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%.
- SourceAvailable from: Ayman A. Abdelaziz[Show abstract] [Hide abstract]
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: Once regarded as "noise", the Doppler shift recorded from moving myocardium provides a great deal of infor-mation about cardiac function and forms the basis of tissue Doppler imaging (TDI). TDI is rapidly becoming a routine part of echocardiographic evaluation of the heart. Given the large amplitude signal obtained with TDI, recordings of myo-cardial velocities are technically easy to acquire and they provide reproducible, quantitative measurements even when 2-dimensional images are suboptimal. Although TDI has broad potential utility in cardiac functional assessment, its most rigorously validated applications include: 1) estimation of left ventricular filling pressures; 2) assessment of systolic and diastolic function; 3) quantification of ventricular dyssynchrony and evaluation for cardiac resynchronization therapy; and 4) detection of myocardial ischemia or segmental contractile dysfunction. Here we highlight some of the fascinating dis-coveries that led to the development of TDI and discuss its clinical application in each of these areas. Because TDI is such a powerful means of noninvasively assessing cardiac physiology and pathophysiology, its application in clinical practice will undoubtedly continue to increase as it is becomes more widely understood.Current Cardiology Reviews 02/2007; 3(1).
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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.