Article

Tissue Doppler imaging - A new prognosticator for cardiovascular diseases

Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
Journal of the American College of Cardiology (Impact Factor: 15.34). 05/2007; 49(19):1903-14. DOI: 10.1016/j.jacc.2007.01.078
Source: PubMed

ABSTRACT 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 > or =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.

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    • "The Ea, E/Ea, and Sa are shown to predict mortality or CV events in these cardiac diseases. Patients with reduced Ea and Sa values, in particular, have a poor prognosis [26]. Besides, left ventricular and left atrial size, left ventricular hypertrophy and left ventricular systolic function were reported to be able to predict CV outcomes [27] [28] [29] [30]. "
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    ABSTRACT: Purpose The pre-ejection period-derived myocardial performance index measured from tissue Doppler echocardiography (PEPa-derived MPI) was reported to be associated with left ventricular systolic and diastolic function in atrial fibrillation (AF). However, its relationship with cardiovascular outcomes in AF has never been evaluated. This study sought to examine the ability of PEPa-derived MPI in predicting adverse cardiovascular events in AF patients. Methods In 196 persistent AF patients, we performed comprehensive echocardiography with measurement of PEPa-derived MPI using index beat method. The index beat was defined as the beat following the nearly equal preceding (RR1) and pre-preceding (RR2) intervals. The cycle length of index beat and RR1 and RR2 must be >500 ms and the difference between RR1 and RR2 must be <60 ms. Cardiovascular events were defined as cardiovascular death, nonfatal stroke, and hospitalization for heart failure. Results In the multivariate analysis, chronic heart failure and increased ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity (E/Ea) and PEPa-derived MPI (per 0.1 increase, hazard ratio, 1.104; 95% confidence interval, 1.032–1.182, p = 0.004) were associated with increased cardiovascular events. The addition of PEPa-derived MPI to a Cox model containing chronic heart failure, systolic blood pressure, age, diabetes, prior stroke, left ventricular ejection fraction, and E/Ea provided an additional benefit in prediction of adverse cardiovascular events (p = 0.015). Conclusions In AF patients, the PEPa-derived MPI was a useful predictor of adverse cardiovascular events and could offer an additional prognostic benefit over conventional clinical and echocardiographic parameters.
    Journal of Cardiology 08/2014; 65(6). DOI:10.1016/j.jjcc.2014.07.014 · 2.57 Impact Factor
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    • "It also appears that diastolic function evaluated by TDI may be impaired in hypertensive subjects in the absence of LV hypertrophy (Müller-Brunotte et al., 2007; Tsilakis et al., 2008; Narayanan et al., 2009). In addition, impaired systolic and diastolic function measured by TDI is a strong individual predictor of adverse clinical outcome in patients with hypertension and preserved LV ejection fraction (Wang et al., 2005; Yu et al., 2007). A healthy lifestyle with regular physical exercise is recommended as part of the non-pharmacological treatment of hypertension (Cornelissen & Fagard, 2005; Fagard & Cornelissen, 2007; Mancia et al., 2007; Cornelissen et al., 2010). "
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    ABSTRACT: We investigated the effects of 3 and 6 months of regular football training on cardiac structure and function in hypertensive men. Thirty-one untrained males with mild-to-moderate hypertension were randomized 2:1 to a football training group (n = 20) and a control group receiving traditional recommendations on healthy lifestyle (n = 11). Cardiac measures were evaluated by echocardiography. The football group exhibited significant (P < 0.05) changes in cardiac dimensions and function after just 3 months: Left ventricular (LV) end-diastolic volume increased from 104 ± 25 to 117 ± 29 mL. LV diastolic function improved measured as E/A ratio (1.15 ± 0.32 to 1.54 ± 0.38), early diastolic velocity, E' (11.0 ± 2.5 to 11.9 ± 2.6 cm/s), and isovolumetric relaxation time (74 ± 13 to 62 ± 13 ms). LV systolic function improved measured as longitudinal displacement (10.7 ± 2.1 to 12.1 ± 2.3 mm). Right ventricular function improved with respect to tricuspid annular plane systolic excursion (21.8 ± 3.2 to 24.5 ± 3.7 mm). Arterial blood pressure decreased in both groups, but significantly more in the football training group. No significant changes were observed in the control group. In conclusion, short-term football training improves LV diastolic function in untrained men with mild-to-moderate arterial hypertension. Furthermore, it may improve longitudinal systolic function of both ventricles. The results suggest that football training has favorable effects on cardiac function in hypertensive men.
    Scandinavian Journal of Medicine and Science in Sports 06/2014; DOI:10.1111/sms.12237 · 3.17 Impact Factor
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    • "In contrast, reported cut-off points of echocardiographic diastolic measures (e and E/e ) for the diagnosis of diastolic dysfunction or the prediction of adverse prognosis are variable depending on age [2] and population studied [4]. Furthermore, e recorded at lateral mitral annular site is usually higher than e at septal site [4]. Thus, in the present study, the best cut-off points of echocardiographic diastolic measures were explored to maximize the likelihood ratio in receiver-operating characteristic curves for the prediction of the outcome. "
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    ABSTRACT: We hypothesized that left ventricular (LV) diastolic dysfunction assessed by cardiac catheterization may be associated with increased risk for cardiovascular events. To test the hypothesis, we assessed diastolic function by cardiac catheterization (relaxation time constant (Tau) and end-diastolic pressure (EDP)) as well as Doppler echocardiography (early diastolic mitral annular velocity (e') and a ratio of early diastolic mitral inflow to annular velocities (E/e')) in 222 consecutive patients undergoing cardiac catheterization for coronary artery disease (CAD). During a followup of 1364 ± 628 days, 5 cardiac deaths and 20 unscheduled cardiovascular hospitalizations were observed. Among LV diastolic function indices, Tau > 48 ms and e' < 5.8 cm/s were each significantly associated with lower rate of survival free of cardiovascular hospitalization. Even after adjustment for potential confounders (traditional cardiovascular risk factors, the severity of CAD, and cardiovascular medications), the predictive value of Tau > 48 ms and e' < 5.8 cm/s remained significant. No predictive value was observed in EDP, E/e', or LV ejection fraction. In conclusion, LV diastolic dysfunction, particularly impaired LV relaxation assessed by both cardiac catheterization and Doppler echocardiography, is independently associated with increased risk for cardiac death or cardiovascular hospitalization in patients with known or suspected CAD.
    04/2012; 2012:243735. DOI:10.1155/2012/243735
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