Isovolumic but not Ejection Phase Doppler Tissue Indices Detect Left Ventricular Dysfunction Caused by Coronary Stenosis

doi:10.1016/j.echo.2005.03.035

Journal of the American Society of Echocardiography

Volume 18, Issue 12, December 2005, Pages 1241-1246

https://doi.org/10.1016/j.echo.2005.03.035 Get rights and content

Background

Isovolumic acceleration (IVA) obtained by tissue Doppler echocardiography (TDE) is a sensitive and relatively load-independent index for assessing systolic ventricular function. IVA also has the ability to describe the force-frequency relationship during incremental atrial pacing in vivo.

Objective

We sought to assess the ability of IVA to detect global left ventricular (LV) dysfunction induced by coronary constriction.

Methods

In 6 open-chest anesthetized pigs we examined right ventricular and LV long-axis function by TDE (4-chamber view) with simultaneous invasive measurements of intraventricular pressure, maximum dP/dt, minimum dP/dt, and τ by microtip catheter. A pneumatic cuff was placed around the proximal portion of left anterior descending coronary artery (LAD) and distal flow was monitored by transonic flow probe. Mean arterial pressures were monitored by indwelling cannula. Baseline studies assessed force-frequency relationships with TDE and invasive measurements during incremental pacing from 100 to 200/min (20/min increments every 10 minutes). The protocol was repeated 10 minutes after balloon inflation to reduce LAD blood flow by 50%.

Results

Compared with baseline, LV pressure decreased significantly (P = .03, 2-way analysis of variance) as did maximum dP/dt (P < .004) with LAD constriction. At the same time IVA and isovolumic velocity at the LV free wall were significantly reduced (P < .002 and P = .04, respectively) and both IVA and isovolumic velocity were correlated with dP/dt (r = 0.45, P < .002, and r = 0.35, P < .02, respectively). TDE systolic indices were unchanged in the right ventricle.

Conclusion

IVA detects changes in global LV systolic function during LAD constriction and may be a useful clinical tool to diagnose ischemia.

Section snippets

Methods

Data were obtained in 6 male Yorkshire pigs weighing 33.2 to 45.2 kg (mean: 36.9 kg) The study protocol was reviewed and approved by the institutional animal care and use committee of the research institute.

Results

TDE data were acquired with a rate between 217 and 316 frames/s. There was no difference in pressure data or TDE-derived indices with continuous pacing or intermittent pacing (see “Protocol”).

Table 1 shows TDE-derived indices from the LV free wall (Figure 1) and RV. Table 2 shows invasive measurements of LV function. Compared with baseline, LV systolic pressure and dP/dtmax decreased (P = .03 and P = .02, respectively) and minimum dP/dt increased (P = .01) significantly after LAD constriction.

Disscussion

This study shows that isovolumic indices of global LV systolic function, but not the ejection phase index, SWV, can detect changes in function occurring as a result of coronary stenosis. Both IVA and IVV, expressed as a FFR (Figure 1), decreased significantly in association with reduced LV pressure and dP/dt. Impairment of FFR may, thus, be an early marker of global dysfunction associated with coronary stenosis.¹³

The degree of ventricular dysfunction was relatively subtle, although manifest as

References (16)

T. Oki et al.
Pulsed tissue Doppler imaging of left ventricular systolic and diastolic wall motion velocities to evaluate differences between long and short axes in healthy subjects
J Am Soc Echocardiogr
(1999)
H. Yamada et al.
Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imagingcomparison with peak dP/dt of the left ventricular pressure curve
J Am Soc Echocardiogr
(1998)
Y. Mishiro et al.
Evaluation of left ventricular contraction abnormalities in patients with dilated cardiomyopathy with the use of pulsed tissue Doppler imaging
J Am Soc Echocardiogr
(1999)
M. Vogel et al.
Systemic ventricular function in patients with transposition of the great arteries after atrial repaira tissue Doppler and conductance catheter study
J Am Coll Cardiol
(2004)
J. Gircsan et al.
Quantitative assessment of alterations in regional left ventricular contractility with color-coded tissue Doppler echocardiographycomparison with sonomicrometry and pressure-volume relations
Circulation
(1997)
G. Derumeaux et al.
Doppler tissue imaging quantitates regional wall motion during myocardial ischemia and reperfusion
Circulation
(1998)
G. Derumeaux et al.
Assessment of nonuniformity of transmural myocardial velocities by color-coded tissue Doppler imagingcharacterization of normal, ischemic, and stunned myocardium
Circulation
(2000)
T. Edvardsen et al.
Quantification of left ventricular systolic function by tissue Doppler echocardiographyadded value of measuring pre- and postejection velocities in ischemic myocardium
Circulation
(2002)

There are more references available in the full text version of this article.

