Tissue Doppler Imaging Variables Research Articles

Tissue Doppler imaging of the diaphragm and outcome of weaning from mechanical ventilation.

This study aimed to employ tissue Doppler imaging to monitor diaphragmatic peak velocity and acceleration during contraction and relaxation in mechanically ventilated patients, with the objective of assessing the potential utility of this technique in predicting weaning outcomes. A total of 89 adult subjects were recruited in this study. After 30 min of spontaneous breathing trial, the diaphragm motion parameters, including peak contraction velocity, peak relaxation velocity, contraction acceleration and relaxation acceleration, were measured in real time using tissue Doppler imaging. According to the results of weaning, the patients were divided into successful weaning group and failed weaning group. The differences of diaphragmatic tissue Doppler imaging monitoring indicators between the two groups were analysed, and the receiver operating characteristic curve was drawn to analyse the value of each ultrasound parameter in predicting weaning. In the successful weaning group, there were 61 subjects, while in the failed weaning group, there were 28 subjects. The peak contraction velocity, peak relaxation velocity, contraction acceleration and relaxation acceleration of the diaphragm were significantly higher in the failed weaning group compared to the successful weaning group (P < 0.05). The area under the curve of diaphragmatic peak contraction velocity, peak relaxation velocity, diaphragmatic contraction acceleration and diaphragmatic relaxation acceleration were 0.81 (0.72-0.91), 0.85 (0.77-0.93), 0.74 (0.63-0.86) and 0.86 (0.78-0.94), respectively. The diaphragm ultrasonic tissue Doppler imaging variables can serve as predictive indicators for weaning mechanical ventilation in patients, thus providing an effective tool to assist critical care physicians in determining the optimal timing for weaning mechanical ventilation.

Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed‐Wave Tissue Doppler Imaging

BackgroundAssessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease.ObjectivesTo describe the use of pulsed‐wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease.AnimalsThirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD.MethodsEchocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one‐way ANOVA and Dunnett's test.ResultsA complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ETm (−118.5 [−154.1 to −82.9] ms; mean difference [95% CI of difference of means]), increased PEPm/ETm (0.11 [0.05 to 0.17]), prolonged IMPm (0.28 [0.18 to 0.37]), increased S 1 (8.9 [5.2 to 12.6] cm/s), and decreased E 1 (−2.6 [−4.7 to −0.5] cm/s), E m (−14.2 [−19.9 to −8.5] cm/s), and E m/A m ratio (−1.6 [−2.6 to −0.6]).Conclusions and Clinical ImportancePulsed‐wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.

Utility of Tissue Doppler Imaging in the Echocardiographic Evaluation of Left and Right Ventricular Function in Dogs with Myxomatous Mitral Valve Disease with or without Pulmonary Hypertension

BackgroundIn human medicine, right ventricular (RV) functional parameters represent a tool for risk stratification in patients with congestive heart failure caused by left heart disease. Little is known about RV alterations in dogs with left‐sided cardiac disorders.ObjectivesTo assess RV and left ventricular (LV) function in dogs with myxomatous mitral valve disease (MMVD) with or without pulmonary hypertension (PH).AnimalsOne‐hundred and fourteen dogs: 28 healthy controls and 86 dogs with MMVD at different stages.MethodsProspective observational study. Animals were classified as healthy or having MMVD at different stages of severity and according to presence or absence of PH. Twenty‐eight morphological, echo‐Doppler, and tissue Doppler imaging (TDI) variables were measured and comparison among groups and correlations between LV and RV parameters were studied.ResultsNo differences were found among groups regarding RV echo‐Doppler and TDI variables. Sixteen significant correlations were found between RV TDI and left heart echocardiographic variables. Dogs with PH had significantly higher transmitral E wave peak velocity and higher E/eʹ ratio of septal (sMV) and lateral (pMV) mitral annulus. These 2 variables were found to predict presence of PH with a sensitivity of 84 and 72%, and a specificity of 71 and 80% at cut‐off values of 10 and 9.33 for sMV E/eʹ and pMV E/eʹ, respectively.Conclusions and clinical importanceNo association between variables of RV function and different MMVD stage and severity of PH could be detected. Some relationships were found between echocardiographic variables of right and left ventricular function.

