Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures

Baylor College of Medicine and Department of Medicine, The Methodist Hospital, Houston, Texas 77030, USA. sherifn@bcm.tmc.edu

OBJECTIVES: This investigation was designed 1) to assess whether the early diastolic velocity of the mitral annulus (Ea) obtained with Doppler tissue imaging (DTI) behaves as a preload-independent index of left ventricular (LV) relaxation; and 2) to evaluate the relation of the mitral E/Ea ratio to LV filling pressures. BACKGROUND: Recent observations suggest that Ea is an index of LV relaxation that is less influenced by LV filling pressures. METHODS: One hundred twenty-five study subjects were classified into three groups according to mitral E/A ratio, LV ejection fraction (LVEF) and clinical symptoms: 34 asymptomatic subjects with a normal LVEF and an E/A ratio > or =1; 40 with a normal LVEF, an E/A ratio <1 and no heart failure symptoms (impaired relaxation [IR]); and 51 with heart failure symptoms and an E/A ratio >1 (pseudonormal [PN]). Ea was derived from the lateral border of the annulus. A subset of 60 patients had invasive measurement of pulmonary capillary wedge pressure (PCWP) simultaneous with Doppler echocardiographic DTI. RESULTS: Ea was reduced in the IR and PN groups compared with the group of normal subjects: 5.8 +/- 1.5 and 5.2 +/- 1.4 vs. 12 +/- 2.8 cm/s, respectively (p < 0.001). Mean PCWP (20 +/- 8 mm Hg) related weakly to mitral E (r = 0.68) but not to Ea. The E/Ea ratio related well to PCWP (r = 0.87; PCWP = 1.24 [E/Ea] + 1.9), with a difference between Doppler and catheter measurements of 0.1 +/- 3.8 mm Hg. CONCLUSIONS: Ea behaves as a preload-independent index of LV relaxation. Mitral E velocity, corrected for the influence of relaxation (i.e., the E/Ea ratio), relates well to mean PCWP and may be used to estimate LV filling pressures.

This article has been cited by other articles:

				M. Kayikcioglu, M. Tumuklu, M. Ozkahya, O. Ozdogan, G. Asci, S. Duman, H. Toz, L. H. Can, A. Basci, and E. Ok The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis Nephrol. Dial. Transplant., November 11, 2008; (2008) gfn599v1. [Abstract] [Full Text] [PDF]

				A. Manouras, K. Shahgaldi, R. Winter, J. Nowak, and L.-A. Brodin Comparison between colour-coded and spectral tissue Doppler measurements of systolic and diastolic myocardial velocities: effect of temporal filtering and offline gain setting Eur J Echocardiogr, November 6, 2008; (2008) jen298v1. [Abstract] [Full Text] [PDF]

				M. Guazzi, J. Myers, M. A. Peberdy, D. Bensimhon, P. Chase, and R. Arena Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights Eur. Heart J., November 2, 2008; 29(22): 2751 - 2759. [Abstract] [Full Text] [PDF]

				L. C. Afonso, J. Bernal, J. J. Bax, and T. P. Abraham Echocardiography in Hypertrophic Cardiomyopathy: The Role of Conventional and Emerging Technologies J. Am. Coll. Cardiol. Img., November 1, 2008; 1(6): 787 - 800. [Abstract] [Full Text] [PDF]

				G J King, R T Murphy, I Almuntaser, K Bennett, E Ho, and A S Brown Alterations in myocardial stiffness in elite athletes assessed by a new Doppler index Heart, October 1, 2008; 94(10): 1323 - 1325. [Abstract] [Full Text] [PDF]

				S. Nottin, G. Doucende, I. Schuster-Beck, M. Dauzat, and P. Obert Alteration in left ventricular normal and shear strains evaluated by 2D-strain echocardiography in the athlete's heart J. Physiol., October 1, 2008; 586(19): 4721 - 4733. [Abstract] [Full Text] [PDF]

