- Email: [email protected]
Doppler derived myocardial tissue velocity detection in normal children
Journal o f the American Society o f Echocardiography Volume 8 Number 3
2613
Abstracts
LONGITUDINAL AXIS D/ASTOLIC DYNAMICS PATIENTS WITH LEFT VENTRICULAR ~PEI~TROPITY: A D O P P L E R T I S S U E I M A G I N G STUDY. Leonardo Rodriguez MD, Mario Garcia MD, Satosh~ Nakatam MD, Miguel Ares MD, Brian Griffin MD, James D. Thomas MD. Department of Cardiology, Cleveland Clinic Foundation.
28D
DOPPLER DERIVED MYOCARDIAL TISSUE VELOCITY DETECTION IN NORMAL CHILDREN Jack Ryehik, M.D., Zhi-Yna Tian M.D. The Children's Hospital of Philadelphia, University of Pennsylvania Schobl of Medicine, Philadelphia, PA.
Myocardial tissue velocity patterns in the normal child have not been investigated, By incrussing the sensitivity to high intensity/low vel~'ity signals, ultrasound techinquas may be used to detect Doppler shift information fxom moving tissue (Doppler Tissue Imaging, DTITM ). This infomtation may then be spcct~ displayed as myocardial velocity versus time. We investigated the myecardial velocity patterns in children using DTITM, and correlated these with conventional diastolic Doppler flow pattmns across the mitral valve. Thirty normal children (median age 7 years, range 0.5-16 years) without congenital heart disease or myocardial dysfunction underwent DTITM velocity analysis with 4.0 MHz fi~luency transducer. Two sites were interrogated: l) the mitral valve annulus (Ann) from the four chamber apical view, and 2) the posterior wall of left ventricle (PW) from the short axis parasternal view at the level of the tips of the papillary muscles. Conventional pulsed-wave Doppler (Cony Dopp) was used to interrogate the inflow pattern across the mh'al valve midway between the annuins and tips of the leaflets. A systolic wave (S) as well as 2 waves in diastole were detected with DTITM (early diastole (E); atrial systole (A)) at both tissue sites. Mean + SD of peak velocities 0/el) and vehicity-time integrals (VTI) are recorded in era/see and cm, respectively. VelE VelA V.e[E/A VTIE VTIA VTIE/A VelS VTIS Cnttv 82.6_+ 49.7_+] LS+ 9.7+ 3.9+ 2.8_+ NA NA Dopp 17.8 18.7 0.5 1.8 1.5 1.0 Ann DTITM ! PW
12.1+ 3.0 11.7+
6.8+. 1.9 4.5+
1.9+0.5 *3.2+
1.6+ 0.6+ 2.6+6,7+ 2.4 0.8 0,7 1.2 1.0+- 0.3+- *3.9+- 5.9+
1.7+ 2.3 1.0+
DTIT M 2.8 2.0 2.5 0.3 0.1 1.7 1.2 0.3 Cony Dopp VT] E/A correlated well ~th Ann DTIT M VTI E/A (r=0.75,p<0.~ 1), but not with PW DTITM VTI E/A (r--0.33,p=0.09). Vel E/A and VTI E/A were higher for the PW than for the Ann (*P<0.005). Conclusions: Panerns of myocardial velocity at the Ann level mimic that of blood inflow across the miWal valve. PW myocardial velocity, however, is higher at early diastole (ventricolar relaxation) with lower velocity in late diastole (atrial systole). Investigation of myocardial velocity under states of volume or pressure overload is warranted.
