Tissue Doppler ImagingA 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.
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Figure 1 Examples of Measures on Myocardial Velocity Curve
Measurement of peak myocardial systolic (Sm), early diastolic (Em), and late diastolic (Am) velocities, as well as the time to peak systolic velocity in ejection phase (Ts) at basal septal and basal lateral segments by 2-dimensional color-coded tissue Doppler imaging in a normal subject (A) and in a patient with systolic heart failure and wide QRS complex (B). Myocardial velocity curves are reconstituted offline from the color tissue Doppler images. Note that in heart failure there is a reduction of Sm and Em. Systolic dyssynchrony is demonstrated by the delay of Ts in the basal lateral segment when compared with the basal septal segment. AVO and AVC = aortic valve opening and closure, respectively; MVO and MVC = mitral valve opening and closure, respectively.
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Figure 2 Cumulative Cardiac Death in Patients Grouped by Tissue Doppler Imaging Parameters
Tertiles of peak systolic velocity (Sm) and peak early diastolic velocity (Em) in a cohort of a variety of cardiac diseases. Reprinted with permission from Wang et al. (16).
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Figure 3 Estimation of Left Ventricular Diastolic Pressure by Tissue Doppler Imaging
Estimation of left ventricular diastolic pressure by the ratio of transmitral E (A) and mitral septal annular velocity (B), E/Ea. The E/Ea ratio in this patient is 8, which is within normal limits. His Ea is also within normal limits. (C and D) A patient with elevated left ventricular diastolic pressure and E/Ea ratio of 40, which is significantly elevated. Note also that the Ea is severely reduced to only 3 cm/s. Both of these parameters were associated with poor prognosis.
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Figure 4 Survival Curve Stratified by E/Ea in Patients With Acute Myocardial Infarction
Patients with E/Ea >15 were associated with a significantly higher mortality. Reprinted with permission from Hillis et al. (27). E/Ea = transmitral to mitral annular early diastolic velocity ratio.
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Figure 6 Survival Curves of Patients With Suspected CHD Undergoing DSE and TDI
Patients with an average peak basal systolic velocity (Av Sm) of >6 cm/s were associated with a higher mortality than those Av Sm  6 cm/s. Reprinted with permission from Marwick et al. (13). CHD = coronary heart disease; DSE = dobutamine stress echocardiography; TDI = tissue Doppler imaging.
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2 on admission, anterior myocardial infarction, and myocardial revascularization during the index admission): chi-square = 20.8 for clinical factors; chi-square = 28.8 for clinical factors plus LVEF; chi-square = 33.2 for clinical factors plus LVEF plus DT