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CARDIAC ULTRASOUND

Tissue Doppler-derived myocardial acceleration for evaluation of left ventricular diastolic function

Ikuo Hashimoto, MD^*, Aarti Hejmadi Bhat, MD^*, Xiaokui Li, MD^*, Michael Jones, MD, Crispin H. Davies, MD^*, Julia C. Swanson, BS^*, Sebastian T. Schindera, MD^* and David J. Sahn, MD, MACC^*,*

^* Clinical Care Center for Congenital Heart Disease, Oregon Health and Science University, Portland, Oregon
National Heart, Lung, and Blood Institute, Bethesda, Maryland

Manuscript received December 1, 2003; revised manuscript received June 23, 2004, accepted June 29, 2004.

^* Reprint requests and correspondence: Dr. David J. Sahn, L608, Pediatric Cardiology, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, Oregon 97239-3098 (Email: sahnd{at}ohsu.edu).

OBJECTIVES: Our purpose was to evaluate a tissue Doppler-based index—peak myocardial acceleration (pACC)—during isovolumic relaxation and in evaluating left ventricular (LV) diastolic function.

BACKGROUND: Simple, practical indexes for diastolic function evaluation are lacking, but are much desired for clinical evaluation.

METHODS: We examined eight sheep by using tissue Doppler ultrasound images obtained in the apical four-chamber views to evaluate mitral valve annular velocity at the septum and LV wall. The pACC thus derived was analyzed during isovolumic relaxation (IVRT) and during the LV filling period (LVFP). We then changed the hemodynamic status of each animal by blood administration, dobutamine, and metoprolol infusion. We compared the pACC values during IVRT and LVFP over the four different hemodynamic conditions with a peak rate of dropin LV pressure (–dP/dt_min) and the time constant of LV isovolumic pressure decay (tau), as measured with a high-frequency manometer-tipped catheter.

RESULTS: The pACC of the septal side of the mitral valve annulus during IVRT showed a good correlation with –dP/dt_min (r = –0.80, p < 0.0001) and tau (r = –0.87, p < 0.0001). The mean left atrial pressure (LAP) correlated well with the septal side pACC during LVFP (r = 0.81, p < 0.0001). There was a weak correlation between the mitral valve annulus pACC at the LV lateral wall and mean LAP.

CONCLUSIONS: The pACC during IVRT is a sensitive, preload-independent marker for evaluation of LV diastolic function. In addition, pACC during LVFP correlated well with mean LAP.

Abbreviations and Acronyms   ACC = myocardial acceleration   IVRT = isovolumic relaxation time   IVS = interventricular septum   LAP = left atrial pressure   LV = left ventricle/ventricular   LVFP = left ventricular filling period   pACC = peak myocardial acceleration   tau = time constant of LV isovolumic pressure decay   TDI = tissue Doppler imaging

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