Single-beat differentiation among left ventricular filling patterns by pulsed wave Doppler echocardiography.
Su Ho-Ming,Lin Tsung-Hsien,Voon Wen-Chol,Lee Kun-Tai,Chu Chih-Sheng,Yen Hsueh-Wei,Lai Wen-Ter,Sheu Sheng-Hsiung
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
We sought to evaluate whether the combination of phantom E wave peak velocity (Ep) to phantom A wave peak velocity (Ap) ratio at the apex (Ep/Ap) and pulsed wave Doppler left ventricular (LV) inflow propagation velocity (LVIPVpw) or the combination of Ep/Ap and Ep/LVIPVpw obtained from the same heartbeat can effectively differentiate LV filling patterns. The study population included 132 patients. They were classified into normal, abnormal relaxation, and pseudonormal/restrictive groups according to the ratio of early to late transmittal filling wave peak velocity (E/A), color M-mode Doppler LV inflow propagation velocity, and E/color M-mode Doppler LV inflow propagation velocity. Standard Doppler parameters of LV filling such as E, A, E/A, and E-wave deceleration time had a bimodal distribution, but LVIPVpw decreased and Ep/LVIPVpw increased progressively with worsening of LV diastolic function (both P < .001). The sensitivity and specificity of combination of Ep/Ap 1 or greater and LVIPVpw less than 77 cm/s or of Ep/Ap 1 or greater and Ep/LVIPVpw greater than 0.87 from the same heartbeat in identifying the pseudonormal/restrictive LV filling pattern were 81% and 95% or 81% and 93%, respectively. In conclusion, with application of range ambiguity phenomenon, it is simple and feasible to differentiate LV filling patterns on the same cardiac cycle by pulsed wave Doppler echocardiography.
10.1016/j.echo.2005.09.011
Clinical utility of single-beat E/e' obtained by simultaneous recording of flow and tissue Doppler velocities in atrial fibrillation with preserved systolic function.
Kusunose Kenya,Yamada Hirotsugu,Nishio Susumu,Tomita Noriko,Niki Toshiyuki,Yamaguchi Koji,Koshiba Kunihiko,Yagi Shusuke,Taketani Yoshio,Iwase Takashi,Soeki Takeshi,Wakatsuki Tetsuzo,Akaike Masashi,Sata Masataka
JACC. Cardiovascular imaging
OBJECTIVES:We evaluated the usefulness of the ratio of the early diastolic transmitral flow velocity (E) to the mitral annular velocity (e') calculated from simultaneously recorded E and e' in atrial fibrillation (AF). BACKGROUND:The ratio of the E to the e' (E/e') has been reported as a useful index even in AF patients. However, E and e' were measured during different beats in the previous studies. METHODS:Fifty-six AF patients with preserved systolic function (mean age 66 +/- 11 years) underwent routine echocardiographic study. The E/e' was calculated from the E and e' simultaneously recorded by the dual Doppler echocardiography. A single-beat E/e' was calculated from simultaneously recorded E and e' when the preceding RR interval/pre-preceding RR interval = 1. Brain natriuretic peptide (BNP) levels were also examined. Twenty-one patients underwent simultaneous pulmonary artery catheterization. RESULTS:The single-beat lateral E/e' correlated with pulmonary capillary wedge pressure (PCWP) (r = 0.74, p < 0.001). The single-beat lateral E/e' of >or=11 could predict elevated PCWP (>or=15 mm Hg) with a sensitivity of 90% and a specificity of 90%. The single-beat lateral E/e' also correlated well with the log BNP concentration. The single-beat lateral E/e' of >or=9.2 predicted a plasma BNP level of >or=200 pg/ml with 88% sensitivity and 84% specificity. CONCLUSIONS:The single-beat lateral E/e' correlated with plasma BNP level and PCWP in AF patients with preserved systolic function. In addition, the single-beat lateral E/e' (>or=11) was a good predictor of elevated PCWP (>or=15 mm Hg). Dual Doppler echocardiography offers an advantage of providing the single-beat lateral E/e' correctly even in AF patients, for the evaluation of left ventricular diastolic function.
