Use Of Tissue Doppler Research Articles

Role of Tissue Doppler Tei Index in Evaluating Myocardial Performance after Coronary Revascularization

Background: Tei index expresses the overall systolic and diastolic myocardial function in a single number. The use of tissue Doppler instead of conventional pulsed wave Doppler enables us to measure Tei index in a single scan. It also has many advantages for the assessment of myocardial function with coronary revascularization in IHD patients. Methods: We included 47 chronic ischemic heart disease patients with LV dysfunction (EF<50%) who were subjected to coronary revascularization with either CABG or PCI. They were divided into 2 groups according to the improvement of EF after revascularization. Group I: Included 35 patients who had an increase ≥ 5% in LV EF at follow up. Group II: Included 12 patients who had an increase <5% increase in LV EF at follow up. Echocardiography including tissue Doppler Tei index (tdTei) was done twice; just before and at least 4 months after coronary revascularization. Results: Following revascularization; improvement of ejection fraction correlated well with tdTei improvement (r=0.67, p<0.001) and was associated with improvement of wall motion score index (p<0.001) and diastolic function parameters including E`/A` (p<0.05) and E/E` (p<0.001). Using ROC curve, we found that the tdTei index at cut-off point 72.9; can predict patients who are expected to have ejection fraction improvement from coronary revascularization with high sensitivity (83.3%) and specifity (80%). It also correlated well to TIMI score (p<0.05). Conclusion: Tissue Doppler Tei index is a promising technique allowing accurate quantitative description of the effect of ischemia on myocardium including both diastolic and systolic dysfunction in a single number. Baseline tdTei index can predict patients who are expected to have improvement of myocardial function (both diastolic and systolic) after coronary revascularization.

Тканевая допплерография в оценке диастолической функции миокарда левого желудочка у спортсменов

The results of the morphological and functional evaluation of the left ventricular in athletes of different sports disciplines are presented in this paper. The aim of the study was to assess morphological and functional condition of the left ventricular in athletes with the emphasis on the evaluation of the diastolic function including the use of tissue Doppler. Methods: 231 athletes of different sports disciplines were examined. All athletes included in this study underwent comprehensive transthoracal echocardiography by means of Doppler study and tissue Doppler. Results: This study revealed the difference in heart morphology between athletes of different sports disciplines. Parameters of the diastolic function of the left ventricular are not significantly differ between athletes of different sports disciplines. The diastolic function was not impaired in athletes with mild hypertrophy of the left ventricular. Violation of diastolic function occur in athletes with complaints of extreme fatigue after exercise. Method of tissue Doppler allows to detect signs of diastolic function impairment in athletes with formally &amp;#34;normal&amp;#34; mitral blood flow. Conclusions: 1. In athletes with small and border myocardial hypertrophy of the left ventricle is not observed violations of diastolic function of the left ventricular myocardium, which indicates the adaptive nature of the appearance of a small hypertrophy. 2. The authors suggest that the impairment of the diastolic function of the left ventricular is linked with the chronic overload of cardiovascular system. 3. The use of tissue Doppler allows to determine the signs of diastolic function impairment in athletes with visually normal mitral blood flow. 4. The authors consider enough check tissue Doppler imaging speed of displacement of the lateral part of the mitral annulus, since the check in other segments rarely gives new information, significantly extending the time of the study. 5. The authors also suggest that it is necessary to assess diastolic function by means of tissue Doppler in athletes with the E/A ratio less than 1.5.

