Tissue Doppler Imaging Velocities Research Articles

A Study of the Usefulness of Tissue Doppler Imaging for the Diagnosis of Coronary Artery Disease in Patients with Left Bundle Branch Block

Abstract Background: In patients with left bundle branch block (LBBB), the diagnosis of ischemia by noninvasive modalities is cumbersome. Most of them such as stress tests, nuclear imaging, and magnetic resonance imaging have limitations in the detection of ischemia in this subset. The postsystolic motion (PSM) during the isovolumetric relaxation period on tissue Doppler imaging (TDI) is a sensitive and specific marker of ischemia. We aimed to see whether the TDI parameters can detect coronary artery disease (CAD) in patients with LBBB. Materials and Methods: Patients with LBBB (n = 64) who underwent coronary angiography were divided into two groups. Group A (n = 30) included patients with left anterior descending (LAD) artery stenosis of ≥70%, and group B (n = 34) included patients without LAD stenosis. All patients underwent TDI and various myocardial tissue velocity parameters were analyzed to detect the presence of CAD. P < 0.05 was considered significant. Results: The TDI of the mid-interventricular septum showed a higher delayed amplitude of PSM (>100 ms after aortic valve closure), lower myocardial systolic (Sm), and early diastolic (Em) velocities, and a higher late diastolic (Am) velocity in group A when compared to group B (all were significant, P < 0.0001). Both the ratios Sm/PSM and Em/Am were significantly lower in group A compared to group B (P < 0.0001). On receiver operating characteristic curve analysis to predict the presence of significant LAD stenosis, the value of Sm/PSM ratio <0.8 showed the best combination of sensitivity (78%) and specificity (96%) with an area under the curve of 0.936. Conclusion: TDI, a noninvasive imaging modality, is reliable and effective in identifying myocardial ischemia in patients with LBBB.

Complementary Value of Tissue Doppler Imaging in Dobutamine Stress Echocardiography: A Prospective Cohort Study

Introduction: In patients with Coronary Artery Diseases (CAD), the presence of viable myocardium predicts the recovery of Left Ventricular (LV) systolic function after revascularisation. The identification of myocardial viability during dobutamine stress echocardiography is subjective and with observer bias. Tissue Doppler Imaging (TDI) echocardiography has opened new possibilities for non-invasive quantification of myocardial function by directly interrogating myocardial velocity with high temporal and spatial resolution. Aim: To determine the baseline regional myocardial and mitral annular Maximum Systolic Velocities (MSV) in patients with LV dysfunction and to compare the MSV values in viable and nonviable myocardium. Materials and Methods: In this prospective Cohort study, TDI of regional and annular LV myocardial velocities was performed at the baseline (at rest) in 352 patients with CAD and LV dysfunction who were referred for Dobutamine stress Echocardiography. Viability assessment by 2 Dimensional (2D) methods was done simultaneously using routine Dobutamine stress protocol. Patients were grouped in two groups based on the presence or absence of viability with 2D stress echocardiography. TDI velocities were compared in the two groups of patients with and without myocardial viability. Measurements of regional wall thickness, Ejection Fraction(EF) and Wall Motion Score Index (WMSI) were done to assess the regional and global LV function in these patients. Those patients who underwent revascularisation were subsequently assessed for functional recovery by 2D and TDI echocardiography before discharge from the hospital. Analyses were conducted using Statistical Package for Social Sciences(SPSS) version 16.0. Results: Among 352 patients studied (124 females and 228 males), mean age 58 years (range 36 to 75 years). A total of 243 patients (69%) with viable myocardium as per 2D echocardiography had higher cut-off Baseline Regional Maximum Systolic Velocity (BRMSV) >0.03 m/s and baseline mitral annular systolic velocity >0.06 m/s with high sensitivity and specificity compared to patients with severe contractile dysfunction and non-viable myocardium. Conclusion: Tissue doppler parameters like regional myocardial systolic and mitral annular velocities have shown significantly higher cut-off values in those patients with ischaemic and viable myocardium compared to non-viable myocardium.

Z Scores and Reference Values for Tissue Doppler Imaging Velocities and Timings of Healthy Egyptian Children

Z Scores and Reference Values for Tissue Doppler Imaging Velocities and Timings of Healthy Egyptian Children

Isoproterenol loading transesophageal echocardiography in atrial fibrillation.