10.1016/j.jcmg.2009.05.013
Prognostic Value of Time Interval Between Mitral and Tricuspid Valve Opening in Patients With Heart Failure.
Sugahara Masataka,Mano Toshiaki,Goda Akiko,Masai Kumiko,Soyama Yuko,Daimon Aika,Asakura Masanori,Masuyama Tohru
Circulation journal : official journal of the Japanese Circulation Society
BACKGROUND:We used dual Doppler echocardiography to measure the time interval between the mitral and tricuspid valve opening (MO-TO time), which we expected would reflect the balance between left and right ventricular hemodynamics. Methods and Results: We prospectively enrolled 60 patients with heart failure (HF) and sinus rhythm. The MO-TO time was measured in addition to routine echocardiography parameters, invasive hemodynamic parameters and plasma B-type natriuretic peptide (BNP) level in all patients. Patients were divided into 2 groups based on the MO-TO time: MOP (mitral opening preceding tricuspid opening), and TOP (tricuspid opening preceding mitral opening) groups. We followed up the predefined adverse outcomes (cardiovascular [CV] death and hospitalization due to worsening HF) for 1 year. Pulmonary artery wedge pressure (PAWP) and mean pulmonary artery pressure (mPAP) were higher in the MOP than in the TOP group (P<0.001; P<0.001, respectively). The probability of an adverse CV outcome was higher in the MOP than in the TOP group (log-rank test; P=0.002). Addition of MOP improved the predictive power of univariate predictors (mitral E/A ratio and BNP) in the bivariate Cox analysis (P=0.017, P=0.024, respectively). CONCLUSIONS:MOP reflects pulmonary hypertension caused by left heart disease and has prognostic value in predicting adverse CV events in patients with HF.
10.1253/circj.CJ-18-0999
Dual pulsed-wave Doppler tracing of right ventricular inflow and outflow: single cardiac cycle right ventricular tei index and evaluation of right ventricular function.
Choi Jin-Oh,Choi Joon Hyouk,Lee Hyun Jong,Noh Hye Jin,Huh June,Kang I Seok,Lee Heung Jae,Lee Sang-Chol,Kim Duk Kyung,Park Seung Woo
Korean circulation journal
BACKGROUND AND OBJECTIVES:The reliability and usefulness of the right ventricular (RV) Tei index (RTX) remains controversial because it has not been possible to simultaneously measure RV inflow and outflow. However, dual pulsed-wave Doppler (DPD) enables flow velocities to be obtained at different sampling sites simultaneously. In this study we evaluated the feasibility and reliability of RTX values obtained by DPD (RTX(DPD)). SUBJECTS AND METHODS:Forty-one patients who underwent cardiac catheterization and echocardiography for RV volume or pressure overloading conditions were evaluated. Symptom-limited exercise treadmill testing with expired gas analysis was performed and maximal exercise capacity was measured. RESULTS:RTX by conventional flow Doppler (RTX(CFD), 0.262±0.164) was similar to RTX(DPD) (0.253±0.117, p=NS), whereas RTX by tissue Doppler echocardiography (RTX(TDE), 0.447±0.125) was significantly larger than RTX(DPD) (p<0.001). Based on multiple regression analysis, maximal exercise capacity was independently related to RTX(DPD) (β=-0.60, p<0.001), mid-RV dimension (β=-0.26, p=0.012), left ventricular ejection fraction (β=0.22, p=0.023), and early diastolic tricuspid annular velocity (β=0.21, p=0.048). CONCLUSION:It is feasible and reliable to evaluate RV function using RTX(DPD) values. However, to evaluate the clinical usefulness of RTX(DPD), additional studies are required with a large number of patients and long-term follow-up.
10.4070/kcj.2010.40.8.391
[Value of Tei index measured by Dual Doppler modality in cardiac function estimation in patients with hypertension].