Dépistage précoce de la cardiotoxicité des anthracyclines par l’écho-Doppler tissulaire à propos de 45 cas à l’institut de cardiologie d’Abidjan

ObjectiveEvaluate the early anthracyclines cardiotoxicity. MethodsIt is a prospective study made on 10months of period from October 2008 to July 2009 and on patients who contracted a solid canny tumor hospitalized or followed in their movement and who would receive chemotherapy with an anthracycline molecule. On this effect, we have used tissue Doppler of mitral ring to detect clinic infratoxicity. ResultForty-five patients (43women and 2men) who contracted the solid cancers were included in the study. The patients were 48 of age in average±10.12. All our patients did not show any cardiovascular symptoms at the time of the study. Cardiothoracic and electrocardiograms were not significantly modified by the chemotherapy. The cardioecography with the use of tissue Doppler revealed as followed: (a) significant low of the ejection fraction and the pick of systolic myocardia wave (Sa) on four patients (8.8%). These concerned patients were considered as having anthracycline cardio toxicity. The factor causing this cardiotoxicity was the nature of the anthracycline, which was used: the doxorubicin. The quantity accumulated threshold of the doxorubicin that shod (where toxicity appeared was 150mg/m2); (b) a low of Sa pick without that of left ventricular fraction ejection observed on five patients (11.11%). These concerned patients were considered as having potential risks to develop anthracyclines cardiotoxicity; (c) the left ventricular ejection fraction was not a good indicator the check up of the patients under chemotherapy made up with anthracyclines. ConclusionThe tissue Doppler not only enables to make diagnostics of early myocardia dysfunctions but it mainly allows to identify people with risks of a cardiotoxicity due to a going on chemotherapy.

Left Ventricular Geometry, Global Function, and Dyssynchrony in Infants and Children With Pompe Cardiomyopathy Undergoing Enzyme Replacement Therapy

Background Enzyme replacement therapy (ERT) for infantile-onset Pompe disease effectively reduces the left ventricular (LV) mass. This study sought to explore detailed process of LV reverse remodeling after ERT with the use of tissue Doppler and stain rate imaging. Methods and Results Nine infants and children with Pompe cardiomyopathy undergoing ERT for ≥1 year, as well as 36 healthy control subjects, were studied. Global systolic and diastolic function was evaluated by peak systolic and early-diastolic velocity at mitral annulus. Temporal systolic and diastolic dyssynchrony was evaluated by the coefficient of variation of the time from the QRS complex to peak systolic and early-diastolic strain rate among 12 LV segments. All pre-ERT patients had impaired global systolic and diastolic function as well as increased regional dyssynchrony ( P < .001 for each of all). During the regression of LV hypertrophy, all of these functional indices improved ( P for trend <.001), with temporal diastolic dyssynchrony being a significant factor linking to LV mass index in multivariate analysis ( P < .001). Conclusions ERT improved global LV function and dyssynchrony in Pompe patients. The relationship between LV mass and temporal diastolic dyssynchrony during reverse remodeling suggested a pathophysiologic role of dyssynchrony in Pompe cardiomyopathy.

Intracoronary infusion of selected autologous bone marrow stem cells improves longitudinal myocardial strain and strain rate in patients with old anterior myocardial infarction without recent revascularization

We sought to evaluate the efficacy of intracoronary infusion of selected bone marrow stem cells (BMSCs) in patients with remote, anterior non-viable MI by the use of tissue Doppler imaging. We infused selected CD133+ and CD133-CD34+ BMSCs in 10 patients enrolled in the study. Peak systolic strain rate, maximum strain during the cardiac cycle (epsilon(max)), strain during ejection time (epsilon(et)), and post-systolic strain (epsilon(ps)) were measured. Peak systolic strain rate (-0.69 +/- 0.2 vs. -1.15 +/- 0.27, P = 0.001), epsilon(max) (-9.87 +/- 3.30 vs. -15.57 +/- 5, P = 0.006), and epsilon(et) (-7.45+/-2.86 vs. -10.92 +/- 4.45, P = 0.015) improved significantly during the rest study 6 months after cell infusion. Low-dose inotropic challenge also showed significant improvement of longitudinal deformation indices in the follow-up study. Global ejection fraction did not improve significantly after cell therapy. Intracoronary infusion of selected BMSCs in patients with remote, anterior, non-viable myocardial infarction is safe and leads to improvement of longitudinal deformation indices 6 months after the infusion.

