The aim of this study was to investigate the value of tissue Doppler imaging (TDI) using transesophageal echocardiography (TEE) in assessing the elastic properties of the thoracic aorta in patients with Marfan's syndrome. Aortic distensibility, stiffness index, and pulse-wave velocity were calculated using M-mode data in a TEE short-axis view in 31 patients with Marfan's syndrome and 22 normal controls. Acceleration time, maximum wall expansion velocity (Vmax), and wall strain were determined from TDI tracings. Indexes derived from TDI differed at a greater level of significance than M-mode-derived indexes in patients with dilated and normal aortas. Significant predictors of aortic dilation were systolic blood pressure, aortic stiffness index, Vmax, and strain. Decreased aortic strain and Vmax and increased stiffness index were predictive of aortic dissection (odds ratios 4.5, 3.3, and 2.2). In conclusion, the TDI assessment of aortic wall mechanics is complementary to standard M-mode measurements in discriminating normal subjects from patients with Marfan's syndrome and is accurate in predicting aortic dilation and dissection.

The purpose of the current study was to compare right ventricular (RV) myocardial wall velocities (tissue Doppler imaging) and strain rate imaging (SRI) parameters with conventional echocardiographic indices evaluating RV function in chronic obstructive pulmonary disease (COPD) patients. In total, 39 patients with COPD and 22 healthy subjects were included in the current study. Seventeen patients had pulmonary artery pressure <35 mmHg (group I) and 22 patients had pulmonary artery pressure >35 mmHg (group II). Tissue Doppler imaging, strain and strain rate (SR) values were obtained from RV free wall (FW) and interventricular septum. Respiratory function tests were performed (forced expiratory volume in one second/vital capacity (FEV(1)/VC) and carbon monoxide diffusion lung capacity per unit of alveolar volume (D(L,CO)/V(A))). Strain/SR values were reduced in all segments of group II patients compared with group I patients and controls with lowest values at basal FW site. A significant relationship was shown between peak systolic SR at basal FW site and radionuclide RV ejection fraction. A significant relationship was shown between peak systolic SR at basal FW site and D(L,CO)/V(A) and FEV(1)/VC. In conclusion, in chronic obstructive pulmonary disease patients, strain rate imaging parameters can determine right ventricular dysfunction that is complementary to conventional echocardiographic indices and is correlated with pulmonary hypertension and respiratory function tests.

Background: A considerable literature suggests that there is a specific cardiomyopathy in acromegaly, resulting in structural and functional abnormalities that may be partially reversed by effective reduction in growth hormone / insulin-like growth factor I (GH/IGF-I) levels. Recent reports suggest that structural changes can occur after short-term exposure to GH. The aim of our study was the early detection of subclinical cardiac involvement in patients with acromegalia using tissue Doppler (TDI) and strain Doppler (SR) imaging. Methods: Thirty-nine patients with acromegalia underwent physical examination, electrocardiogram, and standard transthoracic echocardiogram in order to exclude those with cardiac involvement. The remaining twenty-seven patients without clinical and echocardiographic cardiac involvement (group 1, age 51±13 years, 16 females) were compared to 24 sex and age-matched controls (group 2, age 49±12 years, 11 females). Left and right ventricular ejection fraction (LVEF, RVEF), fractional shortening (LVFS, RVFS), and mitral and tricuspid flow filling parameters (MV and TV E/A ratio, MV and TV DT) were determined. Offline analysis of the myocardial velocity data sets was performed using dedicated software (Aplio, Toshiba Corp.). Velocity and strain traces from left and right ventricular free wall at 3 levels (basal, mid cavity, and apical) were processed from the same wall site in the apical 4-chamber view. Systolic (Sw) and diastolic (Ew, Aw) wall velocities as well as peak systolic strain (ε) and systolic and diastolic (isovolumic, early and late diastolic) SR values (SR-S, SR-IVR, SR-E, SR-A) were determined. Results: Dimensions of left and right atrial and ventricular chambers were similar between the two groups. No significant differences were determined between the two groups for the following parameters: LVEF, RVEF, LVFS, RVFS, MV and TV E/A ratio, MV and TV DT. A significant difference was found between the two groups for MV and TV Ew/Aw ratio at basal level (p<0.001 and p<0.05, respectively). Left and right ventricular peak systolic ε and systolic and early diastolic SR values were significantly reduced compared to controls at basal (p<0.001) and mid-cavity level (p<0.005) but not at apical level. Conclusion: In patients with acromegaly TDI/SR parameters (mainly from basal ventricular segments) can show a possible early cardiac involvement not detected by conventional echocardiography.