0318 : Left ventricular diastolic dysfunction in asymptomatic type 1 diabetic children: two-dimensional echocardiography study

Diabetic cardiomyopathie (DCM) is a distinct new entity. Pathophysiological mechanisms are not well known. It's defined as the presence of abnormal myocardial performance or abnormal structure in the absence of epicardial coronary artery disease, hypertension and significant valvular disease. The relationship between type 1 diabetes (T1D) and cardiac function in children is not well established. Demonstration of an early diastolic and systolic dysfunction help us to diagnose children's DCM, and is important for the timely interventions. The objective of this study was to characterize diastolic function abnormalities using two-dimensional echocardiography in T1D children. Twenty four T1D children were compared to 20 healthy control matched for age, gender and body mass index and having normal echocardiography. A standard 12-lead electrocardiogram was recorded followed by measurement of blood pressure. Laboratory investigations included mean hemoglobin (HbA1c). Echocardiography with simultaneous ECG (standard lead II), including standard echocardiographic views and tissue Doppler imaging (TDI), was performed using Vivid 9, GE Ultrasound. Left ventricular end-diastolic diametre (LV-EDD), interventricular septal end-diastolic diametre (IVS-EDD) were measured. LV conventional Doppler parameters of diastolic function were obtained: peak early (E) and peak late (A) diastolic flow velocities, E-wave deceleration time and E/A ratio were measured on the basis of transmitral flow velocities. LVEF was assessed using the biplane Simpson's method in apical four and two chamber views. TDI was performed in four apical view. The following TDI variables were evaluated: peak systolic (S), peak early diastolic (E’) and peak late diastolic (A). The mean age was 11.13 years±0.54. The T1D children and control group were comparable with respect to age, gender and heart rate. Diabetic children were asymptomatic and had normal physical examination. The mean duration of diabetes was 7±0.54 years. The mean HbA1C was 8.79%±0.25. LVEDD was 41.8±0.84 mm and LVESD was 26.33±0.73 mm. The average of IVS was 5.5±0.19 mm. LVEF was preserved with an average of 67.88±1.18%. The left atrial area was 10.78±0.33 and the volume was 24.35±1.72 ml. For diastolic function, in the diabetic group, E wave was 1.07±0.03cm/s, A wave was 0.58±0.04cm/s and E/A ratio was 4.4±2.08. In the control group, the E wave was 1.04±0.01cm/s, the A wave was 0.59±0.14 and the E/A ratio of 1.78±0.046. There were no significant differences between the two groups. The TDE was however significantly shorter in the diabetic group 146.54±3.69 ms Vs 161.42 ms±2.38 for the control group, with p = 0.005. Similarly, E ’septal wave were significantly decreased in diabetic children compared to controls (0.16±0.006 Vs 0.20±0.007, p = 0.001). The E / E ’ ratio was significantly higher in the diabetic group compared to the control group (6.72±0.33 vs. 5.21±0.15, p = 0.0011). Subclinical left ventricular impairment has been well demonstrated. Our study showed that diastolic function is affected whereas the parameters of systolic function are still preserved. The author hereby declares no conflict of interest

Time From the Beginning of the Right Ventricle Isovolumetric Contraction to the Peak of the S Wave: A New TDI Indicator for the Non-Invasive Estimation of Pulmonary Hypertension.

BackgroundEchocardiography is a key screening tool in the diagnostic algorithm of pulmonary hypertension (PH). In addition, tissue doppler imaging (TDI) is a promising method for the noninvasive estimation of pulmonary artery pressure (PAP).ObjectivesThe aim of this study was to validate the accuracy of measuring the time from the beginning of the right ventricular isovolumetric contraction time (RV IVRT) to the peak of the S wave in the TDI of the base of the RV free wall (time to peak or TTP), as an indicator for the non-invasive estimation of pulmonary hypertension.Patients and MethodsIn this diagnostic test study, 60 consecutive patients referred for right heart catheterization (RHC) were enrolled. A pulse-wave TDI was performed before the cardiac catheterization, with a mean interval of 1 hour between the two measurements. The TDI variables, such as the RV IVRT, myocardial performance index (MPI), and the new “time to peak” parameter, were measured at the lateral basal RV free wall. The patients were divided into two sub-groups according to the RHC findings: no-PH (mean PAP < 25 mmHg) and PH (mean PAP ≥ 25 mmHg) groups. Then, we calculated the specificity and sensitivity of the TDI parameters (including the TTP) for the diagnosis of PH.ResultsIn our study, the TTP showed a significant inverse relationship with the PAP. Based on our results, a TTP of less than 127 ms could be used to predict PH, with a sensitivity and specificity of about 70% (AUC = 0.746 ± 0.064).ConclusionsBased on the results of this study, we suggest the use of a novel “time from the beginning of isovolumetric contraction to the peak of the S wave” (TTP) parameter in the TDI of the base of the RV free wall to predict PH with acceptable accuracy in comparison with RHC.

