Tissue Doppler imaging a new prognosticator for cardiovascular diseases
Cheuk-Man Yu1, John E Sanderson, Thomas H Marwick
1Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China. cmyu@cuhk.edu.hk
Journal of the American College of Cardiology
|May 15, 2007
Summary
Tissue Doppler Imaging (TDI) provides crucial prognostic information in cardiac diseases. Specific TDI parameters, like mitral annular velocities and dyssynchrony assessment, predict mortality and cardiovascular events, aiding clinical decision-making.
Area of Science:
- Cardiology
- Echocardiography
- Medical Imaging
Background:
- Tissue Doppler Imaging (TDI) is an evolving echocardiographic technique.
- TDI allows quantitative assessment of left ventricular (LV) systolic and diastolic function.
- TDI-derived parameters have shown prognostic value in heart failure, myocardial infarction, and hypertension.
Purpose of the Study:
- To explore the prognostic role of TDI-derived parameters in major cardiac diseases.
- To evaluate the predictive value of mitral annular velocities and intraventricular dyssynchrony for clinical outcomes.
- To assess the utility of TDI in dobutamine stress echocardiography for patients with suspected coronary artery disease.
Main Methods:
- Utilized Tissue Doppler Imaging (TDI) to measure myocardial mitral annular systolic (Sm) and early diastolic (Ea or Em) velocities.
- Assessed transmitral to mitral annular early diastolic velocity ratio (E/Ea or E/Em) for LV diastolic pressure estimation.
- Analyzed systolic intraventricular dyssynchrony using segmental analysis of myocardial velocities.
- Investigated TDI parameters during dobutamine stress echocardiography.
Main Results:
- Reduced Sm or Em values (<3 cm/s) indicate a very poor prognosis.
- E/Ea ratio (≥15) is a strong prognosticator of adverse outcomes in heart failure and post-myocardial infarction.
- Systolic intraventricular dyssynchrony independently predicts adverse outcomes in heart failure, irrespective of QRS duration.
- Baseline systolic dyssynchrony predicts favorable LV remodeling and long-term outcomes in heart failure patients undergoing cardiac resynchronization therapy.
- High mean Sm in basal segments during dobutamine stress echocardiography is associated with lower mortality/infarction rates, outperforming wall motion score.
Conclusions:
- TDI-derived parameters, including mitral annular velocities and systolic dyssynchrony, offer significant prognostic value in various cardiac conditions.
- TDI enhances the assessment of LV diastolic pressure and identifies patients at high risk for adverse events.
- TDI improves prognostic accuracy in dobutamine stress echocardiography, particularly for suspected coronary artery disease.
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