In patients with sludge or severe spontaneous echo contrast (SEC) in the left atrial appendage (LAA), cases with isoproterenol loading transesophageal echocardiography (ISP-TEE) have been reported to identify the presence of thrombus in the LAA. This study aimed to assess the validity and hemodynamic changes of ISP-TEE in the LAA. We prospectively enrolled patients with atrial fibrillation (AF) who underwent ISP-TEE. The degree of sludge/SEC was categorized as being either absent (grade 0), mild SEC (grade 1), moderate SEC (grade 2), severe SEC or sludge (grade 3). The hemodynamic evaluation was performed by measuring LAA flow velocity, LAA tissue Doppler imaging (LAA-TDI) velocity, and pulmonary vein systolic forward flow velocity (PVS). In total, 35 patients (mean age 71 ± 7years; 71% male) underwent ISP-TEE. Among 35 patients, 30 patients had grade 3 or 2 SEC, 5 patients had grade 1 SEC. After ISP loading, 23 patients (66% of all patients) showed improved sludge/SEC and one patient was diagnosed with thrombus in the LAA. There were 25 patients with grade 1 SEC, or no SEC (classified as Group1), 10 patients had residual sludge or grade 2 to 3 SEC (classified as Group2) after ISP administration. LAA flow, LAA-TDI, and PVS velocities were significantly higher in group 1 than in group 2 after ISP administration. There was no complication during the examination and after 24h and 3months. ISP infusion may be a potential tool to recognize LAA thrombus under the sludge/SEC during TEE in AF.

Changes in myocardial tissue velocities over a decade: the Copenhagen City Heart study

Abstract Background The aim of the present study was to investigate the impact of cardiovascular risk factors – age, sex, hypertension, hypercholesterolemia, diabetes, smoking and obesity on Tissue Doppler imaging (TDI) measures of systolic and diastolic tissue velocities in the general population over a 10-year period. Identifying risk factors that are associated with changes in TDI velocities could lead to an improved understanding of the pathophysiology of the deteriorating heart and enable early preventive actions and strategies. Methods The study included 1128 members from the general population who participated in both the 4th and 5th Copenhagen City Heart Study. At both examination rounds, the participants underwent echocardiography. The examinations were 10 years apart. Conventional echocardiographic measures of cardiac structure and function and measures of TDI myocardial tissue velocities were obtained. Results Average change in s', e' and a' were −0.4±1.1 cm/s, −0.9±1.7 cm/s and 0.5±1.7 cm/s, respectively. After multivariable adjustments, older age (P<0.001) and higher systolic blood pressure (BP) (P=0.029) were found to be associated with a decrease in s' at follow-up. Male sex (P<0.001) was found to be associated with an increase in s'. Older age (P<0.001) and greater number of smoking pack-years (P=0.004) were associated with a decrease in e' at follow-up after multivariable adjustments. In addition, greater BMI (P=0.004) was significantly associated with a decrease in a'. Higher diastolic BP (P=0.004) and male sex (P=0.004) were associated with an increase in a'. Conclusion In the general population, overall systolic and diastolic function declined over a 10-year period. Both systolic and diastolic function as assessed by myocardial TDI velocities were affected by multiple conventional cardiovascular risk factors. Funding Acknowledgement Type of funding sources: None.

A preliminary study of the safety and effectiveness of isoproterenol loading transesophageal echocardiography in atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background In patients with sludge or severe spontaneous echo contrast (SEC) in the left atrial appendage (LAA), isoproterenol loading transesophageal echocardiography (ISP-TEE) has been reported to check the presence of thrombus in the LAA, as the sludge or severe SEC disappears (Figure 1). Purpose The aim of this study was to assess the safety of ISP-TEE for the identification of LAA thrombus and the hemodynamic changes in the LAA caused by ISP loading. Methods We prospectively enrolled 25 patients with atrial fibrillation (AF) and sludge or SEC in the LAA who underwent ISP-TEE from April 2020 to July 2021. ISP was administered intravenously to achieve the target heart rate (HR) defined as follows: Max HR [beats per minutes: bpm] = 220 – age (years), Target HR [bpm] = Max HR × 0.8. Patients with tachycardia exceeding Max HR before ISP administration, hemodynamic instability, and other contraindications to ISP were excluded from the study. To assess the safety of ISP-TEE, we evaluated patients’ condition, changes in systolic blood pressure (sBP) and HR before and after ISP loading. We also assessed the presence or absence of worsening heart failure, new arrhythmias other than atrial fibrillation, and cerebral infarction or transient ischemic attack during the examination, and after 24 hours. Hemodynamic evaluation was performed using LAA blood flow velocity, LAA tissue Doppler imaging (TDI) velocity, and LAA volume fraction (LAAVF) defined as follows: LAAVF (%) = (Max LAA volume – Min LAA volume) / Max LAA volume × 100. Quantification of LAA volume was performed using the stacked-contour method of a 3-dimensional TEE full-volume acquisition. Results Among 25 patients, 13 patients had sludge or grade3 SEC, 7 patients had grade2 SEC, 5 patients had grade1 SEC. HR after ISP loading was significantly higher than before loading, but sBP did not change significantly before and after ISP loading. No complications due to ISP loading were observed during examination and after 24 hours. After ISP loading, there were 18 patients with grade 1 SEC or no SEC (classified as Group1), 7 patients had residual sludge or grade 2 to 3 SEC (classified as Group2). The differences in LAA blood flow velocity between before and after ISP loading was faster in Group1 than in Group2: 13.0 ± 10.5 vs 2.6 ± 4.2. p = 0.019. The differences in TDI velocity was also faster in Group1 than in Group2: 1.46 ± 1.14 vs 0.19 ± 0.50, p = 0.010. The differences in LAAVF was higher in Group1 than in Group2: 13.7 ± 10.3 vs 2.2 ± 2.0, p = 0.009. Conclusions In our study, no complications were observed in ISP-TEE for the identification of LAA thrombus. Patients with grade 1 SEC or no SEC, the LAA function was increased by ISP loading. These results may provide insights into the mechanisms of ISP loading on SEC in the LAA. Abstract Figure.

