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J Am Coll Cardiol, 2007; 49:1903-1914, doi:10.1016/j.jacc.2007.01.078 (Published online 30 April 2007).
© 2007 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Tissue Doppler Imaging

A New Prognosticator for Cardiovascular Diseases

Cheuk-Man Yu, MD, FRCP, FRACP*,*, John E. Sanderson, MD, FRCP, FACC{dagger}, Thomas H. Marwick, MD, PhD, FACC{ddagger} 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
{dagger} Department of Cardiology, Keele University Medical School, University Hospital of North Staffordshire NHS Trust, City General Hospital, Stoke-on-Trent, United Kingdom
{ddagger} Department of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
§ Mayo Clinic, Rochester, Minnesota.

Manuscript received March 7, 2006; revised manuscript received January 19, 2007, accepted January 22, 2007.

* Reprint requests and correspondence: Prof. Cheuk-Man Yu, Li Ka Shing Institute of Health Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China. (Email: cmyu{at}cuhk.edu.hk).

Tissue Doppler imaging (TDI) is evolving as a useful echocardiographic tool for quantitative assessment of left ventricular (LV) systolic and diastolic function. Recent studies have explored the prognostic role of TDI-derived parameters in major cardiac diseases, such as heart failure, acute myocardial infarction, and hypertension. In these conditions, myocardial mitral annular or basal segmental (Sm) systolic and early diastolic (Ea or Em) velocities have been shown to predict mortality or cardiovascular events. In particular, those with reduced Sm or Em values of <3 cm/s have a very poor prognosis. In heart failure and after myocardial infarction, noninvasive assessment of LV diastolic pressure by transmitral to mitral annular early diastolic velocity ratio (E/Ea or E/Em) is a strong prognosticator, especially when E/Ea is ≥15. In addition, systolic intraventricular dyssynchrony measured by segmental analysis of myocardial velocities is another independent predictor of adverse clinical outcome in heart failure subjects, even when the QRS duration is normal. In heart failure patients who received cardiac resynchronization therapy, the presence of systolic dyssynchrony at baseline is associated with favorable LV remodeling, which in turn predicts a favorable long-term clinical outcome. Finally, TDI and derived deformation parameters improve prognostic assessment during dobutamine stress echocardiography. A high mean Sm value in the basal segments of patients with suspected coronary artery disease is associated with lower mortality rate or myocardial infarction and is superior to the wall motion score.

Abbreviations and Acronyms
  CI = confidence interval
  DT = deceleration time
  Ea = early diastolic velocity at mitral annulus
  EF = ejection fraction
  Em = early diastolic velocity at myocardial segments
  HF = heart failure
  HR = hazard ratio
  LV = left ventricle
  LVEF = left ventricular ejection fraction
  MI = myocardial infarction
  Sa = peak systolic velocity at mitral annulus
  Sm = peak systolic velocity at myocardial segments
  TDI = tissue Doppler imaging




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