically with PH at <12months of age, matched with controls by age and gestational age (GA). TAPSE was measured by M-mode in the apical 4-chamber view. TDI velocities were averaged from three consecutive cardiac cycles. Observers were blinded to patient identity and clinical status. Fifty-seven subjects, including 35 term or near-term infants ≥35weeks GA [mean GA 39weeks (±1.7), median age 1day (range 0-2)] and 22 preterm infants [median GA 25.4weeks (24.1-26.6), age 66days (4-128)], were matched with 57 controls. Subjects with PH had lower TAPSE (term p<0.001, preterm p=0.03) and TAPSE indexed to body surface area (term p<0.001, preterm p=0.005). Mitral annular, septal, and tricuspid annular systolic (S') and early diastolic (E') TDI velocities were also decreased compared to controls (all p<0.05). Intraclass correlation demonstrated 84-99% agreement between observers in measuring TDI and 92% for TAPSE. Intraobserver reliability for these measures was 98-99% and 96%, respectively. We concluded that TDI and TAPSE are reproducible indices of myocardial function and may serve as useful adjuncts to standard echocardiographic measures in infants with PH.

Subclinical Diastolic Dysfunction in Diabetic Population

Abstract Introduction. Left ventricular dysfunction is very frequent in asymptomatic diabetic population. Tissue Doppler Imaging (TDI) is a new echocardiographic technique, able to record early changes of left ventricular dysfunction and to identify asymptomatic diabetic patients at high risk of developing heart failure. Aim. To assess the role of TDI in early detection of diastolic dysfunction in asymptomatic diabetic patients. Methods. Cross-sectional study that involved a total number of 48 subjects. The target group consisted of 25 asymptomatic diabetic patients and control group was composed of 23 subjects without diabetes. All subjects underwent echocardiography (conventional 2D and Pulsed-Wave Doppler and contemporary-TDI) to analyze left ventricular function. We compared the results from both echo-techniques and analyzed the relation of echo-cardiographic parameters with risk factors. Results. We found statistically significant difference between TDI and PW Doppler (E/E'vs E/A) in target (Z=−3.17, p&lt;0.001) and control group (Z=−2.4, p&lt;0.003). There was no significant difference in E/A between the groups (Z=0.0, p&lt;1.0). TDI identified significantly lower E' (Z= 2.03, p&lt;0.04) and higher E/E' (Z= −2.12, p&lt;0.03) in target vs control group. LVDD strongly correlated with duration of DM (p&lt;0.00001), age (p&lt;0.00001), female gender (p&lt;0.0001) and obesity indices (BMI, BSA) (p&lt;0.00001, p&lt;0.00001) in both groups. Conclusion. TDI unmasks the presence of subclinical LV dysfunction in asymptomatic diabetic patients and has a valuable prognostic importance.

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

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

Tissue Doppler Imaging and Focal, Late-Onset Anthracycline-Induced Cardiovascular Disease in Long Term Survivors of Childhood Cancer: A Research Article.

In anthracycline-induced cardiomyopathy, the onset of diastolic dysfunction occurs before systolic dysfunction. Although, conventional echocardiogram is the standard method to assess cardiac function post anthracycline therapy, Tissue Doppler Imaging (TDI) may detect early onset cardiac diastolic dysfunction among anthracycline-recipient survivors of childhood cancers. There are limited data on the use of TDI in assessing anthracycline-associated cardiotoxicity in children. To evaluate the role of Tissue Doppler Imaging (TDI) in assessing late-onset cardiotoxicity in survivors of paediatric cancers. This was a single site, observational, blinded study of 11 long-term survivors of childhood cancer who had been treated with anthracyclines and 22 age-matched controls. The study group and the control group underwent conventional echo and TDI; operators were blind to study group. Conventional echo measurements were obtained. TDI was used to assess systolic and diastolic parameters at the mid-interventricular septum and lateral and medial annuli of the mitral valve; these parameters included: systolic wave (S'), early diastolic wave (E'), late diastolic wave (A'), Isovolemic Contraction Time (ICT), Isovolemic Relaxation Time (IRT) and Ejection Time (ET). Myocardial Performance Index (MPI) was also calculated. Conventional echo measurements were similar in both groups. Using TDI, cases had a lower mean E' velocity (9.7 ± 1.7 cm/s vs. 11.4 ± 1.3 cm/s, p=0.004) and a lower E'/A' (1.8 ± 0.5 vs. 2.2 ± 0.4, p=0.022) at the mid-interventricular septum than controls. The mean E' septum velocity in chemotherapy-recipients who also received chest radiotherapy was 8.5±0.5 cm/s in comparison to 10.2±1.7 cm/s in those that did not receive chest radiotherapy but this not achieve statistical significance. We did not find any additional associations between TDI parameters and patients' gender, age of diagnosis, length of follow-up and dose of anthracycline. In long-term survivors of childhood cancer who received anthracyclines, diastolic dysfunction can be detected earlier by using TDI before overt systolic dysfunction. Further large-scale multicenter studies are needed.

