Comparison of early diastolic annular velocities measured at various sites of mitral annulus in detection of mild to moderate left ventricular diastolic dysfunction.
ABSTRACT Early diastolic mitral annular velocity (Em) as measured by pulsed-wave tissue Doppler echocardiography (PW-TDE) has been described as a relatively load independent index of left ventricular (LV) relaxation allowing more precise assessment of LV diastolic function. Nevertheless, substantial regional differences in Em are encountered. A systematic study comparing accuracy of the Em values measured at various annular sites in the assessment of LV diastolic function is still lacking. In this study we aimed to compare the discriminating power of Em velocities measured at the various sites of the mitral annulus in distinguishing between normal LV filling and mild to moderate LV diastolic dysfunction, and to determine the optimal cutoff values of Em at each mitral annular site. Em determined by PW-TDE was measured at four mitral annular sites in 69 patients with various heart diseases and compared to LV filling patterns obtained using standard flow Doppler indices. A comparison of receiver operating characteristic curves did not show significant differences for areas under the curve in favor of Em measured at any annular site (0.92 for septal, 0.96 for lateral, 0.96 for inferior and 0.93 for anterior site, 0.95 for the averaged value of Em from all annular sites, and 0.93 for the averaged value from septal and lateral sites, P not significant). The optimal cutoff values of Em were 0.08 m s(-1) for septal site (91% sensitivity, 89% specificity), 0.11 m s(-1) for lateral site, 0.09 m s(-1) for inferior site (both 91% sensitivity, 94% specificity), 0.10 m s(-1) for anterior annular site (88% sensitivity, 91% specificity), 0.11 m s(-1) for the averaged value of Em from all sites, and 0.11 m s(-1) for the averaged value from septal and lateral sites (both 97% sensitivity, 86% specificity). There are no differences in the accuracy of Em velocities obtained at various mitral annular sites regarding the detection of mild to moderate LV diastolic dysfunction. However, different cutoff values of Em at each mitral annular site must be considered for distinguishing between normal and mild to moderate LV diastolic dysfunction.
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ABSTRACT: To determine the accuracy of echocardiographic left ventricular (LV) dimension and mass measurements for detection and quantification of LV hypertrophy, results of blindly read antemortem echocardiograms were compared with LV mass measurements made at necropsy in 55 patients. LV mass was calculated using M-mode LV measurements by Penn and American Society of Echocardiography (ASE) conventions and cube function and volume correction formulas in 52 patients. Penn-cube LV mass correlated closely with necropsy LV mass (r = 0.92, p less than 0.001) and overestimated it by only 6%; sensitivity in 18 patients with LV hypertrophy (necropsy LV mass more than 215 g) was 100% (18 of 18 patients) and specificity was 86% (29 of 34 patients). ASE-cube LV mass correlated similarly to necropsy LV mass (r = 0.90, p less than 0.001), but systematically overestimated it (by a mean of 25%); the overestimation could be corrected by the equation: LV mass = 0.80 (ASE-cube LV mass) + 0.6 g. Use of ASE measurements in the volume correction formula systematically underestimated necropsy LV mass (by a mean of 30%). In a subset of 9 patients, 3 of whom had technically inadequate M-mode echocardiograms, 2-dimensional echocardiographic (echo) LV mass by 2 methods was also significantly related to necropsy LV mass (r = 0.68, p less than 0.05 and r = 0.82, p less than 0.01). Among other indexes of LV anatomy, only measurement of myocardial cross-sectional area was acceptably accurate for quantitation of LV mass (r = 0.80, p less than 0.001) or diagnosis of LV hypertrophy (sensitivity = 72%, specificity = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)The American Journal of Cardiology 03/1986; 57(6):450-8. · 3.21 Impact Factor
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ABSTRACT: Conventional Doppler echocardiography offers an indirect assessment of left ventricular (LV) diastolic function, hampered by preload dependency. Tissue Doppler imaging (TDI) is a tool to study diastolic function in a more direct and less preload-dependent manner. The Medline database has been searched for literature on TDI for the analysis of diastolic function. A secondary search reviewed the relevant references related to TDI or diastolic function in general. TDI measures myocardial velocities with a high temporal and velocity resolution but lacks spatial information. In particular, the velocity of early diastolic wall motion (E(m)) and its timing are promising indices of local myocardial relaxation. E(m) at the mitral annulus offers fair estimates of ventricular relaxation, relatively independent of preload and systolic function. Combined with early transmitral flow velocity (E), detection of pseudo-normalized filling patterns and estimation of filling pressures are enhanced by E/E(m). TDI has an emerging role in the study and assessment of diastolic function. However, TDI-derived information needs to be integrated with other echocardiographic data because single diagnostic accuracy remains unsatisfactory.American heart journal 10/2003; 146(3):411-9. · 4.65 Impact Factor
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ABSTRACT: The left ventricular (LV) major axis shortening is an important determinant of its global function. But unlike the LV minor axis dynamics, the long-axis dynamics have not been well characterized. We investigated the amplitudes, durations, and timings of LV long-axis myocardial velocities and related them to LV filling and ejection in normal healthy volunteers. Myocardial velocities from the basal, mid, and distal portions of the four LV walls were recorded from the apical window with spectral Doppler tissue imaging in 20 normal individuals. The timings, amplitudes, and durations were measured and compared both longitudinally and circumferentially. These were also related to mitral inflow and LV ejection. Analysis of the recordings indicated that there were three principal myocardial velocities: apically directed systolic velocity and atrially directed early and late diastolic velocities. The LV posterior wall had the highest shortening velocity and the amount of shortening. The lateral wall had the greatest amplitude of early diastolic lengthening velocity, amount of lengthening, and early to late lengthening velocity and integral ratios, probably indicating most favorable early diastolic properties. There was a striking synchrony in the myocardial velocities circumferentially. The myocardial velocities dropped progressively as the sampling site was moved distally and the LV apex was practically stationary. Although the onsets of the velocity profiles were simultaneous in the meridional orientation, their durations were shorter distally. All myocardial velocities preceded the corresponding blood flow velocities. They also ended before the corresponding blood flow velocities, this being more pronounced in the distal myocardial segments, indicating the presence of inertial factors responsible for the terminal portions of mitral and aortic flows. Recording of apically directed myocardial velocities gives valuable insights into the regional myocardial function. These velocities show significant regional variations in healthy normal individuals. It is speculated that analysis of regional myocardial velocities may have a role in the diagnosis of early myocardial disease.Journal of the American Society of Echocardiography 03/1998; 11(2):105-11. · 4.28 Impact Factor