CLINICAL RESEARCH: CARDIAC IMAGING
Time interval between onset of mitral inflow and onset of early diastolic velocity by tissue Doppler: a novel index of left ventricular relaxation
Experimental studies and clinical application
Carlos Rivas-Gotz, MD*,
Dirar S. Khoury, PhD*,
Michael Manolios, MD*,
Liyun Rao, PhD*,
Helen A. Kopelen, RDCS* and
Sherif F. Nagueh, MD*,*
* Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
Manuscript received December 17, 2002;
revised manuscript received May 12, 2003,
accepted June 15, 2003.
* Reprint requests and correspondence: Dr. Sherif F. Nagueh, 6550 Fannin Street, SM-1246, Houston, Texas 77030-2717, USA. sherifn{at}bcm.tmc.edu
OBJECTIVES: The goal of this study was to examine the diagnostic utility of the time to onset of early (Ea) diastolic velocity of the mitral annulus by tissue Doppler (TD) in comparison with the time to onset of mitral inflow (TEa-E) for the assessment of left ventricular (LV) relaxation.
BACKGROUND: Tissue Doppler imaging of the mitral annulus provides useful information about myocardial function. So far, studies have focused on the measurement of peak Ea, but have not evaluated the diagnostic utility of the time to onset of Ea.
METHODS: Simultaneous left heart catheterization and Doppler echocardiography (DE) were performed in 10 dogs. Left atrial pressures and LV volumes and pressures were measured before and after constriction of the circumflex (cx) coronary artery. The delay in Ea was next examined in 60 consecutive patients, undergoing simultaneous right heart catheterization and DE. Furthermore, (TEa-E) was used to predict filling pressures in a prospective group of 33 patients.
RESULTS: In canine studies, significant prolongation in the time interval (TEa-E) was noted after cx constriction, which had a significant relation with tau ( ) (r = 0.93, p < 0.01). In human studies, Ea was significantly delayed in patients with impaired relaxation and pseudonormal LV filling in comparison with age-matched controls. In the prospective group, pulmonary capillary wedge pressure (PCWP) derived as: PCWPDoppler = LVend-systolic pressure x eIVRT/(TEa-E), where IVRT is isovolumetric relaxation time; PCWPDoppler related well to PCWPcatheter (r = 0.84, p < 0.001).
CONCLUSIONS: TEa-E is a useful novel index of LV relaxation. It can be used to identify patients with diastolic dysfunction and predict PCWP.
|
Abbreviations and Acronyms
| | Aa | = late diastolic velocity by tissue Doppler | | Ea | = early diastolic velocity by tissue Doppler | | EDV | = end-diastolic volume | | EDP | = end-diastolic pressure | | IVC | = inferior vena cava | | IVRT | = isovolumetric relaxation time | | LA | = left atrium or atrial | | LV | = left ventricle/left ventricular | | PCWP | = pulmonary capillary wedge pressure | | TD | = tissue Doppler | | TEa-E | = time interval between onset of Ea andonset of mitral inflow |
|
This article has been cited by other articles:

|
 |

|
 |
 
C. S. Reuss, S. M. Wilansky, S. J. Lester, J. L. Lusk, D. E. Grill, J. K. Oh, and A. J. Tajik
Using mitral 'annulus reversus' to diagnose constrictive pericarditis
Eur J Echocardiogr,
May 1, 2009;
10(3):
372 - 375.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. Wang and S. F. Nagueh
Current Perspectives on Cardiac Function in Patients With Diastolic Heart Failure
Circulation,
March 3, 2009;
119(8):
1146 - 1157.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. F. Nagueh, C. P. Appleton, T. C. Gillebert, P. N. Marino, J. K. Oh, O. A. Smiseth, A. D. Waggoner, F. A. Flachskampf, P. A. Pellikka, and A. Evangelisa
Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography
Eur J Echocardiogr,
March 1, 2009;
10(2):
165 - 193.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Lindqvist, G. Wikstrom, and A. Waldenstrom
The use of E/Em and the time interval difference of isovolumic relaxation (TIVRT-IVRTm) in estimating left ventricular filling pressures
Eur J Heart Fail,
May 1, 2008;
10(5):
490 - 497.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Masutani, W. C. Little, H. Hasegawa, H.-J. Cheng, and C.-P. Cheng
Restrictive Left Ventricular Filling Pattern Does Not Result From Increased Left Atrial Pressure Alone
Circulation,
March 25, 2008;
117(12):
1550 - 1554.
[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]
|
 |
|

|
 |

|
 |
 
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]
|
 |
|

|
 |

|
 |
 
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]
|
 |
|

|
 |

|
 |
 
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. W. Guron, A. Persson, R. Wikh, and K. Caidahl
Can the left ventricular early diastolic tissue-to-blood time interval be used to identify a normal pulmonary capillary wedge pressure?
Eur J Echocardiogr,
March 1, 2007;
8(2):
94 - 101.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. D. Thomas and Z. B. Popovic
Assessment of Left Ventricular Function by Cardiac Ultrasound
J. Am. Coll. Cardiol.,
November 21, 2006;
48(10):
2012 - 2025.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. C. Rojo, J. L. Rodrigo, L. Perez de Isla, C. Almeria, N. Gonzalo, A. Aubele, R. Cinza, J. Zamorano, and C. Macaya
Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index
Eur J Echocardiogr,
October 1, 2006;
7(5):
356 - 364.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Cannesson, D. Jacques, M. R. Pinsky, and J. Gorcsan III
Effects of modulation of left ventricular contractile state and loading conditions on tissue Doppler myocardial performance index
Am J Physiol Heart Circ Physiol,
May 1, 2006;
290(5):
H1952 - H1959.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Q. Ruan, L. Rao, K. J. Middleton, D. S. Khoury, and S. F. Nagueh
Assessment of left ventricular diastolic function by early diastolic mitral annulus peak acceleration rate: experimental studies and clinical application
J Appl Physiol,
February 1, 2006;
100(2):
679 - 684.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. C. Little
Diastolic Dysfunction Beyond Distensibility: Adverse Effects of Ventricular Dilatation
Circulation,
November 8, 2005;
112(19):
2888 - 2890.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. K. Oh
Echocardiography as a Noninvasive Swan-Ganz Catheter
Circulation,
June 21, 2005;
111(24):
3192 - 3194.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Diwan, M. McCulloch, G. M. Lawrie, M. J. Reardon, and S. F. Nagueh
Doppler Estimation of Left Ventricular Filling Pressures in Patients With Mitral Valve Disease
Circulation,
June 21, 2005;
111(24):
3281 - 3289.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. E. Weyman
The year in echocardiography
J. Am. Coll. Cardiol.,
February 1, 2005;
45(3):
448 - 455.
[Full Text]
[PDF]
|
 |
|
|