Spectral Doppler Imaging Research Articles

Future Prospects for Contrast Ultrasound

E-mail: [email protected] New technical approaches in ultrasound are already having an impact on contrast imaging; the most striking among these is planewave imaging. By abandoning focused beams in favour of a broad insonation encompassing the field of view, an image is acquired each pulse, increasing the famerate to the PRF (typically around 5,000 per second). Both linear and nonlinear Doppler processing can be performed with coherent ensemble lengths of around 100, producing simultaneous contrast, colour and spectral Doppler imaging at framerates of 50-100Hz. This allows a new imaging mode, showing real-time anatomy, perfusion and velocity resolved spectral and colour Doppler, greatly increasing the versatility of the clinical contrast exam, particularly in fast moving structures. Efforts are already underway to implement such schemes in 3D using matrix a array probes. A consequence of very high speed acquisition is that ensembles of bubbles, or even individual bubbles, can be tracked from frame to frame. For the former case, combining such ‘short track MIP’ imaging with curvature operators already used in CT and MR angiography produces real time images of vessel morphology of unprecedented quality. In the latter case, if the agent is sufficiently sparse in tissue yet samples all of the microvessels over time, the path of individual bubbles can be tracked to create ‘super-resolution’ images of the perfusion bed, whose dimensions are below the wavelength of the ultrasound, which for conventional imaging, defines a lower limit of spatial resolution. The current generation of microbubbles were developed before the nonlinear imaging methods used to detect them were invented. To a great extent, the resonant properties of these bubbles which are the basis of their use in diagnosis an therapy have come about by serendipity. Slowly, a new generation of agents that are designed for specific applications or functionalised for biological interactions is emerging. Bubbles which are targeted with ligands specific for inflammation, angiogenesis or thrombosis have already been demonstrated. Bubbles can be loaded with drugs or plasmid DNA for theranosis. Yet to date, all of these targets are the endothelial cells that line blood vessels. While microbubbles stay within the vasculature offer a number of advantages to contrast ultrasound imaging, there are situations where the pattern of extravasation of a diffusible tracer has important clinical relevance. Liquid nano-droplets of perfluorocarbon (PFC) of a 200-400nm diameter range can selectively diffusible through angiogenic vascular endothelium and, due to the so-called ‘enhanced permeability and retention’ (EPR) effect, accumulate in solid tumours. An externally applied ultrasound field then ‘activates’ the droplets into bubbles while they remain in the interstitium. Such bubbles can not only report on tumours for diagnosis, they can in principle be targeted to extravascular molecules (such as those expressed on malignantly transformed hepatocytes), and may further be capable of degrading the extracellular matrix, so driving drugs into hitherto hard to treat solid tumours. While the development of instruments results in rapid translation of technological ideas to the clinic, the cycle for new drug development is inevitably slowed by the complexity and cost and of the regulatory process. Nonetheless, developments already apparent in the research field assure a bright and diverse future for ultrasound contrast.

Left Ventricular Outflow Tract Obstruction—be Prepared!

The current trend to treat hypotension in critically ill patients is to place a greater emphasis on inotropic support and less on fluid resuscitation in order to limit the potential harm from fluid overload. This combination may trigger left ventricular outflow tract obstruction (LVOTO) in susceptible patients. Although LVOTO is classically described in patients with hypertrophic cardiomyopathy it has been reported in other conditions including septic shock, apical ballooning syndrome, myocardial infarction, respiratory failure, and post valvular surgery. It is more common in the elderly, females, and in patients with hypertension, diabetes, and chronic vascular disease because of predisposing anatomical conditions such as left ventricular hypertrophy, small left ventricle size, sigmoid septum and alterations in the positions of the aortic and mitral valve annular planes. The onset of LVOTO is largely unpredictable due to a complex interplay between preload, afterload, heart rhythm and rate in susceptible patients. The consequences of missing this treatable condition may lead to life-threatening hypotension refractory to, or exacerbated by, a further increase in inotropic support. Dynamic LVOTO should be considered in any hypotensive intensive care patient. Echocardiography is perhaps the best tool to assess LVOTO and its underlying pathophysiology in the critically ill. Detection of LVOTO is a relatively simple task using a combination of two-dimensional, M-mode and spectral Doppler imaging by an operator alert to the possible diagnosis.