Huang Liwei,Li Chen,Xu Jianjun,Zhou Chan,Tang Hong,Rao Li
Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi
Tei-Index is a useful echocardiographic parameter for evaluating global cardiac function. Conventionally, a value and b value, which the calculation of Tei index is based on, are measured in different cardiac cycle. Therefore, accuracy of Tei index is damaged by cycle dependent variation, especially in patients with arrhythmia. The newly established Dual Doppler modality allows a synchronous measurement of both a value and b value. This study was aimed to explore the value of Tei index measured by Dual Doppler in cardiac function estimation in patients with hypertension. One hundred and forty patients with hypertension were recuited and divided into three groups according to cardiac function. The a value and b value were generated from the transmitral and transaortic flow spectrum of the same cardiac cyle by Dual Doppler modality. The results showed that Tei index was significantly higher in the cardiac dysfunction group than in the control group. There was a high correlation between Tei index and NYHA cardiac performance. Tei index measured by Dual Doppler modality is a highly reproducible parameter with high sensitivity and specificity for cardiac function estimation, even for patients with arrthymia.
[Value of evaluating diastolic function with the single-beat E/(e'×s) obtained by dual doppler echocardiograph in coronary heart disease patients with preserved left ventricular systolic function].
Wang Jingjing,Chen Yundai,Wang Jing,Hui Haipeng,Zhi Guang,Mu Yang
Zhonghua xin xue guan bing za zhi
OBJECTIVE:To assess the value of E/(e'×s) in estimating left ventricular diastolic dysfunction in patients with coronary heart disease by dual Doppler echocardiograph. METHODS:Seventy-seven consecutive coronary heart disease patients with preserved systolic function underwent echocardiographic study were included. The E, e'and s were obtained by the dual Doppler echocardiography and E/(e'×s), E/e' were calculated. All patients underwent left ventricular catheterization to measure left ventricular end diastolic pressure (LVEDP). The relationship between E/(e'×s), E/e' and LVEDP were analyzed. Patients were divided into normal diastolic function (LVEDP < 12 mmHg, 1 mmHg = 0.133 kPa) and diastolic dysfunction group (LVEDP ≥ 12 mmHg) . RESULTS:(1) Pearson correlation analysis showed that both E/(e'×s) and E/e' correlated well with LVEDP (r = 0.68 and r = 0.79, both P < 0.01). (2)Using receiver operating characteristic analysis, the optimal cut-off for E/(e'×s) was 1.2(sensitivity was 80%, specificity was 77%,AUC was 0.85) and for E/e' was 9.2(sensitivity was 74%, specificity was 81%,AUC was 0.87) to predict left ventricular diastolic dysfunction. When combined cut-offs of E/(e'×s) ≥ 1.2 and E/e' ≥ 9.2, the sensitivity and specificity of predicting left ventricular diastolic dysfunction were 83% and 71% respectively, and AUC was 0.87. CONCLUSIONS:E/(e'×s) can correctly reflect diastolic function status in patients with coronary artery disease. However, combined use of E/(e'×s)and E/e' does not add the prediction value on diastolic dysfunction in this patient cohort.
[Evaluation of left ventricular diastolic function by TE-e' measurement using dual Doppler echocardiography in coronary heart disease patients with preserved systolic function].
Wang Jingjing,Chen Yundai,Wang Jing,Zhi Guang,Mu Yang,Xu Yong
Nan fang yi ke da xue xue bao = Journal of Southern Medical University
OBJECTIVE:To evaluate the accuracy of the time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e') (TE-e') measured by dual Doppler echocardiography in the diagnosis of diastolic dysfunction. METHODS:Seventy-seven coronary heart disease patients with preserved systolic function underwent a echocardiographic study. Early transmitral flow velocity E and early diastolic mitral annular velocity e' were simultaneously recorded by dual Doppler echocardiography. The E/e' and TE-e' were calculated and compared with the left ventricular end diastolic pressure (LVEDP), which was measured invasively. The validity of TE-e', E/e' and their combination was analyzed in estimating left ventricular dysfunction (LVEDP ≥12 mmHg). RESULTS:The single-beat E/e' and TE-e' were correlated with the LVEDP (r=0.79 and 0.42, respectively, P<0.001). Receiver-operating characteristic analysis showed that the optimal cut-off for TE-e' was 38 ms (sensitivity 54%, specificity 79%, AUC 0.71) and that for E/e' was 9.2 (sensitivity 74%, specificity 81%, AUC 0.87) for diagnosis of left ventricular diastolic dysfunction. The combined cut-offs of TE-e'≥38 ms and E/e'≥9.2 had a sensitivity of 100% and a specificity of 62% in diagnosing left ventricular diastolic dysfunction with an AUC of 0.96. CONCLUSION:In patients with coronary heart disease, the simultaneous recording of TE-e' by dual Doppler echocardiography can accurately estimate diastolic dysfunction, and its combination with E/e' can further improve the diagnostic accuracy.