Right ventricular tissue Doppler assessment in space during circulating volume modification using the Braslet device

Introduction: This joint US–Russian work aims to establish a methodology for assessing cardiac function in microgravity in association with manipulation of central circulating volume. Russian Braslet-M (Braslet) occlusion cuffs were used to temporarily increase the volume of blood in the lower extremities, effectively reducing the volume in central circulation. The methodology was tested at the International Space Station (ISS) to assess the volume status of crewmembers by evaluating the responses to application and release of the cuffs, as well as to modified Valsalva and Mueller maneuvers. This case study examines the use of tissue Doppler (TD) of the right ventricular (RV) free wall. Results: Baseline TD of the RV free wall without Braslet showed early diastolic E′ (16 cm/s), late diastolic A′ (14 cm/s), and systolic S′ (12 cm/s) velocities comparable with those in normal subjects on Earth. Braslet application caused 50% decrease of E′ (8 cm/s), 45% increase of A′, and no change to S′. Approximately 8 beats after the Braslet release, TD showed E′ of 8 cm/s, A′ of 12 cm/s, and S′ of 13 cm/s. At this point after release, E′ did not recover to baseline values while l A′ and S′ did recover. The pre-systolic cross-sectional area of the internal jugular vein without Braslet was 1.07 cm 2, and 1.13 cm 2 10 min after the Braslet was applied. The respective cross-sectional areas of the femoral vein were 0.50 and 0.54 cm 2. The RV myocardial performance Tei index was calculated by dividing the sum of the isovolumic contraction time and isovolumic relaxation time by the ejection time ((IVCT+IVRT)/ET); baseline and Braslet-on values for Tei index were 0.25 and 0.22, respectively. Braslet Tei indices are within normal ranges found in healthy terrestrial subjects and temporarily become greater than 0.4 during the dynamic Braslet release portion of the study. Conclusions: TD modality was successfully implemented in space flight for the first time. TD of RV revealed that the Braslet influenced cardiac preload and that fluid was sequestered in the lower extremity interstitial and vascular space after only 10 min of application. This report demonstrates that Braslet application has an effect on RV physiology in long-duration space flight based on TD, and that this effect is in part due to venous hemodynamics.

Use of Tissue Doppler to Distinguish Discrete Upper Ventricular Septal Hypertrophy from Obstructive Hypertrophic Cardiomyopathy

Discrete upper septal hypertrophy (DUSH) is a well-recognized but poorly understood echocardiographic finding that may indicate localized remodeling modulated by pressure loading or a forme fruste variant of obstructive hypertrophic cardiomyopathy (HC). It was hypothesized that (1) a comparison of tissue Doppler indexes of myocardial function in normal patients and those with DUSH or aortic stenosis (AS) could provide insight into the clinical significance of DUSH and (2) these indexes could distinguish between DUSH and obstructive HC. A retrospective analysis was performed on patients aged 50 to 80 years who underwent routine echocardiography and who could be classified into normal, DUSH, AS, and HC groups (n = 25, 33, 23, and 34, respectively) on the basis of clinical and echocardiographic criteria. Early diastolic mitral annular velocities (Ea) in the DUSH (7.1 +/- 1.8 cm/s) and AS (7.1 +/- 1.7 cm/s) groups were lower compared with those in the normal group (9.3 +/- 1.9 cm/s) and higher compared with those in the HC group (5.4 +/- 1.3 cm/s), whereas the E/Ea ratio was higher in the DUSH and AS groups (10.0 +/- 3.1 and 11.3 +/- 2.8, respectively) compared with the normal group (7.1 +/- 1.6) and lower compared with the HC group (18.8 +/- 7.5). These differences remained significant after adjusting for age and the use of beta blockers and calcium channel blockers. E/Ea > or =13 distinguished between patients with HC and those with DUSH (sensitivity 78%, specificity 90%, positive predictive value 90%, negative predictive value 81%). In conclusion, abnormal Ea and E/Ea in patients with DUSH, with values similar to those in patients with AS, suggest that DUSH may represent a variant hypertrophic response to chronic pressure loading. Simple echocardiographic indexes may be helpful in distinguishing between patients with DUSH and those with obstructive HC.

