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Updated: Oct 7, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
A comparison of tissue Doppler imaging and velocities of transmitral flow in children with elevated left ventricular
K Harada1, M Tamura, K Yasuoka
1Department of Pediatrics, Akita University School of Medicine, Japan. k-harada@doc.med.akita-u.ac.jp
Insights
Tissue Doppler imaging (TDI) myocardial velocities are less affected by left atrial pressure than transmitral flow velocities in children with congenital heart disease. TDI offers a more reliable assessment of left ventricular function in these patients.
Area of Science:
- Cardiology
- Echocardiography
- Pediatric Cardiac Disease
Background:
- Transmitral flow velocities are influenced by left atrial pressure, a factor that can be elevated in congenital cardiac disease.
- Tissue Doppler imaging (TDI) measures myocardial wall velocities, which are hypothesized to be less affected by left atrial pressure.
- Limited data exist on TDI's utility in pediatric congenital heart disease, particularly concerning preload effects.
Purpose of the Study:
- To compare the effects of left ventricular preload on transmitral inflow and TDI-assessed velocities.
- To evaluate the relationship between left atrial pressure and Doppler-derived parameters in children with left-to-right shunts.
- To assess the impact of surgical correction on these hemodynamic and echocardiographic measures.
Main Methods:
- 33 pediatric patients with ventricular septal defect or patent ductus arteriosus underwent conventional Doppler echocardiography and TDI with simultaneous invasive hemodynamic monitoring.
- Measurements included transmitral velocities (E, A), mitral annular velocities (Ea, Aa), the E/Ea ratio, pulmonary to systemic flow ratio, and mean left atrial pressure.
- Studies were repeated in 10 post-operative patients to evaluate changes after surgical intervention.
Main Results:
- Patients with left-to-right shunts showed significantly higher E and A wave velocities and an increased E/Ea ratio compared to controls.
- Mitral annular velocities (Ea, Aa) did not differ between groups, and TDI velocities showed no significant relationship with mean left atrial pressure or shunt volume.
- The E/Ea ratio correlated well with mean left atrial pressure (r=0.75) and decreased significantly post-operatively, mirroring the reduction in left atrial pressure.
Conclusions:
- Myocardial velocities measured by TDI are less dependent on mean left atrial pressure in children with elevated left ventricular preload due to left-to-right shunts.
- The E/Ea ratio is a reliable indicator of elevated left atrial pressure in this population.
- TDI provides a more robust assessment of diastolic function compared to conventional Doppler in pediatric patients with congenital heart disease and shunts.
Abstract:
Compared with transmitral velocities of flow, myocardial wall velocities obtained by tissue Doppler imaging are less influenced by left atrial pressure. The data supporting this assumption, however, are limited in patients with congenital cardiac disease. The aim of this study was to compare the effects of left ventricular preload on transmitral inflow and velocities assessed by tissue Doppler imaging. Tissue Doppler imaging, and conventional Doppler echocardiography with simultaneous invasive hemodynamic studies, were performed in 33 patients with a simple ventricular septal defect or patency of the arterial duct. Transmitral velocities (E, A) and mitral annular velocities (Ea, Aa) were measured, permitting calculation of the ratio of E to Ea. The ratio of pulmonary to systemic flows, and mean left atrial pressure, were also measured. In 10 of 33 patients, echocardiographic and hemodynamic studies were performed 4 to 5 months after surgery. The E and A values in the patients were greater than those in the controls (p < 0.01). In contrast, neither Ea nor Aa differed between the two group. The ratio of E to Ea in the patients increased significantly compared with that in the controls (8.9+/-2.1 vs 7.3+/-1.3, p < 0.01). The E value was directly related to mean left atrial pressure and the ratio of pulmonary to systemic flows. The velocities measured by Tissue Doppler imaging, however, had no significant relationship to either of these measurements. The ratio of E to Ea correlated well with mean left atrial pressure (r = 0.75, p < 0.01). In 10 post-operative patients, the values for E and A decreased from 119+/-14 to 89+/-10 cm/sec (p < 0.01) and from 91+/-22 to 61+/-9 cm/sec (p < 0.01), respectively. No significant changes were noted in the values of Ea and Aa. The ratio of E to Ea, and mean left atrial pressure, decreased from 10.3+/-1.9 to 8.2+/-1.5 (p < 0.01) and from 11.0+/-1.8 to 7.4+/-1.0 mmHg (p < 0.01), respectively. The percentage change in left atrial pressure correlated with the percent change in the ratio of E to Ea (r = 0.64, p < 0.05). The present study showed that the velocities obtained with tissue Doppler imaging are less dependent on mean left atrial pressure in children with elevated left ventricular preload caused by a left-to-right shunt.