Background: Myocardial involvement in sclerodermia is related to patchy myocardial fibrosis attributed to intermittent and intense ischemia produced by microvascular occlusion. Although cardiac dysfunction can lead to heart failure or sudden cardiac death (particularly in patients with skeletal myopathy), it may also remain clinically silent despite extensive involvement. The purpose of our study was the evaluation of patients with sclerodermia by conventional Doppler echocardiography and tissue Doppler imaging (TDI) in order to detect early patterns of myocardial dysfunction. Methods: Twenty-six patients (age 54±13 years) with sclerodermia were studied. Exclusion criteria were non sinusal rhythm, hypertensive, ischemic, or valvular heart disease. Left ventricular ejection fraction (LVEF), fractional shortening (LVFS), and mitral flow filling parameters (E/A ratio, DT) were determined. Offline analysis of the myocardial velocity data sets was performed using dedicated software (Aplio, Toshiba Corp.). Velocity traces from the left ventricular free wall at 3 levels (basal, mid cavity, and apical) were processed in different cineloops in the apical views. Systolic (Sw) and diastolic (Ew, Aw) wall velocities were determined. Normal patterns (type 1) and relaxation or restrictive abnormalities (type 2 and 3) were examined for both standard and TDI indices. Results: All patients were asymptomatic and had normal LV dimensions, fractional shortening and segmental wall motion. 12 patients (group I) had septal hypertrophy and/or abnormal mitral inflow pattern (type 2 or 3). 14 patients (group II) had none of these abnormalities. 425 segments were analysed by TDI and a type 2 or 3 pattern was found in 139 (33%), from 20 patients. Five patients had pulmonary artery pressure >35mmHg. In six patients there was heterogeneous pattern in different segments and in thirteen a type 1 pattern was found in all segments, which was concordant with mitral flow Doppler pattern. Group I patients had an abnormal TDI pattern in all but one (95%). Nine Group II patients (64%) showed an abnormal TDI pattern. A significant difference was found between Ew and Sw in Groups I and II (p = 0.003 and 0.005, respectively). Conclusion: Thus in patients with sclerodermia and no cardiac involvement as assessed by conventional echocardiography, TDI showed abnormalities of longitudinal systolic and diastolic left ventricular function.

Objective: To evaluate the ability of colour Doppler transoesophageal echocardiography ( TOE) to assess quantitatively prosthetic mitral valve insufficiency.Methods: 47 patients were studied with multiplane TOE and cardiac catheterisation. Proximal jet diameter was measured as the largest diameter of the vena contracta. Regurgitant area was measured by planimetry of the largest turbulent jet during systole. Flow convergence zone was considered to be present when a localised area of increased systolic velocities was apparent on the left ventricular side of the valve prosthesis. Pulmonary vein flow velocity was measured at peak systole and diastole.Results: Mean (SD) proximal jet diameter was 0.63 (0.16) cm, with good correlation with angiographic grades (r = 0.83). Mean ( SD) maximum colour jet area was 7.9 ( 2.5) cm(2) ( r = 0.69) with worse correlation if a single imaging plane was used for measurements ( r = 0.62). The ratio of systolic to diastolic peak pulmonary flow velocity averaged 0.7 (1.3) cm ( r = -0.66) with better correlation ( r = -0.71) if patients with atrial fibrillation were excluded. Mean ( SD) regurgitant flow rate was 168 (135) ml/s and regurgitant orifice area was 0.56 (0.43) cm(2), with good correlation with angiography ( r = 0.77 and r = 0.78, respectively).Conclusions: TOE correctly identified angiographically severe prosthetic mitral regurgitation, mainly by the assessment of the flow convergence region and the proximal diameter of the regurgitant jet.

