SPECIAL SECTION: LETTER TO THE EDITOR
Assessment of diastolic function using myocardial velocity gradient
Masaaki Uematsu, MD, PhD, FACC
Cardiovascular Division, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
uematsu{at}theia.ocn.ne.jp
I read with interest an editorial comment by Dr. Shah (1) regarding a study on myocardial velocity gradient (MVG) and left ventricular dysfunction (2). I agree with his comment that no noninvasive measure of "pure" diastolic function has yet been achieved.
In his comment, Dr. Shah stated that diastolic MVG measurement was first reported by Fleming et al. (3) as being somewhat insensitive to preload or atrial filling pressures. To my knowledge, however, in 1994, MVG was introduced merely for the evaluation of myocardial contractility. Fleming et al. compared the velocity gradient with wall-thickness change to validate the new methodology (3). The application of MVG to assess diastolic dysfunction had to wait until the report by Palka et al. (4) differentiating hypertrophic cardiomyopathy from athletes' hearts, in which, however, they did not assess the effects of preload alterations. Relative independence of MVG from preload alterations as compared to transmitral flow patterns was first reported by Shimizu et al. (5) in 1998. In addition, I would like to emphasize that a robust aspect of the tissue Doppler technique is the potential to assess regional, rather than global, diastolic function noninvasively, which should be validated and clinically applied in the near future.
Although the editorial comment by Dr. Shah raises an important issue in the assessment of diastolic function and thus is very informative, I am afraid his statement on the application of MVG measurements for the assessment of diastolic function seems to be inaccurate.
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References
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1. Shah PM. Hypertrophic cardiomyopathy and diastolic dysfunction. J Am Coll Cardiol. 2003;42:286–287[Free Full Text]
2. Kato T, Noda A, Izawa H, et al. Myocardial velocity gradient as a noninvasively determined index of left ventricular diastolic dysfunction in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2003;42:278–285[Abstract/Free Full Text]
3. Fleming AD, Xia X, McDicken WM, Sutherland GR, Fenn L. Myocardial velocity gradients detected by Doppler imaging. Br J Radiol. 1994;67:679–688[Abstract/Free Full Text]
4. Palka P, Lange A, Fleming AD, et al. Differences in myocardial velocity gradient measured throughout the cardiac cycle in patients with hypertrophic cardiomyopathy, athletes and patients with left ventricular hypertrophy due to hypertension. J Am Coll Cardiol. 1997;30:760–768[Abstract]
5. Shimizu Y, Uematsu M, Shimizu H, et al. Peak negative myocardial velocity gradient in early diastole as a noninvasive indicator of left ventricular diastolic function. J Am Coll Cardiol. 1998;32:1418–1425[Abstract/Free Full Text]
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