Role of P Wave Duration and Tissue Doppler Imaging as Predictive Indicators for Paroxysmal Atrial Fibrillation in Hypertensive Patients

Background: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the heart. AF accounts for one-third of rhythm disorder hospitalizations. AF increases profoundly the risk of stroke, heart failure, and death. This study used P-wave and transthoracic echocardiography with tissue Doppler imaging (TDI) to determine paroxysmal AF predictors in hypertensive individuals. Methods: This case control study was performed on 100 hypertensive adult patients. They were classified into two equal group: Group I included hypertensive patients diagnosed to have paroxysmal AF. Group II (control group) included hypertensive patients with normal sinus rhythm. All subjects were subjected to electrocardiographic and conventional and tissue Doppler Imaging measurements. Results: Pmax had significantly increased in PAF patients compared to sinus rhythm patients. PAL, PAR, PAI, LR, LI and IR had significantly increased in PAF patients compared to sinus rhythm patients. In Multivariate logistic regression analysis, Pmax, PAL, PAI, PAR, LR, LI and IR were found to be independent predictors for PAF. Therefore, Pmax, PAL PAI, PAR, LR, LI and IR were found to be significant predictors for PAF. Best cut-off values for Pmax, PAL, PAI, PAR, LR, LI and IR were: (118, 81, 61, 49.9, 34, 20 and 16 ms) with sensitivity (76, 96, 96, 88, 82, 86 and 77.5 ), specificity (84, 100, 98, 92, 78, 82 and 76) and the AUC of (0.850, 0.979, 0.987, 0.961, 0.836, 0.891 and 0.798) respectively. Conclusions: Electrocardiographic P-wave analysis and echocardiographic TDI may identify hypertension patients at risk for paroxysmal AF, since the combination of Pmax and TDI may help in predicting the development of AF in hypertensive individuals.

Use of tissue doppler imaging for the early detection of myocardial dysfunction in patients with the indeterminate form of Chagas disease

Abstract INTRODUCTION: Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls. METHODS: We compared 194 patients with the indeterminate form of Chagas disease to 72 age-matched healthy individuals. We considered p-values <0.05 to be statistically significant. RESULTS: TDI analysis of the right ventricular (RV) showed lengthened isovolumic relaxation time (IRT) and higher RV index of myocardial performance (RIMP) and left ventricle (LV) index of myocardial performance (LIMP) in the Chagas group than in the control group, indicating RV and LV systolic and diastolic myocardial damage. TDI analysis of the myocardial velocities of the interventricular septum and the lateral wall of the LV also showed a systolic and diastolic myocardial damage. CONCLUSIONS: The study results demonstrated early LV systolic and diastolic myocardial damage in the RV and LV in patients with the indeterminate form of Chagas disease by TDI. These early findings of RV and LV dysfunction may help identify patients who will progress to heart failure during the disease course. TDI should be included in initial patient evaluations because it allows adequate follow-up and treatment.

Detection and evaluation of left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients by conventional and tissue doppler imaging

Background: Diabetic cardiomyopathy is characterised predominantly by diastolic dysfunction. While the traditional echocardiography provides only semiquantitative assessment of diastolic dysfunction, tissue Doppler imaging proved to be an effective technique for the quantification of subclinical diastolic dysfunction.Methods: The current cross-sectional study was conducted in out-patient department of General Medicine, Tagore Medical College and Hospital for a period of 6 months. The study population comprised of 100 patients with type 2 diabetes mellitus including 39 male and 61 females. Echocardiography (using Siemens – Acuson NX3 Elite - system with TDI technology) was performed to all subjects in the left lateral position and 2D, M- mode, Doppler techniques were used. The early E wave corresponding to early ventricular filling and A wave which reflect a trial contraction were typically measured to assess the transmitral flow pattern. Systolic S' (Sa), early diastolic E (Ea) and the late diastolic velocities A' (Aa) were measured by tissue Doppler imaging.Results: The E/A ratio ranged from 0.5 to 2 and E/Ea ratio ranged from 1.59 to 14.67. Around 23 patients and 54 patients were abnormal by E/A and E/Ea ratios respectively. Around 29 patients showed grade II diastolic dysfunction by tissue Doppler imagingConclusions: Prompt diagnosis of diastolic dysfunction help us to identify high risk patients who are likely to be benefitted by early therapeutic intervention. Tissue Doppler imaging may be a better tool in the identification of diastolic dysfunction especially grade II in comparison with the conventional echocardiography.