Cited by (11)

Can Isovolumic Acceleration Be Used in Clinical Practice to Estimate Ventricular Contractile Function? Reproducibility and Regional Variation of a New Noninvasive Index
2010, Journal of the American Society of Echocardiography
Citation Excerpt :
Vogel and colleagues2 reported that IVA as measured in our study also correlates well in animal experiments with invasive ±dp/dt (R2 = 0.92, P < .05). They reported a weaker association with end-systolic maximal elastance (R2 = 0.70, P = .22),2 however, and Shimizu and colleagues,7 although confirming that IVA correlates with ±dp/dt, found a weaker association (R = 0.45, P < .002). Nonetheless, several investigators have reported that IVA is altered by pharmacologic or interventional modification of contractility.4,14,16
Myocardial acceleration during isovolumic contraction (IVA) has been validated as a relatively load-insensitive noninvasive index of contractility. Its feasibility, reproducibility, and variation between segments have not been studied in detail, and thus its utility in clinical practice has not been established.
We analyzed myocardial velocity loops (median frame rate 182 s⁻¹) from 20 young volunteers (10 men, aged 25.7 ± 2.9 years), 20 patients with type 2 diabetes (14 men, aged 64.1 ± 8.5 years), and 20 patients with heart failure (17 men, aged 64.6 ± 7.7 years). Long-axis IVA was measured in all walls at the annulus and in basal and mid-ventricular segments. Intraobserver reproducibility for 1 observer in all subjects and interobserver reproducibility among 3 observers in 10 subjects from each group were assessed.
In control subjects, subjects with diabetes, and subjects with heart failure, the feasibility of measuring IVA was 97%, 89%, and 82%, respectively; intraobserver reproducibility was 12%, 18%, and 30%, respectively (pooled coefficients of variation); and mean interobserver reproducibility was 23%, 21%, and 28%, respectively. IVA was lower in the mid-ventricular segments by 24% to 43% compared with the annulus, and IVA was higher in the right than the left ventricle (P < .001). IVA of the medial mitral annulus discriminated those with heart failure from those with diabetes and controls, and had acceptable intraobserver reproducibility across groups (mean coefficient of variation 13%).
IVA may be used as a research tool if it is measured at the medial mitral annulus, but its clinical applicability is hampered by low reproducibility, especially in patients with impaired left ventricular function in whom it would otherwise be most useful.
Quantitative Echocardiographic Assessment of Myocardial Acceleration in Normal Left Ventricle by Using Velocity Vector Imaging
2008, Journal of the American Society of Echocardiography
Citation Excerpt :
Accordingly, we can speculate that longitudinal forces of LV contraction and relaxation are uniform among the different walls at the same level, and that there is a gradient of increasing forces from apex to base resulting from the “aggregate” of segmental myocardial forces. In the previous studies, myocardial acceleration was calculated as the difference between baseline and peak velocity divided by the time interval between them.3-9 Obviously, the parameter of acceleration obtained by this means is the mean acceleration in a short duration and has a low temporal resolution.
To investigate the characteristics of myocardial acceleration in normal left ventricular walls, velocity vector imaging was performed in 30 normal volunteers. Peak accelerations during early systole and early diastole and time to peak acceleration during early systole were calculated for each segment of the standard 16-segment model. A gradient of accelerations from base to apex and a homogeneity of accelerations among different walls at the same level were observed. There were homogeneities of time to peak acceleration during early systole in both longitudinal and latitudinal directions on left ventricular walls. In 82.29% of all segments, the onset of contraction acceleration during early systole could not be identified. Further research with larger populations is needed to clarify the role of myocardial acceleration in the assessment of the site of initial electrical stimulation and the sequence of ventricular depolarization.
Intraoperative Doppler tissue imaging is a valuable addition to cardiac anesthesiologists' armamentarium: A core review
2009, Anesthesia and Analgesia
Endocardial motion and surface/volume changes during the cardiac cycle are echocardiographic methods for regional (analysis of wall motion) and global (fractional area change, stroke volume, and ejection fraction) evaluation of cardiac function. These conventional methods can be subjective, and/or time consuming and, depending upon circumstances, may divert the anesthesiologist's attention from intraoperative activities. Doppler tissue imaging (DTI) is a novel echocardiographic technique, which displays and measures systolic and diastolic velocity from a myocardial region. DTI is simple to perform and independent of adequate endocardial imaging. The numeric information (velocity or time intervals) is easily obtained and measured. Assessment of systolic and diastolic function on regional (detection of ischemia) as well as global level (ejection fraction, grading of diastolic dysfunction) and evaluation of filling pressure can be derived from DTI signals and used by any practicing cardiac anesthesiologist. This review describes the principles, imaging modalities, and clinical applications of DTI.
Non-invasive measuring of the acceleration of contraction of the left ventricle with the Doppler echocardiography
2015, Wiener Klinische Wochenschrift
Association between right ventricular dysfunction and restrictive lung disease in childhood cancer survivors as measured by quantitative echocardiography
2014, Pediatric Blood and Cancer
Left ventricular radial systolic dysfunction in diabetic patients assessed by myocardial acceleration derived from velocity vector imaging
2012, Journal of Ultrasound in Medicine

View all citing articles on Scopus

View full text

Original articleIsovolumic but not Ejection Phase Doppler Tissue Indices Detect Left Ventricular Dysfunction Caused by Coronary Stenosis

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Disscussion

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

Quantitative assessment of alterations in regional left ventricular contractility with color-coded tissue Doppler echocardiographycomparison with sonomicrometry and pressure-volume relations

Circulation

Doppler tissue imaging quantitates regional wall motion during myocardial ischemia and reperfusion

Circulation

Assessment of nonuniformity of transmural myocardial velocities by color-coded tissue Doppler imagingcharacterization of normal, ischemic, and stunned myocardium

Circulation

Quantification of left ventricular systolic function by tissue Doppler echocardiographyadded value of measuring pre- and postejection velocities in ischemic myocardium

Circulation

Original article
Isovolumic but not Ejection Phase Doppler Tissue Indices Detect Left Ventricular Dysfunction Caused by Coronary Stenosis