Cardiac abnormalities determined by tissue Doppler imaging and arrhythmias in adolescents with anorexia nervosa.

Anorexia nervosa has a prevalence of 0.5-3% in adolescents, placing this population at increased risk of cardiac anomalies including arrhythmias, pericardial effusion, and myocardial dysfunction. Our objective is to describe cardiovascular anomalies observed by tissue Doppler imaging in patients with anorexia nervosa. We retrospectively reviewed electrocardiogram, Holter, and echocardiography findings in 28 patients diagnosed with anorexia nervosa. Electrocardiogram was abnormal in 71% of patients with sinus bradycardia observed in 57%. Holter confirmed sinus bradycardia without significant pauses. Prolonged QTc, low voltage, and ectopic beats were each seen in 14% of patients. Wenckebach atrioventricular block was observed in one patient. Supraventricular or ventricular tachycardia was not observed. Echocardiography showed structurally normal heart in all patients. Pericardial effusion was seen in 7.1% of patients and left ventricular mass was decreased in 10.7%. Mean ejection fraction was 0.73 and mean fractional shortening was 38.4%. Tissue Doppler imaging revealed systolic or diastolic dysfunction in four patients with e', a', and s' velocities in the lateral and septal basal segments more than two standard deviations below the mean. Two patients had decreased left ventricular mass but no significant difference in disease duration from the group. Basal segment velocities below one standard deviation were also observed in an additional seven patients. A trend for decreased tissue Doppler imaging velocities was seen in 25.0% of patients, while significant systolic and diastolic dysfunction was seen in 14.3% of patients, associated with a significant reduction in left ventricular mass and independent of disease duration.

Cardiac and Echocardiographic Markers in Cryptogenic Stroke with Incidental Patent Foramen Ovale

ObjectiveSome cardiac abnormalities could be a substrate for potential embolic source in cryptogenic stroke (CS). We evaluated whether cardiac and echocardiographic markers were associated with CS in patients with incidental patent foramen ovale (PFO) as defined using the Risk of Paradoxical Embolism (RoPE) score. Materials and methodsAmong 677 patients enrolled in a multicenter observational CS registry, 300 patients (44%) had PFOs detected by transesophageal echocardiography. They were classified into probable PFO-related stroke (RoPE score>6, n = 32) and stroke with incidental PFO (RoPE score≤6, n = 268) groups, and clinical characteristics, laboratory findings, cardiac and echocardiographic markers (i.e. brain natriuretic peptide, left atrial [LA] diameter, ejection fraction, early transmitral flow velocity/early diastolic tissue Doppler imaging velocity [E/e’], LA appendage flow velocity, spontaneous echo contrast, atrial septal aneurysm, substantial PFO, and aortic arch plaques), stroke recurrence, and excellent outcome (modified Rankin scale score <2) at discharge were compared. Risk factors for low RoPE scores were determined using multiple logistic regression analysis. ResultsHigher brain natriuretic peptide levels (p = 0.032), LA enlargement (p < 0.001), higher E/e’ (p = 0.001), lower LA appendage flow velocity (p < 0.001), non-substantial PFO (p = 0.021), and aortic arch plaques (p = 0.002) were associated with the low RoPE score group. Patients with high RoPE scores had excellent outcomes (58% versus 78%, p = 0.035). LA enlargement (age- and sex-adjusted odds ratio, 1.15; 95 % confidence interval, 1.00–1.32; p = 0.039) was an independent predictor of low RoPE scores. ConclusionsAbnormal cardiac substrate could be associated with CS occurrence in a subset of patients with PFO. Patients with CS who had incidental PFO may be at risk of cardioembolism.

