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STATE-OF-THE-ART PAPER

Tissue Doppler Imaging

A New Prognosticator for Cardiovascular Diseases

Cheuk-Man Yu, MD, FRCP, FRACP^_*,_*, John E. Sanderson, MD, FRCP, FACC, Thomas H. Marwick, MD, PhD, FACC and Jae K. Oh, FACC

^_* Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
Department of Cardiology, Keele University Medical School, University Hospital of North Staffordshire NHS Trust, City General Hospital, Stoke-on-Trent, United Kingdom
Department of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
Mayo Clinic, Rochester, Minnesota.

Manuscript received March 7, 2006; revised manuscript received January 19, 2007, accepted January 22, 2007.

^_* Reprint requests and correspondence: Prof. Cheuk-Man Yu, Li Ka Shing Institute of Health Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China. (Email: cmyu{at}cuhk.edu.hk).

Tissue Doppler imaging (TDI) is evolving as a useful echocardiographic tool for quantitative assessment of left ventricular (LV) systolic and diastolic function. Recent studies have explored the prognostic role of TDI-derived parameters in major cardiac diseases, such as heart failure, acute myocardial infarction, and hypertension. In these conditions, myocardial mitral annular or basal segmental (Sm) systolic and early diastolic (Ea or Em) velocities have been shown to predict mortality or cardiovascular events. In particular, those with reduced Sm or Em values of <3 cm/s have a very poor prognosis. In heart failure and after myocardial infarction, noninvasive assessment of LV diastolic pressure by transmitral to mitral annular early diastolic velocity ratio (E/Ea or E/Em) is a strong prognosticator, especially when E/Ea is 15. In addition, systolic intraventricular dyssynchrony measured by segmental analysis of myocardial velocities is another independent predictor of adverse clinical outcome in heart failure subjects, even when the QRS duration is normal. In heart failure patients who received cardiac resynchronization therapy, the presence of systolic dyssynchrony at baseline is associated with favorable LV remodeling, which in turn predicts a favorable long-term clinical outcome. Finally, TDI and derived deformation parameters improve prognostic assessment during dobutamine stress echocardiography. A high mean Sm value in the basal segments of patients with suspected coronary artery disease is associated with lower mortality rate or myocardial infarction and is superior to the wall motion score.

Abbreviations and Acronyms   CI = confidence interval   DT = deceleration time   Ea = early diastolic velocity at mitral annulus   EF = ejection fraction   Em = early diastolic velocity at myocardial segments   HF = heart failure   HR = hazard ratio   LV = left ventricle   LVEF = left ventricular ejection fraction   MI = myocardial infarction   Sa = peak systolic velocity at mitral annulus   Sm = peak systolic velocity at myocardial segments   TDI = tissue Doppler imaging

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