Assessment of left ventricular longitudinal function in cats with subclinical hypertrophic cardiomyopathy using tissue Doppler imaging and speckle tracking echocardiography.

Hypertrophic cardiomyopathy (HCM) in cats is characterized by concentric left ventricular (LV) hypertrophy and both diastolic and systolic dysfunction. Although impaired cardiac function detected by tissue Doppler imaging (TDI) in cats with HCM was previously reported, reference ranges of TDI in normal cats and cats with HCM have been reported as widely variable. Two-dimensional speckle tracking echocardiography (STE) was useful for assessment of cardiac function in human patients with HCM, but clinical utility was not known in cats. The aim of this study was to assess global and segmental LV myocardial function using STE in cats with HCM whose TDI variables were within the reference range. A total of 35 cats of different breeds were enrolled in this study. The HCM group (n=22) was cats diagnosed as HCM without left atrial enlargement and with normal TDI measurements. HCM cats were further divided into a segmental hypertrophy (S-HCM) group and a diffuse hypertrophy (D-HCM) group. The control group consisted of 13 clinically healthy cats. No cats in any group showed any clinical symptoms. Conventional echocardiography, TDI, and global and segmental STE indices were evaluated and compared between groups. Only the longitudinal strain rate during early diastole was significantly decreased in both HCM groups, even in all segments including those without hypertrophy in S-HCM group. This study suggests that STE parameters are the more sensitive variables compared with conventional TDI parameters to detect early myocardial diastolic dysfunction in cats with HCM.

Prognostic comparison of tissue Doppler indices of diastolic dysfunction and cardiac biomarkers in septic shock

Diastolic dysfunction as evaluated by tissue Doppler imaging (TDI), particularly by E/E' ratio (peak early diastolic transmitral velocity/peak early diastolic mitral annular velocity) and mitral annular E'-wave, is common and crucial in critical illness. Our prospective observational study assessed the prognostic significance of TDI variables versus cardiac biomarkers, B-type natriuretic peptide (BNP), troponin-T (TnT) and investigated determinants of plasma BNP rise, in septic shock.

The early diastolic myocardial velocity: a marker of increased risk in patients with coronary heart disease

Tissue Doppler imaging (TDI) is a promising echocardiographic modality allowing quantification of myocardial performance. However, the prognostic potential of TDI in patients with acute myocardial infarction (AMI) is not yet investigated. We sought to explore the ability of TDI in identifying patients at risk for new cardiovascular events after AMI. One hundred and nineteen patients with AMI were recruited prospectively (mean age 61 years; range 32-81 years of age). Patients with diabetes mellitus (DM) were excluded. Echocardiography was performed 3-12 months after AMI. Two-dimensional (2-D) and TDI variables were recorded. The patients were followed during a mean period of 4·6 years (range 1-8 years). The primary end-point was defined as any of the following: death from any cause, non-fatal reinfarction or stroke, unstable angina pectoris, congestive heart failure requiring hospitalization and coronary revascularization procedure. Thirty patients had some form of cardiovascular events during follow-up. Seven patients had cardiovascular death, 13 patients had reinfarction and four patients had a stroke. New angina or unstable angina was recorded in 21 patients. Of these patients, 13 underwent percutaneous coronary angioplasty (PCI) or coronary artery bypass grafting (CABG). The early diastolic myocardial velocity (E(m)) emerged as the only echocardiographic variable that offered a clear differentiation between patients that presented with new cardiovascular (CV) events as compared to the corresponding group without any CV events at follow-up (P<0·05). In multivariate statistical analysis and after adjustment for age, sex, total cholesterol, body mass index (BMI) and other baseline characteristics, Em remained as independent predictors of CV events (HR, 1·18, 95% CI, 1·02-1·36; P<0·05). However, none of the investigated variables evolved as an independent predictor of cardiovascular morbidity and mortality. E(m) appears to be a sensitive echocardiographic index in identifying non-diabetic patients with AMI at risk of new cardiovascular events.

