Longitudinal ventricular function: normal values of atrioventricular annular and myocardial velocities measured with quantitative two-dimensional color doppler tissue imaging

doi:10.1016/S0894-7317(03)00279-7

Journal of the American Society of Echocardiography

Volume 16, Issue 9, September 2003, Pages 906-921

Presented in part at the Annual Conference of the British Cardiac Society in Harrogate, United Kingdom, in May 2002; and at the European Society of Cardiology Congress in Berlin, Germany, in September 2002.

https://doi.org/10.1016/S0894-7317(03)00279-7 Get rights and content

Abstract

Objective

Quantitative 2-dimensional color Doppler tissue imaging is a new method to reveal impairment of left ventricular (LV) and right ventricular (RV) longitudinal function, which is a potential marker of early myocardial disease. The aim of this study was to obtain normal values for atrioventricular annular and regional myocardial velocities using this method.

Methods

A total of 123 healthy patients (age range: 22 to 89 years) underwent echocardiography including color Doppler tissue imaging using a scanner (Vivid 5, GE Vingmed, Horten, Norway) with postprocessing analysis (Echopac 6.3, GE Vingmed). Regional myocardial velocities were measured at 12 LV segments in 3 apical views and 2 segments of the free RV wall. Mitral annular velocities from 6 sites, and tricuspid annular velocities at its lateral site, were also assessed. At each site, systolic (S_m), early diastolic (E_m), and late diastolic (A_m) velocities were measured, and the E_m/A_m ratio was calculated.

Results

Patients were classified into 4 groups aged 20 to 39, 40 to 59, 60 to 79, and ≥80 years. Mitral annular velocity and regional LV myocardial S_m and E_m progressively decreased with age. A_m, whereas low in the youngest age group, increased significantly in patients more than 40 years of age. The E_m/A_m ratio gradually declined with aging. There were no differences between age groups in S_m measured at the tricuspid annulus and free RV wall, but the pattern of age-related changes of diastolic velocities and E_m/A_m ratio was the same as in the LV. Slight but significant sex-related differences were observed in middle-aged groups. The intraobserver and interobserver reproducibility was highest for atrioventricular annular velocities.

Conclusions

A progressive decrease in S_m reveals a decline in longitudinal systolic LV function with age, whereas systolic RV function remains unaffected. Atrioventricular annular velocity and regional E_m decrease with aging in both ventricles, suggesting a deterioration in the diastolic properties of the myocardium, whereas A_m increases from middle age implying a compensatory augmentation of atrial function. The study results can be used as reference data for the quantitative assessment of longitudinal LV and RV function in patients with cardiac disease.

Section snippets

Study patients

The study population initially comprised 143 individuals (age 59 ± 18 years; range: 22 to 89 years). We wished to avoid the potential bias of studying volunteer patients. All individuals were identified from the patient lists of local primary care physicians. Patients with no known cardiovascular disease or other chronic illnesses and no recent (<1 year) visit to their family physician were selected and received a written invitation to visit the department for echocardiography. None were taking

General echocardiographic and doppler characteristics

The study patients were classified into 4 groups aged 20 to 39 (group 1, n = 29), 40 to 59 (group 2, n = 30), 60 to 79 (group 3, n = 47), and ≥80 (group 4, n = 17) years. Table 1 shows general echocardiographic characteristics for different age groups.

There was a statistically significant lower body surface area with age principally because younger volunteers were taller than their older counterparts. However, despite these demographic distinctions, there were no statistically significant

Discussion

The LV wall is composed of both circular and longitudinal myocardial fibers. The later fibers dominate in subepicardial and subendocardial layers and in the papillary muscles. Apart from anatomic, there are important functional distinctions with the longitudinal fibers contracting earlier than the circular fibers.25, 26

Cardiac disorders can impair both longitudinal and radial contractile function. However, it has been suggested that in pathologic conditions (eg, myocardial ischemia or

