Tissue Doppler Imaging Systolic Velocities Research Articles

Right ventricular function in patients with significant tricuspid regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Aim The aim of this meta-analysis was to systematically investigate the prognostic value of right ventricular (RV) function in all-comers patients with significant (at least moderate, ≥ 2+) tricuspid regurgitation (TR). Background Chronic significant TR imposes a volume overload to the RV leading to a progressive RV dilatation and dysfunction. A comprehensive assessment of RV function is of paramount importance to guide the therapeutic management of these patients; however, it remains challenging, particularly in presence of altered loading conditions. Methods MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to July 2022. Studies reporting data on at least one echocardiographic RV function parameter and outcome in patients with significant TR were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause long-term mortality (more than one year). Results Out of 3,152 studies, a total of 10 were included in the analytic synthesis, enrolling 3435 subjects. The median follow-up in our study population was 28 [22 – 70] months. All-cause long-term mortality was 40% (95% confidence interval [CI]: 32–49%, p = 0.028; Figure 1). To explore the potential impact of effect size modifiers on all-cause long-term mortality, we performed a meta-regression analysis of the baseline characteristics of the included studies. At long-term, a significant relation was found between RV fractional area change (RV-FAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular tissue doppler imaging systolic velocity (TDI s’) and mortality. In particular, RV-FAC was associated with reduced incidence of all-cause mortality [7 studies enrolling 2,611 subjects, intercept 5.18, slope −0.15, P = 0.007; Figure 2]; whereas both TAPSE and TDI s’ were unsatisfactory to predict the outcome in these patients [TAPSE 9 studies enrolling 2,891 subjects, intercept 1.73, slope −0.12, P = 0.36; TDI s’ 5 studies enrolling 1429 subjects, intercept −2.06, slope 0.15, P = 0.78]. Interestingly, diabetes mellitus (DM) and hyperlipidaemia were associated with an increased risk of mortality [DM 9 studies enrolling 3371 subjects, intercept −2.62, slope 0.09, P = 0.004; hyperlipidaemia 6 studies enrolling 2338 subjects, intercept −2.91, slope 0.05, P = 0.01]. Conclusions Significant TR is associated with increased risk of all-cause. To our knowledge, this is the first study to demonstrate that only RV-FAC, and not conventional echocardiographic indexes of RV longitudinal function, correlates with adverse outcomes in patients with significant TR.

Using Mitral Annular Plane Systolic Excursion (MAPSE) and Tissue Doppler Imaging Systolic Velocity (TDIS’) As Surrogates of Left Ventricular Systolic Function

Purpose: Echocardiography has become a useful method for assessing structural diseases of the heart. MAPSE and TDI S’ have also been shown to be reproducible assessments of longitudinal heart changes as LVEF is ineffective in cases of sub-optimal echocardiographic imagery caused by artefacts or air trapping.
 Methodology: One hundred patients referred for echocardiography at the cardiac laboratory of DELSUTH, Oghara, Nigeria was recruited for the study. All patients had trans-thoracic echocardiography done with M-Mode, 2D and Spectral Doppler and Tissue Doppler echocardiographic images acquired. Data obtained was analyzed using IBM-SPSS version 22. A p-value of ≤0.05 was considered significant for all comparisons.
 Findings: Hypertension was the commonest indication for an echocardiogram. The prevalence of abnormal left ventricular function was 13%, 24% and 28% as determined using LVEF, TDI S’ and MAPSE. MAPSE had a higher specificity than TDI S’ with statistically significant correlations found between TDI S’ (p<0.001); MAPSE (p=0.032) and LVEF. Multiple linear and binomial logistic regression analysis showed significant relationships (beta=0.423; p <0.001) and odd ratios [OR(CI) = 10.80(2.56- 49.07)] respectively between TDI S’ and LVEF.
 Unique Contribution to Theory, Policy and Practice: MAPSE’s specificity allows for diagnosis of longitudinal heart functional changes even in cases where the LVEF may be within normal limits. A combination of both MAPSE and TDI S’ offer a greater prognostic significance. The correlation between MAPSE and TDI S’ were good. Thus, MAPSE and TDI S’ can serve as surrogates for LVEF in assessing left ventricular systolic function and prognosticating cardiac disease

Tricuspid Annular Systolic Velocity to Left Ventricular Outflow Velocity Time Integral Ratio: Proof of Concept Utility Analysis.