Correlation between myocardial velocity measured using tissue doppler imaging in the left ventricular lead-implanted segment and response to cardiac resynchronization therapy

OBJECTIVES: This study investigated whether tissue Doppler imaging parameters, especially the peak systolic velocity of the left ventricular lead-implanted segment (Ss), affect cardiac resynchronization therapy response. METHODS: In this case-control study, 110 enrolled patients were divided into cases (responder group, n=65) and controls (nonresponder group, n=45) based on whether their left ventricular end-systolic volume was reduced by ≥15% at 6 months after surgery. Preoperative clinical and echocardiographic data were collected. Multivariate logistic regression models were used to analyze the factors affecting the response to cardiac resynchronization therapy, and receiver operating characteristic curves were plotted to evaluate their diagnostic values. RESULTS: The proportion of patients with left bundle branch block in the case group was higher than that in the control group. The control group showed a higher left atrial volume index, E/A ratio and E/Em ratio but lower Ss than that of the case group. A multivariate regression analysis showed that left bundle branch block, Ss, and an E/Em ratio>14 were independent risk factors affecting the response to cardiac resynchronization therapy. Ss=4.1 cm/s was the best diagnostic threshold according to the receiver operating characteristic curve. CONCLUSIONS: Ss is an important factor affecting the response to cardiac resynchronization therapy. Patients with heart failure associated with Ss<4.1 cm/s have a higher risk of nonresponse.

Quantification of left ventricular performance in different phenotypes of hypertrophic cardiomyopathy / 中华超声影像学杂志

Objective@#To evaluate the characteristics of left ventricular structure, function, myocardial mechanics, hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy (HCM) using state-of-the-art echocardiography.@*Methods@#A consecutive series of 85 adult HCM patients who were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected. According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography, the patients were divided into three groups: patients with non-obstructive HCM (n=28), those with labile-obstructive HCM (n=27), and those with obstructive HCM (n=30). In addition, 16 normal family members of HCM patients were included as control group. Two-dimensional speckle tracking imaging, tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states.@*Results@#①As compared with the control group, left ventricular end-diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups(all P<0.05). Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM, followed by labile-obstructive and non-obstructive HCM, and the lowest in the control group (all P<0.05). ②At rest, the left ventricular global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as the twist of obstructive HCM were significantly lower than the other three groups (all P<0.05). As compared with the control group, the GLS and twist decreased in the labile-obstructive and non-obstructive HCM(all P<0.05), but there were no significant changes of GCS and GRS (all P>0.05). The obstructive HCM had the lowest mitral annular plane systolic excursion (MAPSE) and s′, and the longest systolic peaking time standard deviation(Ts-SD) and early diastolic peaking time standard deviation(Te-SD) (all P<0.05). The left ventricular diastolic function of obstructive HCM (e′, the E/e′ ratio and the left atrial volume index) was the worst, labile-obstruction and non-obstructive HCM were better, and the control group was the best (all P<0.001). ③During exercise, the GLS, GCS, GRS, twist of the left ventricle and the MAPSE were the lowest in the obstructive HCM, which increased in the labile-obstructive and non-obstructive HCM, and were best in the control group. The Ts-SD and Te-SD were the shortest in the control group, were prolonged in non-obstructive and labile-obstruction HCM, and were longest in obstructive HCM (all P<0.05). Additionally, the exercise time of the control group was the longest, followed by non-obstructive and labile-obstruction HCM, and the shortest in the obstructive HCM (all P<0.05). The METs of obstructive HCM were significantly lower than the other three groups (all P<0.05).@*Conclusions@#In obstructive HCM, the left ventricular systolic strain and synchronization, as well as the MAPSE, are significantly impaired in patients both at rest and during exercise. The patients with labile-obstructive and non-obstructive HCM have reduced left ventricular GLS, twist, and e′, but normal left ventricular GCS, GRS, synchrony, and MAPSE at rest, which are all impaired during exercise.