Role of tissue Doppler imaging in predicting left ventricular dysfunction after myocardial infarction

Left ventricular (LV) dysfunction is a well known complication following ST-segment elevation myocardial infarction (STEMI). Tissue Doppler imaging (TDI) is used as a non-invasive method to assess LV diastolic function. Measurements obtained from TDI augment the prognostic information of clinical risk score.In this study, we are trying to use TDI to predict the development of LV dysfunction (LVEF% <50%) in patients presenting with first attack of STEMI.We randomly selected 40 patients with acute STEMI, followed-up for 6 months. Two groups of patients were included according to the presence or absence of LV dysfunction.Of 40 stable post-STEMI patients, 14 (35%) developed LV dysfunction during 6-month follow-up. Along the lateral and septal mitral annulus, the e′-wave velocity and E/e′ ratio showed a significant correlation with LV dysfunction following STEMI (p-value <0.001). A baseline cutoff value of E/e′ ratio at the lateral mitral annulus >8.0 showed high sensitivity and specificity, 93% and 89%, respectively. Also, a baseline cutoff value of E/e′ ratio at the septal mitral annulus >10.0 had a sensitivity of 79% and specificity of 88%.In conclusion, selected TDI parameters (e′-wave and E/e′ along the septal and lateral mitral annulus) could guide post-STEMI risk stratification, and thus predicting LV dysfunction.

The Role of Tissue Doppler Imaging in Predicting Left Ventricular Filling Pressures in Patients Undergoing Cardiac Surgery: An Intraoperative Study

The Role of Tissue Doppler Imaging in Predicting Left Ventricular Filling Pressures in Patients Undergoing Cardiac Surgery: An Intraoperative Study

Diastolic Function Evaluations by Tissue Doppler Imaging in Patients With Mitral Valve Prolapse.

BackgroundTissue Doppler imaging (TDI) is a new echocardiographic imaging technique that is believed to be superior to older conventional techniques in assessing abnormalities of cardiac function in many conditions affecting the heart. There are very limited data regarding the role of TDI in evaluating patients with mitral valve prolapse (MVP). Current study evaluates diastolic function in patients with MVP by this method.MethodsFrom November 2009 to April 2011, one hundred and ten adults matched for age and sex and without structural heart disease were studied in two groups, with and without MVP, at Madani Heart Center, Tabriz, Iran. TDI was performed at the basal-lateral wall and S, E, E’, A, and A’ velocities, as well as the E/A and E’/A’ ratios were measured. Mitral annular systolic velocity and early diastolic (E’) velocities were measured lateral corner of mitral valve in apical 4-chamber view.ResultsPatients with MVP had higher left atrium volume (42.31 ± 10.47 vs. 35.19 ± 9.15 cm3; P < 0.001) and deceleration time (186.70 ± 26.00 vs. 176.89 ± 20.36 ms; P = 0.03). Diastolic dysfunction, although seemed more prevalent in MVP group (14.54%) than normal subjects (5.45%), the difference was not statistically significant between groups (P = 0.11).ConclusionLeft atrial volume and deceleration time of mitral valve inflow was significantly higher in MVP which could be indicative of early stages of diastolic dysfunction in patients with MVP. However, larger follow-up studies are required to evaluate clinical significance of our findings in these patients.