Aortic tissue Doppler imaging after tetralogy of Fallot repair: beyond aortic diameters

Purpose: Structural abnormalities of the aortic wall have been described in tetralogy of Fallot (ToF) and could be responsible for aortic stiffening leading to aortic dilatation. We aimed to study if aortic root stiffness indices assessed by tissue Doppler imaging (TDI) could be related to the aortic diameter late after ToF repair. Methods: We included adult (≥ 18 years) patients (pts) with surgically repaired ToF followed at a terciary care center from January till December 2012. We defined two groups based on the Cornell data-based z-score formulae for two-dimensional transthoracic echocardiographic diameter of the aortic root at the level of the sinuses of Valsalva (AoZ), in parasternal long-axis view: group 1 - with Ao dil (AoZ > 2) and group 2 - without Ao dil (AoZ ≤ 2). Aortic root M-mode systolic and diastolic diameters and TDI variables were measured, including systolic maximum anterior wall expansion velocity (SAo), early (EAo) and late (AAo) diastolic retraction velocity and time to peak systolic (TAo). Strain, distensibility and stiffness index of the aortic root were determined noninvasively. Results: We included 43 pts (mean age 32±11 years; 58% female); mean follow-up time since ToF repair was 22±8 years. In 21 pts (49%) an aortopulmonary (AP) shunt was done prior to complete repair, with a median interval of 3 years. In 15 pts complete repair used a transannular patch. In 10 pts (23%) we identified Ao dil (mean age 32±11 years; 5 males). Only 1 pt had moderate aortic regurgitation. Both group 1 and 2 were similar concerning age, gender, body surface area, age at ToF repair and follow up time after repair. Also, no differences could be found in systemic blood pressure, pulse pressure, and TDI variables. There was a trend to a positive correlation between the aortic root z-score and the aortic stiffness index, whereas a trend to a negative correlation was found for the aortic strain and distensibility. The aortic stiffness index was significantly increased in group 1 (14.8±6.3 vs 8.5±6.8, p=0.019) and in univariate and multivariate analysis, the aortic stiffness index was an independent predictor of aortic dilatation (odds ratio 1.30, 95% confidence interval 1.02-1.65, p=0.033). Conclusions: TDI can assess the aortic elastic properties noninvasively in this subset of pts and the aortic stiffness index may be a predictor of aortic dilatation late after ToF repair.

Left Ventricular Diastolic Dysfunction — Early Cardiac Impairment in Patients with Polymyositis/Dermatomyositis: A Tissue Doppler Imaging Study

To investigate early cardiac involvement in patients with polymyositis/dermatomyositis (PM/DM), and to evaluate the risk factors for early cardiac impairment. The study population included 46 patients with PM/DM who did not have overt cardiovascular manifestations and 21 age- and sex-matched healthy controls. Traditional echocardiography and tissue Doppler imaging (TDI) were used to evaluate cardiac function in both groups. Clinical characteristics were recorded. Multivariate logistics regression analysis was applied to investigate risk factors for early cardiac impairment in patients with PM/DM. No significant difference was found between patients and controls by traditional echocardiography. However, compared to controls, PM/DM patients had a significantly lower ratio of early diastolic mitral annulus velocity to late diastolic mitral annulus velocity (Em/Am; 1.23 ± 0.52, 1.79 ± 0.37, respectively; t = -4.485, p < 0.001) and a higher ratio of peak early diastolic transmitral flow velocity to Em (E/Em; 8.26 ± 2.57, 6.76 ± 1.17; t = 3.287, p < 0.05) as found by TDI measurements. There was no significant difference between the TDI variables of patients with PM and DM. The multivariate regression analysis showed that female sex (OR 11.044, 95% CI 1.066-114.357, p = 0.044), late onset (OR 1.157, 95% CI 1.047-1.278, p = 0.004), and duration of disease (OR 1.060, 95% CI 1.008-1.115, p = 0.023) were risk factors for abnormal left ventricular filling pressures. TDI is useful for detecting early cardiac impairment in patients with PM/DM. Left ventricular diastolic dysfunction is an early feature of cardiac involvement. Female sex, late onset, and long course of disease are 3 independent risk factors for predicting left ventricular diastolic dysfunction in patients with PM/DM.