				A. Sharp, R. Tapp, D. P. Francis, S. A. McG. Thom, A. D. Hughes, A. V. Stanton, A. Zambanini, N. Chaturvedi, S. Byrd, N. R. Poulter, et al. Ethnicity and Left Ventricular Diastolic Function in Hypertension: An ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) Substudy J. Am. Coll. Cardiol., September 16, 2008; 52(12): 1015 - 1021. [Abstract] [Full Text] [PDF]

				A. L. Baggish, K. Yared, F. Wang, R. B. Weiner, A. M. Hutter Jr., M. H. Picard, and M. J. Wood The impact of endurance exercise training on left ventricular systolic mechanics Am J Physiol Heart Circ Physiol, September 1, 2008; 295(3): H1109 - H1116. [Abstract] [Full Text] [PDF]

				N R Van de Veire, J De Sutter, J J Bax, and J R T C Roelandt Technological advances in tissue Doppler imaging echocardiography Heart, August 1, 2008; 94(8): 1065 - 1074. [Abstract] [Full Text] [PDF]

				I. Barutcu, A. M. Esen, D. Kaya, E. Onrat, M. Melek, A. Celik, C. Kilit, M. Turkmen, O. Karakaya, O. B. Esen, et al. Effect of Acute Cigarette Smoking on Left and Right Ventricle Filling Parameters: A Conventional and Tissue Doppler Echocardiographic Study in Healthy Participants Angiology, July 1, 2008; 59(3): 312 - 316. [Abstract] [PDF]

				A. Drighil, J. E. Madias, J. W. Mathewson, H. El Mosalami, N. El Badaoui, B. Ramdani, and A. Bennis Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles Eur J Echocardiogr, July 1, 2008; 9(4): 530 - 535. [Abstract] [Full Text] [PDF]

				A. Evangelista, F. Flachskampf, P. Lancellotti, L. Badano, R. Aguilar, M. Monaghan, J. Zamorano, P. Nihoyannopoulos, and on behalf of the European Association of Echocardi European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies Eur J Echocardiogr, July 1, 2008; 9(4): 438 - 448. [Abstract] [Full Text] [PDF]

				A. Y-M. Wang, M. Wang, C. W-K. Lam, I. H-S. Chan, Y. Zhang, and J. E. Sanderson Left Ventricular Filling Pressure by Doppler Echocardiography in Patients With End-Stage Renal Disease Hypertension, July 1, 2008; 52(1): 107 - 114. [Abstract] [Full Text] [PDF]

				C. E. Veltman, O. I.I. Soliman, M. L. Geleijnse, W. B. Vletter, P. C. Smits, F. J. ten Cate, L. J. Jordaens, A. H.H.M. Balk, P. W. Serruys, E. Boersma, et al. Four-year follow-up of treatment with intramyocardial skeletal myoblasts injection in patients with ischaemic cardiomyopathy Eur. Heart J., June 1, 2008; 29(11): 1386 - 1396. [Abstract] [Full Text] [PDF]

				W. Zhang and S. J. Kovacs The diastatic pressure-volume relationship is not the same as the end-diastolic pressure-volume relationship Am J Physiol Heart Circ Physiol, June 1, 2008; 294(6): H2750 - H2760. [Abstract] [Full Text] [PDF]

				I. Ikonomidis, J. P. Lekakis, M. Nikolaou, I. Paraskevaidis, I. Andreadou, T. Kaplanoglou, P. Katsimbri, G. Skarantavos, P. N. Soucacos, and D. T. Kremastinos Inhibition of Interleukin-1 by Anakinra Improves Vascular and Left Ventricular Function in Patients With Rheumatoid Arthritis Circulation, May 20, 2008; 117(20): 2662 - 2669. [Abstract] [Full Text] [PDF]

				J. J.V. McMurray, B. Pitt, R. Latini, A. P. Maggioni, S. D. Solomon, D. L. Keefe, J. Ford, A. Verma, J. Lewsey, and for the Aliskiren Observation of Heart Failure Tre Effects of the Oral Direct Renin Inhibitor Aliskiren in Patients With Symptomatic Heart Failure Circ Heart Fail, May 1, 2008; 1(1): 17 - 24. [Abstract] [Full Text] [PDF]

				M. Tretjak and M. Kozelj Tissue Doppler annular velocities, NT-proBNP and exercise capacity in healthy elderly Age Ageing, May 1, 2008; 37(3): 336 - 339. [Full Text] [PDF]

