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Ventricular excitation maps using tissue Doppler acceleration imaging: potential clinical application

Li-Xue Yin, MD^* , Chuen-Mei Li, MD^* , QinGue Fu, MD^* , Yiu Lo, MB , QiHua Huang, MB , Li Cai, MD and Zhu-Xui Zheng, MD

^* Echocardiography Laboratory, Sichuan Provincial Hospital, Chengdu, Sichuan, China
Cardiac Catheter Laboratory, Sichuan Provincial Hospital, Chengdu, Sichuan, China
Sichuan Red Cross Hospital, Chengdu, Sichuan, China

View larger version (55K): [in a new window]   Figure 1 Normal case. Long-axis view of the left ventricle. (A) Electrocardiographic gate indicated that the time phase was end-diastole; there was low ventricular acceleration (blue). (B) Electrocardiographic gate indicated that the phase was early systole. The position of normal onset of ventricular acceleration (arrow, red and yellow area) was within the upper interventricular septum beneath the right coronary cusp.

View larger version (53K): [in a new window]   Figure 2 Normal case. Long-axis view of the regional upper interventricular septum. (A) The position of normal onset of ventricular acceleration was within the upper interventricular septum beneath the right coronary cusp (yellow and red area) at early systole. (B) The propagation of ventricular acceleration proceeded from membrane to mid part at early systole.

View larger version (109K): [in a new window]   Figure 3 Patient with paroxysmal supraventricular tachycardia. Short-axis view of the left ventricle at mitral valve orifice level. At the beginning of an electrical stimulating pulse, the left ventricular posterior wall was the site of initial acceleration (arrow, red and yellow area). A stimulating electrode within the esophagus was near the left ventricular posterior wall.

View larger version (49K): [in a new window]   Figure 4 Patient with permanent pacemaker (VVI). Apical short-axis view of left ventricle. (A) The stimulating electrode was located at the endocardium of the right ventricular posterior wall (arrow). (B) The position of abnormal onset of ventricular acceleration (arrow, red and yellow area) was localized at the same position of the electrode within 25 ms after electrical stimulation.

View larger version (54K): [in a new window]   Figure 5 Patient with Wolff–Parkinson–White syndrome (type A). (A) Short-axis view of the left ventricle at papillary muscle level at delta wave. Abnormal onset of ventricular acceleration was at the subepicardium of the left ventricular posterior wall (arrow, yellow and green area). (B) The initial ventricular acceleration area had extended.

View larger version (52K): [in a new window]   Figure 6 Patient with Wolff–Parkinson–White syndrome (type B). Short-axis view of the left ventricle at level of mitral valve orifice. (A) At the delta wave, abnormal onset of ventricular acceleration (arrow, yellow point) was at the subendocardium of the right ventricular posterior wall. (B) At early systole, the initial ventricular acceleration had extended (red area).