Tissue doppler imaging of left atrial appendage during transoesophageal echocardiography predicts successful cardioversion in patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Restoration of sinus rhythm in patients with atrial fibrillation (AF) prevents from thromboembolic events, decreases the risk for cardiomyopathy and improves quality of life. Purpose This study aimed to determine whether Tissue Doppler Imaging (TDI) during transesophageal echo (TEE) could predict successful electrical cardioversion (CV) of AF lasting more than 48 hours but less than 6 months. Methods One hundred patients, 74 men and 26 women of mean age 64.7 ± 9.8 years old with non-valvular AF were included. Pulse wave (PW) Doppler velocities as well as TDI velocities of the medial and lateral walls of the left atrial appendage (LAA) were recorded during TEE before cardioversion. Synchronized electrical cardioversion was occurred within 12 hours after TEE using 100-200 Joules. We also evaluated LA size and the global strain of LAA. Results Sinus rhythm restoration was succeeded in 80% of patients and maintained until discharge, 48 hours later. TDI velocities &amp;gt; 8cm/s were correlated with successful cardioversion (sensitivity 70% and specificity 63%) and were more predictive compared to PW Doppler velocities of &amp;gt; 40cm/s. TDI recordings at the medial LAA wall were more accurate, with less artefacts and better positioning of the sample volume. Global longitudinal strain was not significantly correlated with CV outcome. Conclusion Our results indicate that TDI velocities of the LAA walls more than 8cm/s could be used as a cut-off value predicting successful cardioversion of AF.

Association of pericardial adipose tissue with left ventricular structure and function: a region\u2010specific effect?

BackgroundThe independent role of pericardial adipose tissue (PAT) as an ectopic fat associated with cardiovascular disease (CVD) remains controversial. This study aimed to determine whether PAT is associated with left ventricular (LV) structure and function independent of other markers of general obesity.MethodsWe studied 2471 participants (50.9 % women) without known CVD from the Korean Genome Epidemiology Study, who underwent 2D-echocardiography with tissue Doppler imaging (TDI) and computed tomography measurement for PAT.ResultsStudy participants with more PAT were more likely to be men and had higher cardiometabolic indices, including blood pressure, glucose, and cholesterol levels (all P < 0.001). Greater pericardial fat levels across quartiles of PAT were associated with increased LV mass index and left atrial volume index (all P < 0.001) and decreased systolic (P = 0.015) and early diastolic (P < 0.001) TDI velocities, except for LV ejection fraction. These associations remained after a multivariable-adjusted model for traditional CV risk factors and persisted even after additional adjustment for general adiposity measures, such as waist circumference and body mass index. PAT was also the only obesity index independently associated with systolic TDI velocity (P < 0.001).ConclusionsPAT was associated with subclinical LV structural and functional deterioration, and these associations were independent of and stronger than with general and abdominal obesity measures.

Echocardiographic Parameters and Mortality in Pediatric Sepsis: A Systematic Review and Meta-Analysis.