Use of tissue Doppler and its comparison with other conventional Doppler techniques in the assessment of diastolic functions in patients with active rheumatoid arthritis

This study aims to assess left ventricular diastolic functions with tissue Doppler imaging (TDI), which is a new technique, and to compare it with conventional Doppler echocardiography techniques in patients with active rheumatoid arthritis (RA). Fifty-two patients with active RA and 47 healthy persons were included in this study. All patients and the control group were evaluated by M-mod, two-dimensional, conventional Doppler echocardiography and TDI. Left ventricular early diastolic (E)/late diastolic (A) flow velocity (E/A ratio) was found to be lower in patients with RA than in the control group (p<0.001). Mitral annular early diastolic (E(m))/late diastolic (A(m)) velocity(E(m)/A(m) ratio) was found to decrease in RA patients compared with the control group (p<0.001). E/E(m) ratio was higher in patients with RA than in the control group (p<0.001). Left ventricular diastolic functions were impaired in patients with RA. We have concluded that TDI alone, or together with conventional Doppler echocardiography, is useful for the evaluation of diastolic functions in RA patients.

Use of Tissue Doppler to Assess Right Ventricle Function in Hemodialysis Patients

Aims: Although there are plenty of data about the differences in left ventricular tissue Doppler (TD) velocities by preload reduction, only a few studies regarding right ventricular function are found in the literature. We investigated the effect of intravascular volume reduction on right ventricular function by ultrafiltration in dialysis patients. Methods: 27 end-stage renal failure patients who were hypervolemic and undergoing hemodialysis were included in the study. TD studies of the right ventricle were performed before and 1 h after dialysis. These data were compared. Results: The mean age of the patients was 41 ± 15 years and mean volume of ultrafiltration was 3.8 ± 1.8 liters. Systolic, early and late diastolic lateral annular TD velocities before dialysis were 0.109 ± 0.029, 0.088 ± 0.039, 0.111 ± 0.039 m/s, and after dialysis were 0.099 ± 0.028, 0.078 ± 0.036, 0.106 ± 0.037 m/s, respectively (p = 0.216, p = 0.112, p = 0.350). Myocardial early diastolic velocity decreased significantly (p = 0.049) but systolic and late diastolic velocities did not change significantly (p = 0.579, p = 0.146). Conclusion: Right ventricular systolic and diastolic velocities detected by TD were not or only minimally affected by preload reduction in hemodialysis patients and the TD early/late ratio is the most valuable variable that can predict right ventricular diastolic function. The right ventricular systolic and early diastolic TD velocities were positively correlated with left ventricle ejection fraction.

Tissue Doppler assessment of diastolic and systolic alterations of radial and longitudinal left ventricular motions in Golden Retrievers during the preclinical phase of cardiomyopathy associated with muscular dystrophy

To quantify radial and longitudinal left ventricular free wall (LVFW) velocities in dogs during the preclinical phase of Golden Retriever muscular dystrophy (GRMD)-associated cardiomyopathy by use of tissue Doppler imaging (TDI). 9 dogs with GRMD and 6 healthy control dogs. All dogs (< 3 years old) were examined via conventional echocardiography and 2-dimensional color TDI. Myocardial velocities in the LVFW were recorded from right parasternal ventricular short-axis (radial motion) and left apical 4-chamber (longitudinal motion) views. Cardiac assessments via TDI included maximal systolic and early and late diastolic LVFW velocities in the endocardial and epicardial layers (for radial motion) and in the basal and apical segments (for longitudinal motion) (for longitudinal motion), -No notable ventricular dilatation or alteration of inotropism was detected in dogs with GRMD via conventional echocardiography. Compared with healthy dogs, endocardial velocities were significantly decreased in dogs with GRMD, resulting in marked decreases in radial myocardial velocity gradients during systole and early and late diastole. Similarly, basal and apical velocities were significantly decreased in systole and the former also in early diastole, resulting in significant decreases in the 2 corresponding longitudinal myocardial velocity gradients. The radial epicardial and longitudinal late diastolic velocities were comparable in the 2 groups. Results indicated that GRMD-associated cardiomyopathy in dogs is associated with early marked dysfunction of both radial and longitudinal LVFW motions. These combined regional myocardial abnormalities might be useful criteria for detection of dilated cardiomyopathy at the preclinical stage of the disease in dogs.

