Doppler Tissue Imaging and Color M-Mode Flow Propagation Velocity: Are They Really Preload Independent?

Hsiao, Shih-Hung; Huang, Wei-Chen; Sy, Cheng Len; Lin, Shih-Kai; Lee, Tao Yu; Liu, Chun–Peng

doi:10.1016/j.echo.2005.07.016

Cited by 35 publications

(23 citation statements)

References 36 publications

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“…31 However, several reports have revealed that, even with these techniques, the advantage over conventional parameters for the assessment of LV diastolic function is limited in patients on maintenance HD. [32][33][34][35] Thus, at present, it would have been very difficult to discern the presence of LV diastolic function in our study cohort.…”

Section: Discussionmentioning

confidence: 86%

“…[28][29][30] Evaluation of E/A in HD patients is complicated. The early diastolic mitral annulus velocity determined by Doppler tissue echocardiography (E') 31 and LV inflow propagation velocity measured from color M-mode 32,33 are purported to be less sensitive to alterations in loading conditions than the transmitral flow velocity pattern. 31 However, several reports have revealed that, even with these techniques, the advantage over conventional parameters for the assessment of LV diastolic function is limited in patients on maintenance HD.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Congestive Heart Failure in Patients on Maintenance Hemodialysis

Ito¹,

Murai²,

Sugiura³

et al. 2007

Circ J

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Background Cardiovascular disease is a major cause of death in patients on maintenance hemodialysis (HD). Predictors of congestive heart failure (CHF) events in patients on HD were investigated, focusing on left ventricular (LV) function. Methods and ResultsOne hundred consecutive patients on HD were followed for at least 5 years after index examination performed 1 day after the last HD session. Tests included M-mode and Doppler echocardiography and plasma brain natriuretic peptide (BNP) and hemoglobin (Hb) concentration measurements. Patients with atrial fibrillation or poor echocardiographic images were excluded. Confounding factors included diabetes mellitus (DM), hypertension, age, HD duration, LV fractional shortening, E/A of transmitral flow velocity pattern, Tei index, LV mass index (LVMI), BNP level, Hb, and use of antihypertensive or antiarrhythmic drugs. Six CHF events occurred during 1,703±565 days. DM and Hb <10 g/dl were identified as independent predictors of CHF events in a stepwise Cox regression model after DM, LVMI, BNP, and Hb <10 g/dl were selected in the univariate analysis. The hazard ratio (confidence interval) was 10.96 (1.49-80.44) for DM, and 23.00 (2.41-219.76) for Hb <10 g/dl. The estimated hazard across time was constant (T_COV*DM; p=0.726, T_COV*Hb <10 g/dl; p=0.681) by time-dependent covariates analysis. Conclusion In patients on maintenance HD, DM and anemia (Hb <10 g/dl), but not echo-derived cardiac function, predicted CHF events. (Circ J 2007; 71: 1424 -1429

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Predictors of Congestive Heart Failure in Patients on Maintenance Hemodialysis

Ito¹,

Murai²,

Sugiura³

et al. 2007

Circ J

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“…What is the potential underlying mechanism? According to our previous reports [36, 37], tissue Doppler velocity is not totally preload-independent especially in uremic patients when more than 2 kg are removed during HD. It also depends on the different status of LV ejection fraction [37].…”

Section: Discussionmentioning

confidence: 99%

Tissue Doppler Velocity Is Not Totally Preload-Independent: A Study in a Uremic Population after Hemodialysis