We conducted a systematic review and meta-analysis to investigate the prognostic value of echocardiographic parameters in pediatric septic patients. MEDLINE, PubMed, and EMBASE (last update April 5, 2020). Observational studies of pediatric sepsis providing echocardiographic parameters in relation to mortality. Echocardiography data were categorized as those describing left ventricular systolic or diastolic function, right ventricular function, and strain echocardiography parameters. Data from neonates and children were considered separately. Analysis is reported as standardized mean difference and 95% CI. We included data from 14 articles (n = 5 neonates, n = 9 children). The fractional shortening was the most commonly reported variable (11 studies, n = 555 patients) and we did not identify an association with mortality (standardized mean difference 0.22, 95% CI [-0.02 to 0.47]; p = 0.07, I2 = 28%). In addition, we did not find any association with mortality also for left ventricular ejection fraction (nine studies, n = 417; standardized mean difference 0.06, 95% CI [-0.27 to 0.40]; p = 0.72, I2 = 51%), peak velocity of systolic mitral annular motion determined by tissue Doppler imaging wave (four studies, n = 178; standardized mean difference -0.01, 95% CI [-0.34 to 0.33]; p = 0.97, I2 = 0%), and myocardial performance index (five studies, n = 219; standardized mean difference -0.51, 95% CI [-1.10 to 0.08]; p = 0.09, I2 = 63%). However, in regard to left ventricular diastolic function, there was an association with mortality for higher early wave of transmitral flow/peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging ratio (four studies, n = 189, standardized mean difference -0.45, 95% CI [-0.80 to -0.10]; p = 0.01, I2 = 0%) or lower peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging wave (three studies, n = 159; standardized mean difference 0.49, 95% CI [0.13-0.85]; p = 0.008, I2 = 0%). We did not find any association with mortality for early wave of transmitral flow/late (atrial) wave of trans-mitral flow ratio (six studies, n = 273; standardized mean difference 0.28, 95% CI [-0.42 to 0.99]; p = 0.43, I2 = 81%) and peak velocity of systolic mitral annular motion determined by tissue Doppler imaging wave measured at the tricuspid annulus (three studies, n = 148; standardized mean difference -0.18, 95% CI [-0.53 to 0.17]; p = 0.32, I2 = 0%). Only a few studies were conducted with strain echocardiography. This meta-analysis of echocardiography parameters in pediatric sepsis failed to find any association between the measures of left ventricular systolic or right ventricular function and mortality. However, mortality was associated with higher early wave of transmitral flow/peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging or lower peak velocity of early diastolic mitral annular motion determined by tissue Doppler imaging, indicating possible importance of left ventricular diastolic dysfunction. These are preliminary findings because of high clinical heterogeneity in the studies to date.

Cardiac functions in children with steroid-sensitive nephrotic syndrome.

The aim of the present study was to evaluate the presence of cardiac systolic and diastolic dysfunction in pediatric patients with steroid-sensitive nephrotic syndrome (NS). The study population consisted of 19 patients with debut-relapse of NS aged 1-18years and 30 sex and age-matched healthy controls. Blood and urine samples, two M-mode conventional echocardiograms and tissue Doppler velocity imaging were evaluated in both attack and remission periods. With regard to conventional pulse wave Doppler (cPWD), steroid-sensitive NS patients (both in debut / relapse and in remission periods) had a higher peak of late diastolic flow velocities (A peak), and patients in debut / relapse had a lower E/A ratio than the control group, indicating diastolic dysfunction (overall P = 0.003 and P = 0.006, respectively). Based on tissue Doppler velocity imaging echocardiography results, patients in debut/relapse had a higher A' and a lower E'/A' ratio (overall P < 0.001 and P = 0.001, respectively). There was also a significant difference in the cPWD E/TDI E' ratio between the patients showing an increased cPWD E/TDI E' ratio in remission periods compared to in debut/relapse periods (P = 0.09). The albumin levels were positively correlated with E'/A' and E/ E' ratio (r = 0.609; P = 0.007, r = 0.472; P = 0.041 respectively). Systolic cardiac functions are preserved but diastolic functions are affected in steroid-sensitive NS patients both in debut/relapse and in remission periods in a relatively short time. The persistence of left ventricular (LV) dysfunction during the remission period requires special attention during the follow up for early detection of cardiac abnormalities.

Echocardiographic abnormalities in 124 severely malnourished adult anorexia nervosa patients: frequency and relationship with body composition and biological features