Role of Tissue Doppler Imaging for Detection of Diastolic Dysfunction in the Elderly

The role of tissue Doppler imaging (TDI) in the assessment of diastolic dysfunction in elderly patients seen in echocardiographic practice is poorly defined.The aim of this study was to investigate the prevalence of diastolic dysfunction in a cohort of elderly patients referred to an echocardiographic examination for routine clinical indications and to compare the findings obtained by conventional Doppler with those obtained by TDI.A total of 457 elderly patients with preserved left ventricular (LV) systolic function (mean age 73 ± 5 years, 45% men, 76% with hypertension) underwent a comprehensive echo-Doppler examination; diastolic dysfunction was defined by the following conventional and TDI criteria: E/A ratio (ratio between transmitral peak velocity of E and A waves) <0.7 or >1.5 and lateral annular early diastolic peak velocity (Ei) <8 cm/sec, respectively.Diastolic dysfunction was present in 130 patients (28.4%) according to the conventional Doppler criterion, namely 119 (26.0%) because of E/A <0.7 and 11 because of E/A >1.5. A higher proportion of participants (60.1%) had LV diastolic dysfunction according to TDI. Notably, more than one-half of the patients with 'normal' diastolic function by conventional criterion exhibited an abnormal Ei value.A large proportion of elderly patients with normal E/A ratios may have more subtle alterations in LV diastolic mechanics characterized by a reduced annular motion velocity. Thus, evaluation of diastolic function by the simple E/A ratio may markedly underestimate diastolic abnormalities. This finding supports the view that diastolic function should be routinely assessed by comprehensive Doppler methodologies including both conventional and tissue Doppler measurements in order to improve the management of elderly patients seen in clinical practice.

585 The role of tissue doppler imaging using intraoperative transesophageal echocardiography in the assessment of pulmonary filling pressures during cardiac surgery

Cardiac surgical patients require the frequent use of invasive hemodynamic monitoring using pulmonary artery catheters (PAC) for the determination of left ventricular filling pressures (LVFP). Tissue Doppler imaging (TDI) using transthoracic echocardiography (TTE) is a validated method for the noninvasive assessment of LVFP. Using the ratio of early diastolic mitral inflow (E) to early diastolic annular velocity (E'), an E/E'<8 indicates normal LVFP, whereas E/E'>15 indicated elevated LVFP. Little is known, however, on the role of TDI using intraoperative transesophageal echocardiography (TEE) in the assessment of LVFP during cardiac surgery.

SHORT –TERM RESULT OF STUDY LEFT VENTRICULAR DIASTOLIC FUNCTION IN ADROID OBESITY PATIENTS BY TISSUE DOPPLER IMAGING

Aim of study: To study changes of left ventricular diastolic function and morphology in adroid obesity patients by standard doppler echocardiography and tissue doppler imaging. In that, evaluate the role of Tissue Doppler Imaging(TDI) in studying the left ventricular diastolic function. Patients and methods: We studied 30 obese patients (12 men have waist circumference ≥90cm and 18 women have waist circumference ≥80 cm), mean age 49.33±7.16 years , non hypertension and non diabetic, by conventional doppler echocardiography and tissue doppler imaging. Results: Mean BMI of obese patients: 25,35±2,87kg/m2. Waist circumference: 91,03±6,29cm. Left ventricular end- diastolic diameter: 45,9±4,05mm. Left ventricular mass: 143,47±35,56g. Left ventricular mass index: 85,69±19,55g/m2. Left atrial diameter: 36,34±4,33mm. The early diastolic wave of the transmitral flow velocity(E): 75,2±17,5 cm/s; the atrial systolic wave of the transmitral flow velocity: 76,2±16,5cm/s; the ratio of early diastolic wave to atrial systolic wave of the transmitral flow velocity: 0,99±0,29. The early diastolic wave of mitral annu-lus using pulsed TDI(Em): 12,1±3,3cm/s. The atrial systolic wave of mitral annu-lus using pulsed TDI(Am): 12,7±2,9cm/s. E to Em wave ratio: 6,76±2,19. Conclusion: In adroid obesity patients, the morphology of diastolic left ventricular changes earlier than the one’s function. Key word: Left ventricular function; Obesity; Tissue Doppler Echocardiography

