Copyright © 1999 by the European Society of Cardiology.
Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging
Laboratorio de Ecocardiografia, Servicio de Cardiologia No Invasiva, Departamento de Cardiologia, Hospital General Universitario ‘Gregorio Marañón, Madrid, Spain
revised July 23, 1998; accepted July 29, 1998
Abstract
Aims The aim of this study was to determine the utility of pulsed wave Doppler tissue imaging in the evaluation of regional left ventricular diastolic function in patients with ischaemic heart disease.
Methods and Results In 30 normal subjects and 43 patients with ischaemic heart disease, Doppler tissue imaging was performed in each of the 16 segments of the myocardium. The following diastolic pulsed wave Doppler tissue imaging parameters were obtained for each segment: (1) regional early diastolic peak velocity (regional e wave cm.s–1); (2) regional late diastolic peak velocity (regional a wave cm.s–1); (3) regional diastolic e/a velocity ratio; and (4) the regional isovolumic relaxation time, defined as the time interval from the second heart sound to the onset of the diastolic E wave. In patients with ischaemic heart disease, each of these parameters was evaluated and compared in ischaemic and normally perfused segments, based on the presence or absence of obstructive lesions of the supplying coronary artery. In patients with coronary artery disease, several differences were observed between diseased and normal wall segments: the mean segmental peak early diastolic velocity (e wave) was reduced (mean±SD: 6·4±2·1cm.s–1vs 8·5±2·8cm.s–1;P<0·01); the e/a diastolic velocity ratio was decreased (0·95±0·3 vs 1·5±0·6, respectively;P<0·01) and the regional isovolumic relaxation time was prolonged (104±36·7ms vs 69·6±30ms;P<0·01. No differences were observed in any of these parameters between the normally perfused segments of ischaemic patients and normal subjects. Patients with a normal transmitral diastolic Doppler inflow pattern had a mean of 3·7±2·7 myocardial segments with a local e/a pulsed wave Doppler tissue imaging velocity ratio <1, fewer than those with an inverted diastolic transmitral Doppler inflow pattern (10·3±3 segments;P<0·001). Overall sensitivity and specificity for an inverted local e/a ratio and a local isovolumetric relaxation time 
85ms were of 62% and 72% and 69% and 80%, respectively.
Conclusion Regional diastolic wall motion is impaired at baseline in ischaemic myocardial segments, even when systolic contraction is preserved. Pulsed wave Doppler tissue imaging is a useful non-invasive technique which allows the assessment of regional diastolic performance and dynamics of the left ventricular myocardium. Further studies are required to define this role in the evaluation of coronary heart disease.
Key Words: Doppler tissue imaging, diastole, coronary artery disease
f1 Correspondence : M. A. García-Fernández, MD, Departamento de Cardiologia, Laboratorio de Ecocardiografia, Hospital General Universitario ‘Gregorio Marañón’, c/Doctor Esquerdo 46, 28007 Madrid, Spain.
References
- Grossman W. Diastolic dysfunction and congestive heart failure. Circulation. 1990;81:1–7
[Abstract/Free Full Text] - Gibson D, Mehmel H, Schwartz F, Li K, Kubler W. Changes in left ventricular regional asynchrony after intracoronary thrombolysis in patients with impending myocardial infarction. Br Heart J. 1986;56:121–130
[Abstract/Free Full Text] - Dawson JR, Gibson DG. Left ventricular filling and early diastolic function at rest and during angina in patients with coronary artery disease. Br Heart J. 1989;61:248–257
[Abstract/Free Full Text] - Ingels NB Jr, Fann JI, Daughters GT, Nikolic SD, Miller DC. Left ventricular volume is not constant during isovolumic contraction and relaxation using standard LV models (abstract). Circulation. 1994;90:431
- Upton MT, Gibson DG, Brown DJ. Echocardiographic assessment of abnormal left ventricular relaxation in man. Br Heart J. 1976;38:1001–1009
[Abstract/Free Full Text] - Bonow RO, Vitale DF, Bacharach SL, Fredick TM, Kent KM, Green MV. Asynchronous left ventricular regional function and impaired global diastolic filling in patients with coronary artery disease; reversal after coronary angioplasty. Circulation. 1985;71:297–307
[Abstract/Free Full Text] - Ludbrook PA, Byrne JD, Tiefenbrunn AJ. Association of asynchronous protodiastolic segmental wall motion with impaired left ventricular relaxation. Circulation. 1981;64:1011–1021
- Gibson D, Mehmel H, Schwarz F, Li K, Kubler W, Mehmel H. Asynchronous left ventricular wall motion early after coronary thrombosis. Br Heart J. 1986;55:4–13
[Abstract/Free Full Text] - Gibson D. Roelandt RFT, Sutherland Gr, Iliceto S, Linker DT. Regional left ventricular wall motion. : Churchill Livingtone; 1993. p. 241–251
- Kondo H, Masuyama T, Ishihara K. Digital substraction high-frame-rate echocardiography in detecting delayed onset of regional left ventricular relaxation in ischemic heart disease. Circulation. 1995;91:304–312
