Contraction and Relaxation Velocities of the Normal Left Ventricle Using Pulsed-Wave Tissue Doppler Echocardiography

Galiuto, Leonarda; Ignone, Gianfranco; DeMaria, Anthony N.

doi:10.1016/s0002-9149(97)00990-9

Cited by 219 publications

(150 citation statements)

References 19 publications

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“…A further reason for the increased sensitivity shown by PWTDI in recognizing diastolic dysfunction could be represented by the heterogeneity of regional myocardial contraction and relaxation. In agreement with previous evidence that the relaxation activity in the longitudinal axis is predominant in the lateral aspect of the left ventricular wall (17), in our study the lateral walls were shown to be the worst affected.…”

Section: Pwtdi: Regional Systolic/diastolic Functionsupporting

confidence: 93%

“…The regional limitation of systolic myocardial dysfunction to the lateral wall revealed by PWTDI could be ascribed to the essential contribution of this region to longitudinal LV systolic shortening. It has in fact been demonstrated that, compared with the septum, the lateral wall is characterized by greater longitudinal contractile activity in normal individuals (17); it might be because of this particular working load that the basal lateral wall segment was the ®rst myocardial region to show signs of systolic dysfunction in acromegalic cardiomyopathy.…”

Section: Intraobserver Differencesmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac dysfunction in acromegaly: evidence by pulsed wave tissue Doppler imaging

Mercuro

Zoncu²,

Colonna³

et al. 2000

European Journal of Endocrinology

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Objective: To verify whether the accuracy of data on myocardial function provided by pulsed-wave tissue Doppler imaging (PWTDI), a new echocardiographic application that allows quantitative measurements of myocardial wall velocities, could help towards a better understanding of the natural history of acromegalic cardiomyopathy. Design: Eighteen patients with active acromegaly (ten men and eight women; mean age 48.0 6 15.0 years) with no other detectable cause of heart disease underwent PWTDI. Thirteen healthy individuals matched for age and body mass index acted as a control group. Methods: Ejection fraction (EF), transmitral early/late diastolic velocity (E/A) ratio and isovolumic relaxation time (IVRT) were measured by conventional echocardiography; systolic peak (Sv) and early (Ev) and late (Av) diastolic peak velocities, Ev/Av ratio and regional IVRT (IVRTs) were obtained by PWTDI.Results: All patients showed appreciably abnormal left ventricular global diastolic function represented by prolongation of the IVRT (P < 0.001). Using PWTDI we found a prolongation of IVRTs and inversion of the Ev/Av ratio. In addition, the Ev/Av ratio proved to be signi®cantly negatively correlated with IVRT; this correlation was not present in the case of the E/A ratio. Furthermore, a decrease in Sv was detected in the basal segment of the lateral wall (P < 0.01), which had the greatest degree of diastolic dysfunction. Conclusions: PWTDI con®rmed the acknowledged diastolic dysfunction that accompanies acromegalic cardiomyopathy and highlighted the greater sensitivity of regional PWTDI with respect to global Doppler diastolic indexes. Furthermore, by revealing an impairment of regional systolic function in presence of a normal EF, the ®ndings with PWTDI contradicted the largely accepted theory that systolic function remains normal for several years in patients affected by acromegalic cardiomyopathy.

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Section: Pwtdi: Regional Systolic/diastolic Functionsupporting

confidence: 93%

Section: Intraobserver Differencesmentioning

confidence: 99%

Cardiac dysfunction in acromegaly: evidence by pulsed wave tissue Doppler imaging

Mercuro

Zoncu²,

Colonna³

et al. 2000

European Journal of Endocrinology

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“…14,15 A Doppler velocity range of Ϯ30 cm/s was selected to display systolic and early diastolic velocities. Total amplitude was defined as maximum displacement of the ring between the onset of QRS and peak inward movement at or after A2 (identified from the valve-closure artifact on aortic Doppler).…”

