Doppler tissue imaging: a reliable method for estimation of left ventricular filling pressure in patients with mitral regurgitation.
ABSTRACT Doppler of mitral and pulmonary vein flows are used to estimate left ventricular (LV) filling pressure. Mitral regurgitation (MR) makes unreliable these parameters by inducing changes of both mitral inflow and pulmonary vein flow.
To evaluate whether Doppler tissue imaging (DTI) diastolic indices obtained at the level of LV lateral mitral annulus can provide accurate estimation of LV filling pressure in patients with MR.
Forty-three patients (age 55 +/- 11 years) with severe MR and mean LV ejection fraction (EF) 58 +/- 13 were enrolled, 10 (23%) with LV EF < 50% and 33 (77%) with LV EF > 50%. Doppler signals from the mitral inflow, pulmonary venous flow, and DTI indices of the lateral mitral annulus were obtained. LV end-diastolic pressure (LVEDP) was measured invasively with fluid-filled catheter.
In the overall population, the majority of standard Doppler and DTI indices correlated with LVEDP, but the multivariate analysis showed that the ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/Em ratio) (beta = .87, P = .0001) was independent predictor of LVEDP (R2 = 0.74, SE = 4, P = .0001). An E/Em ratio > 10 predicted an LVEDP > 15 mm Hg (sensitivity 90%, specificity 83%). In both groups with LV EF > 50% (beta = .77, P = .005; cumulative R2 = 0.73, SE = 2.5, P = .0001) and < 50% (beta = .89, P = .002; cumulative R2 = 0.77, SE = 2.1, P = .002), multivariate analysis underscored again only E/Em ratio as independent predictor of LVEDP.
The combination of DTI indices of the mitral annulus and mitral inflow velocities provides reliable parameters to predict LV filling pressure in patients with MR both in patients with LV EF > 50% and < 50%.
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ABSTRACT: Introduction The development of ischemic mitral regurgitation (IMR) after myocardial infarction (MI) may impose hemodynamic load during a period of active left ventricular remodeling and promote heart failure (HF). The aim of our study was to evaluate left ventricular (LV) long axis contraction assessed by both mitral annular plane systolic excursion (MAPSE) and peak systolic velocity (Sa) in patients with ischemic MR after acute MI. Methods Thirty-eight patients with a first attack of acute MI were classified into two groups. Group I comprised 18 patients with MI and ischemic MR, and group II comprised 20 patients with MI without IMR. Twenty age-matched subjects were considered as the control group (group III). Measurement of MAPSE from M-mode tracing of the mitral annulus in apical 4- and 2-chamber view, and pulsed wave tissue Doppler imaging (PW-TDI) of the 4 sides of the mitral annulus for assessment of the Sa velocity were done. Results A significant decrease of MAPSE was observed in 4 sides in patients with acute MI with IMR compared to MI without IMR and control group (P < 0.05). Peak systolic velocity (Sa) in septal, anterior, and inferior sides of mitral annulus was significantly decreased in MI patients compared to control group (P < 0.05). A significant correlation between MAPSE on anterior side of mitral annulus and LV ejection fraction (P < 0.001) in patients with ischemic MR after acute MI was found. Conclusion Mitral annular plane systolic excursion is a useful and superior parameter over peak Sa for assessment of longitudinal LV function in patients with ischemic MR after MI.Egyptian Journal of Chest Diseases and Tuberculosis. 03/2014;
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ABSTRACT: BACKGROUND: Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. METHODS: In this prospective, observational study conducted in 2 intensive care units at a tertiary-care hospital, 78 patients (age 53.2 +/- 17.1; 51% Female; Mean APACHE II score 23.3 +/- 7.4) with severe sepsis or septic shock underwent TTE within 6 hours of intensive care unit (ICU) admission, after 18 to 32 hours, and after resolution of shock. LV diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines, using E, A, and e' velocities; E/A and E/e'; and E deceleration time. Systolic dysfunction was defined as an ejection fraction (EF) < 45%. RESULTS: Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 (61.8%) patients had diastolic dysfunction on at least one echocardiogram. Overall mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE central venous pressure (CVP) (11+/-5 mmHg) did not differ among grades 1-3, although patients with grade I received less intravenous fluid. CONCLUSIONS: LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not Grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis, despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.Critical ultrasound journal 05/2012; 4(1):8.
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ABSTRACT: Conventional Doppler measurements, including mitral inflow and pulmonary venous flow, are used to estimate left ventricular end diastolic pressure (LVEDP). However, these parameters have limitations in predicting LVEDP among patients with mitral regurgitation. This study sought to establish whether the correlation between measurements derived from tissue Doppler echocardiography and LVEDP remains valid in the setting of severe mitral regurgitation. THIRTY PATIENTS (MEAN AGE: 57.37 ± 13.29 years) with severe mitral regurgitation and a mean left ventricular ejection fraction (EF) of 46.0 ± 14.95 were enrolled; 16 (53.4%) patients were defined to have EF < 50% and 14 (46.6%) patients had EF ≥ 50%. Doppler signals from the mitral inflow, pulmonary venous flow, and Doppler tissue imaging indices were obtained, and LVEDP was measured invasively through cardiac catheterization. The majority of the standard Doppler and Doppler tissue imaging indices were not significantly correlated with LVEDP in the univariate analysis. In the multiple linear regression, however, early (E) transmitral velocity to annular E' (E/E') ratio (β = 1.09, p value < 0.01), E wave velocity to propagation velocity (E/Vp) ratio (β = 7.87, p value < 0.01), and isovolumic relaxation time (β = 0.21, p value = 0.01) were shown as independent predictors of LVEDP (R(2) = 91.7%). The ratio of E/Vp and E/E' ratio and also the isovolumic relaxation time could be applied properly to estimate LVEDP in mitral regurgitation patients even in the setting of severe mitral regurgitation.The journal of Tehran Heart Center. 01/2010; 5(3):122-7.