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Circulation. 1997;95:2423-2433

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(Circulation. 1997;95:2423-2433.)
© 1997 American Heart Association, Inc.


Articles

Quantitative Assessment of Alterations in Regional Left Ventricular Contractility With Color-Coded Tissue Doppler Echocardiography

Comparison With Sonomicrometry and Pressure-Volume Relations

John Gorcsan, III, MD; David P. Strum, MD; William A. Mandarino, MS; Vijay K. Gulati, MD; Michael R. Pinsky, MD

From the Divisions of Cardiology (J.G., W.A.M., V.K.G.) and Anesthesiology and Critical Care Medicine (D.P.S., M.R.P.), University of Pittsburgh (Pa).

Correspondence to John Gorcsan III, MD, Division of Cardiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213-2582. E-mail gorcsan{at}a1.isd.upmc.edu

Background Tissue Doppler imaging (TDI) is a novel method of color-coding myocardial velocity on-line. The objective of the present study was to evaluate endocardial velocity with TDI as a method of objectively quantifying alterations in regional contractility over a wide range induced by inotropic modulation.

Methods and Results Myocardial length crystals were used to simultaneously assess regional left ventricular (LV) function, and high-fidelity pressure and conductance catheters were used to assess global LV contractility by pressure-volume relations in nine open-chest dogs. Mid-LV M-mode and two-dimensional color TDI images were recorded during control and inotropic modulation stages with dobutamine and esmolol. Predicted significant increases in TDI indices occurred with dobutamine: peak systolic velocity of 4.41±1.07 to 6.67±1.07 cm/s*, systolic time-velocity integral (TVI) of 0.43±0.12 to 0.62±0.10 cm*, and diastolic TVI of 0.49±0.11 to 0.71±0.17 cm*. Opposing significant decreases occurred with esmolol: peak systolic velocity of 4.46±0.94 to 2.31±0.81 cm/s*, systolic TVI of 0.47±0.12 to 0.19±0.11 cm*, and diastolic TVI of 0.55±0.11 to 0.33±0.11 cm* (*all P<.001 versus control). Changes in TDI peak systolic velocity were correlated with changes in fractional shortening (r=.88) and shortening velocity (r=.87) by sonomicrometry. Changes in TDI peak velocity from multiple mid-LV sites also correlated significantly with maximal elastance (r=.85±.04) from pressure-volume relations.

Conclusions TDI measures reflect directional and incremental alterations in regional and global LV contractility and have the potential to quantify regional LV function.


Key Words: dynamics • echocardiography • myocardium • mechanics • imaging




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Am. J. Respir. Crit. Care Med., April 1, 2001; 163(5): 1212 - 1218.
[Abstract] [Full Text]


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J Am Coll CardiolHome page
T. Edvardsen, H. Skulstad, S. Aakhus, S. Urheim, and H. Ihlen
Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography
J. Am. Coll. Cardiol., March 1, 2001; 37(3): 726 - 730.
[Abstract] [Full Text] [PDF]


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CirculationHome page
G. Derumeaux, J. Loufoua, G. Pontier, A. Cribier, and M. Ovize
Tissue Doppler Imaging Differentiates Transmural From Nontransmural Acute Myocardial Infarction After Reperfusion Therapy
Circulation, January 30, 2001; 103(4): 589 - 596.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
E. Vermes, R. Houel, M. Simon, P. Le Besnerais, and D. Loisance
Doppler tissue imaging to predict myocardial recovery during mechanical circulatory support
Ann. Thorac. Surg., December 1, 2000; 70(6): 2149 - 2151.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Urheim, T. Edvardsen, H. Torp, B. Angelsen, and O. A. Smiseth
Myocardial Strain by Doppler Echocardiography : Validation of a New Method to Quantify Regional Myocardial Function
Circulation, September 5, 2000; 102(10): 1158 - 1164.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
K. Shan, R. J. Bick, B. J. Poindexter, S. Shimoni, G. V. Letsou, M. J. Reardon, J. F. Howell, W. A. Zoghbi, and S. F. Nagueh
Relation of tissue Doppler derived myocardial velocities to myocardial structure and beta-adrenergic receptor density in humans
J. Am. Coll. Cardiol., September 1, 2000; 36(3): 891 - 896.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. Palka, A. Lange, J. E. Donnelly, and P. Nihoyannopoulos
Differentiation Between Restrictive Cardiomyopathy and Constrictive Pericarditis by Early Diastolic Doppler Myocardial Velocity Gradient at the Posterior Wall
Circulation, August 8, 2000; 102(6): 655 - 662.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
L. Hatle and G. R. Sutherland
Regional myocardial function--a new approach.
Eur. Heart J., August 1, 2000; 21(16): 1337 - 1357.
[PDF]


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Eur J Heart FailHome page
C. Jarnert, M. Mejhert, M. Ring, H. Persson, and M. Edner
Doppler tissue imaging in congestive heart failure patients due to diastolic or systolic dysfunction: a comparison with Doppler echocardiography and the atrio-ventricular plane displacement technique
Eur J Heart Fail, June 1, 2000; 2(2): 151 - 160.
[Abstract] [Full Text] [PDF]


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CirculationHome page
G. Derumeaux, M. Ovize, J. Loufoua, G. Pontier, X. Andre-Fouet, and A. Cribier
Assessment of Nonuniformity of Transmural Myocardial Velocities by Color-Coded Tissue Doppler Imaging : Characterization of Normal, Ischemic, and Stunned Myocardium
Circulation, March 28, 2000; 101(12): 1390 - 1395.
[Abstract] [Full Text] [PDF]


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Anesth. Analg.Home page
D. P. Strum and M. R. Pinsky
Modeling of Asynchronous Myocardial Contraction by Effective Stroke Volume Analysis
Anesth. Analg., February 1, 2000; 90(2): 243 - 243.
[Abstract] [Full Text] [PDF]


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Anesth. Analg.Home page
D. P. Strum and M. R. Pinsky
Esmolol-Induced Regional Wall Motion Abnormalities Do Not Affect Regional Ventricular Elastances
Anesth. Analg., February 1, 2000; 90(2): 252 - 252.
[Abstract] [Full Text] [PDF]


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HeartHome page
F Larrazet, D Pellerin, D Daou, S Witchitz, C Fournier, A Prigent, and C Veyrat
Concordance between dobutamine Doppler tissue imaging echocardiography and rest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium
Heart, October 1, 1999; 82(4): 432 - 437.
[Abstract] [Full Text] [PDF]


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CirculationHome page
G. Geskin, C. M. Kramer, W. J. Rogers, T. M. Theobald, D. Pakstis, Y.-L. Hu, and N. Reichek
Quantitative Assessment of Myocardial Viability After Infarction by Dobutamine Magnetic Resonance Tagging
Circulation, July 21, 1998; 98(3): 217 - 223.
[Abstract] [Full Text] [PDF]


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CirculationHome page
G. Derumeaux, P. Mulder, V. Richard, A. Chagraoui, C. Nafeh, F. Bauer, J.-P. Henry, and C. Thuillez
Tissue Doppler Imaging Differentiates Physiological From Pathological Pressure-Overload Left Ventricular Hypertrophy in Rats
Circulation, April 2, 2002; 105(13): 1602 - 1608.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. Edvardsen, S. Urheim, H. Skulstad, K. Steine, H. Ihlen, and O. A. Smiseth
Quantification of Left Ventricular Systolic Function by Tissue Doppler Echocardiography: Added Value of Measuring Pre- and Postejection Velocities in Ischemic Myocardium
Circulation, April 30, 2002; 105(17): 2071 - 2077.
[Abstract] [Full Text] [PDF]