BackgroundThe tricuspid annular plane systolic excursion (TAPSE) / pulmonary artery systolic pressure (PASP) ratio has been a useful marker of right ventricular (RV)-pulmonary artery coupling. However, given the intricate functional and mechanical interdependence of the right and left ventricles, we believe this ratio would be less useful when assessing reduced left ventricular (LV) systolic function. Instead, we proposed using the tricuspid annular tissue Doppler imaging systolic velocity to LV outflow tract velocity time integral ratio (TA TDI s’ / LVOT VTI r) for this purpose. MethodsFor this proof-of-concept study, a retrospective analysis was conducted on 60 patients with complete echocardiographic studies while in sinus rhythm. The population was divided as follows; Group 1 included 20 individuals with normal left ventricular ejection fraction (LVEF) as well as normal RV and PASP. Group 2 was composed of 20 patients known to have been evaluated or treated for pulmonary hypertension, while group 3 was comprised of 20 patients treated for heart failure (HF). ResultsTAPSE/PASP ratios were no different from any of the studied groups. However, the proposed TA TDI s' /LVOT VTI r was statistically different among all three groups (Group 1: 0.6 ± 0.1*; Group 2: 0.5 ± 0.1°; and Group 3: 0.8 ± 0.3#; p < 0.001).ConclusionsBased on these results, there is now a need for additional prospective studies to explore the overall utility of using this TA TDI s' / LVOT VTI r in day-to-day routine assessments not only for diagnostic purposes but also to determine how this ratio correlates with symptoms and changes with therapy.

Conventional and advanced echocardiographic assessment of systolic function in dogs sedated with dexmedetomidine or acepromazine

Dexmedetomidine and acepromazine, sedatives commonly used in dogs have opposite vascular effects, resulting in afterload increase and decrease, respectively. This could variably affect systolic myocardial function. Previous echocardiographic studies assessing the cardiovascular effects of these drugs used conventional echocardiography, while advanced techniques such as speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI), which are known to provide a more accurate assessment of systolic function, have been rarely used for this aim. Moreover, in the few studies using advanced techniques, the drugs where combined with opioids. Therefore, the main objective of this prospective study was to assess systolic myocardial function by conventional and advanced echocardiography (STE and TDI), in dogs sedated exclusively with dexmedetomidine or acepromazine not combined with other drugs. Twenty healthy dogs were randomly divided into two groups, Group A (acepromazine, 20 μg/kg IM), and Group D (dexmedetomidine, 5 μg/kg IM), cardiovascular parameters were assessed before sedation (T0), and thirty minutes afterwards (T1). Systolic arterial pressure and heart rate decreased in both groups at T1 as compared to T0. Only one conventional echocardiographic raw variable (left ventricular internal dimension in systole) and three out of five advanced echocardiographic variables (radial TDI systolic velocities at the epicardial region of the left ventricular free wall, longitudinal TDI systolic velocities of the septal mitral valve annulus and the STE-derived left ventricular global strain), were affected in Group D. A systolic impairment was observed in Group D and better estimated by advanced echocardiography. In Group A, only the end diastolic voume index (conventional echocardiography) was decreased. Both protocols seem to induce echocardiographic changes more likely secondary to their vascular action.

PO013 Using Mitral Annular Plane Systolic Excursion (MAPSE) and Tissue Doppler Imaging Systolic Velocity (TDI S’) as Surrogates of Left Ventricular Ejection Function

PO013 Using Mitral Annular Plane Systolic Excursion (MAPSE) and Tissue Doppler Imaging Systolic Velocity (TDI S’) as Surrogates of Left Ventricular Ejection Function

112 - The Ascent Component of Mitral Annular Motion Mainly Reflects the Left Ventricular Diastolic Function