TISSUE DOPPLER IMAGING IN NORMAL SUBJECTS: ASSESSMENT OF VARIABILITY Akira Kisanuki MD, David Kovaeieh MD, Thomas Ryan MD Indiana University School of Medicine, Krannett Institute of Cardiology, Indianapolis Tissue Doppler Imaging (TDI) is a new method which determines the velocity of myocardial motion and assigns a different color image dependent on the tissue velocitiy that is registered. The purposeof this study was to assess the variability of TDI in evaluating maximal systolic left ventricalar wall velocity. We examined 14 normal subjects using a TDI mode (Toshiba SSA-380A) with a measurable maximal velocity of 4.8 cm/sec. Wall velocity ranging from 0.0 to 0.2 cndsec was displayed as black, 0.2 to 2.4 cm/sec as blue, 2.4 to 4.0 cm/sec as green, 4.0 to 4.8 cnffsec as yellow and more than 4.8 era/see as red. The map used was designed so that color aliasing would not occur even when velocity exceeded the maximal range. In addition, the direction of tissue motion did not affect the color displayed. TDI frame rates ranged from 28-40 frames/second. A standard 16 segment model was used and TDI interogation of the myocardium performed using both parasternal and apical windows. The color image which represented the maximal systolic wall velocity of the left ventdcniar wall segments was determined off-line by visual frame-by-frame analysis of VHS videotape. inter- and intra-observer reproducibility and variability between cardiac cycles was assessed. Color determination could be performed in 153/224 segments (68%). The primary reason for inability to perform TDI was an inadequate 2D image. Images interpreted included 67/84 (80%), 65/84 (77%), and 26/56 (46%) of basal, mid and apical segments, respectively. The maximal wall velocity occurred in early systole. Red was observed in 66 segments (43%), yellow in 40 segments (26%) and green in 47 segments (31%). Blue and black were not observed in any segments analyzed. Red was observed in 69% (46/67) of basal segments, in 29% (19/65) of midsegments, in 4% (1/26) of anterior septal segments and in 50% (13/26) of posterior segments. Yellow was observed in 18 % of basal segments (12/67) and in 40% of mid-segments (26/65). Green was observed in 31% of midsegments (20/65) and in 81% (17/21) of apical segments. Interobserver agreement was 81% (124/153), inuaobserver agreement was 86% (131/153) and agreement among different cardiac cycles was 85% (130/153), respectively. In conclusion, TDI color analysis is a reproducible method for assessing left ventricular wall velocity in normal subjects. TDI images are most readily obtained for basal and mid venWicularsegments.
The study o f diastolic function by Doppler echocardiography is limited by the difficulty in separating the confounding effects o f loading conditions and left ventrieular relaxation. W e hypothesized that long axis dynamics as measured by the mitral annulus velocities, might be a useful index of L V diastolic function. Methods: We studied 23 normal subjects and 17 patients with L V H (walt thickness > 13 mml. Peak early mitral annulus vdocities (E,) were measured using Doppler Tissue Imaging. The sample volume was placed on the lateral mitral annulus from the apical 4-chamber view and spectra[ Doppler recorded. Mitral inflow E wave velocities were acquired using standard pulsed Doppler. Results compared between the both groups using Student's t-test. Results: Early diastolic annular velocities were significantly decreased in patients with left ventricular hypertrophy despite similar mitral inflow E vdockies. Control LVH p E (cm/s) 66.5+16 76 +36 NS E . (cm/s) 15.3+_5 7.3_+2.4 <0.000 l EdE 0.24_+0.08 0.11_+0.06 <0.0001 Condusions: 1) Longitudinal axial velocities during early filling (Ea) are reduced in patients with LVH. 2) These velocities appear to provide information about filling dynamics independeut o f Doppler mitral inflow. 3) Both E, and E J E ratio provide new quantitative indices o f diastolic function
27D
391
29D
MEASUREMENT OF ATRIAL APPENDAGE CYCLE LENGTH BY TRANSTHORACIC ECHOCARDIOGRAPHY USING DOPPLER TISSUE IMAGING. Leonardo Rodriguez MD, SatoshJ Nakatani MD, Dominic Leung MD, Brian Griffin MD, William Stewart MD, James D Thomas MD, Richard Grimm D O Department o f Cardiology, Cleveland Ciirdd Foundation, Cleveland, OH. Measurement o f left atrial appendage cycle length from emptying flow velocities in atrial fibrillation (AF) has been shown to be the mecha~fical correlate o f the atrial electrogram. However these vdocities can only be recorded using transesophageal echocardiography. The ability to obtain these velocities using transthoracic echocardiography would allow for cycle length determination in a larger population o f patients with A F W e explored the possibility o f recording atrial appendage motion from transthoracic echocardiography using Doppler Tissue Imaging. Methods: We studied 8 patients with chronic atrial fibrillation or flutter. The left atrial appendage was imaged from the parasternal window or modified apical view. The sample volume o f the DTI was placed on the atrial appendage wall close to the junction with the left atrium. In six of the patients D T I recordings were performed immediately following the acquisition o f atrial appendage flow by TEE. Cycle length was measured in late diastole. Results: Left atrial appendage motion was reliably recorded in all patients. This low velocity motion (3-7 cm/s) was best appreciated during long R-R intervals, with mean cycle length averaging 166 msc+66 reset. In the six patients in whom there were TEE data available, there was an excellent agreement in cycle length between the 2 methods (y-~l.0x-9, r=098; A(DTI-TEE)=-8A+_13 msec). Conclusions: 1) This preliminary result shows that it is possible to record left atrial appendage motion from the transthoracic window using Doppler Tissue Imaging. 2) There is an excellent agreement between appendage cycle length measured from the D T I tracings and from the appendage emptying flow velocities obtained by TEE.
