CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Cheuk-Man Yu, MD, FRCP, FRACP*,
John E. Sanderson, MD, FRCP, FACC,
Thomas H. Marwick, MD, PhD, FACC and
Jae K. Oh, FACC
* Li Ka Shing Institute of Health Sciences, Institute of Vascular Medicine, S. H. Ho Cardiovascular and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N. T. SAR, Hong Kong (Email: cmyu{at}cuhk.edu.hk).
We would like to express our thanks for the valuable comment of Dandel et al. (1) on our recent article in the Journal (2) regarding the use of tissue Doppler imaging (TDI) as a new prognosticator in cardiac diseases. The authors draw attention to the potential role of TDI in cardiac transplantation. We recognize their unique work using myocardial systolic and early diastolic velocities, as well as acceleration for detecting transplant rejection and coronary heart disease (3). Because our article was a review, we aimed to provide a useful overview of TDI applications, in particular for common cardiac diseases. Therefore, we did not include after-cardiac-transplant patients because they are not commonly encountered in the clinical practice of most physicians. Furthermore, the article mainly explored the role of established TDI parameters for estimating prognosis in terms of major cardiovascular events and/or mortality. Therefore, it included mostly studies that had at least medium-term follow-up for the prediction of hard cardiovascular events. Although transplant rejection and development of coronary heart disease may indicate a worse prognosis, we would be very interested to see such follow-up data provided by this group and others.
With respect to the prognostic role of deformation imaging, we are intrigued by the extensive application of 2-dimensional strain and strain rate imaging in various patients who received cardiac surgery or cardiac surgical devices. However, many of these potential applications still lack major published data to support their regular clinical usage, not to mention their prognostic role, which will need additional follow-up assessment. Lastly, although 2-dimensional speckle tracking analysis of strain has been recently validated (4) as another technique for deformation imaging, more studies are needed to characterize the clinical application(s) of this new tool, including its value as a prognosticator.
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- Dandel M, Hummel M, Muller J, et al. Reliability of tissue Doppler wall motion monitoring after heart transplantation for replacement of invasive routine screenings by optimally timed cardiac biopsies and catheterizations Circulation 2001;104:I184-I191.[ISI][Medline]
- Yu CM, Sanderson JE, Marwick TH, Oh JK. Tissue Doppler imaging—a new prognosticator for cardiovascular diseases J Am Coll Cardiol 2007;49:1903-1914.[Abstract/Free Full Text]
- Dandel M, Wellnhofer E, Hummel M, Meyer R, Lehmkuhl H, Hetzer R. Early detection of left ventricular dysfunction related to transplant coronary artery disease J Heart Lung Transplant 2003;22:1353-1364.[CrossRef][ISI][Medline]
- Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging J Am Coll Cardiol 2006;47:789-793.[Abstract/Free Full Text]
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