Background: M-mode interrogation of the mitral annular plane systolic excursion (MAPSE) and tissue Doppler imaging (TDI) of the MA systolic velocity are accepted surrogate measures of left ventricular (LV) systolic function. Since the MA continues to move during diastole and not only determines the MA ascent (MAa) component but also maximal MAPSE; our study intended to investigate the overall contribution of MAa to LV systole and diastole in patients with normal LV systolic function and in sinus rhythm. Methods: A total of 106 echocardiograms were retrospectively evaluated. LV systolic function was assessed using the modified Simpson's rule, MAPSE and MA TDI measures. LV diastolic function was investigated using standard Doppler criteria. Finally, MAa data was measured as shown in Fig. 1. The studied population was divided according to age: Group 1 included 16 patients (24–39 years); Group 2 contained 52 patients (40–55 years) while Group 3 comprised 38 patients (56–89 years). Results: All measured echocardiographic data is shown in Table 1. In our study sample, while there was no difference in terms of MAPSE; MAa was lowest in Group 1. In a multiple regression analysis, MAa correlated best with MAPSE (<0.001), both early and late diastolic MA velocities (<0.001) and mitral valve inflow early to late diastolic flows (<0.001). No correlation was seen with regards to age, LV systolic function by Simpson’s, or MA TDI systolic velocity. Conclusions: In this study, MAa only correlated with Doppler parameters of LV diastolic and with none of the systolic measures of LV function, except maximal MA systolic excursion. The latter association might simply reflect normal atrio-ventricular dependency that exists between LV systole and diastole. Specifically, the final end diastolic MA resting position determines were the next LV cardiac systolic cycle starts. Additional studies are now required to better examine this atrio-ventricular dependence between LV systole and diastole.Table 1Echocardiographic data of the study population.VariablesGroup 1 (n = 16)Group 2 (n = 52)Group 3 (n = 38)ANOVAAge31 ± 548 ± 467 ± 8<0.001LVEF69 ± 568 ± 973 ± 100.034MV E/A ratio1.6 ± 0.81.3 ± 0.51.0 ± 0.6<0.001MA S' velocity10 ± 38 ± 28 ± 30.009MA E' velocity14 ± 59 ± 38 ± 2<0.001MA A' velocity7 ± 28 ± 210 ± 40.004MA E'/A' ratio2.1 ± 0.81.2 ± 0.50.9 ± 0.4<0.001MAPSE1.4 ± 0.21.3 ± 0.21.3 ± 0.30.102MAa0.4 ± 0.10.6 ± 0.20.6 ± 0.20.017 Open table in a new tab

Maximal systolic excursion of the tricuspid annulus is independent of right atrial size and function in chronic pulmonary hypertension.

Even though the tricuspid annulus (TA) is anatomically and functionally related to right atrioventricular dependence and tricuspid annular plane systolic excursion (TAPSE) is a well-known measure of right ventricular (RV) systolic function, there is paucity of data regarding the potential impact that right atrial (RA) size and function have on TAPSE. Hence, we sought to determine whether RA volumetric and longitudinal measures affect TAPSE in patients with chronic pulmonary hypertension (cPH). In this retrospective study, echocardiographic data from 110 patients were reviewed and the studied population was divided into Group I consisting of 50 patients (50±11years) without PH and Group II that included 60 patients (55±14years) with cPH. Even though RA areas, RA fractional area change, and maximal long-axis length measurements were abnormal in cPH patients, TA tissue Doppler imaging systolic velocity and RV fractional area change were the only useful variables in identifying patients with abnormal TAPSE (P<.0001 and P=.018, respectively). Additionally, TAPSE was independent of all RA measures, left ventricular ejection fraction, and age (P>.05). Based on these results, TAPSE does not appear to be influenced by either RA size or function. Additional studies using strain echocardiography to interrogate RA mechanics might now be very useful to advance our understanding of TA motion in cPH patients given recent data showing that RA function accounts for a significantly greater proportion of total right heart function in patients with cPH than in normal subjects.