Right Ventricular Dysfunction and Remodeling in Chronic Obstructive Pulmonary Disease Without Pulmonary Hypertension

The aim of the present study was to elucidate right ventricular (RV) function and structure in patients with chronic obstructive pulmonary disease (COPD) without pulmonary hypertension (PH). There is little knowledge of RV function and remodeling in COPD without PH. Thirty-four controls and 98 patients with COPD were included. The study patients were divided into 2 groups by right heart catheterization: no PH (mean pulmonary artery pressure [mPAP]<25 mm Hg) and PH (mPAP≥25 mm Hg). The echocardiographic tissue Doppler imaging variables of RV isovolumic acceleration, peak systolic strain, and RV myocardial performance index were measured at the basal free wall, and RV wall thickness and RV internal dimension were measured in the RV outflow tract. The increases in RV wall thickness and RV dimension were more evident when comparing controls with the no PH group (3.5 ± 0.5 mm to 5.5 ± 1.0 mm [p< 0.01] and 1.5 cm ± 0.2 to 2.0 ± 0.5 cm [p< 0.01]) than comparing the no PH group with the PH group (5.5 ± 1.0 mm to 6.6 ± 1.1 mm [p< 0.01] and 2.0 cm ± 0.5 to 2.1 ± 0.3 cm [p = NS]), respectively. Similarly, RV isovolumic acceleration, performance index, and strain deteriorated significantly when comparing controls with the no PH group and comparing the no PH group with the PH group (p< 0.01). Significant correlations were observed between mPAP and RV isovolumic acceleration, performance index, strain, and RV wall thickness (p< 0.01). RV impairment and increased RV wall thickness and RV dimensions were present even at slight elevations of mPAP (18 ± 3 mm Hg) in the no PH group. The present study showed that impaired RV systolic function, hypertrophy, and dilation were present even at a slight increase of mPAP, which indicates an early impact on RV function and structure in patients with COPD. RV isovolumic acceleration, performance index, and strain could detect subclinical disease and separate controls from those with no PH.

The prognostic value of left ventricular systolic function measured by tissue Doppler imaging in septic shock

IntroductionLeft ventricular (LV) dysfunction is common in septic shock. Its association with the clinical outcome is still controversial. Tissue Doppler imaging (TDI) is a useful tool to quantify LV function; however, little knowledge is available about the prognostic value of these TDI variables in septic shock. Therefore, we performed this prospective study to determine the role of TDI variables in septic shock.MethodsPatients with septic shock in a medical intensive care unit were studied with transthoracic echocardiography with TDI within 24 hours after the onset of septic shock. Baseline clinical, laboratory, and echocardiographic variables were prospectively collected. Independent predictors of 90-day mortality were analyzed with the Cox regression model.ResultsDuring a 20-month period, 61 patients were enrolled in the study. The 90-day mortality rate was 39%; the mean APACHE IV score was 84 (68 to 97). Compared with survivors, nonsurvivors exhibited significantly higher peak systolic velocity measured at the mitral annulus (Sa) (11.0 (9.1 to 12.5) versus 7.8 (5.5 to 9.0) cm/sec; P < 0.0001), lower PaO2/FiO2 (123 (83 to 187) versus 186 (142 to 269) mm Hg; P = 0.002], higher heart rate (120 (90 to 140) versus 103 (90 to 114) beats/min; P = 0.004], and ahigher dose of norepinephrine (0.6 (0.2 to 1.0) versus 0.3 (0.2 to 0.5) μg/kg/min; P = 0.007]. In the multivariate analysis, Sa > 9 cm/sec (hazard ratio (HR), 5.559; 95% confidence interval (CI), 2.160 to 14.305; P < 0.0001), dose of norepinephrine (HR, 1.964; 95% CI, 1.338 to 2.883; P = 0.001), and PaO2/FiO2 (HR, 0.992; 95% CI, 0.984 to 0.999; P = 0.031) remain independent predictors of 90-day mortality in septic-shock patients.ConclusionsOur study demonstrated that LV systolic function as determined by TDI, in particular, Sa, might be associated with mortality in patients with septic shock.