Usefulness of Z-score of early diastolic velocities using tissue Doppler imaging in evaluating left ventricular diastolic function in children with dilated cardiomyopathy / 中华超声影像学杂志

Objective To evaluate the impact of Z-score of early diastolic velocities using tissue Doppler imaging(TDI) in children with dilated cardiomyopathy(DCM) . Methods Fifty-eight children with DCM and 58 healthy children (control group) were selected ,tissue Doppler velocities were converted to Z-score on the basis of body-surface-area-adjusted . The Z-score head-to-head with the raw velocities were compared.Results ①Lateralwalle'velocitiesandinterventricularseptale'velocitieswerepositively correlated with age ( r = 0 .710 ,0 .622;all P < 0 .05 ) . Tissue Doppler velocities and Z-score of mitral annular in DCM children were lower than the normal children( P <0 .001) . ② The discriminant capacity was higher for the Z-score than for the e'raw velocities ,which were assessed by the area under the receiver operating characteristic curves . Conclusions The Z-score of early diastolic velocities are better than the raw velocities in evaluating left ventricular diastolic function in children with dilated cardiomyopathy

Quantification of left ventricular performance in different phenotypes of hypertrophic cardiomyopathy / 中华超声影像学杂志

Objective To evaluate the characteristics of left ventricular structure ,function ,myocardial mechanics ,hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy ( HCM ) using state‐of‐the‐art echocardiography . Methods A consecutive series of 85 adult HCM patients w ho were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected . According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography ,the patients were divided into three groups :patients with non‐obstructive HCM ( n ＝28) ,those with labile‐obstructive HCM ( n ＝27) ,and those with obstructive HCM ( n ＝ 30 ) . In addition ,16 normal family members of HCM patients were included as control group . T wo‐dimensional speckle tracking imaging ,tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states . Results ① As compared with the control group ,left ventricular end‐diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups ( all P ＜ 0 .05 ) . Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM , followed by labile‐obstructive and non‐obstructive HCM ,and the lowest in the control group ( all P ＜0 .05) . ②A t rest ,the left ventricular global longitudinal ,circumferential and radial strain ( GLS ,GCS and GRS) ,as well as the twist of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . As compared with the control group ,the GLS and twist decreased in the labile‐obstructive and non‐obstructive HCM ( all P ＜0 .05 ) ,but there were no significant changes of GCS and GRS ( all P ＞ 0 .05 ) . T he obstructive HCM had the lowest mitral annular plane systolic excursion ( M APSE ) and s′,and the longest systolic peaking time standard deviation( T s‐SD) and early diastolic peaking time standard deviation ( Te‐SD) ( all P ＜0 .05) . T he left ventricular diastolic function of obstructive HCM ( e′,the E/e′ratio and the left atrial volume index ) was the worst ,labile‐obstruction and non‐obstructive HCM were better ,and the control group was the best ( all P ＜ 0 .001 ) . ③ During exercise ,the GLS ,GCS ,GRS ,twist of the left ventricle and the M APSE were the lowest in the obstructive HCM ,which increased in the labile‐obstructive and non‐obstructive HCM ,and were best in the control group . T he T s‐SD and Te‐SD were the shortest in the control group ,were prolonged in non‐obstructive and labile‐obstruction HCM ,and were longest in obstructive HCM ( all P ＜ 0 .05 ) . Additionally ,the exercise time of the control group was the longest , followed by non‐obstructive and labile‐obstruction HCM ,and the shortest in the obstructive HCM ( all P ＜0 .05) . T he M ET s of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . Conclusions In obstructive HCM ,the left ventricular systolic strain and synchronization ,as well as the M APSE ,are significantly impaired in patients both at rest and during exercise . T he patients with labile‐obstructive and non‐obstructive HCM have reduced left ventricular GLS , twist ,and e′,but normal left ventricular GCS ,GRS ,synchrony ,and M APSE at rest ,which are all impaired during exercise .

Are objective measures of tricuspid annular motion and velocity used as frequently as recommended by current guidelines? A pilot study

In this retrospective study 420 echocardiograms from a single center were reviewed showing that TAPSE was acquired in 66% while TA TDI s’ signals were recorded in 98% of all echocardiograms. Based on these results greater efforts are required to standardize acquisition and reporting of objective measurements of RV function.