BackgroundAnorexia Nervosa (AN) is a complex psychiatric disorder that can lead to specific somatic complications. Heart abnormalities are frequently reported, while their frequency and associated factors in severely malnourished AN patients remain poorly defined.ObjectivesThis study aimed to characterize echocardiographic abnormalities in severely malnourished AN patients and to assess associated clinical, biological and related body composition features.MethodsBetween January 2013 and January 2015, all severely malnourished adult patients with AN (Mental Disorders, 4th Edn.-DSM IVr) were included in a monocentric study performed in in a highly specialized AN inpatient unit. Electrocardiogram (ECG) and echocardiography were used to assess both heart rhythm and function. All inpatients underwent a Doppler echocardiography procedure after undergoing combined blood volume adjustment, micronutrients deficiencies supplementation and electrolyte disorders correction. Right Ventricular (RV) and Left Ventricular (LV) systolic and diastolic functions were collected and compared to 29 healthy normal subjects in a control group.ResultsOne hundred and 24 patients (119 (96%) women, 5 (4%) men) with a mean age of 30.1 ± 11 years old and an average Body Mass Index (BMI) of 12 kg/m2 were included. Ninety patients (73%) had been diagnosed with AN Restrictive type (AN-R), 34 (27%) an AN Binge eating/Purging type (AN-BP). Eighteen patients (15%) disclosed an abnormal Left Ventricular Ejection Fraction (LVEF) (< 52% for male and < 54% for female). LVEF impairment was associated with AN-BP patients (p < 0.017) and hypertransaminasemia (AST and/or ALT ≥2 N) (p < 0.05). Left Ventricular mass (LV mass) and Left Ventricular End Diastolic Diameter (LVEDD) were significantly reduced in patients (p < 0.001, p < 0.001). Left and right ventricular tissue Doppler Imaging Velocities (TDI) peak were reduced in patients: Septal and Lateral LV Sm velocities peaks respectively 10 ± 2 cm/s (vs 14 ± 2 cm/s in controls, p < 0.001), 12 ± 3 cm/s (vs 16 ± 3 cm/s in controls, p < 0.001), basal RV Sm velocity peaks at 14 ± 3 cm/s (vs 19 ± 3 cm/s in controls, p < 0.001). Additionally, LV and RV diastolic velocity peaks were reduced: LV septal and lateral velocity peaks were respectively 13 ± 3 cm/s (vs 18 ± 2 cm/s p < 0.001), 12 ± 3 cm/s (vs 22 ± 4 cm/s, p < 0.001) and RV diastolic velocity peaks at 14 ± 3 cm/s (vs 21 ± 4 cm/s p < 0.001). LV diastolic velocity TDI peaks were significantly associated with hypertransaminasemia (p < 0.05) and tended to be associated with a low all body Fat-Free Mass Index (FFMI) (using Dual-energy X- ray Absorptiometry (DXA) (HOLOGICQDR 4500) (p = 0.056). Thirty-four patients (27%) had a pericardial effusion and were significantly associated with a decreased all body FFMI (p < 0.036).ConclusionHeart abnormalities are frequent in malnourished patients with AN, particularly in AN-BP type. Both liver enzymes and body composition abnormalities tended to be associated with heart dysfunction (non-significant association). Prospective studies are needed to better characterize and describe the evolution of cardiac abnormalities during the refeeding period and subsequent weight restoration.

Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation

Although there are numerous studies reflecting predictors of atrial fibrillation (AF) recurrence (AFR) after pulmonary vein isolation (PVI), data on atrial appendages' mechanics is scarce. This study aimed to assess atrial appendages' mechanics by 2-dimensional (2D) and 3-dimenssional (3D) transoesphageal echocardiography (TEE) and to explore its value to predict AFR after PVI. Consecutive patients with paroxysmal AF undergoing first PVIwere analysed. 3D and 2D-TEE with tissue Doppler imaging (TDI) and strain analysis was obtained prior to the PVI, including: left atrial appendage (LAA) TDI and strain analysis, LAA ostium surface area, right atrial appendage's TDI velocity and superior vena cava (SVC) ostium surface area. The primary end-point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 s. This single-centre, prospective study included 74 patients with paroxysmal AF (median age 59 years; 36% female; BMI 27.4 ± 4.1 kg/m2, LA volume index 32 ± 11 mL/m2). After a median follow-up of 14 (IQR 10-22) months, 21 (28%) patients had AFR. In a univariate and multivariate Cox-regression analysis LAA TDI velocity (HR 1.48, 95%CI 1.28-1.62, p < 0.001) and LAA ostium surface area(HR 1.58, 95%CI 1.06-1.81, p = 0.033) both independently predicted AFR after single PVI. RAA TDI velocity and SVC ostium surface area were not correlated to AFR. Paroxysmal AF patients with lower LAA TDI tissue velocity and LAA ostium surface area have higher risk of developing AFR after PVI. To our knowledge, this is the first study assessing atrial appendages' mechanics in predicting AFR after PVI.Clinical trial registration: www.drks.de(Identifier: DRKS00010495).

The clinical significance of the incorporation of tissue Doppler imaging into low-dose Dobutamine stress echocardiography in patients with aortic stenosis prior to Transcatheter aortic valve implantation

BackgroundLow-dose dobutamine stress echocardiography (DSE) is indicated in patients with low flow (stroke volume index [SVi] < 35 ml/m2) low gradient (mean pressure gradient < 40 mmHg) and left ventricular ejection fraction (LVEF) < 50% aortic stenosis (AS) to assess LV contractile reserve (> 20% increase in SVi) and severity grade of AS. Severe AS is defined by a mean pressure gradient of 40 mmHg occurring at any time during the test when aortic valve area remains < 1.0 cm2.Case presentationThis case report highlights the utility of mitral annular systolic velocity (S′) by tissue Doppler imaging and peak LV outflow tract (LVOT) velocity as markers of LV intrinsic contractile function during DSE in a patient with low flow low gradient AS and reduced EF prior to transcatheter aortic valve implantation (TAVI).ConclusionsMitral annular S′ and peak LVOT velocities are reliable markers of LV intrinsic contractile function and should be incorporated into routine low-dose DSE.