				G W K Yip, M Wang, T Wang, S Chan, J W H Fung, L Yeung, T Yip, S-T Lau, C-P Lau, M-O Tang, et al. The Hong Kong diastolic heart failure study: a randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction Heart, May 1, 2008; 94(5): 573 - 580. [Abstract] [Full Text] [PDF]

				T. G. Neilan, T.-T. Ton-Nu, Y. Kawase, R. Yoneyama, K. Hoshino, F. del Monte, R. J. Hajjar, M. H. Picard, R. A. Levine, and J. Hung Progressive nature of chronic mitral regurgitation and the role of tissue Doppler-derived indexes Am J Physiol Heart Circ Physiol, May 1, 2008; 294(5): H2106 - H2111. [Abstract] [Full Text] [PDF]

				H. M. Ippisch, T. H. Inge, S. R. Daniels, B. Wang, P. R. Khoury, S. A. Witt, B. J. Glascock, V. F. Garcia, and T. R. Kimball Reversibility of Cardiac Abnormalities in Morbidly Obese Adolescents J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1342 - 1348. [Abstract] [Full Text] [PDF]

				Y. Zhu, A. O. Gramolini, M. A. Walsh, Y.-Q. Zhou, C. Slorach, M. K. Friedberg, J. K. Takeuchi, H. Sun, R. M. Henkelman, P. H. Backx, et al. Tbx5-dependent pathway regulating diastolic function in congenital heart disease PNAS, April 8, 2008; 105(14): 5519 - 5524. [Abstract] [Full Text] [PDF]

				C. E. Papadopoulos, G. Pitsiou, T. D. Karamitsos, H. I. Karvounis, T. Kontakiotis, G. Giannakoulas, G. K. Efthimiadis, P. Argyropoulou, G. E. Parharidis, and D. Bouros Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study Eur. Respir. J., April 1, 2008; 31(4): 701 - 706. [Abstract] [Full Text] [PDF]

				S. Y. Hayashi, A. Seeberger, B. Lind, S. Gunnes, A. Alvestrand, M. M. d. Nascimento, B. Lindholm, and L.-A. Brodin Acute effects of low and high intravenous doses of furosemide on myocardial function in anuric haemodialysis patients: a tissue Doppler study Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1355 - 1361. [Abstract] [Full Text] [PDF]

				D. J. Weaver Jr., T. R. Kimball, T. Knilans, W. Mays, S. K. Knecht, Y. M. Gerdes, S. Witt, B. J. Glascock, J. Kartal, P. Khoury, et al. Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease J. Am. Soc. Nephrol., March 1, 2008; 19(3): 624 - 630. [Abstract] [Full Text] [PDF]

				P. Innelli, R. Sanchez, F. Marra, R. Esposito, and M. Galderisi The impact of aging on left ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study Eur J Echocardiogr, March 1, 2008; 9(2): 241 - 249. [Abstract] [Full Text] [PDF]

				J.-M. Tartiere, D. Logeart, L. Tartiere-Kesri, and A. Cohen-Solal Colour tissue Doppler underestimates myocardial velocity as compared to spectral tissue Doppler: Poor reliability between both methods Eur J Echocardiogr, March 1, 2008; 9(2): 268 - 272. [Abstract] [Full Text] [PDF]

				M. Guazzi, R. Arena, and M. D. Guazzi Evolving changes in lung interstitial fluid content after acute myocardial infarction: mechanisms and pathophysiological correlates Am J Physiol Heart Circ Physiol, March 1, 2008; 294(3): H1357 - H1364. [Abstract] [Full Text] [PDF]

				S. J. Lester, A. J. Tajik, R. A. Nishimura, J. K. Oh, B. K. Khandheria, and J. B. Seward Unlocking the Mysteries of Diastolic Function Deciphering the Rosetta Stone 10 Years Later. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 679 - 689. [Abstract] [Full Text] [PDF]