Screening for cardiomyopathy in muscular dystrophy with tissue doppler imaging

To study role of Tissue Doppler imaging (TDI) in identification of cardiomyopathy before development of ventricular dysfunction. Twenty-five patients with Duchenne's (DMD) and 10 with Becker's (BMD) muscular dystrophy along with 20 controls were evaluated using TDI. Pulse Tissue Doppler signals of the lateral left ventricle wall (lateral mitral annulus) revealed reduced systolic velocities in the DMD patients (mean +/- SD: 7.8 +/- 1.1 cm/sec vs. 8.6 +/- 1.1 cm/sec in controls) in patients of DMD. 60% of the non ambulatory DMD (ejection fraction 45+/-9%) patients had mild LV dysfunction and reduced systolic velocities (6.96 +/- 1.7 cm/sec, p<0.05 vs controls). The ambulatory DMD patients also had reduced systolic velocities (7.8 +/- 1.1 cm/sec) though ejection fraction was normal. Reduced tissue Doppler systolic velocities in the ambulatory DMD patients with normal conventional echocardiography would suggest that perhaps some of these patients (20% had velocities less than Mean - 2 SD of controls) have early myocardial dysfunction (picked up only as abnormal myocardial velocities). TDI picked up systolic dysfunction of the lateral wall in DMD even when overall LV function was normal conventional echocardiography. Tissue Doppler imaging is a useful technique to pick up early ventricular dysfunction and should be evaluated in larger studies and also with other techniques like magnetic resonance imaging.

Assessment of diastolic dysfunction in elderly hypertensive patients using integrated Doppler echocardiography

The aim of this study was to assess the different stages of diastolic dysfunction (DD) in elderly, asymptomatic, hypertensive patients with preserved systolic function, and to investigate the role of Tissue Doppler imaging (TDI) and Pulmonary venous (PV) flow added to the routine echocardiographic assessment. Patients. 322 patients (age: 70.8±9.1 years) were enrolled. Methods. Mitral inflow pattern, TDI (Ea: early diastolic velocity) and PV flow was assessed to evaluate diastolic function. Deceleration time of mitral E velocity < 150ms, E/Ea≥7 and/or S/D< 1 of PV flow indicated elevated filling pressure (EFP). Patients were divided into four groups: no DD, mild DD, moderate DD and severe DD. Results. In 63 cases we found no DD, mild DD was present in 150 cases, moderate DD in 86 cases and severe DD in 23 cases. Compared with patients without DD, the Ea was decreased in mild and moderate DD (14.8±2.3 vs 12.2±2.4 cm/s, p<0.001; vs 13.3±2.6 cm/s, p=0.005). Normal mitral inflow pattern was found in 149 patients, 86 of them had EFP (58%). Conclusions. One third of elderly hypertensive patients with preserved systolic function had moderate-to-severe asymptomatic DD. More than half of the patients had EFP with normal mitral inflow pattern.

The Role of Tissue Doppler Imaging in the Noninvasive Detection of Chronic Rejection after Heterotopic Cardiac Transplantation in Rats

Chronic rejection is a risk factor for the development of cardiac allograft vasculopathy (CAV) in heart transplant recipients. A useful animal model to study the role of immunosuppressive strategies in the prevention of chronic rejection involves heterotopic abdominal cardiac transplantation in rats. The detection of rejection and concurrent CAV traditionally involves subjective serial palpation of the graft from a scale of 0 to 4, with 4 indicating vigorous beats. Recent advances in murine echocardiography, in particular Tissue Doppler imaging (TDI), may allow for objective in vivo monitoring of chronic rejection in this transplant model. The objective of this study was to compare the diagnostic accuracy of murine echocardiography as compared to the abdominal palpation heart score for the noninvasive detection of chronic cardiac graft rejection. In an animal model of heterotopic cardiac transplantation, 18 male Fischer and Lewis rats were used as donors and recipients, respectively. Abdominal palpation and murine transthoracic echocardiography were performed to assess in vivo function of the transplanted heart. Left ventricular (LV) structure and function and TDI indices, including endocardial velocity (Vendo) and strain rate (SR), were evaluated in the ectopic heart. Graft tissues were processed for histological examination and graded for chronic rejection. Abdominal palpation scores were obtained in all 18 rats; score 1 (n = 5); score 2 (n = 4); score 3 (n = 6); and score 4 (n = 3). The mean LV ejection fraction was significantly (P <0.01) lower in score 3 and 4 grafts as compared to score 1 grafts. There was no correlation between the abdominal palpation score and LV systolic function. There was a significant relationship between decreasing Vendo or SR values and increasing grades of rejection (r = 0.65, P <0.05 and r = 0.75, P < 0.05, respectively). TDI of the transplanted heart in rats is feasible, reproducible, and more sensitive than palpation for the detection of chronic rejection.