2613
Abstracts
LONGITUDINAL AXIS D/ASTOLIC DYNAMICS PATIENTS WITH LEFT VENTRICULAR ~PEI~TROPITY: A D O P P L E R T I S S U E I M A G I N G STUDY. Leonardo Rodriguez MD, Mario Garcia MD, Satosh~ Nakatam MD, Miguel Ares MD, Brian Griffin MD, James D. Thomas MD. Department of Cardiology, Cleveland Clinic Foundation.
28D
DOPPLER DERIVED MYOCARDIAL TISSUE VELOCITY DETECTION IN NORMAL CHILDREN Jack Ryehik, M.D., Zhi-Yna Tian M.D. The Children's Hospital of Philadelphia, University of Pennsylvania Schobl of Medicine, Philadelphia, PA.
Myocardial tissue velocity patterns in the normal child have not been investigated, By incrussing the sensitivity to high intensity/low vel~'ity signals, ultrasound techinquas may be used to detect Doppler shift information fxom moving tissue (Doppler Tissue Imaging, DTITM ). This infomtation may then be spcct~ displayed as myocardial velocity versus time. We investigated the myecardial velocity patterns in children using DTITM, and correlated these with conventional diastolic Doppler flow pattmns across the mitral valve. Thirty normal children (median age 7 years, range 0.5-16 years) without congenital heart disease or myocardial dysfunction underwent DTITM velocity analysis with 4.0 MHz fi~luency transducer. Two sites were interrogated: l) the mitral valve annulus (Ann) from the four chamber apical view, and 2) the posterior wall of left ventricle (PW) from the short axis parasternal view at the level of the tips of the papillary muscles. Conventional pulsed-wave Doppler (Cony Dopp) was used to interrogate the inflow pattern across the mh'al valve midway between the annuins and tips of the leaflets. A systolic wave (S) as well as 2 waves in diastole were detected with DTITM (early diastole (E); atrial systole (A)) at both tissue sites. Mean + SD of peak velocities 0/el) and vehicity-time integrals (VTI) are recorded in era/see and cm, respectively. VelE VelA V.e[E/A VTIE VTIA VTIE/A VelS VTIS Cnttv 82.6_+ 49.7_+] LS+ 9.7+ 3.9+ 2.8_+ NA NA Dopp 17.8 18.7 0.5 1.8 1.5 1.0 Ann DTITM ! PW
12.1+ 3.0 11.7+
6.8+. 1.9 4.5+
1.9+0.5 *3.2+
1.6+ 0.6+ 2.6+6,7+ 2.4 0.8 0,7 1.2 1.0+- 0.3+- *3.9+- 5.9+
1.7+ 2.3 1.0+
DTIT M 2.8 2.0 2.5 0.3 0.1 1.7 1.2 0.3 Cony Dopp VT] E/A correlated well ~th Ann DTIT M VTI E/A (r=0.75,p<0.~ 1), but not with PW DTITM VTI E/A (r--0.33,p=0.09). Vel E/A and VTI E/A were higher for the PW than for the Ann (*P<0.005). Conclusions: Panerns of myocardial velocity at the Ann level mimic that of blood inflow across the miWal valve. PW myocardial velocity, however, is higher at early diastole (ventricolar relaxation) with lower velocity in late diastole (atrial systole). Investigation of myocardial velocity under states of volume or pressure overload is warranted.