Use of tissue Doppler improves the prediction of events in patients with positive stress echocardiograms

103 had past revascularization. EXE was performed in 333 pts able to exercise maximally (8.2 + 3.2 METS). DbE using a standard dobutamine stress was used in 604 pts. Pts were followed for up to 9 years (av 3.9 f 2.3), for death and revascularization. Results Normal studies were obtained in 567 (60%); 29% had resting LV dysfunction and 25% had ischemia. Abnormalities were confined to one territory in 183 pts (20%), and to multiple territories in 187 pts (20%). Death (in 275 pts, 29%) was predicted by referral for pharmacologic stress (hazard ratio 3.89, P < O.OOOl), number of ischemic territories (HR 1.42, P < O.OOOl), age (HR 1.02, P = O.OOl), and heart failure (HR 1.51, P = 0.01). In stepwise models replicating the sequence of clinical evaluation, the predictive power of independent clinical predictors (age and heart failure, model chisq 39.6) was significantly enhanced by addition of LV dysfunction data (model chisq 60.9) and further enhanced by ischemia (model chisq 79.4). However, pts with a normal DbE had a higher event-rate (6% per year) than those with normal EXE (1.2% per year). Conclusion Results of stress echo are independent predictors of death in DM pts with known or suspected CAD. Ischemia adds risk that is incremental to clinical risks and LV dysfunction. Inability to exercise is a powerful negative feature and a negative DbE does not necessarily signify low risk in this group.

Diagnosis of Diastolic Dysfunction: Importance of Spectral Doppler Imaging

In Response: Dr. Poelaert’s comments are of great interest to us and we agree that Doppler pattern can be influenced by loading condition. This is particularly true for transmitral valve velocity pattern, but the pulmonary venous flow is also affected by other factors, including age, heart rate, cardiac output, left ventricular systolic function, and left atrial function (1). In our study, the diagnosis of diastolic dysfunction was based not only on the mitral valve inflow but also on the pulmonary vein velocity signal as suggested by the Canadian Consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography (2). The Doppler examination was performed, as we mentioned, “before pericardiotomy during a period of hemodynamic stability.” We routinely evaluate both pulmonary veins and have rarely encountered significant velocity differences before cardiac surgery Doppler signal from the right and left pulmonary veins are similar unless the Doppler signal intensity is attenuated because of improper positioning. The Doppler signal from the pulmonary vein can vary with mechanical ventilation, as we published before (1), but the systolic to diastolic ratio stayed the same. Klein et al. (3) observed discrepancies in velocities in up to 24% of patients with significant mitral regurgitation but in their series, the pulmonary flow was still abnormal in both veins. The use of a loading test (4) was not published when we collected the data and the use of tissue Doppler (5–8) was not a modality available on our transesophageal echocardiographic system at the time of the study. Furthermore, they are not yet part of the Canadian Consensus, which we used in the evaluation of diastolic dysfunction (2). We do agree however that they provide complementary and useful information on the appreciation of diastolic function. Our cardiologist, who was familiar with the use of tissue Doppler, did evaluate the mitral annular displacement in a semiqualitative fashion and could predict and confirm the type of diastolic abnormality based on visual inspection. This mode of evaluation, which is frequently discussed among “diastologists,” had not been formally validated at the time of the study, so we could not mention it in the methodology. André Denault, MD, FRCPC Francis Bernard, MD, FRCPC Pierre Couture, MD, FRCPC