Sample volume positioning in colour-coded Doppler myocardial imaging: effect of systolic and diastolic tracking

To date, Doppler myocardial imaging (DMI) is no longer an intriguing new research tool only, but is rather on the verge of becoming a routinely used diagnostic method in adult and pediatric cardiology. Clinical studies have proven its diagnostic relevance for global left and right ventricular function. Concerns about reliability and reproducibility of DMI functional analysis, however, rely on lacking standards for the acquisition and analysis of DMI parameters. This study focuses on the effect of sample volume positioning during the cardiac cycle on the absolute myocardial velocities. Our hypothesis was that systolic sample volume placement leads to altered diastolic measurements, and diastolic placement vice versa to altered systolic measurements, when compared with continuous systolic and diastolic tracking. The effect of tracking on intra- and interobserver variability was a second endpoint of the study. Twenty healthy women underwent color-coded Doppler myocardial imaging. Clips of three heart cycles were stored in digital format for off-line analysis, administering sector angles of approximately 30 degrees and a mean frame rate of 280 frames per second. Using the Echopac software (GE, Germany), the sample volume was positioned immediately below the atrioventricular valvar annulus within the basal segments of the right and left ventricular free wall and the interventricular septum. Three conditions were investigated: conventional end-systolic or end-diastolic placement of the Doppler probe, or continuous tracking to the ideal position during systole or diastole. Descriptive statistics, intra and interobserver variabilities and Bland-Altman analyses were performed. Tracking revealed higher values of early diastolic myocardial velocities compared with measurements during systolic sample volume placement only, and higher systolic myocardial velocities, preejection acceleration and late diastolic myocardial velocities using diastolic sample volume placement. Inter and intraobserver reproducibility improved remarkably with the new procedure with the exception of isovolumic acceleration (IVA), which could not be reproduced satisfactorily at all. In summary, tracking is a promising method that helps to improve reproducibility of DMI-derived myocardial velocities. It helps to minimize the effect of changing myocardial velocities during the natural longitudinal cardiac movement, and should be considered as standard method during DMI.