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Changes in Myocardial Tissue Velocities over a Decade: The Copenhagen City Heart Study
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Sex-, Age-, and Race-Related Normal Values of Right Ventricular Diastolic Function Parameters: Data from the World Alliance Societies of Echocardiography Study
2022, Journal of the American Society of Echocardiography
Although the assessment of right ventricular (RV) diastolic function is feasible, it has garnered far less momentum for use compared with its left ventricular counterpart. The scarcity of data defining normative RV diastolic function and the fact that implications of RV diastolic dysfunction in different disease states on outcomes are less well known both hinder integration into routine clinical assessment. The aim of this study was to establish normal values of RV diastolic parameters stratified by sex, age, and race using data from the World Alliance Societies of Echocardiography study.
A subset of 888 normal subjects from the World Alliance Societies of Echocardiography database were analyzed, including measurements of tricuspid valve (TV) inflow E- and A-wave velocities, E-wave deceleration time, and TV annular tissue Doppler e′ and a′ velocities. Additionally, right atrial (RA) maximal volume and RA peak reservoir strain were measured. Patients were grouped by age (<40, 41-65, and >65 years) and stratified by sex and race. Differences were analyzed using unpaired t tests.
Compared with men, women had significantly higher TV e′ and E-wave and A-wave velocities, though differences were modest. Increasing age was associated with stepwise lower TV E wave, e′ velocity, and TV E/A ratio and higher a′ velocity and E/e′ ratio. RA peak reservoir strain was also lower, and RA end-systolic volume trended toward being smaller for older age groups. Asian subjects demonstrated significantly higher a′ velocities, lower E wave, the smallest RA end-systolic volumes, and the lowest RA peak strain values compared with white subjects of both sexes.
This study provides normal values for parameters used in the assessment of RV diastolic function stratified by race, sex, and age. The results demonstrate significant differences in RV diastolic parameters between age groups, which manifest in both individual parameters and composite ratios of TV inflow and annular velocities. Although limited sex- and race-related differences were also noted, age appears to have the most significant impact on RV diastolic parameters. These findings may aid in refining current normative values.
Right Ventricular Systolic Assessment by Transesophageal Versus Transthoracic Echocardiography: Displacement, Velocity, and Myocardial Deformation
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First, to compare tricuspid annular displacement and velocity in transthoracic and transesophageal echocardiography (TTE, TEE) using conventional angle-dependent technologies. Second, to evaluate both alternative TEE views as well as an alternative technology (speckle tracking) for overcoming proposed differences in TTE and TEE.
Prospective, comparative, cross-over study with a randomized order of image acquisition.
University hospital.
Adults undergoing cardiac surgery.
Postinduction standardized image acquisition and analysis in TTE and TEE by 2 echocardiographers.
The authors measured tricuspid annular plane systolic excursion (TAPSE) by M-mode and velocity by tissue Doppler (S′) in the apical 4-chamber TTE view and midesophageal 4-chamber TEE view (AP4C, ME4C). They then examined (1) the same measurements in alternative TEE views with proposed better ultrasound angulation; and (2) speckle tracking–based endpoints (TAPSE by speckle tracking, strain, and strain rate).
Data were available in 24 of 25 patients. Conventional TAPSE by M-mode and velocity by tissue Doppler (TDI) were underestimated in the ME4C compared with the AP4C reference (mean ± standard deviation: TAPSE: 13.1 ± 3.8 mm v 17.3 ± 4.0 mm; S′: 6.7 ± 2.1 cm/s v 9.1 ± 2.2 cm/s; both p < 0.001). Neither a modified deep transgastric view (TAPSE 14.5 ± 4.7 mm, p = 0.017; S′ 6.8 ± 1.8 cm/s, p < 0.001) nor a transgastric right ventricular inflow view (TAPSE 12.3 ± 4.0 mm, p = 0.001; S′ 6.0 ± 1.3 cm/s, p < 0.001) was similar to the AP4C. Speckle tracking TAPSE was unbiased but with high variability (mean bias = –0.3 mm, 95% limits of agreement = –9.1 to 8.4); strain and strain rate were higher in TEE than for TTE (–17.7 ± 3.6 v –12.6 ± 2.1, p < 0.001; –1.0 ± 0.2/s v –0.7 ± 0.1/s, p < 0.001).
Right ventricular displacement, velocity, and myocardial deformation measured by TEE versus TTE are different. Neither alternative transesophageal echocardiography views nor speckle tracking–based deformation is promising; TAPSE by speckle tracking is unbiased but imprecise.
Assessing Right Ventricular Function in the Perioperative Setting, Part I: Echo-Based Measurements