[Abstract/Free Full Text] - Miyatake K, Yamagisshi M, Tanaka N. A new method for the evaluation of left ventricular wall motion by color-coded tissue Doppler imaging. J Am Coll Cardiol. 1995;25:717–724[Abstract]
- Sutherland GR, Steward MJ, Groustroem KWE. Colour Doppler myocardial imaging: A new technique for the assessment of myocardial function. J Am Soc Echocardiogr. 1994;7:441–458[Medline]
- Azevedo J, García-Fernández MA, Puerta P. Patterns of pulsed Doppler tissue imaging of regional ventricular wall diastolic velocities in a normal population: Its relation with the left ventricular Doppler inflow profile (Abstr). Eur Heart J. 1995;16 (Abstr Suppl):541
- Garcia-Fernandez MA, Azevedo J, Puerta P. Quantitative analysis of segmental myocardial left ventricular wall diastolic dysfunction by pulsed Doppler tissue imaging. A new insight into diastolic performance (Abstr). Eur Heart J. 1995;16 (Abstr Suppl):541
- Circulation. 1980;62:212
[Free Full Text] - Yamamoto K, Masuyama T, Tanouchi J, Kitabatake A, Kamada T. Effects of heart rate on left ventricular filling dynamic: assessment from simultaneous recording of pulsed Doppler transmitral flow velocity pattern and haemodynamic variables. Cardiovas Res. 1993;27:933–941
- Appleton CP, Hatle LK, Popp RL. The relationship of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988;12:426–440[Abstract]
- Hamersermeister KE, Gibson DG, Hughes D. Regional variation in the timing and extent of left ventricular wall motion in normal subjects. Br Heart J. 1986;56:226–235
[Abstract/Free Full Text] - Gibson DG, Prewitt TA, Brown DJ. Analysis of left ventricular wall movement during isovolumic relaxation time and its relation to coronary artery disease. Br Heart J. 1976;38:1010–1019
[Abstract/Free Full Text] - Popp R. ‘High time’ for non invasive assessment of regional ventricular diastolic ischemic dysfunction. Circulation. 1995;91:552–554
[Free Full Text] - Schnittger I, Fitgerald PJ, Gordon EP, Alderman EL, Popp RL. Computerized quantitative analysis of left ventricular wall motion by two dimensional echocardiography. Circulation. 1984;70:242–254
[Abstract/Free Full Text] - Clayton PD, Jeppson GM, Klausner SC. Should a fixed reference system be used to analyze left ventricular wall motion? Circulation. 1982;65:1518–1521
[Abstract/Free Full Text] - Bates JR, Ryan T, Rimmerman CM. Color coding of digitized echocardiograms: description of a new technique and application in detecting and correcting for cardiac translation. J Am Soc Echocardiogr. 1994;7:363–369[Medline]
- Karwatowsky SP, Mohiaddion R, Yang ZG, Firmin DN, Sutton MSJ, Underwood R. Regional myocardial velocity imaged by magnetic resonance in patients with ischemic heart disease. Br Heart J. 199;72:332–338
- García-Fernández MA, Azevedo J, Puerta P. Regional left ventricular diastolic dysfunction evaluated by tissue Doppler imaging as an earlier signal of myocardial ischemia: experimental study of induced ischemia and reperfusion in pigs (abstr). J Am Coll Cardiol. 1996;27:298A
- García-Fernández MA, Azevedo J, Puerta P. Sequential changes in regional left ventricular myocardial velocities of ischaemic versus non-ischaemic wall segments by pulsed doppler tissue imaging in an ‘in vivo’ model of single vessel coronary occlusion and reperfusion (abstr). Eur Heart J. 1995;16 (Abstr Suppl):39
- Pollak JF, Kemper AJ, Biasnco JA, Parisi AF, Tow DE. Resting early peak distolic filling rate: A sensitive index of myocardial dysfunction in patients with coronary artery disease. J Nucl Med. 1982;23:471–478
[Abstract/Free Full Text] - Soufer R, Wohlgelernter D, Vita NA. Intact systolic left ventricular function in clinical congestive heart failure. Am J Cardiol. 1985;55:1032–1036[CrossRef][ISI][Medline]
- Ghali JK, Kadakia S, Cooper RS, Liao YL. Bedside diagnosis of preserved versus impaired left ventricular systolic function in heart failure. Am J Cardiol. 1991;67:1002–1006[CrossRef][ISI][Medline]
- Perrone FP, Bacharach SL, Dilsizian V, Bonow RO. Impaired left ventricular filling and regional diastolic asynchrony at rest in coronary artery disease and relation to exercise-induced myocardial ischaemia. Am J Cardiol. 1991;67:356–360[CrossRef][ISI][Medline]
- Gillebert TC, Lew WY. Nonuniformity and volume loading independently influence isovolumic relaxation rate. Am J Physiol. 1989;257:H1927–1935
- Blaustein AS, Gassh WH. Myocardial relaxation VI: Effects of beta-adrenergic tone and asyncronition LV relaxation rate. Am J Physiol. 1983;244:H417–422
- Silverman HS, Nimoyina M, Blank PS. A cellular mechanism for impaired posthypoxic relaxation in isolated cardiac myocites altered myofilament relaxation kinetics at reoxigenation. Cir Res. 1991;69:196–208
[Abstract/Free Full Text] - Nishimura RA, Housmans PR, Hatle KL, Tajik AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography, Part 1: physiologic and pathophysiologic features. Mayo Clin Proc. 1989;64:71–81[ISI][Medline]
- Rackley CE, Rusell RO, Mantle JA, Rogers WJ. Modern approach to the patient with acute myocardial infarction. Curr Prob Cardiol. 1977;1:49–56
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