				G. A. Whalley, S. P. Wright, A. Pearl, G. D. Gamble, H. J. Walsh, M. Richards, and R. N. Doughty Prognostic role of echocardiography and brain natriuretic peptide in symptomatic breathless patients in the community Eur. Heart J., February 2, 2008; 29(4): 509 - 516. [Abstract] [Full Text] [PDF]

				A. J. Kerr, O. C. Raffel, G. A. Whalley, I. Zeng, and R. A. Stewart Elevated B-type natriuretic peptide despite normal left ventricular function on rest and exercise stress echocardiography in mitral regurgitation Eur. Heart J., February 1, 2008; 29(3): 363 - 370. [Abstract] [Full Text] [PDF]

				L. Mont, D. Tamborero, R. Elosua, I. Molina, B. Coll-Vinent, M. Sitges, B. Vidal, A. Scalise, A. Tejeira, A. Berruezo, et al. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals Europace, January 4, 2008; (2008) eum263v1. [Abstract] [Full Text] [PDF]

				L. Groban, L. M. Yamaleyeva, B. M. Westwood, T. T. Houle, M. Lin, D. W. Kitzman, and M. C. Chappell Progressive Diastolic Dysfunction in the Female mRen(2).Lewis Rat: Influence of Salt and Ovarian Hormones J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2008; 63(1): 3 - 11. [Abstract] [Full Text] [PDF]

				A. Strand, S.E. Kjeldsen, H. Gudmundsdottir, I. Os, G. Smith, and R. Bjornerheim Tissue Doppler imaging describes diastolic function in men prone to develop hypertension over twenty years Eur J Echocardiogr, January 1, 2008; 9(1): 34 - 39. [Abstract] [Full Text] [PDF]

				G. Acharya, J. Rasanen, K. Makikallio, T. Erkinaro, T. Kavasmaa, M. Haapsamo, L. Mertens, and J. C. Huhta Metabolic acidosis decreases fetal myocardial isovolumic velocities in a chronic sheep model of increased placental vascular resistance Am J Physiol Heart Circ Physiol, January 1, 2008; 294(1): H498 - H504. [Abstract] [Full Text] [PDF]

				J. B. Geske, P. Sorajja, R. A. Nishimura, and S. R. Ommen Evaluation of Left Ventricular Filling Pressures by Doppler Echocardiography in Patients With Hypertrophic Cardiomyopathy: Correlation With Direct Left Atrial Pressure Measurement at Cardiac Catheterization Circulation, December 4, 2007; 116(23): 2702 - 2708. [Abstract] [Full Text] [PDF]

				T. P. Abraham, V. L. Dimaano, and H.-Y. Liang Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice Circulation, November 27, 2007; 116(22): 2597 - 2609. [Full Text] [PDF]

				S. Huez, F. Roufosse, J-L. Vachiery, A. Pavelescu, G. Derumeaux, J-C. Wautrecht, E. Cogan, and R. Naeije Isolated right ventricular dysfunction in systemic sclerosis: latent pulmonary hypertension? Eur. Respir. J., November 1, 2007; 30(5): 928 - 936. [Abstract] [Full Text] [PDF]

				R D Abeles, D L Shawcross, and G Auzinger E/A ratio alone cannot reliably diagnose diastolic dysfunction in the assessment before and after TIPS Gut, November 1, 2007; 56(11): 1642 - 1642. [Full Text] [PDF]

				B. A. Borlaug, V. Melenovsky, M. M. Redfield, K. Kessler, H.-J. Chang, T. P. Abraham, and D. A. Kass Impact of Arterial Load and Loading Sequence on Left Ventricular Tissue Velocities in Humans J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1570 - 1577. [Abstract] [Full Text] [PDF]

				W. J. Paulus, C. Tschope, J. E. Sanderson, C. Rusconi, F. A. Flachskampf, F. E. Rademakers, P. Marino, O. A. Smiseth, G. De Keulenaer, A. F. Leite-Moreira, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology Eur. Heart J., October 2, 2007; 28(20): 2539 - 2550. [Abstract] [Full Text] [PDF]

				E. Konduracka, A. Gackowski, P. Rostoff, D. Galicka-Latala, W. Frasik, and W. Piwowarska Diabetes-specific cardiomyopathy in type 1 diabetes mellitus: no evidence for its occurrence in the era of intensive insulin therapy Eur. Heart J., October 2, 2007; 28(20): 2465 - 2471. [Abstract] [Full Text] [PDF]