Importance and inter-relationship of tissue Doppler variables for predicting adverse outcomes in high-risk patients: an analysis of 388 diabetic patients referred for coronary angiography

To investigate the relative importance of individual tissue Doppler imaging variables to predict adverse events in a high-risk population with diabetes, ischaemic heart disease, and/or systolic dysfunction. Transthoracic echocardiograms were analysed in 388 diabetic patients without significant valve disease, bundle branch block, and atrial fibrillation who underwent coronary angiography. Multivariable Cox's regression analyses were used to establish the association between peak systolic (s'), early diastolic (e'), and late diastolic (a') tissue velocities and outcomes (hospitalization for heart failure or death). The mean age and left ventricular ejection fraction (LVEF) was 66±10 years and 45±12%, respectively. During 2.3 (±1.0) years of follow-up, 91 patients (24%) met the combined endpoint. After adjustment for LVEF, coronary artery pathology, heart failure at baseline, age, and gender, each 1 cm/s decrease in s', e', and a' was associated with a hazard ratio (HR) of 1.18 (0.89-1.57), 1.03 (0.86-1.22), and 1.20 (1.05-1.37), respectively. A significant interaction was found between s' and a', P<0.01. In patients with lower than mean s', 1 cm/s decrease in a' was associated with HR 1.31 (1.10-1.55, P<0.01), whereas a' was without prognostic importance in patients with higher than mean s' [HR 0.99 (0.78-1.25, P=0.6)]. Patients having lower than mean values of both s' and a' had a poorer prognosis than patients having at least one of s' and a' high. Peak systolic and late diastolic tissue velocities add prognostic information beyond LVEF in high-risk patients. Variables should be considered together as they interact on prognosis.

Tissue Doppler imaging is useful for predicting the need for inotropic support after cardiac surgery

Low preoperative left ventricular ejection fraction (EF) is a predictor of the need for inotropic support after cardiac surgery. However, EF can be misinterpreted and difficult to measure in some cases. The purpose of this study was to compare the value of preoperative EF and intraoperative tissue Doppler imaging variables in predicting the need for postoperative inotropic support. Forty-eight consecutive adult patients undergoing cardiac surgery were enrolled in this study. Systolic mitral annular velocity (S(m)), early diastolic mitral annular velocity (E(m)), the ratio of E(m) to late diastolic mitral annular velocity (E(m)/A(m)), and the ratio of early diastolic transmitral velocity to E(m) (E/E(m)) were measured using transesophageal echocardiography before median sternotomy. The primary outcome was the need for inotropic support for 12 or more hours after surgery. Preoperative, intraoperative, and echocardiographic characteristics were analyzed to determine the independent predictors of the need for postoperative inotropic support. Postoperative inotropic support was required for ≥12 h in 26.7% of patients. Multivariate logistic regression identified only cardiopulmonary bypass (CPB) time as an independent predictor of inotropic support (odds ratio, 1.015; 95% CI, 1.004-1.025; P = 0.004). Additional analysis was performed in the 25 patients with a CPB time of ≥200 min. In this analysis, only S(m) was significantly associated with the need for inotropic support for ≥12 h. This study suggests that those patients who have decreased S(m) and extended CPB times are more likely to require inotropic support after surgery, independent of a preserved left ventricular EF.

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

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

Evaluation of the influence of age on pulmonary arterial pressure by use of right ventricular catheterization, pulsed-wave Doppler echocardiography, and pulsed-wave tissue Doppler imaging in healthy Beagles

To assess the influence of age on pulmonary hemodynamics and hemorheological properties in healthy dogs. 14 healthy Beagles. Dogs were placed in 2 age groups as follows: young dogs (<or= 5 years old; n = 8) and old dogs (>or= 8 years old; 6). Hematologic characteristics, plasma total protein and fibrinogen concentrations, and blood viscosity were measured. Systolic time intervals of pulmonary blood flow were recorded by pulsed-wave Doppler echocardiography. Early (E') and late (A') diastolic myocardial velocities, isovolumic contraction velocity, and systolic myocardial velocity of the free tricuspid annulus were recorded by pulsed-wave tissue Doppler imaging (TDI). Dogs were anesthetized and pulmonary arterial pressures (PAP) and cardiac output were recorded with a pediatric thermodilution Swan-Ganz catheter. Hemorheological measurements were not different between the 2 groups. Systolic, mean, and diastolic PAP were higher in old dogs, compared with values in young dogs; this difference was attributed to a high pulmonary vascular resistance and low arterial compliance in old dogs. Systolic time intervals of pulmonary blood flow stayed unchanged. The A' wave of the free tricuspid annulus was increased in old, compared with that young dogs, and the E':A' ratio was decreased. Pulmonary vascular resistance was inversely correlated with compliance. The age of dogs should be taken into account when interpreting pulmonary hemodynamic results and TDI variables of right ventricular diastolic function.

