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Pulsed tissue Doppler evaluation of mitral annulus motion: A new window to assessment of diastolic function
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
1999 (English)In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 19, no 1, 1-10 p.Article in journal (Refereed) Published
Abstract [en]

Diastolic dysfunction is an important cause of cardiac heart failure. To date detailed assessment of diastolic left ventricular (LV) function has required invasive methods which are impractical in the clinical routine. The prevailing non-invasive method has been Doppler echocardiography with use of mitral inflow and pulmonary vein inflow parameters, measurements providing no direct assessment of either ventricular relaxation or compliance, and influenced by multiple haemodynamic factors. We sought to determine the tissue Doppler pattern from the mitral annulus motion in normals and in patients with expected LV-diastolic dysfunction. Using pulsed tissue Doppler we recorded peak velocities from the mitral annulus motion in 16 young normals, 10 older normals and in two groups of patients expected to have an LV-diastolic relaxation abnormality, i.e. 15 patients with systemic hypertension and 10 patients with significant aortic stenosis. The peak early diastolic (E) annulus velocity was significantly (< 0·001) lower in older normals compared with young, and the late diastolic velocity (A) was higher (< 0·01). Compared with the older normals, patients showed significantly lower E-velocities (< 0·05 hypertensive patients), more pronounced in the patients with aortic stenosis (< 0·001), but the A-velocities were not higher. In systole a decrease in peak velocity was noted with increasing age and in patients with aortic stenosis. In conclusion, pulsed tissue Doppler measurement of annulus motion seems to provide valuable and easily obtainable information about LV-diastolic function, and furthermore there is a striking change in velocity pattern with increasing age which necessitates age-matched reference values.

Place, publisher, year, edition, pages
1999. Vol. 19, no 1, 1-10 p.
Keyword [en]
diastolic function, echocardiography, tissue Doppler
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26987DOI: 10.1046/j.1365-2281.1999.00137.xLocal ID: 11623OAI: oai:DiVA.org:liu-26987DiVA: diva2:247538
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Annular Motion: Assessment of Cardiac Function using Echocardiography and Magnetic Resonance Imaging
Open this publication in new window or tab >>Annular Motion: Assessment of Cardiac Function using Echocardiography and Magnetic Resonance Imaging
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis concentrates on the assessment of cardiac function, both systolic and diastolic using variables originating from the longitudinal motion of the heart using both established and novel non-invasive imaging techniques. We developed a new magnetic resonance imaging (MRI) technique that creates an M-mode MRI image, analogous to the one used in echocardiography and enables quantitative assessment of cardiac motion. The MRI M-mode method was compared with M-mode echocardiography in a phantom study, by measuring mitral and tricuspid annular motion in 20 normal subjects, and in a study of right ventricular function in 17 patients after coronary artery bypass surgery. The agreement between M-mode MRI and Mmode echocardiography was good. However, the amplitudes were somewhat higher measured by MRI, probably because of less angle error in the MRI calculation, furthermore the lower resolution in the MRI image may have contributed.

Pulsed tissue Doppler, a recently developed Doppler modality that gives the possibility of recording instantaneous annular /or myocardial velocities on-line, was used to obtain reference values of mitral and tricuspid annular motion in 27 normal subjects of different ages. Diastolic left ventricular function was assessed in 15 patients with systemic hypertension and in 10 patients with moderate to severe aortic stenosis. Furthermore, pulsed tissue Doppler was used in the evaluation of right and left ventricular function in 15 patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).

The mitral and tricuspid annular velocity pattern in normal subjects is characterised by three major components: asystolic (SA) velocity, an early (EA) diastolic velocity, and a late (AA) diastolic velocity. In normal young subjects, the EA-peak velocity was highest; with increasing age, the EA-peak velocity decreases and the AA-peak velocity increases, with similar changes in both the mitral and tricuspid annular velocity pattern. In patients with left ventricular hypertrophy the EA/AA-ratio was significantly decreased compared with age- match normal subjects. Comparing ARVC patients with normal subjects the tricuspid annular EA-peak velocity was significantly decreased as well as the lateral SA-peak velocity. Our result indicates that abnormal diastolic tricuspid annular velocity pattern may be an early sign of right ventricular myocardial dysfunction in patients with ARVC. The septal mitral annular SA-peak velocity was significantly decreased in ARVC patients compared to the controls. This in accordance with subjective analysis of echocardiographic wall motion and T1-201 SPECT that showed left ventricular abnormalities in 93% of the patients predominantly located in the anteroseptal and posteroseptal segments.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 56 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 620
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27516 (URN)12172 (Local ID)91-7219-577-0 (ISBN)12172 (Archive number)12172 (OAI)
Public defence
2000-03-24, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-02Bibliographically approved

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