Tissue Doppler Imaging in Coronary Heart Diseases and Heart Failure: An Up to Date

The application of tissue Doppler imaging (TDI) has shown remarkable growth in clinical practice during the past years, especially, in risk stratification of patients with coronary heart disease or heart failure (systolic and diastolic). TDI systolic velocities have been used to detect impaired systolic function in patient with coronary artery disease and heart failure. Important patents were reported in the last years. Main Future development is the application of threedimensional echocardiography with TDI and other technologies derived from TDI, as Strain, Strain Rate and Twodimensional (2D) Strain. Keywords: Coronary artery disease, echocardiography, heart failure, tissue doppler imaging, TDI parameters.

Automated functional imaging for assessment of left ventricular mechanics in the presence of left ventricular hypertrophy.

Increased left ventricular (LV) mass is a well-known independent predictor of cardiovascular morbidity and mortality. Even though these patients have an increased risk of LV diastolic dysfunction; recent data have suggested the presence of subtle LV systolic abnormalities. This study sought to demonstrate if a novel speckle tracking automated functional imaging (AFI) tool would be useful in identifying differences in strain generation between patients with normal and increased LV wall mass. Standard measures of LV systolic and diastolic function were collected from 90 patients divided into Group I with LV mass index < 100 g/m(2) and Group II with LV mass index values ≥ 100 g/m(2). AFI was also obtained to measure peak global LV myocardial strain. As expected, patients with an increased LV mass index had significant LV diastolic abnormalities. However, in addition these patients in Group II not only had significantly lower peak systolic strain values but also significantly lower mitral annular plane systolic excursion (MAPSE) and MA tissue Doppler imaging systolic velocity values than patients in Group I despite having comparable estimates of LV ejection fraction, based on the Simpson's method. Based on these results, AFI provides prompt point of care information regarding LV function and mechanics and identifies differences in longitudinal strain generation between patients with normal and increased LV wall mass. Additional studies are now required to prospectively determine if AFI measures of LV function might be useful to identify patients with an increased LV mass that will develop symptomatic systolic or diastolic heart failure.

Clinical and echocardiographic predicators of postoperative atrial fibrillation.

Postoperative atrial fibrillation is the most common arrhythmiaafter coronary artery bypass grafting,with a reported incidence of 10% to 60%. Preoperative clinical and echocardiographic data, especially the atrial electromechanical interval, predict postoperative atrial fibrillation in elective coronary artery bypass patients. A prospective study evaluated preoperative clinical and echocardiographic data in 192 patients who underwent elective coronary artery bypass from 2010 to 2012. 18 (9.37%) patients developed postoperative atrial fibrillation. Compared to patients without postoperative atrial fibrillation, these 18 had significantly longer intensive care unit and hospital stays, they were significantly older (58.62 ± 10.02 vs. 53.22 ± 8.23 years; p = 0.02), with a larger left atrial volume (83.39 ± 8.31 vs. 55.47 ± 8.37 cm(3), p = 0.001), longer atrial electromechanical interval (133.67 ± 8.15 vs. 98.05 ± 6.71 ms p < 0.0001), and lower tissue Doppler imaging systolic velocity wave amplitude (6.6 ± 1 vs. 9.4 ± 2.2 cm·s(-1); p = 0.001); they also had a higher prevalence of hypertension (61.11% vs. 38.5%; p = 0.04). Using 115 ms as the cutoff value of atrial electromechanical interval enabled us to detect patients who developed postoperative atrial fibrillation with 100% sensitivity, 77% specificity, 78% positive predictive value, and 100% negative predictive value. Older hypertensive patients are at higher risk of developing postoperative atrial fibrillation. Preoperative measurement of atrial electromechanical interval by tissue Doppler echocardiography is a useful predictor of postoperative atrial fibrillation in coronary artery bypass patients.