Metformin enhances left ventricular function in patients with metabolic syndrome / La metformina mejora la función ventricular izquierda en pacientes con síndrome metabólico

Background: Metabolic syndrome foretells several cardiovascular complications, including heart failure (HF). Left ventricular (LV) dysfunction accompanies the MS. Although metformin improves LV function in diabetics with HF, there is no evidence of its effect on LV dysfunction in MS patients. We studied the effect of metformin on LV dysfunction in MS patients using tissue Doppler myocardial imaging and two-dimensional speckle tracking. Aims: To evaluate the effects of metformin on metabolic syndrome (MS) induced left ventricular dysfunction. Material and methods: Patients with MS were randomly allocated into two groups (n = 20 each) receiving, an antagonist of angiotensin 2 receptors and; statins, fibrates or both. One group received 850 mg of metformin daily. LV mass, relative wall thickness (RWT), ejection fraction, E/A and E/E' relationship, systolic tissue Doppler velocity (Sm), mean peak systolic strain (SS), and peak early diastolic strain rate (SR-LVe) echocardiographic measurements, at baseline and six months were obtained. Results: All patients had LH concentric hypertrophy or remodeling. Metformin reduced LV mass and RWT. There were LV systolic and diastolic alterations in both groups that metformin improved significantly. SR-LVe increased nearly 2-fold with metformin. Diastolic function improvement was not related to regression of hypertrophy. Conclusions: Patients with MS experienced subtle alterations of systolic and diastolic functions, which improved significantly with a small dosage of metformin over a treatment period of six months.

Antecedentes: El síndrome metabólico (SM) predice varias complicaciones cardiovasculares, como la insuficiencia cardiaca (IC). La disfunción ventricular izquierda (DVI) acompaña al síndrome metabólico. Aunque la metformina mejora la función del ventrículo izquierdo en pacientes diabéticos con insuficiencia cardiaca, no hay evidencia de su efecto sobre la disfunción ventricular izquierda en pacientes con síndrome metabólico. Se estudió el efecto de la metformina sobre la disfunción ventricular izquierda en pacientes con síndrome metabólico utilizando imágenes Doppler de tejido miocárdico y rastreo de manchas bidimensional. Objetivos: Evaluar los efectos de la metformina sobre la disfunción ventricular izquierda inducida por el SM. Material y métodos: Los pacientes con SM fueron asignados al azar en dos grupos (n = 20 cada uno) que recibieron, un antagonista de la angiotensina 2 y receptores; estatinas, fibratos o ambos. Un grupo recibió 850 mg de metformina diaria. La masa del VI, el espesor relativo de la pared (ERP), fracción de eyección, E/A y relación E/E', la velocidad Doppler tisular sistólica (Sm), el promedio de pico de tensión sistólica (SS), y la velocidad de deformación diastólica precoz pico (VDDPP) se obtuvieron por mediciones ecocardiográficas al inicio del estudio y a los seis meses. Resultados: Todos los pacientes presentaban hipertrofia concéntrica o remodelado. La metformina reduce la masa del VI y el ERP. Había alteraciones del ventrículo izquierdo sistólica y diastólica, alteraciones en ambos grupos que la metformina mejoró significativamente. VDDPP aumentó casi al doble con metformina. La mejoría de la función diastólica no se relacionó con regresión de la hipertrofia. Conclusiones: Los pacientes con SM experimentaron alteraciones sutiles de las funciones sistólica y diastólica, lo que mejoró significativamente con una pequeña dosis de metformina en un periodo de tratamiento de seis meses.

Myocardial Tissue Doppler Velocity in Child Growth

BACKGROUND: In adults, tissue Doppler imaging (TDI) is a recommended component of routine echocardiography. However, TDI velocities are less accepted in pediatrics, due to their strong variability and age dependence in children. This study examines the distribution of myocardial tissue Doppler velocities in healthy children to assess the effect of age with cardiac growth on the various echocardiographic measurements. METHODS: Total 144 healthy children were enrolled in this study. They were recruited from the pediatric outpatient clinic for routine well-child visits. The statistical relationships between age and TDI values were analyzed. Also, the statistical relationships between body surface area (BSA) and TDI values, left ventricle end-diastolic dimension (LVEDD) and TDI values were analyzed. Also, we conducted multivariate analysis of cardiac growth parameters such as, age, BSA, LVEDD and TDI velocity data. RESULTS: All of the age, BSA, and LVEDD had positive correlations with deceleration time (DT), pressure half-time (PHT), peak early diastolic myocardial velocity, peak systolic myocardial velocity, and had negative correlations with peak late diastolic velocity (A) and the ratio of trans-mitral inflow velocity to early diastolic velocity of mitral annulus (E/E'). In the multivariate analysis, all of the age, BSA, and LVEDD had positive correlations with DT, PHT, and negative correlations with A and E/E'. CONCLUSION: The cardiac growth parameters related alterations of E/E' may suggest that diastolic myocardial velocities are cardiac growth dependent, and diastolic function has positive correlation with cardiac growth in pediatric group. This cardiac growth related myocardial functional variation would be important for assessment of cardiac involvement either in healthy and sick child.