2019, Anesthesiology Clinics
A Novel Speckle-Tracking Based Method for Quantifying Tricuspid Annular Velocities in TEE
2019, Journal of Cardiothoracic and Vascular Anesthesia
A novel speckle-tracking-based option for measuring tricuspid annular velocities in the midesophageal 4-chamber view (ME4C) was compared with velocities measured by tissue Doppler in the apical-4 chamber view (AP4C). Because this method was based on a modified speckle-tracking-based measurement of tricuspid annular plane systolic excursion (TAPSE), the authors also compared TAPSE by speckle tracking in the ME4C with TAPSE by M-mode in the AP4C. The authors hypothesized that velocities measured by speckle tracking in transesophageal echocardiography (TEE) would be similar, correlate, and agree with those measured by tissue Doppler in transthoracic echocardiography (TTE).
Prospective diagnostic study with randomization of the order of post-induction echocardiography views by TTE (AP4C) and TEE (ME4C). Images were both acquired and analyzed by 2 echocardiographers independently. The primary outcome was S’; secondary outcomes were E’, A’, and TAPSE.
Single university hospital.
Consecutive adult patients undergoing cardiac surgery (mainly coronary artery bypass grafting).
None.
Complete data was available in 24 of 25 patients. For the primary outcome, S’ measured by speckle tracking in the ME4C correlated and agreed with S’ measured by tissue Doppler in the AP4C (S’_STE = 0.87S_TDI + 0.60, p < 0.001, r = 0.78; mean bias –0.6 cm/s, 95% limits of agreement (LoA) –3.5 to 2.4 cm/s). Similarly results were found for E’, but not A’ (E’_STE = 0.69E’_TDI + 2.37, p < 0.001, r = 0.71; mean bias 0.1 cm/s, 95%LoA –2.5 to 2.8cm/s; A’_STE = 0.15A’_TDI + 11.17, p = 0.629). TAPSE measurements by the authors’ modified speckle-tracking-based technique were similar to TAPSE by M-mode (18.2 ± 5.5 mm and 17.1 ± 3.9 mm, respectively).
Tricuspid annular velocities (S’_STE, E’_STE) determined by speckle tracking in TEE seem to be promising surrogates for velocities measured in TTE. This may be important for perioperative assessment of the right ventricle.
Age-related changes in four-dimensional CMR-derived atrioventricular junction velocities and displacements: Implications for the identification of altered annular dynamics for ventricular function assessment
2019, IJC Heart and Vasculature
We determined the age-related changes in atrioventricular junction (AVJ) velocities and displacements by feature tracking cardiovascular magnetic resonance (FT-CMR) in a healthy community-based population. We also investigated the importance of age-matching for the identification of altered AVJ dynamics.
FT-CMR was performed in 230 controls (18–78 years) and in two patient groups each consisting of 40 subjects (group 1: 23–55 years, group 2: 56–80 years). AVJ dynamic parameters, including systolic velocity Sm, early diastolic velocity Em, late diastolic velocity Am, maximal systolic excursion MAPSE and the new parameter sweep surface area velocity SSAV were measured.
Increasing age in the control group was significantly associated with reductions in Sm, Em, MAPSE (r = −0.40, −0.76, −0.34, all P < 0.001) and an increase in Am (r = 0.45, P < 0.001). For patient group 1, the selection of an age-unmatched control group (56–76 years) underestimated the number of patients with abnormal AVJ dynamics during systole and early diastole (38% vs. 70% for Sm; 20% vs. 60% for Em; 35% vs. 50% for MAPSE). In contrast, for patient group 2, the number of patients with systolic and early diastolic AVJ dynamic abnormalities was overestimated (88% vs. 63% for Sm; 90% vs. 68% for Em; 73% vs. 58% for MAPSE) when compared with age-unmatched controls (24–55 years). Fifty-percent (20/40) of the sub-group of patients with normal left ventricular ejection fraction exhibited abnormal systolic Sm or MAPSE measurements.
Significant correlations exist between age and AVJ dynamics. Age matching is important for evaluating AVJ long-axis function.

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^☆: Dr Nikitin was supported by an international traveling research fellowship grant from the Wellcome Trust.

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Original articleLongitudinal ventricular function: normal values of atrioventricular annular and myocardial velocities measured with quantitative two-dimensional color doppler tissue imaging☆

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Study patients

General echocardiographic and doppler characteristics

Discussion

J Am Soc Echocardiogr

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J Am Soc Echocardiogr

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J Am Coll Cardiol

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Original article
Longitudinal ventricular function: normal values of atrioventricular annular and myocardial velocities measured with quantitative two-dimensional color doppler tissue imaging☆