Comparison of myocardial tissue Doppler with transmitral flow Doppler in left ventricular hypertrophy.

We sought to determine the most useful echocardiographic measurements for assessment of diastolic function in patients with left ventricular hypertrophy (LVH) and normal systolic function. We compared myocardial Doppler velocities of the basal inferoposterior wall with mitral inflow pulsed wave Doppler velocities in 11 healthy volunteers (age, 36 +/- 6 years), 25 patients (age, 64 +/- 14 years) without LVH, and 37 patients (age, 67 +/- 14 years) with LVH and otherwise normal echocardiograms. The discriminatory measurements were myocardial A-wave duration (120 +/- 18 versus 98 +/- 20 and 92 +/- 12 ms, P <.0001), myocardial isovolumetric relaxation time (124 +/- 45 versus 95 +/- 48 and 78 +/- 25 ms, P =.0035), mitral A-wave velocity (0.98 +/- 0.37 versus 0.73 +/- 0.28 m/s and 0.61 +/- 0.22 m/s, P =.009), and mitral E-wave deceleration time (257 +/- 93 versus 201 +/- 85 ms and 184 +/- 83 ms, P =.015), which were significantly increased, and myocardial E-wave velocity (0.84 +/- 0.04 m/s versus 0.13 +/- 0.03 m/s and 0.14 +/- 0.03 m/s, P <.0001), which was significantly decreased, in patients with LVH compared with patients without LVH and normal volunteers, respectively. Left ventricular posterior wall thickness correlated with myocardial isovolumetric relaxation time (r = 0.52, P <.0001) and myocardial A-wave duration (r = 0.59, P <.0001), negatively with myocardial E wave (r = -0.43, P <.0001), and showed no correlation with mitral inflow parameters except mitral inflow A wave (r = 0.43, P =.002). On multivariate analysis using these variables, myocardial isovolumetric relaxation time (P =.0014) and A-wave duration (P =.001) were the only 2 variables that correlated with posterior wall thickness (multiple R = 0.71). In the presence of LVH and preserved left ventricular systolic function, myocardial relaxation time and velocities are more sensitive than mitral Doppler inflow parameters in detecting abnormal left ventricular relaxation.

Myocardial Doppler tissue imaging: findings in inferior myocardial infarction and left ventricular hypertrophy--wall motion assessment.

BACKGROUND: Because of the geometry of the basal inferior wall and its relation with the posterior medial papillary muscle, differentiating abnormal from normal basal inferior wall motion can be challenging. METHODS: We performed pulsed wave Doppler echocardiography of the basal inferior wall and basal interventricular septum in 26 patients (63 +/- 14 years) with a normal echocardiogram, 33 patients (67 +/- 14 years) with inferior myocardial infarction (MI) associated with hypokinesis to dyskinesis of the basal inferior wall, and 38 patients (67 +/- 14 years) with left ventricular hypertrophy (LVH). RESULTS: Systolic velocity was significantly lower in the basal interventricular septum (0.071 +/- 0.013 m/s versus 0.084 +/- 0.023 m/s) and basal inferior wall (0.075 +/- 0.014 m/s versus 0.085 +/- 0.019 m/s) in the MI group compared with the LVH group, and both were significantly lower compared with normal values at the interventricular septum (0.090 +/- 0.023 m/s, P <.001, analysis of variance) and basal inferior wall (0.095 +/- 0.014 m/s, P <.0001, analysis of variance). The sum of the systolic (S), early diastolic (E'), and late diastolic (A') velocities of 0.30 m/s at the basal inferior wall had 91%, 76%, and 84% sensitivity, specificity, and accuracy, respectively, for the differentiation of a normal wall from an infarcted basal inferior wall, and 76%, 73%, and 75% sensitivity, specificity, and accuracy, respectively, for the differentiation of a normal wall from a hypertrophied basal inferior wall. The sum of systolic and diastolic velocities of 0.25 m/s at the basal interventricular septum had 70%, 66%, and 68% sensitivity, specificity, and accuracy, respectively, for the differentiation of an infarcted from a hypertrophied basal interventricular septum. Mitral inflow early-filling wave deceleration time by pulsed wave Doppler was the most sensitive parameter for the differentiation of LVH from MI (P <.0001). CONCLUSION: Doppler tissue imaging velocities of the basal inferior wall and basal interventricular septum may help differentiate normal from infarcted and hypertrophied myocardium.