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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

View larger version (31K): [in a new window]   Figure 1 Representative tissue velocity and myocardial acceleration of the septal mitral valve annulus and synchronized waveforms of LV pressure (LVP) and left atrial pressure (LAP). Early diastolic annular velocity (Ea) and late diastolic annular velocity (Aa) were noted in velocity curve 1-A. Definite positive peaks for myocardial acceleration were noted during isovolumic relaxation time (IVRT) (•), and a negative peak for acceleration at the beginning of the left ventricular filling period (*) was also noted corresponding to the Ea wave in ACC curve 1-B. The LVP and LAP were displayed together (1-C), and the difference between LAP and LVP was shown in 1-D. The derivative of LV pressure (dLVp/dt) was also displayed in 1-E. The derivativeof the difference between LAP and LVP was calculated and displayed in 1-F. ECG = electrocardiogram.

View larger version (51K): [in a new window]   Figure 2 Two-dimensional myocardial acceleration map during IVRT (upper left) and during LVFP (lower left). The tissue velocity and ACC waveform for IVS are shown (right) in the baseline condition (LAP of 9 mm Hg). MAP = mean atrial pressure; MV = mitral valve; other abbreviations as in Figure 1.

View larger version (53K): [in a new window]   Figure 3 A myocardial acceleration map during IVRT (left upper column) and during LVFP (left lower column) in blood loading (LAP of 18 mm Hg). Abbreviations as in Figures 1 and 2.

View larger version (34K): [in a new window]   Figure 4 Relationship of septal peak myocardial acceleration (pACC) (A) and left ventricular lateral pACC (B) during LVFP to mean LAP (left), –dP/dtmin (middle), and tau (right) in all experimental stages (n = 32). Abbreviations as in Figure 1.

View larger version (34K): [in a new window]   Figure 5 Relationship of septal pACC (A) and LV lateral pACC (B) during IVRT to mean LAP (left), –dP/dtmin (middle), and tau (right) in all experimental stage (n = 32). Abbreviations as in Figures 1 and 4.