Lee¹,

Kang²,

Hsiao³

et al. 2007

Cardiology

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Objectives: The aim of this study was to investigate the changes of regional tissue Doppler velocity after volume removal following regular hemodialysis (HD) in uremic patients. Is tissue Doppler velocity really preload-independent? Background: Diastolic dysfunction was divided into four stages: normal pattern, abnormal relaxation pattern, pseudonormalization pattern, and restrictive pattern. Pulse wave Doppler and color Doppler echocardiography were important diagnostic tools for these forms of diastolic dysfunction. However, they were preload-dependent and sometimes there was confusion between the normal pattern and the pseudonormalization pattern. Tissue Doppler echocardiography was promising for problems in diastolic dysfunction and appeared to be preload-independent. However, there are still some disputes over this point. Methods: Ninety-three uremic patients receiving regular HD were included in the study. There were 45 males and 48 females aged 59 ± 14 years. The mean volume removed after HD was 2.3 ± 0.9 kg. The mean heart rates before and after HD were 77 ± 11 and 76 ± 12 beats per minute, respectively (p = 0.73). All patients received complete transthoracic echocardiography examinations before and after HD. The studies included cardiac chamber size, left ventricular systolic performance, pulse wave Doppler echocardiographic data of mitral inflow and the right upper pulmonary vein including peak velocity of early diastolic E wave, E wave time velocity integral (TVI-E), peak velocity of late diastolic A wave, A wave TVI, systolic phase of pulmonary vein (S wave TVI), early diastolic phase of pulmonary vein (D wave TVI) and atrial contraction phase of pulmonary vein (Ar wave TVI). Pulsed tissue Doppler echocardiography (TDE) was performed and a 4-mm sample volume was placed at the 6 corners of the mitral annulus including septal, lateral, anterior, inferior, anteroseptal and posterior corners. Five to ten cardiac cycles were recorded and the data were averaged. Measurements performed included peak velocity of systolic phase (Sa), early diastolic phase (Ea), late diastolic phase (Aa), Ea/Aa ratio and time from the beginning of electrocardiogram Q wave to the beginning of Sa (Q-Sa time). The same measurements were repeated after HD. Results: After HD, left atrium diameter and left ventricular internal dimensions at end diastole became smaller. There were significant reductions for mitral peak E wave velocity, TVI-E, peak A wave velocity and E/A ratio. As for the pulmonary vein, systolic phase of pulmonary vein and early diastolic phase of pulmonary vein decreased significantly. Peak Ar wave did not change significantly. For TDE, Sa and Aa did not change but Ea did decrease. Conclusion: After HD, there is a significant reduction of intravascular effective volume. No significant change is found for myocardial peak systolic velocity and peak late diastolic velocity. However, there is a significant reduction of myocardial early diastolic phase peak velocity. This suggests that TDE is not completely preload-indep...

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“…Koga et al discussed the correlation between the amount of weight loss (≥1.5 kg and <1.5 kg) and PDETei index and reported that only the group that lost ≥ 1.5 kg showed significant changes in Tei index before and after HD (P=0.0002) [24]. Others have presented similar results with a weight loss ≥ 2 kg [25]. A subgroup comparison by Su et al showed that the effect of HD on the PDE-Tei index was not different between the patients with body weight reduction < 3 kg and those with reductions ≥3 kg.…”

Section: Discussionmentioning

confidence: 94%

Preload dependence of Doppler tissue imaging-derived indices in adolescents

et al. 2008

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Doppler tissue imaging (DTI) has been proposed as a tool for evaluation of diastolic function. Controversy exists regarding whether DTI measurements are influenced by preload. To determine the influence of preload reduction on DTI, we studied 17 patients (mean age 17 +/- 1.82 years) with end-stage renal disease and without overt heart disease, using DTI before and after hemodialysis (HD). Peak systolic (S), peak early diastolic (Ea), and peak late diastolic (Aa) velocities, and tissue Doppler-derived Tei index (the sum of the isovolumetric contraction and relaxation times divided by the ejection time: TDE-Tei), were determined for each patient from the septum, and lateral mitral and lateral tricuspid annuluses. The Ea of the mitral annulus (12.47 +/- 4.51 cm/s to 10.71 +/- 5.18 cm/s, P = 0.023), isovolumetric contraction time (ICT) of the mitral annulus (85.29 +/- 33.66 ms to 68.76 +/- 17.24 ms, P = 0.031) and Aa of the lateral tricuspid annulus (15.94 +/- 6.46 cm/s to 12.47 +/- 3.85 cm/s, P = 0.044) decreased significantly after HD. With weight loss of more than 1.5 kg, significant changes in the TDE-Tei index of the septum was observed (P = 0.036). From these findings, it is concluded that the Ea of the mitral annulus and the Aa of the tricuspid annulus are decreased by acute preload reduction. The TDE-Tei index is affected by preload reduction of more than 1.5 kg; therefore, it seems necessary to consider the preload status of HD patients when myocardial function is assessed by DTI.

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Doppler Tissue Imaging and Color M-Mode Flow Propagation Velocity: Are They Really Preload Independent?

Cited by 35 publications

References 36 publications

Predictors of Congestive Heart Failure in Patients on Maintenance Hemodialysis

Predictors of Congestive Heart Failure in Patients on Maintenance Hemodialysis

Tissue Doppler Velocity Is Not Totally Preload-Independent: A Study in a Uremic Population after Hemodialysis

Preload dependence of Doppler tissue imaging-derived indices in adolescents

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