Background: The introduction of Doppler measurement of myocardial wall velocities (tissue Doppler imaging, TDI) and the recently developed strain rate (SR) imaging technique have made possible a more adequate assessment of global and regional systolic and diastolic right ventricular (RV) function. Our purpose was: 1) to compare TDI/SR parameters with conventional indices evaluating RV function; 2) to assess the correlation among TDI/SR parameters and respiratory function tests. Methods: Twenty-nine patients (age 53 13 years) with chronic obstructive pulmonary disease were included in the study. 15 patients had pulmonary artery pressure 35mmHg (group I), 14 patients 35mmHg (group II). Sixteen age/gender-matched healthy subjects served as controls (group III). RV ejection fraction (EF), fractional shortening (FS), and tricuspid flow filling parameters (E/A ratio, DT) were determined. Velocity and strain traces (Aplio software, Toshiba Corp.) from RV free wall at 3 levels (basal, mid cavity, and apical) were processed in the same site in the apical 4-chamber view. Diastolic TDI values (Ew, Aw), peak systolic strain and systolic and diastolic strain rate values were determined. Echocardiographic parameters were evaluated after the respiratory function tests were performed (FEV1 forced expiratory volume in one second; FEV1/VC forced expiratory volume in one second / vital capacity; DLCO single-breath diffusion capacity of the lung for carbon monoxide; DLCO/ VA carbon monoxide diffusion capacity per unit of alveolar volume). Results: Measurements of TDI/SR parameters were rapidly obtained with a low interand intra-observer variability. Ew/Aw ratio at apical and mid level was lower in Group I and II than in Group III (p 0.005). Peak systolic strain and systolic and diastolic strain rate at apical and mid level were lower in Group I and II than in Group III (p 0.001). Right ventricular EF, FS, E/A ratio, and DT were not different among the three groups. No correlation was found between EF, FS, E/A ratio, DT, and respiratory function tests. A highly significant relationship was shown between peak systolic strain atmid level andDLCO/VA (r 0.67, p 0.001) and peak systolic strain at mid level and FEV1/VC (r 0.69, p 0.001).Conclusion: Thus in COPD patients TDI/SR parameters can determine RV dysfunction that is not shown by conventional echocardiographic indices and is correlated with respiratory function tests.

Background: No study has so far tested the diagnostic accuracy of strain rate Doppler echocardiography (SR) during dobutamine testing for detecting myocardial viability and predicting recovery of chronic ischemic LV dysfunction. Our purpose was: 1) to establish the accuracy of quantitative segmental analysis by SR during dobutamine testing for detecting myocardial viability in patients with chronic ischemic regional LV dysfunction; 2) to compare results of dobutamine SR with those of rest-4h-24h redistribution Thallium SPECT (T1 SPECT), a well validated method for assessing hibernating myocardium. Methods: Twenty-nine patients (age 54±13 years) with chronic ischemic regional LV dysfunction (EF 29±11%) underwent dobutamine SR and T1 SPECT on different days and in random order, within 15 days before myocardial revascularization (PTCA in 16 and CABG in 13). Functional recovery was identified at 99±18 days after coronary revascularization by means of resting 2D echocardiography. Offline analysis of the myocardial velocity data sets was performed using dedicated software (Aplio, Toshiba Corp.). Velocity and strain traces from different wall segments were processed simultaneously in the same cineloop. Dobutamine was administered by infusion pump, at 3 min intervals up to a maximum of 20 mcg/Kg/min. Each patient was injected i.v. with 3.0 mCi of Tl in the rest state. Four hours and 24 hours after injection, delayed Tl SPECT acquisitions were performed using the same parameters. A 16-segment- 4-grade score model was used for analysis of both Dobutamine SR and Tl SPECT. Results: Of 194 segments with baseline WMA, 67 (35%) segments showed viability on Dobutamine SR, and 79 (41%) on Tl SPECT. Positive and negative predictive values were 86% and 60% for Dobutamine SR and 78% and 63% for Tl SPECT (p = NS). The sensitivity, specificity and accuracy of SR dobutamine echocardiography were 77%, 84%, and 83%, respectively; those of thallium tomography were 81%, 66%, and 73%, respectively. Conclusion: Segmental analysis of SR images during dobutamine infusion appears to be as feasible as visual diagnosis of regional wall motion changes but with the advantage of being automated and quantitative. Regional LV contractile reserve assessed by dobutamine SR is highly concordant with Tl SPECT in identifying hibernating myocardium.