Improvement in left ventricular function assessed by tissue Doppler imaging after aortic valve replacement for severe aortic stenosis

<p><b>INTRODUCTION</b>The effects of reduction of left ventricular (LV) systemic afterload following aortic valve replacement (AVR) for severe aortic valve stenosis (AS) were investigated, using echocardiography and tissue Doppler imaging (TDI).</p><p><b>METHODS</b>We compared the preoperative and postoperative echocardiographic assessments of 23 patients with severe AS who had undergone isolated AVR (n = 13) or concomitant AVR with coronary artery bypass grafting (CABG) (n = 10). Conventional echocardiographic evaluations and TDI at the lateral mitral annulus were performed.</p><p><b>RESULTS</b>Echocardiography was performed at a median of 120 (interquartile range: 66-141) days after AVR. There was significant reduction in aortic transvalvular mean pressure gradient after AVR. Although LV dimensions, mass and ejection fraction remained unchanged, LV diastolic and systolic functions improved (as observed on TDI). Early diastolic (E'), late diastolic (A') and systolic (S') mitral annular velocities increased significantly (p < 0.05). There was significant improvement in TDI-derived parameters among the patients who had isolated AVR, while among the patients who had concomitant AVR with CABG, only S' had significant improvement (p = 0.028).</p><p><b>CONCLUSION</b>TDI was able to detect improvements in LV systolic and diastolic function after AVR for severe AS. There was less improvement in the TDI-derived diastolic parameters among patients who underwent concomitant AVR with CABG than among patients who underwent isolated AVR.</p>

Development of left and right ventricular function in healthy children explored by tissue Doppler imaging / 中华实用儿科临床杂志

Objective To explore the development and interaction of left and right ventricular function in healthy children using tissue Doppler imaging.Methods Healthy children aged 0-15 years and adolescents were recruited,then children were divided into 6 groups:0-1 year,＞ 1-3 years,＞ 3-6 years,＞ 6-9 years,＞ 9-12 years,＞ 12-15 years.Healthy adolescents aged ＞ 15-25 years were also recruited.Every subject underwent echocardiography including cardiac dimension measurements,atrio-ventricular valvular velocity and early-diastolic flow velocity(E)/late-diastolic flow evlocity(A) ratio measured by pulsed color Doppler,atrio-ventricular annular myocardial velocity (including systolic velocity (s),early diastolic velocity (e) and late diastolic velocity (a)),time intervals (including isovolumic contraction time,ejection time and isovolumic relaxation time),isovolumic acceleration (ⅣA) and Tei index measured by tissue Doppler imaging.Results were compared among different groups,the correlations with age and other factors were explored.Furthermore,comparison was done between left and right ventricular functional parameters.Results Left ventricular Tei index and isovolumic contraction time were significantly lower during puberty.From infancy to pre-school stage,left ventricular E/A (flow velocity) and e/a(tissue velocity) increased accordingly,then presented with no significant changes among the following age groups(P ＞ 0.05).There were no significant differences in right ventricular Tei index,ⅣA,E/A (flow velocity) and e/a (tissue velocity) among the 6 groups (P ＞ 0.05).Left ventricular systolic myocardial velocity (s) and ⅣA were significantly lower than right ventricle (all P ＜ 0.001).However,left ventricular E/e(flow velocity) and e/a(tissue velocity) were significantly greater than right ventricle (all P ＜0.001).Conclusions In healthy children,left ventricular systolic function enhances during puberty,diastolic function increases from infancy to pre-school stage,then keeps stable till adolescents.Right ventricular systolic and diastolic function present with no significant changes during growth.Left ventricular diastolic function is greater than right one,however,right ventricular longitudinal systolic function is greater than left one.