Introduction to the Special Issue on Flow Measurement and Imaging

The investigation of flow by ultrasound (frequently referred to as Doppler ultrasound) has fascinated several generations of researchers. Thanks to the contributions of pioneers, such as P. N. T. Wells, J. M. Reid, D. W. Baker, P. Peronneau, L. Pourcelot, B. A. J. Angelsen, and others, the feasibility of blood velocity measurements based on the estimate of the phase shift in the received echo-signals has been well established since the 1970s. A first peak of interest in this topic was achieved during the 1980s, when real-time spectral Doppler and color flow imaging could be implemented in most ultrasound machines and rapidly became standard tools in clinical practice. By the end of the century, most aspects of Doppler ultrasound had been definitively clarified by the work of researchers, such as D. H. Evans, R. S. C. Cobbold, A. P. G. Hoeks, and many others.

AIUM Practice Parameter for the Performance of Ultrasound Vascular Mapping for Preoperative Planning of Dialysis Access

AIUM Practice Parameter for the Performance of Ultrasound Vascular Mapping for Preoperative Planning of Dialysis Access

Echocardiography in shock management.

Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography. A more comprehensive diagnosis can be achieved with advanced levels of competency, for which practice guidelines are also now available. Hemodynamic evaluation and ongoing monitoring are possible with advanced levels of competency, which includes the use of colour Doppler, spectral Doppler, and tissue Doppler imaging and occasionally the use of more recent technological advances such as 3D or speckled tracking.The four core types of shock—cardiogenic, hypovolemic, obstructive, and vasoplegic—can readily be identified by echocardiography. Even within each of the main headings contained in the shock classification, a variety of pathologies may be the cause and echocardiography will differentiate which of these is responsible. Increasingly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock or hypovolemia and ventricular outflow obstruction.The diagnostic benefit of echocardiography in the shocked patient is obvious. The increasing prevalence of critical care physicians experienced in advanced techniques means echocardiography often supplants the need for more invasive hemodynamic assessment and monitoring in shock.

Coded Spectral Doppler Imaging: From Simulation to Real-Time Processing.

Transmission of coded pulses and matched receive filtering can improve the ultrasound imaging penetration depth while preserving the axial resolution. This paper shows that the pulse compression technique may be integrated in a low-cost scanner to be profitably used also in spectral Doppler investigations. By operating on beamformed, demodulated, and down-sampled data in the frequency domain, a single digital signal processor is proved sufficient to perform both pulse compression and multigate spectral Doppler algorithms in real time. Simulations, phantom, and in vivo experiments demonstrate that the transmission of (2.5 or [Formula: see text] long) linear frequency-modulated chirps with bandwidths over the range 1.6-5.4 MHz, rather than of corresponding sine-burst pulses, provides signal-to-noise ratio (SNR) improvements very close to theory. Even in the presence of selective tissue attenuation, SNR gains up to 11 and 13.3 dB have been obtained for the short and the longer chirp, respectively. This may be important in clinical Doppler applications where the needed penetration depth is not achieved with sufficient SNR unless very long bursts are transmitted.

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

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

Left Ventricular Diastolic Dysfunction Assessed by Conventional Echocardiography and Spectral Tissue Doppler Imaging in Adolescents With Arterial Hypertension.

Compared to conventional echocardiography, spectral tissue Doppler imaging (s-TDI) allows more precise evaluation of diastolic cardiac function. The purpose of this study was to conduct s-TDI to analyze the slow movement of the left ventricular (LV) myocardium in adolescents with systemic arterial hypertension (HT) and to determine whether patients with HT suffer from LV diastolic dysfunction. The study group comprised 69 consecutive patients (48 boys and 21 girls aged 14–17 years [mean, 15.5 ± 1.1 years]) with primary HT, and the control group comprised 48 healthy participants (24 boys and 24 girls aged 14–17 years [mean, 15.8 ± 1.3 years]). Physical examinations, 24-hour arterial blood pressure monitoring, conventional 2-dimensional and Doppler echocardiography, and s-TDIs were performed. Analysis revealed that study group participants were significantly heavier and had greater LV mass indices than controls (P < 0.001). There were no differences between the velocities of E waves (peak early filling of mitral inflow), but the deceleration times of the mitral E waves were significantly shorter whereas the A waves survived longer in the study group than in the control group. The velocities of A waves (peak late filling of mitral inflow) were elevated (P = 0.041), and the E/A wave pattern (E/A = 1.8 ± 0.4) was normal. These results suggest pseudonormalization, a type of LV diastolic dysfunction in adolescents with HT.In the study group, when the sample volume was positioned at the septal or lateral insertion site of the mitral leaflet, the e′ wave velocity was significantly depressed whereas the a′ wave velocity was elevated, compared to those of the control group (P < 0.001).The e′/a′ ratios from the septal and lateral insertion sites were lower, whereas the E/e′ ratio from the septal insertion site was significantly higher in the study group, similar to that seen in atrial reversal velocity (P < 0.001).These findings indicate that using sTDI to find and measure diastolic LV failure is valuable when the probe is placed at the septal and lateral mitral valve annuli during examination.Changes in the myocardium appear similar to those seen in adults.