Value of Index Beat in Evaluating Left Ventricular Systolic and Diastolic Function in Patients with Atrial Fibrillation: A Dual Pulsed-Wave Doppler Study.
Kong Ling-Yun,Sun Lan-Lan,Chen Ling-Ling,Lv Xiuzhang,Liu Fang
Ultrasound in medicine & biology
Atrial fibrillation (AF) poses challenges in use of the echocardiogram to assess left ventricular (LV) function. The index beat method has been found to agree well with the average method. We aimed to assess the value of the index beat method in evaluation of LV function using the dual pulsed wave Doppler technique. Peak early diastolic mitral inflow velocity (E) and diastolic (e') and systolic (s') mitral annulus velocity were simultaneously obtained and measured beat-to-beat in patients with AF. The index beat s' exhibited the best correlation (r = 0.96 and 0.92, respectively, for septal and lateral wall, both p values = 0.000) with the mean, while E/e' at the pre-index beat, rather than at the index beat-initiated cycle, had the best correlation with the mean (r = 0.88 for septal and 0.97 for lateral wall, both p values = 0.000).
10.1016/j.ultrasmedbio.2019.10.028
[Evaluating the left ventricular diastolic function of diabetes mellitus patients using dual-gate Doppler].
Liu Jiani,Chen Liping,Zhang Xiaoling,Shang Yanwen,Wang Fang,Tang Hong
Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi
To evaluate the value of left ventricular diastolic function in type 2 diabetes mellitus (DM) using dual-gate Doppler and relative factors, we included 50 non-obesity and hypertension-free DM patients into the controlled group in the study along with 48 age-and-gender-matched healthy volunteer subjects. The peak early diastolic velocity (E), peak later diastolic velocity (A), deceleration time (DT), anterior mitral annulus diastolic peak velocity (e') , isovolumic relaxation time (IVRT), E/A, E/e', Tei index and T(E-e), were measured with dual-gate Doppler. 20 subjects were randomly selected for repetitive analysis. Study showed statistical difference in E/A, DT, e', E/e', IVRT, Tei index and T(E-e), between the two groups (P < 0.05). Linear regression analysis showed positive correlation between T(E-e), and IVRT, course of DM patients and T(E-e), (Beta = 0.295, P = 0.020), and HbA1c control level and T(E-e), (Beta = 0.399, P = 0.010). Repeated analysis showed good reproducibility for both within and between groups. Dual-gate Doppler has clinical value in evaluating left ventricular diastolic function in type 2 diabetes mellitus patients. The course of type 2 diabetes mellitus patients and HbA(1C) control level were both closely related with left ventricular diastolic function.
[Evaluations of diastolic functions with E/e' obtained by dual-Doppler simultaneous recording of flow and tissue Doppler velocities in coronary heart disease patients with preserved systolic function].