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

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

Assessment of Right Ventricular Endocardial Dysfunction in Mild‐to‐Moderate Mitral Stenosis Patients Using Velocity Vector Imaging

Right ventricular (RV) function plays an important role in the development of clinical symptoms, exercise capacity, prognosis, and survival in patients with mitral stenosis (MS). The purpose of this study was to evaluate global and regional RV systolic functions using a novel technique, VVI, in mild-to-moderate MS patients without clinical symptoms of heart failure. The study population consisted of 60 patients (mean age 51.7 ± 11.6 years; 85% female) with isolated rheumatic mitral valve stenosis and 40 age- and sex-matched control subjects (mean age 49.1 ± 10.5 years; 76.7% female). Conventional echocardiography, tissue Doppler imaging (TDI), strain (S), and strain rate (SRs) analysis were performed in all patients. Transmitral mean pressure gradient was 6.1 ± 3.0 mmHg and mean mitral valve area was 1.41 ± 0.31 cm(2) in patients with MS. TDI systolic velocity was significantly lower in MS patients compared to control subjects (0.13 ± 0.03 m/sec vs. 0.17 ± 0.03 m/sec; P < 0.0001). RV-isovolumic acceleration was reduced in MS patients (3.75 ± 1.09 m/sec(2) vs. 4.62 ± 1.0 m/sec(2) ; P = 0.006). RV-myocardial performance index was significantly increased in patients with MS (0.75 ± 0.05 in MS and 0.29 ± 0.04 in controls; P < 0.0001) revealing impaired RV systolic and diastolic function. The mean longitudinal peak systolic S and SR were significantly reduced in patients with MS (P < 0.0001). Our data revealed that RV systolic performance is reduced in patients with mild-to-moderate MS.

Myocardial perfusion SPECT and dobutamine stress tissue Doppler imaging in evaluation of patients with stable angina pectoris

To evaluate longitudinal function of ischemic and nonischemic myocardial tissue detected by Tc-99m MIBI single photon emission computed tomography (SPECT) prior to coronary revascularization in patients with stable angina pectoris. We studied 24 consecutive patients (mean age 62+/-9 years; 5 women) with stable angina pectoris. All patients underwent myocardial perfusion SPECT. Tissue Doppler imaging (TDI) was performed to detect myocardial systolic velocities of anterior, inferior, septum and lateral walls at rest and peak dobutamine stress. A total of 96 segments were visualized with SPECT study. Maximum mean septal, lateral, anterior and inferior TDI systolic velocities were similar in ischemic and nonischemic segments (6.73+/-1.04 cm/sec, 6.93+/-1.34 cm/sec, respectively) at rest. At peak stress, maximum mean TDI systolic velocities were lower in the 37 ischemic segments (11.00+/-2.03 cm/sec) than 59 nonischemic segments (13.76+/-1.97 cm/sec, p = 0.001). Because we detected ischemia in whole group using both diagnostic tests, coronary angiography was decided. Critical coronary artery stenosis related to ischemic segments was detected and coronary revascularization decided. TDI with dobutamine stress can be used in patients with stable angina pectoris. In this study, we observed that quantitative data by TDI associated with SPECT showed an agreement for coronary revascularization.

Prognostic Value of Tissue Doppler Right Ventricular Systolic and Diastolic Function Indexes Combined With Plasma B-Type Natriuretic Peptide in Patients With Advanced Heart Failure Secondary to Ischemic or Idiopathic Dilated Cardiomyopathy

Right ventricular (RV) dysfunction adversely affects prognosis in patients with chronic heart failure (CHF) due to left ventricular (LV) dysfunction. However, little evidence exists regarding the prognostic role of RV systolic and diastolic function indexes in combination with plasma B-type natriuretic peptide (BNP) in advanced CHF. Thus, 102 consecutive hospitalized patients with advanced CHF (New York Heart Association classes III to IV) due to LV systolic dysfunction (LV ejection fraction <35%) were studied by 2-dimensional conventional and tissue Doppler imaging (TDI) echocardiography of the left and right ventricles. Plasma BNP was also measured. Patients were followed for 6 months for major cardiovascular events (cardiovascular death and/or CHF-related hospitalization). During follow-up, 13 patients died and 63 patients reached the combined end point of cardiovascular death or CHF-related hospitalization. By univariate analysis, RV TDI systolic velocity, dilated cardiomyopathy, digoxin treatment (all p values <0.01), and female gender (p <0.05) were associated with increased cardiovascular death. Transmitral Doppler to mitral annular TDI early diastolic velocity ratio, RV TDI early diastolic velocity (p <0.05), and ratio of early to late RV diastolic TDI velocities (p <0.01) predicted the combined end point. In multivariate analysis, decreased RV systolic velocity, dilated cardiomyopathy, and female gender (all p values <0.05) were independent predictors of cardiovascular death, whereas increased ratio of early to late RV diastolic TDI velocities (p <0.01) and increased BNP (p <0.05) predicted the combined end point. In conclusion, RV TDI indexes combined with increased plasma BNP additively predict adverse cardiac outcomes in advanced CHF.