EP04.06: Prenatal diagnosis of absent pulmonary valve syndrome

To analyse the echocardiographic features of absent pulmonary valve syndrome (APVS). The echocardiographic findings were retrospectively analysed in seven fetuses with APVS and the echocardiographic features of APVS were summarised. Of all seven fetuses with APVS, all of which demonstrated cardiac enlargement, the axis of the heart was to the left and the main pulmonary artery or branches were significantly dilated. The pulmonary valve was absent or rudimentary. Colour Doppler flow imaging demonstrated severe pulmonary regurgitation. Spectral Doppler imaging showed stenosis of the pulmonary annulus. Four fetuses associated with tetralogy of Fallot, one case of which associated with small foci in the left ventricle and one case associated with single umbilical artery. Two fetuses associated with right aortic arch. Two fetuses associated with double outlet of right ventricle. One fetus associated with atresia of mitral valve, right-ventricle typed single ventricle. One fetus associated with double outlet of right ventricle. One fetus associated with ventricular septal defect. Three fetuses associated with absent ductus arteriosus. The fetal echocardiographic findings of the APVS are characteristic and the APVS should be considered when markedly dilated right ventricle and dilated pulmonary arteries in combine with the stenosis and severe regurgitation of the pulmonary annulus. Identifying whether or not the ductus arteriosus is present can help in evaluating the prognosis.

The Short-Term Effects of Ketogenic Diet on Cardiac Ventricular Functions in Epileptic Children

ObjectiveOur primary aim was to determine the short-term effects of a ketogenic diet on cardiac ventricular function in patients with refractory epilepsy. MethodsThirty-eight drug-resistant epileptic patients who were treated with a ketogenic diet were enrolled in this prospective study. Echocardiography was performed on all patients before beginning the ketogenic diet and after the sixth month of therapy. Two-dimensional, M-mode, color flow, spectral Doppler, and pulsed-wave tissue Doppler imaging measurements were performed on all patients. ResultsThe median age of the 32 patients was 45.5 months, and 22 (57.8%) of them were male. Body weight, height, and body mass index increased significantly at the sixth month of therapy when compared with baseline values (P < 0.05). Baseline variables assessed by conventional M-mode echocardiography showed no significant difference at month 6 (P > 0.05). Doppler flow indices of mitral annulus and tricuspid annulus velocity of patients at baseline and month 6 showed no significant differences (P > 0.05). Tricuspid annular E/A ratio was lower at month 6 (P < 0.05). Although mitral annulus tissue Doppler imaging studies showed no significant difference (P > 0.05), there was a decrease in Ea velocity and Ea/Aa ratio gathered from tricuspid annulus at month 6 compared with baseline (P < 0.05). ConclusionA 6-month duration ketogenic diet does not impair left ventricular functions in children with refractory epilepsy; however, it may be associated with a right ventricular diastolic dysfunction.

Utility of Isovolumic Contraction Peak Velocity for Evaluation of Adult Patient Status after Transcatheter Closure of Atrial Septal Defect.