Wang Jingjing,Chen Yundai,Wang Jing,Mu Yang,Zhi Guang,Xu Yong
Zhonghua yi xue za zhi
OBJECTIVE:To evaluate the usefulness of ratio of early diastolic transmitral flow velocity (E) to mitral annular velocity (e') calculated by simultaneously recording E and e' in coronary heart disease (CHD) patients. METHODS:A total of 77 CHD patients with preserved systolic functions underwent echocardiography. Left ventricular catheterization was performed to measure left ventricular end diastolic pressure (LVEDP). The accuracy of E/e' was compared by recording the dual-Doppler and conventional methods for diagnosing diastolic dysfunction and the relationships between N-terminal pro-brain natriuretic peptide (NT-proBNP). The validity of E/e'dual Doppler and combined E/e'dual Doppler and NT-proBNP in estimating left ventricular diastolic dysfunction namely LVEDP ≥ 12 mmHg (1 mmHg = 0.133 kPa) were estimated. RESULTS:E/e'dual Doppler was correlated with left ventricular end diastolic pressure (LVEDP) and logNT-proBNP (r = 0.79, r = 0.47, respectively, P < 0.01). E/e'conventional was correlated with LVEDP and logNT-proBNP (r = 0.61, P < 0.01, r = 0.35, P < 0.05, respectively). The area under curve (AUC) of E/e'dual Doppler and E/e'conventional was 0.87 and 0.82. The optimal cut-off of E/e'dual Doppler was 9.2 with a sensitivity of 74% and a specificity of 81%. And the optimal cut-off of plasma NT-proBNP was 108 ng/L with a sensitivity of 69% and a specificity of 86%, AUC 0.79.When E/e'dual Doppler ≥ 9.2 and NT-proBNP ≥ 108 ng/L were combined, the sensitivity and specificity for diagnosing diastolic dysfunction were 86% and 69%, AUC 0.89. CONCLUSION:The accuracy of E/e'dual Doppler is better than E/e'conventional for diagnosing left diastolic dysfunction. When E/e'dual Doppler and NT-proBNP are combined, it improves the evaluation accuracy of left diastolic dysfunction.
Dual Coronary-Pulmonary Fistula Firstly Found at Routine Doppler Echocardiogram.
Casavecchia Grazia,Zicchino Stefano,Gravina Matteo,Martone Alessandro,Cuculo Andrea,Macarini Luca,Di Biase Matteo,Brunetti Natale Daniele
Journal of cardiovascular echography
Congenital coronary-pulmonary fistulas (CPFs) are defined as an abnormal direct communication between one or more coronary arteries, with a cardiac or thoracic structure bypassing the capillary network. We report the case of a 73-year-old male, with a history of hypertension, asymptomatic for angina and dyspnea, who was referred for routine clinical control. Echocardiogram unexpectedly showed the presence of diastolic flow from the pulmonary trunk in parasternal short-axis view. Pulsed-wave Doppler confirmed the presence of diastolic flow and displayed the typical coronary flow pattern. Coronary angiography hence showed the presence of dual CPFs originating from the second segment of the left anterior descending coronary and the right coronary arteries. Careful routine Doppler echocardiograph examination may raise the suspicion of CPF in case of otherwise unexplained symptoms and may represent a simple, easy, repeatable tool for the first suspected diagnosis and follow-up of CPFs.
10.4103/jcecho.jcecho_47_18
[Estimating Left Ventricular Diastolic Function through Simultaneous Measurement of T E-e' using Dual-Doppler].
He Yong,Li Ya-jiao,Li Chen,Liu Dan,Tang Hong,Rao Li
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition
OBJECTIVE:Time interval between the onset of E and e' (T E-e') was applied as a non-invasive index for estimating left ventricular diastolic function. The T E-e' was measured simultaneously using dual- Doppler. METHODS:Dual-Doppler method was established, which allowed simultaneous recording and display of E and e', thus facilitating the measuring of T E-e'. Seventy-eight patients with suspected coronary artery disease, class II or above NYHA heart function, and ≥ 50% left ventricle ejection fraction (LVEF) were recruited. The patients were given conventional echocardiography and dual-Doppler echocardiography. Left ventricle end diastolic pressure (LVEDP) of the patients was measured during left heart catheterization. The patients were divided into diastolic dysfunction group (n = 48) and control group (n = 30) according to their LVEDP. RESULTS:The patients with diastolic dysfunction had higher T E-e' [(24.1 ± 31.4) ms vs. the controls (8.1 ± 23.3) ms, P = 0.019]. Significant linear correlation was found between T E-e' and LVEDP (r = 0.424, P < 0.001). The receiver operating characteristic (ROC) curve showed a sensitivity of 56.3% and a specificity of 76.7% for T E-e' detecting elevated LVEDP. T E-e' estimated by dual-Doppler had better inter-observer reliability (limit of agreement: -28. 0-27. 3 ms) compared with the conventional method (limit of agreement: -37.7-34.9 ms). CONCLUSION:Simultaneous T E-e' estimated by dual-Doppler has improved reliability, which is correlated with LVEDP. Patients with diastolic dysfunction have greater T E-e'.