Hemodynamic monitoring by echocardiography in the ICU: the role of the new echo techniques

The present review will discuss the usefulness of ultrasound in the ICU in assessing hemodynamic instability in various critical care conditions. We will discuss how to interpret echocardiographic findings in critically ill patients including the physiological consequences of mechanical ventilation. Most of the studies performed in the ICU used transesophageal echocardiography. However, with improvements in image acquisition with harmonic imaging and new contrast agents, transthoracic echocardiography allows a rapid and accurate diagnosis for almost all patients with unexplained hemodynamic instability. Furthermore, recent studies have shown the usefulness of hand-held echocardiography in a crowded ICU room. One of the major recent advances in echocardiography is the noninvasive assessment of filling pressures using tissue Doppler imaging, including the use of peak mitral flow velocity of the early rapid filling wave and early diastolic velocity of the mitral annulus ratio or peak mitral flow velocity of the early rapid filling wave to early diastolic velocity of the mitral annulus timing relationship. The role of tissue Doppler imaging in the ICU needs to be further explored. Echocardiography is now an unavoidable tool in assessing hemodynamic instability in the ICU. Echocardiography is complementary to a pulmonary artery catheter in the management of critical care patients. Echocardiography training is crucial to help its widespread use in all ICUs.

Early Cardiac Abnormalities in Obese Children: Importance of Obesity Per Se Versus Associated Cardiovascular Risk Factors

We investigated whether obese children and adolescents have early echocardiographic signs of subclinical cardiac dysfunction and evaluated the respective influence of obesity per se versus parameters of carbohydrate and lipid metabolism that are frequently abnormal in obese subjects. The role of tissue Doppler imaging as a screening tool for these abnormalities was explored. Blood pressure and echocardiographic parameters, including tissue Doppler measurements of the septal mitral annulus were evaluated in 49 obese children and adolescents and 45 age and sex matched controls. The respective influence of obesity versus parameters of carbohydrate and lipid metabolism was examined with linear regression analysis. Obese subjects showed significantly larger left ventricular wall dimensions (posterior wall, septum, and left ventricular mass index) and signs of early diastolic filling abnormalities on conventional and tissue Doppler echocardiography compared with nonobese subjects. Multiple regression analysis showed that mainly BMI-SD scores and/or body surface area explained significant proportions of the variance of the early cardiac abnormalities. In conclusion, young, obese children and adolescents have significant changes in left ventricular wall dimensions and early diastolic filling compared with nonobese subjects. Obesity per se and not the parameters of carbohydrate and lipid metabolism predicted the early cardiac abnormalities.

Tissue Doppler Imaging in the assessment of selection and response from cardiac resynchronization therapy

Mechanistic studies, observational evaluations, and randomized trials have consistently demonstrated the beneficial effects of cardiac resynchronization therapy (CRT) in patients with moderate-to-severe chronic systolic heart failure and ventricular dyssynchrony who have failed optimal medical treatment. However, despite the promising results, in some patients undergoing CRT, the symptoms of heart failure do not improve or even worse. One of the most important reasons for this failure is probably the lack of distinct mechanical dyssynchrony before implantation. This review discusses the actual and potential role of Tissue Doppler Imaging in selection of patients and optimisation of CRT.

The Role of Tissue Doppler Imaging (TDI) in the Diagnosis of Cardiac Amyloidosis.

The Role of Tissue Doppler Imaging (TDI) in the Diagnosis of Cardiac Amyloidosis.

Role of tissue Doppler imaging in diagnosis of diastolic dysfunction in patients with hypertension in primary care setting

Role of tissue Doppler imaging in diagnosis of diastolic dysfunction in patients with hypertension in primary care setting

Letter Regarding Article by Yu et al, “Tissue Doppler Imaging Is Superior to Strain Rate Imaging and Postsystolic Shortening on the Prediction of Reverse Remodeling in Both Ischemic and Nonischemic Heart Failure After Cardiac Resynchronization Therapy”

To the Editor: We want to congratulate Yu et al on their article on the role of tissue Doppler imaging in the assessment of cardiac function in cardiac resynchronization therapy (CRT), which we read with great interest.1 We agree that tissue Doppler imaging provides important information for the prediction of functional recovery after CRT. We would like to comment, however, on the comparison of velocity data with strain-rate data that was used in their study. Based on the intrinsic properties of deformation analysis, in theory, strain-rate data should be more reliable in assessing regional contraction and thus in describing regional “asynchrony” more precisely than are myocardial velocity data, which are always influenced by overall heart motion and tethering effects.2,3 It is surprising, then, based on their study data that the authors come to the opposite conclusion, in favor of velocity data. We are convinced that this might be caused by the technical limitations encountered during the acquisition …