Cardiovascular Screening in Asymptomatic Adolescents with Metabolic Syndrome

BACKGROUND: In recent days, the prevalence of childhood metabolic syndrome (MS) has increased substantially due to the increasing rate of childhood obesity on a global scale. The aims of this study were to detect the important parameters and provide the screening system to prevent cardiovascular disease in adolescents with MS. METHODS: Ninety one male adolescents were divided into two groups based on the presence or absence of MS. Anthropometric measurement and laboratory study were studied. Intimal medial thickness and pulse wave velocity were estimated. Left ventricular mass index (LVMI), ejection fraction, myocardial velocity, strain and strain rate were measured by tissue Doppler imaging and strain rate imaging. RESULTS: The prevalence of MS was 7.7%. Weight, body mass index (BMI), waist circumference (WC), glucose, insulin, homeostasis model assessment of insulin resistance, triglyceride and LVMI were significantly increased in the MS group. High density lipoprotein-cholesterol (HDL-C), peak early diastolic myocardial velocity (e'), systolic myocardial velocity (s') and global longitudinal strain were significantly lower in the MS group. In univariant analysis, LVMI was significantly correlated with BMI, WC, fat %, fat mass, systolic blood pressure, alanine aminotransferase, total cholesterol (TC) and low density lipoprotein-cholesterol. e' was significantly correlated with BMI, fat %, fat mass, and HDL-C. Global circumferential strain had significant correlation with glucose and TC. Basal anterolateral strain rate was significantly correlated with weight, BMI, WC, fat %, and fat mass. CONCLUSION: LVMI, strain and strain rate are practical and accurate parameters for assessment of left ventricular function in adolescents with MS.

Comparison of N-terminal Pro-B type Natriuretic Peptide and Tissue Doppler in Diagnosing Diagstoic Heart Failure.

Background: Heart failure (HF) has become a main cardiac problem. Doppler echocardiography has been used to examine left ventricular (LV) diastolic filling dynamics. Limitations of this modality suggest the need for other objective measures of diastolic HF. Aim of the Study: The hypothesis of this study is to assess the utility of N-terminal pro-B type natriuretic peptide (NTproBNP) in the diagnostic evaluation of diastolic HF in comparison with tissue Doppler imaging (TDI) recordings. Methods: A prospective study was carried out between May 2010 and December 2011. Patients with signs and symptoms of HF with normal LV systolic function by 2D-echocardiography were recruited. M-mode and 2-dimensional images, left atrial volume index (LAVI), spectral and TDI of the mitral annulus were obtained for all the patients. NTproBNP levels were measured with a bedside immunoassay. Results: We found linear correlation between NTproBNP levels and grade of diastolic dysfunction (DD), LAVI, ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E’) [r=0.72, p<0.001]. Patients with elevated left ventricular end diastolic pressure, defined as E/E’>15 (n =18), had the highest NTproBNP levels (3028±2674pg/mL). NTproBNP levels (4146±2887.43 pg/mL) were highest in patients with grade III DD. A receiver operator characteristic curve showed NTproBNP value, 286 pg/mL, the best cut-off for diagnosing diastolic HF with a sensitivity of 89% and a specificity of 100%. Conclusions: Plasma NTproBNP levels can reliably estimate LV filling pressures in patients with HF and normal systolic function which might help to reinforce the diagnosis of “diastolic HF”.

Tissue Doppler and strain imaging of left ventricle in Beagle dogs with iatrogenic hypercortisolism

Changes in radial and longitudinal left ventricular (LV) function were investigated in beagles with iatrogenic hypercortisolism. A total of 11 normal dogs were used, and 2 mg/kg prednisone was administered per oral q12 h for 28 days to 7 out of 11 dogs to induce iatrogenic hypercortisolism. Body weight, blood pressure, conventional echocardiography and tissue Doppler imaging (TDI) of normal and iatrogenic hypercortisolism groups were conducted. The myocardial wall velocity of the LV was measured using color TDI and myocardial deformation was determined by the strain and strain rate. Conventional echocardiography revealed that the diastolic LV free wall and interventricular septum in the hypercortisolism group were thickened relative to those in the normal group. The peak early diastolic myocardial velocity and early to late diastolic myocardial velocity ratio of TDI in the hypercortisolism group were significantly lower than those in the normal group. The strain values in the hypercortisolism group were significantly lower than those in the normal group, particularly for longitudinal wall motion. The lower values of myocardium from TDI and strain imaging could be used to investigate subclinical LV systolic and diastolic dysfunction in dogs with the iatrogenic hypercortisolism.

