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.

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).

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.

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.

The addition of left ventricular ejection fraction (LVEF), deceleration time (DT), and the ratio of transmitral E and mitral annular velocity (E/Ea) resulted in significant incremental improvements in the predictive value of a model including clinical variables (age, Killip class 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 140 ms; and chi-square = 43.0 for clinical factors plus LVEF plus DT 140 ms plus E/Ea >15. Reprinted with permission from Hillis et al. (27).

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.