CARDIOVASCULAR MEDICINE

Is Doppler tissue velocity during early left ventricular filling preload independent?

F Yalçin¹, A Kaftan¹, H Muderrisolu¹, M E Korkmaz¹, F Flachskampf², M Garcia², J D Thomas²

¹ Department of Cardiology, Bakent and Pamukkale University, Adana, Denizli, Turkey
² Cardiovascular Imaging Center, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Correspondence to:
Correspondence to:
Dr Fatih Yalçin, Department of Cardiology, Bakent University School of Medicine, Practice and Research Hospital, Yüreir, Adana, Turkey 01250;
fyalcin{at}baskent-adn.edu.tr

Background: Transmitral Doppler flow indices are used to evaluate diastolic function. Recently, velocities measured by Doppler tissue imaging have been used as an index of left ventricular relaxation.

Objective: To determine whether Doppler tissue velocities are influenced by alterations in preload.

Methods: Left ventricular preload was altered in 17 patients (all men, mean (SD) age, 49 (8) years) during echocardiographic measurements of left ventricular end diastolic volume, maximum left atrial area, peak early Doppler filling velocity, and left ventricular myocardial velocities during early filling. Preload altering manoeuvres included Trendelenberg (stage 1), reverse Trendelenberg (stage 2), and amyl nitrate (stage 3). Systolic blood pressure was measured at each stage.

Results: In comparison with baseline, left ventricular end diastolic volume (p = 0.001), left atrial area (p = 0.003), peak early mitral Doppler filling velocity (p = 0.01), and systolic blood pressures (p = 0.001) were all changed by preload altering manoeuvres. Only left ventricular myocardial velocity during early filling remained unchanged by these manoeuvres.

Conclusions: In contrast to standard transmitral Doppler filling indices, Doppler tissue early diastolic velocities are not significantly affected by physiological manoeuvres that alter preload. Thus Doppler tissue velocities during early left ventricular diastole may provide a better index of diastolic function in cardiac patients by providing a preload independent assessment of left ventricular filling.

Keywords: Doppler tissue echocardiography; preload alterations

Abbreviations: DTI, Doppler tissue imaging; E, left ventricular early mitral inflow velocity, EDTV, early diastolic tissue velocity; LVEDV, left ventricular end diastolic volume

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Sharp, A., Tapp, R., Francis, D. P., McG. Thom, S. A., Hughes, A. D., Stanton, A. V., Zambanini, A., Chaturvedi, N., Byrd, S., Poulter, N. R., Sever, P. S., Mayet, J. (2008). Ethnicity and Left Ventricular Diastolic Function in Hypertension: An ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) Substudy. J Am Coll Cardiol 52: 1015-1021 [Abstract] [Full Text]  
• Tretjak, M., Kozelj, M. (2008). Tissue Doppler annular velocities, NT-proBNP and exercise capacity in healthy elderly. Age Ageing 37: 336-339 [Full Text]  
• Lindqvist, P., Calcutteea, A., Henein, M. (2008). Echocardiography in the assessment of right heart function. Eur J Echocardiogr 9: 225-234 [Abstract] [Full Text]  
• Caiani, E. G., Weinert, L., Takeuchi, M., Veronesi, F., Sugeng, L., Corsi, C., Capderou, A., Cerutti, S., Vaida, P., Lang, R. M. (2007). Evaluation of alterations on mitral annulus velocities, strain, and strain rates due to abrupt changes in preload elicited by parabolic flight. J. Appl. Physiol. 103: 80-87 [Abstract] [Full Text]  
• Shmuylovich, L., Kovacs, S. J. (2006). Load-independent index of diastolic filling: model-based derivation with in vivo validation in control and diastolic dysfunction subjects. J. Appl. Physiol. 101: 92-101 [Abstract] [Full Text]  
• George, K., Oxborough, D., Forster, J., Whyte, G., Shave, R., Dawson, E., Stephenson, C., Dugdill, L., Edwards, B., Gaze, D. (2005). Mitral annular myocardial velocity assessment of segmental left ventricular diastolic function after prolonged exercise in humans. J. Physiol. 569: 305-313 [Abstract] [Full Text]  
• Kidawa, M., Coignard, L., Drobinski, G., Krzeminska-Pakula, M., Thomas, D., Komajda, M., Isnard, R. (2005). Comparative Value of Tissue Doppler Imaging and M-Mode Color Doppler Mitral Flow Propagation Velocity for the Evaluation of Left Ventricular Filling Pressure. Chest 128: 2544-2550 [Abstract] [Full Text]  
• Tretjak, M., Verovnik, F., Benko, D., Kozelj, M. (2005). Tissue Doppler velocities of mitral annulus and NT-proBNP in patients with heart failure. Eur J Heart Fail 7: 520-524 [Abstract] [Full Text]  
• Hasegawa, H., Little, W. C., Ohno, M., Brucks, S., Morimoto, A., Cheng, H.-J., Cheng, C.-P. (2003). Diastolic mitral annular velocityduring the development of heart failure. J Am Coll Cardiol 41: 1590-1597 [Abstract] [Full Text]