Evaluation of pulmonary arterial hypertension with simple congenital heart disease using tissue Doppler imaging / 中华超声影像学杂志

Objective To evaluate the value of tissue Doppler imaging (TDI) in diagnosing pulmonary arterial hypertension(PAH) with common simple congenital heart disease(CHD).Methods 104 patients of CHD approved by operation or intervention were retrospectively analyzed.Both TDI and right cardiac catheterization were performed in all patients,whose were divided into PAH and non-PAH groups according to mean pulmonary arterial pressure (mPAP) on diagnostic right cardiac catheterization:60 PAH patients[mPAP ≥25 mmHg(1 mmHg =0.133 kPa) and pulmonary arterial capillary wedge pressure ≤15 mmHg],44 non-PAH patients (mPAP ＜25 mmHg).The PAH group was divided into mild (25 mmHg≤ mPAP≤35 mmHg),moderate (36 mmHg≤mPAP≤50 mmHg) and severe (mPAP＞50 mmHg) subgroups.The tricuspid annular systolic peak velocity (TS'),early diastolic peak velocity (TE'),late diastolic peak velocity (TA') were measured by TDI and TE'/TA' and Tei index were calculated.The correlation between TDI parameters and the cardiac catheterization findings (sPAP,mPAP and dPAP) were assessed.Results ①TS' and TE' in PAH group were significantly lower than those in non-PAH(P ＜ 0.05),but Tei in PAH group were significantly higher than that in non-PAH (P ＜0.001),however,there were no significant difference in TA' and TE'/TA' between two groups (P ＞ 0.05).②Tei correlated positively with pulmonary arterial pressure (P ＜0.001),TS' was found to be negatively correlated with pulmonary arterial pressure(P ＜0.05),but no correlation between TE',TA',TE'/TA' and pulmonary arterial pressure(P ＞0.05).③ROC analysis showed the area under curves for Tei index and TS' diagnosis for PAH was 0.893 and 0.699,respectively.At the cutoff of Tei＞0.49 and TS'＜16 cm/s for indicating PAH,the sensitivity were 86.67 ％ and 80.00％,respectively and the specificity were 79.55 ％ and 45.45 ％,respectively.④Tei in the moderate and severe PAH were significantly higher than that in mild PAH (P ＜ 0.05),TS' and TE' in severe PAH were significantly lower than those in mild and moderate PAH (P ＜ 0.05),At the cutoff of Tei＞0.55 for indicating moderate or severe PAH,the sensitivity and specificity were 95.24％ and 72.22％.Conclusions Tei index and TS' have high application value in assessing PAH and classification of PAH.Tei＞0.49 indicates PAH,while Tei＞0.55 suggests moderate or severe PAH.

Research on dynamic three-dimensional reconstruction of tissue doppler ultrasound heart images / 中国医学装备

Objective:To discuss the dynamic three-dimensional reconstruction of tissue Doppler ultrasound cardiac image.Methods: To separate anatomical structure and function parameter information from Doppler ultrasound medical image, and then combines with the three-dimensional distribution to reconstruct it and fuse imaging.Results: Ultimately, it reveals the relationship between function parameter and anatomical structure. The dynamic three-dimensional reconstruction of tissue Doppler ultrasound cardiac image is also expounded in this paper.Conclusion: It scientifically completed the dynamic three-dimensional reconstruction of tissue Doppler ultrasound cardiac image by combining both tissue Doppler imaging and ultrasound medical image reconstruction technique. It is of great significance in clinical medicine.

Functional Assessment for Congenital Heart Disease

Significant improvement in survival of children with congenital cardiac malformations has resulted in an increasing population of adolescent and adult patients with congenital heart disease. Of the long-term cardiac problems, ventricular dysfunction remains an important issue of concern. Despite corrective or palliative repair of congenital heart lesions, the right ventricle, which may be the subpulmonary or systemic ventricular chamber, and the functional single ventricle are particularly vulnerable to functional impairment. Regular assessment of cardiac function constitutes an important aspect in the long-term follow up of patients with congenital heart disease. Echocardiography remains the most useful imaging modality for longitudinal monitoring of cardiac function. Conventional echocardiographic assessment has focused primarily on quantification of changes in ventricular size and blood flow velocities during the cardiac cycles. Advances in echocardiographic technologies including tissue Doppler imaging and speckle tracking echocardiography have enabled direct interrogation of myocardial deformation. In this review, the issues of ventricular dysfunction in congenital heart disease, conventional echocardiographic and novel myocardial deformation imaging techniques, and clinical applications of these techniques in the functional assessment of congenital heart disease are discussed.