The predictive value of intra-left atrial mechanical delay for 1-year recurrence of atrial fibrillation after catheter ablation: A clinical follow-up study using dual Doppler echocardiography.
Zhou Yanxiang,Chen Jinling,Hu Bo,Cao Sheng,Zhou Qing,Guo Ruiqiang
Journal of clinical ultrasound : JCU
PURPOSE:The availability of dual Doppler echocardiography (DDE), which facilitates the simultaneous recording of Doppler waveforms at two different sites, has enhanced ability to assess single-beat atrial mechanical delay. We sought to investigate the predictive value of intra-left atrial mechanical delay for atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) with DDE. METHODS:Eighty-six patients with paroxysmal AF scheduled to undergo RFCA were prospectively enrolled. Intra-atrial and interatrial mechanical delays were evaluated by DDE and traditional tissue Doppler imaging (tTDI), respectively. The time of whole analysis process with each method was recorded. After RFCA, patients were followed for 1 year. RESULTS:Thirty (34.88%) patients had AF recurrence, and 56 (65.12%) patients maintained sinus rhythm. Cut-off values of 39.38 ms for intra-left atrial mechanical delay obtained by DDE and 32.70 ms by tTDI predicted AF recurrence. Areas under curves were comparable in receiver operator characteristic analysis (P > .05). The whole analysis time of DDE was less than tTDI. Parameters obtained by DDE had better reproducibility. CONCLUSION:Intra-left atrial mechanical delay best predicted 1-year AF recurrence after RFCA. Compared with tTDI, DDE can noninvasively assess single-beat atrial mechanical delay with high predictive power, less analysis time, and better reproducibility.
10.1002/jcu.22629
Value of dual Doppler echocardiography for prediction of atrial fibrillation recurrence after radiofrequency catheter ablation.
Chen Fengjiao,Sun Qinliang,Li Hairu,Qu Shaohui,Yu Weidong,Jiang Shuangquan,Tian Jiawei
BMC cardiovascular disorders
BACKGROUND:Increasing evidence has been presented which suggests that left ventricular (LV) diastolic dysfunction may play an important role in the development of atrial fibrillation (AF). However, the potential for LV diastolic dysfunction to serve as a predictor of AF recurrence after radiofrequency catheter ablation remains unresolved. METHODS:Dual Doppler and M-PW mode echocardiography were performed in 67 patients with AF before ablation and 47 patients with sinus rhythm. The parameters measured within identical cardiac cycles included, the time interval between the onset of early transmitral flow peak velocity (E) and that of early diastolic mitral annular velocity (e') (TE-e'), the ratio of E to color M-mode Doppler flow propagation velocity (Vp)(E/Vp), the Tei index, the ratio of E and mitral annular septal (S) peak velocity in early diastolic E/e'(S) and the ratio of E and mitral annular lateral (L) peak velocity E/e'(L). A follow-up examination was performed 1 year after ablation and patients were divided into two groups based on the presence or absence of AF recurrence. Risk estimations for AF recurrence were performed using univariate and multivariate logistic regression. RESULTS:TE-e', E/Vp, the Tei index, E/e'(S) and E/e'(L) were all increased in AF patients as compared with the control group (p < 0.05). At the one-year follow-up examination, a recurrence of AF was observed in 21/67 (31.34%) patients. TE-e' and the Tei index within the recurrence group were significantly increased as compared to the group without recurrence (p < 0.001). Results from multivariate analysis revealed that TE-e' can provide an independent predictor for AF recurrence (p = 0.001). CONCLUSIONS:Dual Doppler echocardiography can provide an effective and accurate technique for evaluating LV diastolic function within AF patients. The TE-e' obtained within identical cardiac cycles can serve as an independent predictor for the recurrence of AF as determined at 1 year after ablation.
10.1186/s12872-019-1233-x