The Effects of Pulmonary Arterial Hypertension on Left Ventricular Systolic and Diastolic Synchrony

Purpose: Pulmonary arterial hypertension (PAH) is known to alter right ventricular (RV) function and mechanics, resulting in RV dyssynchrony. However, the effects of PAH on left ventricular (LV) mechanics are less well known. We therefore queried our tissue Doppler imaging (TDI) database to identify patients with chronic PAH who had normal QRS duration and normal LV ejection fraction to examine the effect of PAH on LV systolic and diastolic synchronicity. Methods: The mid LV septum and lateral wall were sampled, as seen in Figure 1A, to obtain a TDI velocity signal. Systolic synchronicity was determined by the time interval between peak TDI systolic velocities (Ss) while diastolic synchronicity was defined as the time interval between peak TDI early (E) wave diastolic signals in 2 groups of patients. Figure 1B is a sample TDI velocity signal from a normal patient (Group I) and Figure 1C is a sample from a patient with PAH (Group II). Group I consisted of 18 patients (57 ± 16 years) with chronic PAH (PA systolic pressure of 78 ± 20 mmHg) and Group II included 18 healthy volunteers (47 ± 14 years; p = NS and PA systolic pressure of 21 ± 4 mmHg; p<0.001). Results: There was no difference between Group I and II regarding LV ejection fraction (79 ± 12% vs 65 ± 5%) or QRS duration (89 ± 14 ms vs. 90 ± 7 ms). However, Group I patients had significantly longer temporal delay between their septal and LV lateral wall systolic TDI signals (41 ± 36 ms vs. 8 ± 12ms; p<0.001) as well as their early diastolic E wave TDI signals (45 ± 56ms vs. 11 ± 9ms; p<0.01) than Group II as seen in Figure 1D and 1E. Conclusions: Systolic as well as early diastolic dyssynchrony is present in PAH patients despite having normal LV ejection fraction and a narrow QRS duration. It appears that geometric alterations in RV anatomy, due to pressure overload, rather than a electromechanical coupling delay in these patients not only impair LV systolic mechanics but also early LV relaxation. Further studies are now needed to determine the temporal evolution of these alterations and their relation to clinical outcomes.

Abnormalities of Left Ventricular Function in Asymptomatic Patients with Systemic Sclerosis Using Doppler Measures of Myocardial Strain

To verify whether myocardial impairment can be detected by tissue Doppler imaging (TDI) in patients with asymptomatic systemic sclerosis (SSc), 35 patients with SSc with normal left ventricular (LV) ejection fraction and 35 control subjects were studied. Myocardial longitudinal peak systolic velocity, strain, and strain rate (SR) were measured by TDI at a regional level, and for each parameter the average value was calculated using an LV 12-segment model. In addition, the mitral annulus diastolic velocities and the E/Ea ratio were obtained. Myocardial calibrated integrated backscatter (cIB) was used as an index of fibrosis. Compared with controls, patients with SSc showed lower peak strain (-19.5% +/- 2.3% vs -26.1% +/- 2.4%, P < .001), peak SR (-1.34 +/- 0.14 s(-1) vs -1.59 +/- 0.14 s(-1), P < .001), septal cIB (-19.5 +/- 3.1 dB vs -23.8 +/- 1.6 dB, P < .001), and posterior wall cIB (-23.4 +/- 2.9 dB vs -28.6 +/- 2.5 dB, P = .001), and higher E/Ea (11.7 +/- 2.5 vs 9.8 +/- 1.1, P < .001), whereas peak systolic velocities did not differ. Strain, SR, and E/Ea correlated better with cIB than systolic velocities. TDI-derived strain, SR, and E/Ea can detect impairment of LV myocardial function in asymptomatic patients with SSc with normal LV ejection fraction better than TDI systolic velocities.