TISSUE DOPPLER IMAGING IN NORMAL SUBJECTS: ASSESSMENT OF VARIABILITY Akira Kisanuki MD, David Kovaeieh MD, Thomas Ryan MD Indiana University School of Medicine, Krannett Institute of Cardiology, Indianapolis Tissue Doppler Imaging (TDI) is a new method which determines the velocity of myocardial motion and assigns a different color image dependent on the tissue velocitiy that is registered. The purposeof this study was to assess the variability of TDI in evaluating maximal systolic left ventricalar wall velocity. We examined 14 normal subjects using a TDI mode (Toshiba SSA-380A) with a measurable maximal velocity of 4.8 cm/sec. Wall velocity ranging from 0.0 to 0.2 cndsec was displayed as black, 0.2 to 2.4 cm/sec as blue, 2.4 to 4.0 cm/sec as green, 4.0 to 4.8 cnffsec as yellow and more than 4.8 era/see as red. The map used was designed so that color aliasing would not occur even when velocity exceeded the maximal range. In addition, the direction of tissue motion did not affect the color displayed. TDI frame rates ranged from 28-40 frames/second. A standard 16 segment model was used and TDI interogation of the myocardium performed using both parasternal and apical windows. The color image which represented the maximal systolic wall velocity of the left ventdcniar wall segments was determined off-line by visual frame-by-frame analysis of VHS videotape. inter- and intra-observer reproducibility and variability between cardiac cycles was assessed. Color determination could be performed in 153/224 segments (68%). The primary reason for inability to perform TDI was an inadequate 2D image. Images interpreted included 67/84 (80%), 65/84 (77%), and 26/56 (46%) of basal, mid and apical segments, respectively. The maximal wall velocity occurred in early systole. Red was observed in 66 segments (43%), yellow in 40 segments (26%) and green in 47 segments (31%). Blue and black were not observed in any segments analyzed. Red was observed in 69% (46/67) of basal segments, in 29% (19/65) of midsegments, in 4% (1/26) of anterior septal segments and in 50% (13/26) of posterior segments. Yellow was observed in 18 % of basal segments (12/67) and in 40% of mid-segments (26/65). Green was observed in 31% of midsegments (20/65) and in 81% (17/21) of apical segments. Interobserver agreement was 81% (124/153), inuaobserver agreement was 86% (131/153) and agreement among different cardiac cycles was 85% (130/153), respectively. In conclusion, TDI color analysis is a reproducible method for assessing left ventricular wall velocity in normal subjects. TDI images are most readily obtained for basal and mid venWicularsegments.
The study o f diastolic function by Doppler echocardiography is limited by the difficulty in separating the confounding effects o f loading conditions and left ventrieular relaxation. W e hypothesized that long axis dynamics as measured by the mitral annulus velocities, might be a useful index of L V diastolic function. Methods: We studied 23 normal subjects and 17 patients with L V H (walt thickness > 13 mml. Peak early mitral annulus vdocities (E,) were measured using Doppler Tissue Imaging. The sample volume was placed on the lateral mitral annulus from the apical 4-chamber view and spectra[ Doppler recorded. Mitral inflow E wave velocities were acquired using standard pulsed Doppler. Results compared between the both groups using Student's t-test. Results: Early diastolic annular velocities were significantly decreased in patients with left ventricular hypertrophy despite similar mitral inflow E vdockies. Control LVH p E (cm/s) 66.5+16 76 +36 NS E . (cm/s) 15.3+_5 7.3_+2.4 <0.000 l EdE 0.24_+0.08 0.11_+0.06 <0.0001 Condusions: 1) Longitudinal axial velocities during early filling (Ea) are reduced in patients with LVH. 2) These velocities appear to provide information about filling dynamics independeut o f Doppler mitral inflow. 3) Both E, and E J E ratio provide new quantitative indices o f diastolic function
27D
391
29D
MEASUREMENT OF ATRIAL APPENDAGE CYCLE LENGTH BY TRANSTHORACIC ECHOCARDIOGRAPHY USING DOPPLER TISSUE IMAGING. Leonardo Rodriguez MD, SatoshJ Nakatani MD, Dominic Leung MD, Brian Griffin MD, William Stewart MD, James D Thomas MD, Richard Grimm D O Department o f Cardiology, Cleveland Ciirdd Foundation, Cleveland, OH. Measurement o f left atrial appendage cycle length from emptying flow velocities in atrial fibrillation (AF) has been shown to be the mecha~fical correlate o f the atrial electrogram. However these vdocities can only be recorded using transesophageal echocardiography. The ability to obtain these velocities using transthoracic echocardiography would allow for cycle length determination in a larger population o f patients with A F W e explored the possibility o f recording atrial appendage motion from transthoracic echocardiography using Doppler Tissue Imaging. Methods: We studied 8 patients with chronic atrial fibrillation or flutter. The left atrial appendage was imaged from the parasternal window or modified apical view. The sample volume o f the DTI was placed on the atrial appendage wall close to the junction with the left atrium. In six of the patients D T I recordings were performed immediately following the acquisition o f atrial appendage flow by TEE. Cycle length was measured in late diastole. Results: Left atrial appendage motion was reliably recorded in all patients. This low velocity motion (3-7 cm/s) was best appreciated during long R-R intervals, with mean cycle length averaging 166 msc+66 reset. In the six patients in whom there were TEE data available, there was an excellent agreement in cycle length between the 2 methods (y-~l.0x-9, r=098; A(DTI-TEE)=-8A+_13 msec). Conclusions: 1) This preliminary result shows that it is possible to record left atrial appendage motion from the transthoracic window using Doppler Tissue Imaging. 2) There is an excellent agreement between appendage cycle length measured from the D T I tracings and from the appendage emptying flow velocities obtained by TEE.