Rapid, Single-View Speckle-Tracking-Based Method for Examining Left Ventricular Systolic and Diastolic Function in Point of Care Ultrasound.

A rapid, reliable quantitative assessment of left ventricular systolic and diastolic function is important for patient treatment in urgent and dynamic settings. Quantification of annular velocities based on a single 2-dimensional image loop, rather than on Doppler velocities, could be useful in point-of-care or focused cardiac ultrasound. We hypothesized that novel speckle-tracking-based mitral annular velocities would correlate with reference standard tissue Doppler imaging (TDI) velocities in a focused cardiac ultrasound-esque setting. Two echocardiographers each performed transthoracic echocardiographic measurements before and after induction of anesthesia in supine patients undergoing cardiac surgery. Speckle-tracking echocardiography (STE)-based systolic (S'STE ) and diastolic (E'STE and A'STE ) velocities were compared to TDI and global longitudinal strain/strain rate. We also compared mitral annular displacement by speckle tracking with M-mode imaging. Twenty-five patients were included and examined in both preinduction and postinduction states. Speckle-tracking-based velocities correlated with TDI measurements in both states (S', r = 0.73 and 0.76; E', r = 0.87 and 0.65; and A', r = 0.65 and 0.73), showing a mean bias of 25% to 30% of the reference standard measurement. The correlation of S'STE with strain and the strain rate (S-wave) and E'STE with the strain rate (E-wave) was good in awake, spontaneously breathing patients but was less strong in the ventilated state. Similarly, displacement by speckle tracking correlated with M-mode measurements in both states (r = 0.91 and 0.84). Measurements required medians of 31 and 34 seconds; reproducibility was acceptable for S'STE and E'STE . Speckle-tracking-based mitral annular velocities and displacement correlate well with conventional measures as well as with deformation imaging. They may be clinically useful in rapidly assessing both systolic and diastolic function from a single 2-dimensional image loop.

Study of immediate and late effects of successful PTMC on left atrial appendage function in patients with severe rheumatic mitral stenosis IN SINUS rhythm

IntroductionSince its introduction in 1984, Percutaneous Transvenous Mitral Commissurotomy (PTMC) has become established as a safe and effective treatment for rheumatic Mitral Stenosis (MS).( Ben Farhat et al., 1998) 1 Chronic pressure and volume overload imposed by MS causes left atrial (LA) and Left Atrial Appendage (LAA) dysfunction. Risk of cerebrovascular accident (CVA) is increased approximately 17-fold in patients of MS in Atrial Fibrillation (AF) and is present even in patients of MS in sinus rhythm (SR). This study was undertaken to evaluate the effect of PTMC on LAA function by Trans-esophageal echocardiography (TEE) Doppler and Doppler Tissue Imaging (DTI). MethodsTotal 70 cases were enrolled in this study. Patients with symptomatic severe MS (Mitral Valve Area <1.5cm2), in SR, who underwent a successful PTMC during the period from May 2016 to May 2019 were selected. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, immediately after (within 24 h) & after 6 months of PTMC. ResultsThere was non significant improvement in Left Atrial appendage fractional area change {LAAAC (%)} immediately Post PTMC but there was significant improvement at 6 months Post PTMC. There was significant increase in LAA PW Doppler velocities (LAAEDE, LAALDE and LAAF velocity) immediately Post PTMC which got further improved significantly at 6 months of follow up. There was significant increase in LAA DTI velocities (ELAA, ALAA and SLAA velocity) immediately Post PTMC which got further improved significantly at 6 months of follow up. ConclusionPTMC improves left atrial appendage function in patients with mitral stenosis.

Effect of thyroid dysfunction on left ventricular performance using different echo-Doppler modalities

Background Thyroid dysfunction (Thy.D) is one of the commonest endocrinological disorders that increase cardiovascular morbidity and mortality. Echocardiography is a useful, noninvasive, easily accessible, and affordable tool for detection of early cardiovascular changes in patients with thyroid disorders. Aim To assess the effect of Thy.D on left ventricular (LV) performance using different echo-Doppler modalities. Patients and methods This study included 60 individuals, divided into three groups: GI: 20 patients (hypothyroidism), GII: 20 patients (hyperthyroidism), and 20 healthy individuals as controls (GIII). All participants underwent history taking, clinical examination, thyroid profile (free triiodothyronine, free tetraiodothyronine, and thyroid-stimulating hormone), conventional echocardiography, tissue Doppler imaging (TDI) velocities averaged from four annular sites (Av-Sa, Av-Ea, and Av-Aa), TDI-derived strain, and two-dimensional-global longitudinal strain (2D-GLS). Results Despite LV systolic function being preserved in all studied groups, there was a statistically significant reduction in GI and GII compared with GIII (CL), with more reduction in GI (P Conclusion Thyroid disorders have a significant effect on LV systolic and diastolic functions. TDI (velocities and strain) and 2D-GLS are useful indices for detection of LV functions in patients with Thy.D.