				L. Hatle How to diagnose diastolic heart failure a consensus statement Eur. Heart J., October 2, 2007; 28(20): 2421 - 2423. [Full Text] [PDF]

				J. E.A.K. Bamfo, N. A. Kametas, K. H. Nicolaides, and J. B. Chambers Maternal left ventricular diastolic and systolic long-axis function during normal pregnancy Eur J Echocardiogr, October 1, 2007; 8(5): 360 - 368. [Abstract] [Full Text] [PDF]

				C-C. Balick-Weber, P. Nicolas, M. Hedreville-Montout, P. Blanchet, and F. Stephan Respiratory and haemodynamic effects of volume-controlled vs pressure-controlled ventilation during laparoscopy: a cross-over study with echocardiographic assessment Br. J. Anaesth., September 1, 2007; 99(3): 429 - 435. [Abstract] [Full Text] [PDF]

				S. Chumnanvej, M. J. Wood, T. E. MacGillivray, and M. F. V. Melo Perioperative Echocardiographic Examination for Ventricular Assist Device Implantation Anesth. Analg., September 1, 2007; 105(3): 583 - 601. [Abstract] [Full Text] [PDF]

				A. K.Y. Chan, J. E. Sanderson, T. Wang, W. Lam, G. Yip, M. Wang, Y.-Y. Lam, Y. Zhang, L. Yeung, E. B. Wu, et al. Aldosterone Receptor Antagonism Induces Reverse Remodeling When Added to Angiotensin Receptor Blockade in Chronic Heart Failure J. Am. Coll. Cardiol., August 14, 2007; 50(7): 591 - 596. [Abstract] [Full Text] [PDF]

				M. Kasner, D. Westermann, P. Steendijk, R. Gaub, U. Wilkenshoff, K. Weitmann, W. Hoffmann, W. Poller, H.-P. Schultheiss, M. Pauschinger, et al. Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Diastolic Function in Heart Failure With Normal Ejection Fraction: A Comparative Doppler-Conductance Catheterization Study Circulation, August 7, 2007; 116(6): 637 - 647. [Abstract] [Full Text] [PDF]

				E. G. Caiani, L. Weinert, M. Takeuchi, F. Veronesi, L. Sugeng, C. Corsi, A. Capderou, S. Cerutti, P. Vaida, and R. M. Lang Evaluation of alterations on mitral annulus velocities, strain, and strain rates due to abrupt changes in preload elicited by parabolic flight J Appl Physiol, July 1, 2007; 103(1): 80 - 87. [Abstract] [Full Text] [PDF]

				U. Wisloff, A. Stoylen, J. P. Loennechen, M. Bruvold, O. Rognmo, P. M. Haram, A. E. Tjonna, J. Helgerud, S. A. Slordahl, S. J. Lee, et al. Superior Cardiovascular Effect of Aerobic Interval Training Versus Moderate Continuous Training in Heart Failure Patients: A Randomized Study Circulation, June 19, 2007; 115(24): 3086 - 3094. [Abstract] [Full Text] [PDF]

				R. Pirracchio, B. Cholley, S. De Hert, A. C. Solal, and A. Mebazaa Diastolic heart failure in anaesthesia and critical care Br. J. Anaesth., June 1, 2007; 98(6): 707 - 721. [Abstract] [Full Text] [PDF]

				C. Schmidt, J. Frielingsdorf, M. Debrunner, R. Tavakoli, M. Genoni, E. Straumann, O. Bertel, and B. Naegeli Acute biventricular pacing after cardiac surgery has no influence on regional and global left ventricular systolic function Europace, June 1, 2007; 9(6): 432 - 436. [Abstract] [Full Text] [PDF]

				N. C Van Pelt, R. A H Stewart, M. E Legget, G. A Whalley, S. P Wong, I. Zeng, M. Oldfield, and A. J Kerr Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis Heart, June 1, 2007; 93(6): 732 - 738. [Abstract] [Full Text] [PDF]