Transcatheter closure is a well-established treatment for patients with atrial septal defect (ASD), but long-term outcome prognostic factors for adults have not been fully identified yet. Forty-nine consecutive patients (age 57 ± 17 years, 59% female), who underwent transcatheter closure of ASD, were the subjects of this study. Transthoracic echocardiography was performed before and midterm after the procedure (6 ± 1 months). Isovolumic contraction peak velocity (IVV) was measured at the lateral site of the tricuspid annulus using spectral tissue Doppler imaging, and ΔIVV was determined as the absolute change at midterm follow-up. Long-term unfavorable outcome events, tracked for 19 ± 9 months, were prespecified as primary end points comprising newly developed atrial fibrillation, cerebral infarction, and heart failure. Symptomatic improvement, defined as an improvement in New York Heart Association functional class by one grade or more at midterm after the procedure, was observed in 24 patients (49%), and the remaining 25 (51%) were classified as not symptomatically improved. ΔIVV was significantly larger for patients with symptomatic improvement than for those without (from 11.5 ± 4.3 cm/s to 14.2 ± 3.7 cm/s vs. from 11.8 ± 4.1 cm/s to 12.5 ± 2.9 cm/s; P = 0.045). An important finding of the multivariate Cox proportional-hazards analysis was that only ΔIVV was independently associated with cardiovascular events (HR: 0.701; 95% CI 0.537-0.916; P = 0.01). Kaplan-Meier analysis showed that more patients with enhanced ΔIVV presented with favorable long-term outcome than those with diminished ΔIVV (log-rank P = 0.0001). IVV, which is a less volume-sensitive parameter, can be useful for comprehensive evaluation of ASD patients referred for transcatheter closure.

34 Can Exercise Induced Changes in Cardiac Synchrony Predict Response to CRT? – Primary Results from the Exert Trial

<h3>Introduction</h3> Cardiac resynchronisation therapy (CRT) improves symptoms of heart failure (HF) in the majority of patients but echocardiographic measures of selection have produced disappointing results. These measurements are often carried out at rest. Exercise can alter the magnitude and extent of ventricular dyssynchrony and dynamic changes vary between patients. The aim of this study was to determine whether changing dyssynchrony by exertion would predict a positive response to CRT. <h3>Method</h3> 38 patients with symptomatic heart failure were included in this study. All patients had a depressed LVEF (&lt;35%) and were clinically selected for CRT therapy. Two comparator groups were formulated: Phasers – subjects whose total mechanical delay (normalised for RR interval) decreased with exercise, and dephasers – subjects whom normalised mechanical remained stable or increased. Mechanical delay was defined from spectral tissue Doppler imaging, time from R wave to onset of post isovolumic S’ at the lateral right and left ventricular annular and interventricular septum. The primary end point was VO2peak at 3 months post implant. <h3>Results</h3> The overall population showed significant improvements in NYHA class, quality of life, LVEF, resting S’, end diastolic and systolic volumes, and dimensions following CRT at 3 months. No significant improvements were observed for exercise parameters including VO2peak. 14 phasers and 24 dephasers were identified and no differences were found for VO2peak or for any other parameters obtained at 3 months (table 1). <h3>Conclusion</h3> All patients showed that CRT significantly improved echocardiographic and functional parameters, no improvements were observed for exercise parameters. Exercise dyssynchrony was unable to identify if patients responded positively to CRT therapy. Both phasers and dephasers responded in a similar way to CRT.

Adnexal Masses: Role of Supplemental Imaging With Magnetic Resonance Imaging

Sonography is the primary and often the only imaging modality used for evaluation of an adnexal mass. Grayscale sonography with color and spectral Doppler imaging is able to accurately characterize most of the adnexal masses. Supplemental imaging with computed tomography and magnetic resonance imaging (MRI) is useful in selected cases. Computed tomography is preferred for evaluation of bowel-related pathology masquerading as an adnexal mass and for staging of gynecologic cancers. Owing to its superior contrast resolution and multiplanar imaging capability, MRI is helpful in characterizing an indeterminate adnexal mass, as well as determining the organ of origin of an adnexal mass. MRI thereby allows planning of appropriate surgical or nonsurgical management of neoplastic and nonneoplastic conditions affecting the adnexa. Imaging evaluation of adnexal masses and the supplemental role of MRI in the management of adnexal masses are discussed.