Assessment of the elasticity properties of the ascending aorta in patients with subclinical hypothyroidism by tissue Doppler imaging / Avaliação das propriedades de elasticidade da aorta ascendente por Doppler tecidual em pacientes com hipotireoidismo subclínico

OBJECTIVE: We aimed to investigate whether aortic elastic properties were affected in subclinical hypothyroidism (SCH) by using tissue Doppler imaging (TDI). SUBJECTS AND METHODS: Forty-three patients with newly diagnosed SCH and forty-eight healthy controls were included to the study. Systolic and diastolic diameters of the ascending aorta were measured by M-mode transthoracic echocardiography, and the upper wall velocities of ascending aorta and mitral annulus velocities were measured by TDI. Aortic stiffness index (ASI) and aortic distensibility were computed using the formulas accepted in literature. RESULTS: The clinical and demographic features of both groups were comparable. Aortic distensibility was significantly lower, and ASI was significantly higher in SCH patients than in controls. Systolic aortic upper wall velocity (Sao) was also significantly lower in SCH patients. Early (Eao) and late diastolic aortic upper wall (Aao) velocities did not differ between the two groups. Mitral annulus (Sm, Em, and Am) velocities were also similar between the groups. Sao was negatively correlated with ASI, and positively correlated with aortic distensibility. TSH level was positively correlated with ASI, total cholesterol and low-density lipoprotein-cholesterol, and negatively correlated with aortic distensibility and Sao. CONCLUSIONS: In this study, our results showed that SCH is associated with impaired elasticity of the ascending aorta. Elastic properties of the ascending aorta can be directly evaluated by the reproducibly measurement of the upper wall movements of the ascending aorta by TDI in SCH patients.

OBJETIVO: Nosso objetivo foi investigar se as propriedades elásticas da aorta são afetadas no hipotireoidismo subclínico (HSC), utilizando o Doppler tecidual (UDT). SUJEITOS E MÉTODOS: Quarenta e três pacientes com diagnóstico recente de HSC e 48 indivíduos saudáveis ​​foram incluídos no estudo. Os diâmetros sistólico e diastólico da aorta foram medidos por ecocardiografia transtorácica modo M e as velocidades de fluxo da parede superior da aorta ascendente e de fluxo transvalvar mitral foram medidas por UDT. O índice de rigidez da aorta (IRA) e a distensibilidade aórtica foram calculados usando fórmulas aceitas na literatura. RESULTADOS: As características clínicas e demográficas dos dois grupos foram comparáveis. A distensibilidade aórtica foi significativamente menor e IRA significativamente maior nos pacientes com HSC do que nos controles. A velocidade de fluxo sistólico na parede aórtica superior (Sao) foi significantemente menor em pacientes com HSC. A velocidade de fluxo diastólico inicial (Eao) e tardio (Aao) na parede aórtica superior e as velocidades de fluxo transvalvar (Sm, Em e Am) não diferiram entre os dois grupos. Sao foi negativamente correlacionada com IRA e positivamente correlacionada com a distensibilidade aórtica. O nível de TSH foi positivamente correlacionado com IRA, colesterol total e lipoproteína de baixa densidade-colesterol e negativamente correlacionado com a distensibilidade aórtica e Sao. CONCLUSÕES: Os resultados do presente estudo demonstraram que o HSC é associado com elasticidade deficiente da aorta ascendente. Propriedades elásticas da aorta ascendente podem ser diretamente avaliadas por medições reprodutíveis dos movimentos da parede superior da aorta por UDT em pacientes com HSC.

Pulsed tissue Doppler imaging of the left ventricular septal mitral annulus in healthy dogs

This study evaluated pulsed TDI variables including the isovolumic time interval and duration of the major wave in a population of large healthy dogs. Longitudinal myocardial motion at the septal mitral annulus was evaluated with pulsed TDI in 45 healthy adult dogs. Maximal myocardial velocities, isovolumic time intervals, and duration of the myocardial waves were measured. The correlation between time intervals and velocity variables was also investigated. The mean maximal systolic velocity was 6.92 +/- 1.78 cm/sec, the mean early diastolic velocity (Em) was 6.58 +/- 1.81 cm/sec, the mean late diastolic velocity (Am) was 5.10 +/- 2.00 cm/sec, the mean isovolumic contraction time (IVCT) was 53.61 +/- 95.13 msec, and the mean isovolumic relaxation time (IVRT) was 26.74 +/- 57.24 msec. The early diastolic mitral inflow velocity (E)/Em ratio was 10.94 +/- 3.27 while the Em/Am ratio was 1.40 +/- 0.40. There was a negative correlation between Am duration and Am amplitude, and a positive correlation between the IVRT and Em/Am ratio (p < 0.05). The normal LV parameter using pulsed TDI method could be used as the reference range for identifying myocardial dysfunction in dogs.