Tissue Doppler and Strain Imaging in Dogs with Myxomatous Mitral Valve Disease in Different Stages of Congestive Heart Failure

Tissue Doppler imaging (TDI) including strain and strain rate (SR) assess systolic and diastolic myocardial function. TDI, strain, and SR variables of the left ventricle (LV) and the interventricular septum (IVS) differ significantly between dogs with myxomatous mitral valve disease (MMVD) with and without congestive heart failure (CHF). Sixty-one dogs with MMVD with and without CHF. Ten healthy control dogs. Prospective observational study. Radial motion: None of the systolic variables were altered and 3 of the diastolic velocities were significantly increased in dogs with CHF compared with dogs without CHF and control dogs. Longitudinal motion: 2 systolic velocities and 3 diastolic velocities were significantly increased in dogs with CHF compared with dogs without CHF and control dogs. Difference in systolic velocity time-to-peak between LV and IVS was significantly increased in dogs with MMVD with and without CHF compared with control dogs. In total, 11 (23%) of 48 TDI and strain variables differed significantly between groups. Left atrial to aortic ratio was positively correlated to early diastolic velocities, percentage increase in left ventricular internal diameter in systole was positively correlated to systolic and diastolic velocities, and mitral E wave to peak early diastolic velocity in the LV basal segment (E/Em) was positively correlated to radial strain and SR. Few TDI and strain variables were changed in dogs with MMVD with and without CHF. Intraventricular dyssynchrony may be an early sign of MMVD or may be an age-related finding.

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

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

Abstract 2436: Tricuspid E/Ea is a Powerful Predictor of Cardiac Events in Patients with Chronic Pulmonary Hypertension

Background: Right ventricular (RV) filling pressure can be estimated using tissue Doppler imaging (TDI) from the tricuspid lateral annulus. There are sparse data on the significance of estimated RV filling pressure in predicting the prognosis of chronic pulmonary hypertension (PH). Methods: In 50 consecutive patients with chronic PH undergoing right heart catheterization, early diastolic myocardial velocity (E a ) at the tricuspid lateral annulus and early diastolic tricuspid inflow (E) were obtained from 4-chamber view using TDI. The tricuspid E/E a ratio was calculated and compared with the invasive hemodynamic variables including pulmonary arterial systolic pressure (PASP), mean right atrial pressure (RAP) and RV end-diastolic pressure (RVEDP). Cardiac events including cardiac death or rehospitalization due to RV failure were assessed at long-term follow-up (mean 14.0±1.4 months). Results: The tricuspid E/E a ratio was significantly positively correlated with RAP (r=0.80, p&lt;0.001) and RVEDP (r=0.72, p&lt;0.001), irrespective of RV systolic function (depressed RV systolic function, n=32, r=0.81; preserved RV systolic function, n=18, r=0.75; both p&lt;0.001). An E/Ea ratio &gt; 7.3 had a sensitivity of 87% and a specificity of 97% for mean RAP ≥ 10mmHg. We divided patients into group A with cardiac events (n=19) and group B without events (n=31). There was no significant difference in PASP between the groups. However, serum brain natriuretic peptide and E/Ea ratio were significantly higher in group A than in group B (349±310 vs 129±136 pg/dl, p=0.001; 7.0±3.2 vs 4.5±.9, p=0.004, respectively). Multivariate Cox’s analysis using TDI and conventional echocardiographic variables showed that the tricuspid E/E a ratio (relative risk 1.226, 95%CI 1.011–1.486, p = 0.039) and RA area index (relative risk 1.078, 95%CI 1.002–1.159, p = 0.043) were predictive for cardiac events. Kaplan-Meier analysis showed patients with E/E a &gt; 7.3 had a significantly worse outcome than those with E/E a ≤ 7.3 (log-lank: 10.5, p = 0.0012). Conclusion: RV filling pressure can be well estimated using the tricuspid E/Ea ratio. This index and RA size are powerful predictors of cardiac events in patients with chronic PH, suggesting the prognostic importance of RV diastolic dysfunction.

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