TIME SEQUENCE SPECTROSCOPY OF AW UMa. THE 518 nm Mg I TRIPLET REGION ANALYZED WITH BROADENING FUNCTIONS

High resolution spectroscopic observations of AW UMa, obtained on three consecutive nights with the median time resolution of 2.1 minutes, have been analyzed using the Broadening Functions method in the spectral window Doppler images of the system reveal the presence of vigorous mass motions within the binary system; their presence puts into question the solid-body rotation assumption of the contact binary model. AW UMa appears to be a very tight, semi-detached binary; the mass transfer takes place from the more massive to the less massive component. The primary, a fast-rotating star with V sin i = 181.4+\-2.5 km s^-1, is covered by inhomogeneities: very slowly drifting spots and a dense network of ripples more closely participating in its rotation. The spectral lines of the primary show an additional broadening component (called the "pedestal") which originates either in the equatorial regions which rotate faster than the rest of the star by about 50 km s^-1 or in an external disk-like structure. The secondary component appears to be smaller than predicted by the contact model. The radial velocity field around the secondary is dominated by accretion of matter transferred from (and possibly partly returned to) the primary component. The parameters of the binary are: A sin i = 2.73 +/- 0.11 R_odot and M_1 sin^3 i = 1.29 +/- 0.15 M_odot, M_2 sin^3 i = 0.128 +/- 0.016 M_odot. The mass ratio q_rm sp = M_2/M_1 = 0.099 +/- 0.003, while still the most uncertain among the spectroscopic elements, is substantially different from the previous numerous and mutually consistent photometric investigations which were based on the contact model. It should be studied why photometry and spectroscopy give so very discrepant results and whether AW UMa is an unusual object or that only very high-quality spectroscopy can reveal the true nature of W UMa-type binaries.

Looking a bit superficial to the pleura.

BackgroundThe internal thoracic artery (ITA) is a descendant branch of the subclavian artery. The former is located bilaterally in both internal sides of the thorax near the sternum and is accompanied by two internal thoracic veins (ITV). From a practical point of view, the ITA (and the ITV) identification is important because these vessels can be injured when pericardiocentesis with the parasternal approach is used. Other advantage of the ITA recognition is to check the patency of the ITA grafts in coronary artery revascularizated patients with new onset chest pain. The purpose of this article is to introduce a simple ultrasonographic technique for recognition of the aforementioned vessels and to highlight the utility of this finding in clinical practice.FindingsWith linear probe and along paraesternal line, the internal thoracic vessels are recognized on grayscale imaging as an anechoic tubular structure immediately anterior to pleural line. Color Doppler identifies a pulsatile (ITA) and a non-pulsatile (ITV) flow. Spectral Doppler normally shows a high resistance velocity profile in non-grafted ITA and a phasic flow in ITV. A biphasic low resistance velocity profile is normally expected in the grafted and permeable ITA.ConclusionsThe ITA (non-grafted) and ITV are recognized routinely along the parasternal line. The operators should identify these vessels when the parasternal approach pericardiocentesis is required and should also consider obtaining spectral Doppler images to check permeability of grafted ITA in coronary artery bypass graft patients with chest pain.

AIUM practice guideline for the performance of peripheral arterial ultrasound examinations using color and spectral doppler imaging.

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FRI0135 Unexpected High Prevalence of Cardiac Disease in Patients with Ankylosing Spondylitis

BackgroundAnkylosing spondylitis (AS) is associated with an increased cardiovascular (CV) risk that is caused by accelerated atherosclerosis as well as specific cardiac manifestations: valvular disease, conduction disturbances and congestive heart...

Combined Vector Velocity and Spectral Doppler Imaging for Improved Imaging of Complex Blood Flow in the Carotid Arteries

Color flow imaging and pulsed wave (PW) Doppler are important diagnostic tools in the examination of patients with carotid artery disease. However, measurement of the true peak systolic velocity is dependent on sample volume placement and the operator's ability to provide an educated guess of the flow direction. Using plane wave transmissions and a duplex imaging scheme, we present an all-in-one modality that provides both vector velocity and spectral Doppler imaging from one acquisition, in addition to separate B-mode images of sufficient quality. The vector Doppler information was used to provide automatically calibrated (angle-corrected) PW Doppler spectra at every image point. It was demonstrated that the combined information can be used to generate spatial maps of the peak systolic velocity, highlighting regions of high velocity and the extent of the stenotic region, which could be used to automate work flow as well as improve the accuracy of measurement of true peak systolic velocity. The modality was tested in a small group (N = 12) of patients with carotid artery disease. PW Doppler, vector velocity and B-mode images could successfully be obtained from a single recording for all patients with a body mass index ranging from 21 to 31 and a carotid depth ranging from 16 to 28 mm.

