clinical application of motion and deformation parameters

Measurement of longitudinal shortening of the left ventricle to assess LV-function. (mitral annular descent, which can be evaluated by TDI at different sites.

Peak systolic velocities by tissue Doppler imaging in systolic heart failure

The 6-site peak mitral annular descent velocity average > 5.4 cm/s was 88% sensitive and 97% specific for ejection fraction > 50%. The peak mitral annular descent velocity from the apical 4-chamber view (average from inferoseptal and lateral sites) correlated most closely with the LV ejection fraction .

Vijay K. Gulati et al American Journal of Cardiology,1996; 979-984,

Mortality is significantly higher when AVPD is < 10 mm.

Substantial mortality increase when AVPD is < 7 mm.

Results-Total mortality was 22.7% (41/181), and was highly significantly (P= 0.001) related to atrioventricular plane displacement. Mortality within prospectively defined categories of displacement was: > 10.0 mm, 0% (0/19); 8.2 to 9.9 mm, 10.3% (3/29); 6.4 to 8.1 mm, 19.4% (12/62); and < 6.4 mm, 36.6% (26/71). Conclusions-Mortality in heart failure is strongly related to atrioventricular plane displacement.

Heart 1997; 78; 230-236

Normal Values: In general, septal e’ > 8 cm/s and

lateral e’ >10 cm/s are usually observed in normal subject, and are reduced in patients with impaired LV relaxation and increased LV filling pressures.

Normal values of strain and SR are yet to be established.

Carolyn Y. Ho et al Circulation 2006;113;e396-e398

LV filling pressures are correlated with the ratio of the mitral inflow E wave to the tissue Doppler Ea wave (E/Ea).

This relation is based on Ea velocities that “correct” E-wave velocities for the impact of relaxation.

The E/Ea ratio can be used to estimate LV filling pressures as follows:

Lateral E/ Ea > 10 or septal E/Ea >15 is correlated with an elevated LV end-diastolic pressure,

E/Ea < 8 is correlated with a normal LV end-diastolic pressure.

The ratio of E to SRIVR was useful in predicting LV filling pressure in patients in whom the E/e’ ratio was inconclusive

It was more accurate than E/e’ in patients with normal EFs and those with regional dysfunction.

SRIVR was shown to have an incremental prognostic value in patients with ST-segment elevation myocardial infarction.

Systolic long axis velocity measurement of the free wall tricuspid annulus is useful and accurate to assess RV systolic function: Systolic LA velocity > 12 cm/s N RV EF >

55% 9-12 cm /s moderately reduced RVEF >

30-55% < 9 cm/s severely reduced RV EF < 30 %

IVCT

ET

IVRT

TDE may be helpful for identifying subclinical left ventricular dysfunction in patients with chronic severe aortic regurgitation who are asymptomatic but may be candidates for surgery.

In one study of 21 asymptomatic patients, reduced long axis contraction, as measured by mitral annular excursion and systolic velocity, were indicators of subclinical left ventricular dysfunction.

1. A systolic annular excursion <12 mm 2. a resting mitral annular velocity <9.5

cm/secwere the best indicators of subclinical left

ventricular dysfunction.