Significance of Tissue Doppler Echocardiography-Based Dispersion Index of Myocardial Velocities in the Differentiation of Ischemic and Nonischemic Cardiomyopathy: A Novel Echocardiographic Parameter

Background: Tissue Doppler imaging (TDI) echocardiography, an objective method for the quantification of left ventricular (LV) function, can detect subtle alterations in contractility both in rest and stress echocardiography. Aim: The study aims were to (1) compare TDI parameters in patients with heart failure (HF) of ischemic and nonischemic etiology, (2) to differentiate both subsets based on velocity dispersion index (VDI) at mitral valve, and (3) to identify parameters that help in identifying the ischemic etiology of HF. Materials and Methods: Patients with symptomatic HF (NYHA class ≥II; LV ejection fraction &lt;40%) were included in the study. Patients with aortic and mitral valve diseases, prosthetic valves, and cor pulmonale were excluded from the study. All patients underwent coronary angiography after stabilization. A total of 100 patients admitted between May 2017 and October 2018 were enrolled. Results: The mean age of presentation was earlier in nonischemic group compared to that of ischemic group of HF (43.4 ± 10.91 vs. 54.06 ± 10.40; P= 0.001). No significant differences in the mitral inflow velocities by conventional Doppler were found. The mean mitral TDI velocities were lower in the nonischemic group compared to those of the ischemic group. Systolic VDI, V s' &gt;25.40 (sensitivity 91.7% and specificity 100%), and diastolic VDI, V e' &gt;17.35 (sensitivity 86.7% and specificity 87.5%), were associated with the probability of diagnosing the ischemic cause of HF. Conclusions: VDIs help in the differentiation of ischemic and nonischemic etiologies of HF compared to the conventional echocardiography.

Diaphragm sniff ultrasound: Normal values, relationship with sniff nasal pressure and accuracy for predicting respiratory involvement in patients with neuromuscular disorders

BackgroundIn patients with neuromuscular disorders, assessment of respiratory function relies on forced vital capacity (FVC) measurements. Providing complementary respiratory outcomes may be useful for clinical trials. Diaphragm sniff ultrasound (US) is a noninvasive technique that can assess diaphragm function that may be affected in patients with neuromuscular disorders.PurposeWe aimed to provide normal values of sniff diaphragm ultrasound, to assess the relationship between sniff diaphragm US, vital capacity (VC) and sniff nasal pressure. Additionally, we aimed to evaluate the diagnostic accuracy of sniff diaphragm US for predicting restrictive pulmonary insufficiency.Materials and methodsWe included patients with neuromuscular disorders that had been tested with a sniff diaphragm US and functional respiratory tests. Healthy subjects were also included to obtain normal diaphragm sniff ultrasound. We performed diaphragm tissue Doppler imaging (TDI) and time movement (TM) diaphragm echography combined with sniff maneuver.ResultsA total of 89 patients with neuromuscular diseases and 27 healthy subjects were included in our study. In patients, the median age was 32 years [25; 50] and the median FVC was 34% of predicted [18; 55]. Sniff diaphragm motion using TM ultrasound was significantly associated with sniff nasal pressure, both for the right hemidiaphragm (r = 0.6 p <0.0001) and the left hemidiaphragm (r = 0.63 p = 0.0008). Right sniff peak TDI velocity was also significantly associated with FVC (r = 0.72, p<0.0001) and with sniff nasal pressure (r = 0.66 p<0.0001). Sniff diaphragm ultrasound using either TM mode or TDI displayed significant accuracy for predicting FVC<60% with an area under curve (AUC) reaching 0.93 (p<0.0001) for the right sniff diaphragm ultrasound in TM mode and 0.86 (p<0.001) for right peak diaphragm TDI velocity.ConclusionSniff diaphragm TM and TDI measures were significantly associated with sniff nasal pressure. Sniff diaphragm TM and TDI had a high level of accuracy to reveal respiratory involvement in patients with neuromuscular disorders. This technique is useful to assess and follow up diaphragm function in patients with neuromuscular disorders. It may be used as a respiratory outcome for clinical trials.