PREDICTION OF CORONARY ARTERY DISEASE BY DETECTION OF POSITIVE ISOVOLUMIC RELAXATION VELOCITY IN PATIENTS WITH NORMAL RESTING WALL MOTIONS "A Tissue Doppler Echocardiographic Study"

Background: Diagnosis of coronary artery disease (CAD) is of importance in the contemporary society of ever-increasing CAD (1,2). Isovolumic relaxation velocity (VIR), Postsystolic motion or postsystolic shortening (PSS) is a delayed ejection motion of the myocardium occurring after the aortic valve closure during a generally prolonged isovolumic relaxation time, which is related with myocardial ischemia in human(3,4) and in experimental studies(5). Spectral tissue Doppler imaging (TDI) is a simple echocardiographic technique that can provide velocity measurement of the myocardial segments(6). A positive myocardial velocity during isovolumic relaxation phase (VIR) detected by TDI, which corresponds to postsystolic motion or PSS, has been shown to indicate severely ischemic myocardium(8). So, detection of positive VIR by spectral TDI may be used as a noninvasive, nonprovocative method to predict possible CAD; specially for those with coexisting morbidities, such as peripheral artery disease in the lower limb, orthopedic diseases. Aim of the work: Diagnostic value of positive myocardial velocity during isovolumic relaxation phase (VIR) by spectral TDI in prediction of CAD in patients with typical ischemic chest pain and normal resting wall motions. Patients and methods: This study was done in Cardiology department, Zagazig University on 80 patients; 41 females (51%) & 39 males (49%)) with typical ischemic chest pain and no regional wall motion abnormalities detected by resting echocardiography. Patients were divided into 2 groups according to presence of significant coronary artery lesion by coronary angiography; group A (patients with CAD) and group B (patients without CAD). All the following parameters were measured by TDI; 5 peak velocities during; Isovolumic contraction phase (VIC), Systolic ejection phase (S'), Early diastolic relaxation phase (Em), Atrial contraction phase (Am) and Isovolumic relaxation phase (VIR) if present and VIR time. Then coronary angiography was done for all patients. Results: As regard to presence of VIR velocity, there was significant difference (<0.05) between group A and group B at mid septal and anterior walls, highly significant difference (<0.001) at basal septal and anterior walls. There was highly significant difference between group A and B at mid and basal lateral and inferior walls. There was highly significant correlation between coronary angiography and VIR velocity regarding detection of positive and negative cases and also there was highly significant correlation between previous 2 tests by Kappa test p value (<0.001). Conclusion: Positive VIR detected by spectral tissue Doppler imaging is a useful indicator of CAD in patients with apparently normal left ventricular contraction and chest pain. Key words: TDI, VIR velocity, coronary angiofraphy, coronary artery disease.

The relationship between mitral annular systolic velocity and ejection fraction in patients with preserved global systolic function of the left ventricle.

BackgroundThe aim of the study was to investigate the relationship between the ejection fraction (EF) and the mitral annular systolic velocity (Sm) in patients with preserved left ventricular systolic function (EF>55%). The study task was to evaluate whether the assessment of Sm(avg) can be used as an alternative to the Simpson’s method in assessment of the EF. The expected benefit was that Sm could be used to predict EF, when EF is difficult to assess due to poor image quality (IQ).MethodSm was obtained by spectral pulse wave Tissue Doppler Imaging (pwTDI) from the lateral and septal sites of the mitral annulus (MA) and an averaged value was calculated - Sm(avg). EF was assessed using Simpson’s rule. Participants were divided into controls (n=70), hypertensive (HTN, n=56), HTN with diastolic dysfunction (HTN/DD, n=65), HTN with diabetes mellitus (HTN/DM, n=52) and HTN with DD and DM (HTN/DD/DM, n=65).ResultsSm(avg) showed strong correlation with EF (r=0.978; p<0.0001). There were no significant differences between the correlation coefficients between the subgroups and the controls. The mathematical model that the study recommended to assess the EF is: EF=45.0 + 2 × Sm(avg).ConclusionThe assessment of Sm(avg) could be used as an alternative to EF. This approach may be useful especially when the IQ is poor. The method maintains high accuracy and reproducibility in prediction of the EF.