Section: Measurementsmentioning

confidence: 99%

Differentiation of Ischemic From Nonischemic Cardiomyopathy During Dobutamine Stress by Left Ventricular Long-Axis Function

et al. 2003

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Background-Resting regional wall-motion abnormalities do not reliably distinguish ischemic from nonischemic cardiomyopathy. Dobutamine stress echocardiography with use of the wall-motion score index (WMSI) identifies coronary artery disease (CAD) in dilated cardiomyopathy (DCM), but the technique is subjective and further complicated by left bundle-branch block (LBBB). Long-axis motion is sensitive to ischemia and can be assessed quantitatively. We aimed to compare long-axis function with WMSI for detecting CAD in DCM with or without LBBB. Methods and Results-Seventy-three patients with DCM, 48 with CAD (16 with LBBB), and 25 without CAD (10 with LBBB) were studied. Long-axis M-mode, pulsed-wave tissue Doppler echograms (lateral, septal, and posterior walls), and WMSI were assessed at rest and at peak dobutamine stress. Failure to increase systolic amplitude (total amplitude minus postejection shortening) by 2 mm or early diastolic velocity by 1.1 cm/s was the best discriminator for CAD (systolic amplitude, sensitivity 85%, specificity 86%; lengthening velocity, 71% and 94%, respectively; PϭNS). Both had greater predictive accuracy than did WMSI (sensitivity 67%, specificity 76%; PϽ0.001). The predictive accuracy of changes in septal long-axis function was similar to those of average long-axis function (systolic amplitude cutoffϭ1.5 mm, lengthening velocity cutoffϭ1.5 cm/s). However in LBBB, systolic amplitude proved to be the only significant discriminator for CAD, with sensitivity and specificity reaching 94% and 100%, respectively (PϽ0.01 versus early diastolic lengthening velocity). Conclusions-Quantified stress long-axis function identifies CAD in DCM with greater sensitivity and specificity than does standard WMSI, particularly in the presence of LBBB.

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“…7,8) Two studies reported by Alam, et al 7) and Palmes, et al 8) suggested that in patients with acute AMI, remote areas such as the inferior mitral annulus of lateral myocardial segments show subtle dynamic changes in their TDE profiles despite normal wall motion on two-dimensional echocardiography. Considering this wide spectrum of functional impairment including both infarct-related portions and apparently normal remote areas, and the well-known predominance of longitudinally aligned myocardial fibers in both ventricular free walls, 15) the contribution of base-to-apex dynamics to preserve left ventricular function is of paramount importance in a condition like AMI where a large quantity of myocardium undergoes ischemic injury. The subclassification criteria we used in this study clearly discriminated a subset of patients with well-preserved diastolic-systolic left ventricular functions; and three single variables that significantly differentiate two groups were two anterior mitral annular velocities as expected, and the systolic TDE velocity measured at the inferior annulus corner.…”

Section: Discussionmentioning

confidence: 99%

Specific Tissue Doppler Predictors of Preserved Systolic and Diastolic Left Ventricular Function after an Acute Anterior Myocardial Infarction

et al. 2003

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SUMMARYThe degree of left ventricular (LV) dysfunction determines the outcome of patients suffering an acute anterior myocardial infarction (AAMI). Many recent studies have utilized tissue Doppler echocardiography (TDE) parameters in the assessment of LV function. We sought to investigate whether some variables easily obtained from TDE profiles of mitral annulus corners would predict a relatively preserved LV global function traditionally assessed with ejection fraction (EF) and deceleration time (DT), within the acute phase of AAMI. Included were 50 consecutive patients with a first AAMI. Standard echocardiography and TDE of mitral annulus were performed within 36 hours of admission. Pulsed wave sample volumes were set at the septal, lateral, anterior, and inferior corners of the mitral annulus. Preserved LV function was defined as an EF > 40% together with a DT ≥ 140 ms and < 220 ms. An inferior annular systolic velocity of > 7.5 cm/s predicts preserved global left ventricular function with a sensitivity of 81% and specificity of 71%. An anterior mitral annular early diastolic velocity of > 8cm/s had a sensitivity of 69% and specificity of 85%. When these two velocities both exceed the limits above, such a combined index yielded a sensitivity of 69%, specificity of 94%, and an overall diagnostic accuracy of 86% for the estimation of preserved LV global function. The parameters derived from TDE profiles of inferior and anterior mitral annulus corners provide valuable information to predict preserved global left ventricular function during the early period of AAMI. (Jpn Heart J 2003; 44: 347-355)

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Contraction and Relaxation Velocities of the Normal Left Ventricle Using Pulsed-Wave Tissue Doppler Echocardiography

Cited by 219 publications

References 19 publications

Cardiac dysfunction in acromegaly: evidence by pulsed wave tissue Doppler imaging

Cardiac dysfunction in acromegaly: evidence by pulsed wave tissue Doppler imaging

Differentiation of Ischemic From Nonischemic Cardiomyopathy During Dobutamine Stress by Left Ventricular Long-Axis Function

Specific Tissue Doppler Predictors of Preserved Systolic and Diastolic Left Ventricular Function after an Acute Anterior Myocardial Infarction

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