CLINICAL STUDY: CARDIAC ULTRASOUND
Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value
Mei Wang, MD*,
Gabriel W. K. Yip, MRCP*,
Angela Y. M. Wang, MB*,
Yan Zhang, MD*,
Pik Yuk Ho, BN*,
Mui Kiu Tse, RN*,
Peggo K. W. Lam, MA and
John E. Sanderson, MD, FRCP, FACC*,*
* Division of Cardiology, Department of Medicine and Therapeutics, Hong Kong SAR, China
Center of Clinical Trials and Epidemiological Research, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
Manuscript received May 22, 2002;
revised manuscript received July 26, 2002,
accepted August 1, 2002.
* Reprint requests and correspondence: Dr. John E. Sanderson, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Clinical Sciences Building, Prince of Wales Hospital, Shatin, N. T., Hong Kong SAR, China.
jesanderson{at}cuhk.edu.hk
OBJECTIVES: The aim of this study was to ascertain if left ventricular mitral annulus velocities measured by tissue Doppler imaging (TDI) are more powerful predictors of outcome compared with clinical data and standard Doppler-echocardiographic parameters.
BACKGROUND: Tissue Doppler imaging of basal or mitral annulus velocities provides rapid assessment of ventricular long axis function. But it is not known if TDI-derived velocities in systole and diastole add incremental value and are superior to the standard Doppler-echocardiographic measurements as a predictor of outcome.
METHODS: The study population consisted of 518 subjects, 353 with cardiac disease and 165 normal subjects who had full Doppler two-dimensional–echocardiographic studies with measurement of mitral inflow velocities in early and late diastole, E-wave deceleration time (DT), peak systolic mitral annular velocity (Sm) early and late diastolic mitral annular velocity (Em and Am) by TDI, early diastolic flow propagation velocity, and standard chamber dimensions. All subjects were followed up for two years. The end point was cardiac death.
RESULTS: Tissue Doppler imaging mitral annulus systolic and diastolic velocities were all significantly lower in the non-survivors (all p < 0.05) as was DT (p = 0.024). In the Cox model the best predictors of mortality were Em, Sm, Am, left ventricular ejection fraction, left ventricular mass, and left atrial diameter in systole (LADs). By backward stepwise analysis Em and LADs were the strongest predictors. After forcing the TDI measurements into the covariate model with clinical and mitral DT <0.16 s, Em provided significant incremental value for predicting cardiac mortality (p = 0.004).
CONCLUSIONS: Mitral annulus velocity measured by TDI in early diastole gives incremental predictive power for cardiac mortality compared to clinical data and standard echocardiographic measurements. This easily available measurement adds significant value in the clinical management of cardiac patients.
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Abbreviations and Acronyms
| | Am | | late diastolic mitral annular velocity | | CI | | confidence interval | | DT | | mitral deceleration time | | E | | early diastolic mitral inflow velocity | | Em | | early diastolic mitral annular velocity | | HR | | hazard ratio | | LA | | left atrial | | LADs | | left atrial diameter in systole | | LV | | left ventricular | | LVEF | | left ventricular ejection fraction | | Sm | | systolic mitral annular velocity | | TDI | | tissue Doppler imaging | | Vp | | left ventricular flow propagation velocity |
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