Impaired right ventricular systolic function demonstrated by reduced atrioventricular plane displacement in adults with Marfan syndrome

The right ventricle (RV) ejects the same volume of blood at the same rate as the left ventricle (LV). Mild LV dysfunction has been demonstrated in Marfan syndrome (MFS). However, little attention has been paid to the functioning of the RV. The aim of this study was to assess RV function in unoperated adult MFS patients. In 66 unoperated (15-58 years) MFS patients and 61 controls, rate of pressure rise (dp/dt) in RV, and tricuspid annular motion (TAM) were studied using conventional echocardiography and tissue Doppler imaging (TDI). When compared with controls, MFS patients showed impaired RV systolic function as expressed by a reduced dp/dt, TAM obtained by M-mode echocardiography, and peak TDI systolic velocities at the basal lateral wall (745.36+/-37.85 vs. 1103.30+/-27.30 mmHg, P<0.001; 2.2+/-0.05 vs. 2.5+/-0.05 cm, P<0.001; and 0.13+/-0.002 vs. 0.16+/-0.002 m/s, P<0.001, respectively). This study demonstrated a primary impairment of RV systolic function in MFS. This is the first study to report RV dysfunction in MFS. Such data could prove valuable during the peri-operative and long-term medical management of MFS patients.

Tissue Doppler imaging study of right ventricular myocardial systolic activation in subjects with pulmonary arterial hypertension

Tissue Doppler imaging (TDI) has provided an objective means to quantify global and regional left ventricular (LV) and right ventricular (RV) function with improved accuracy and greater reproducibility than conventional echocardiography. This study was conducted to assess RV myocardial systolic activation by TDI in subjects with pulmonary arterial hypertension (PAH). A total of 30 patients with PAH and 30 healthy volunteers, all comparable in age and sex, underwent standard Doppler echo and TDI. Using pulsed Doppler echocardiography combined with TDI, the following regional parameters were evaluated in three different myocardial segments (RV basal lateral wall, basal septal, and LV basal lateral) on apical 4-chamber view: systolic (Sm), early- and late-diastolic (Em and Am) peak velocities. RV myocardial systolic activation delay was defined as the difference in time to peak TDI systolic velocities between the RV basal lateral wall and basal septal. In addition, RV end-diastolic and end-systolic areas were measured to calculate RV fractional area change from the same apical 4-chamber view. Compared with the control group, patients with PAH showed increased RA and RV end-diastolic diameter (RA: (4.5 +/- 1.2) cm vs (3.0 +/- 0.8) cm, P < 0.05 and RV: (4.8 +/- 1.9) cm vs (3.4 +/- 0.5) cm, P < 0.05) and reduced RV fractional area change; (35 +/- 14)% vs (56 +/- 9)%, P < 0.05. These PAH patients showed lower myocardial peak velocities and a significant activation delay compared with controls (P < 0.05). Moreover, a strong correlation between RV myocardial systolic activation delay and RV fractional area change was shown in patients with pulmonary arterial hypertension (r = -0.82). In PAH, RV myocardial systolic activation was markedly delayed, which was directly related to the RV fractional area change. RV myocardial systolic activation delay assessed by TDI could offer a unique approach to predict RV dysfunction.

Use of Tissue Doppler Imaging following Coronary Artery Bypass Surgery

This study assessed the effect of coronary artery bypass grafting (CABG) on myocardial systolic functions using tissue Doppler imaging (TDI). Fourteen patients (three women and 11 men) who had undergone isolated coronary bypass surgery were included in the study. Their mean age was 61 +/- 8 years. TDI systolic velocity measures were obtained from four different sites on the left ventricular wall (anterior, septal, lateral and inferior) at the papillary muscle level in the parasternal short axis view before CABG, and then at 1 and 6 weeks post-operatively. There were significant increases in the myocardial wall velocities at all left ventricular sites 1 week after CABG. This increase persisted to week 6 after CABG, but the velocities were lower than week 1 values. We conclude that the ischaemic myocardium responded to surgical revascularization with marked increases in myocardial segmental systolic velocities in the early post-operative period.