Necip Alp

Pulsed Doppler tissue imaging can help to identify patients with right ventricular infarction.

This study was planned to assess whether tissue Doppler imaging is a useful method for the detection of the right ventricular myocardial infarction. Forty-eight patients with acute inferior myocardial infarction and 24 age- and sex-matched healthy controls were included in this study. Twenty-four patients had electrocardiographic signs of inferior myocardial infarction without right ventricular infarction (group I), and the other 24 patients had electrocardiographic signs of inferior myocardial infarction with right ventricular infarction (group II). From the echocardiographic apical four-chamber view, peak systolic, early diastolic, and late diastolic velocities of the tricuspid annulus at the right ventricular free wall were recorded with the use of pulsed-wave Doppler tissue imaging. The tricuspid annular peak tissue Doppler imaging systolic velocity was significantly lower in group I (14.03 ± 2.57 cm/s, P ≪ 0.005) and in group II (8.50 ± 0.84 cm/s, P ≪ 0.005) than in controls (16.63 ± 2.31 cm/s). The tricuspid annular peak systolic (8.50 ± 0.84 cm/s vs 16.63 ± 2.31 cm/s) and peak early diastolic (10.99 ± 3.28 cm/s vs 19.39 ± 4.3 cm/s) velocities were significantly lower in group II than in group I, as compared with controls (P ≪ 0.001). Peak early diastolic velocity of tricuspid annulus (10.99 ± 3.28 cm/s vs 19.39 ± 4.3 cm/s) was significantly lower in group I than in controls (P ≪ 0.001); however, late diastolic velocity was significantly lower in group II (15.98 ± 5.08 cm/s, P ≪ 0.05) than in group I (18.21 ± 2.63 cm/s, P ≪ 0.05) and in controls (19.02 ± 5.29 cm/s). The results of this study indicate that tricuspid annular peak systolic and early diastolic velocities are reduced in patients with right ventricular infarction. The velocity of the tricuspid annulus by tissue Doppler imaging is simple and can be used to distinguish whether patients with inferior myocardial infarction have right ventricular infarction.

Tissue Doppler properties of the left atrial appendage in patients with mitral valve disease.

Objective: The purpose of this study was to compare the left atrial appendage (LAA) tissue Doppler imaging (TDI) with the classical LAA function parameters in patients with mitral valve disease. Methods: Twenty patients who had pure mitral regurgitation (group 1), 20 patients who had pure rheumatic mitral stenosis (group 2), and 20 healthy patients (group 3) were included in this study. All the cases were sinus rhythm. In order to determine the LAA functions, LAA late filling (LAALF), and late emptying (LAALE) flow velocities and LAA fractional area change (LAAFAC) were measured. LAA tissue Doppler evaluations were obtained from the PW Doppler, which was placed on the LAA lateral wall in a transverse basal short‐axis approach. LAA late systolic (LAALSW) and late diastolic (LAALDW) wave velocities were obtained from TDI records transesophageal echocardiography (TEE). Results: There were no significant differences among groups 1, 2, and 3 in terms of age, left ventricular (LV) ejection fraction, gender, and heart rate. No differences were observed between group 1 and the control group with respect to LAALE, LAALF, and LAAFAC. LAALE velocity and LAAFAC were significantly decreased in group 2 than group 1. LV diastolic diameter was significantly greater, whereas LAALSW and LAALDW velocities were significantly decreased in group 1 compared with group 3. There were no differences between groups 1 and 2 regarding to LAALSW and LAALDW velocities. LAALE, LAALF, LAALSW, LAALDW velocities, and LAAFAC were significantly decreased in group 2 than group 3. Conclusion: The TDI method may detect the LAA systolic dysfunctions, which cannot be detected using classical methods, on tissue level in patients with mitral regurgitation. In addition, the deterioration of the LAA functions at tissue level in patients with rheumatic mitral stenosis was also detected. (ECHOCARDIOGRAPHY, Volume 21, May 2004)

Left Atrial Mechanical Functions in Elite Male Athletes

I athletic conditioning is associated with hemodynamic changes and affects the loading conditions of the heart. It is known that the heart of an athlete has become physiologically adapted by prolonged training. These changes include an increase in left ventricular (LV) chamber size, wall thickness, and mass. It is reported that athletes involved in mainly static or isometric exercise develop concentric hypertrophy, and in contrast to this, athletes involved in endurance training or isotonic exercise develop eccentric hypertrophy. There are a large number of echocardiographic studies on LV wall thickness and dilatation, but there are very few studies concerning left atrial (LA) mechanical function in the athlete’s heart. This study was undertaken to assess the possible adaptive changes in LA mechanical function in elite athletes. • • • Thirty-six top-level male athletes (21 4 years), all members of the national running team, wrestling team, skiing team, or other professional sports teams (14 runners, 10 wrestlers, 4 boxers, 5 basketball players, and 3 skiers) and 21 age-matched healthy male controls (21 4 years) were included. Mean athletic competition time was 7.7 4.1 years and the mean average training time was 11.5 3.9 hours/week in the athletes. All athletes were in the intense training period. Athletes in the off-training period or during prolonged rest ( 10 days) were not included. All subjects enrolled in this study were free from cardiac disease on the basis of a negative medical history and normal physical examination and electrocardiogram. The subjects who had a history of taking any cardioactive medication or anabolic steroids were excluded from this study. The study protocol was approved by the ethics committee of our institute and all subjects gave written consent for the study. A Vingmed System Five Doppler echocardiographic unit (GE Vingmed Ultrasound, Horten, Norway) with 2.5-MHz FPA probe was used. All echocardiograms were recorded by the same investigator. An echocardiographic study was performed in the left lateral decubitus position, with parasternal long and apical 2-, 4-, and 5-chamber views. Diastolic ventricular septal thickness, diastolic posterior wall thickness, and LV end-diastolic and end-systolic dimensions were measured in the parasternal long-axis view, and LV mass was determined by the method of Devereux and Reichek and indexed to body surface area. A sample volume of pulsed-wave Doppler was placed between tips of mitral leaflets on the apical 4-chamber view. Peak early (E) and late (A) mitral inflow velocities, E/A ratio, and deceleration time of E velocity were obtained. Isovolumic relaxation time was obtained with the sample volume of the pulsedwave Doppler positioned between mitral inflow and LV outflow tract as the time interval from the cessation of aortic flow to the onset of mitral valve inflow. LV end-diastolic and end-systolic volumes were determined from the apical 4-chamber view according to the modified Simpson’s method, and LV stroke volume and ejection fraction were calculated. LA volumes were measured echocardiographically at the time of mitral valve opening (maximal, Vmax), at the onset of atrial systole (p wave on electrocardiography Vp), and at mitral valve closure (minimal, Vmin) according to the biplane area-length method in the apical 4and 2-chamber view. All volumes were corrected for body surface area and the following LA emptying functions were calculated: LA passive emptying volume Vmax Vp; LA passive emptying fraction LA passive emptying volume/Vmax; conduit volume LV stroke volume (Vmax Vmin); LA active emptying volume Vp Vmin; LA active emptying fraction LA active emptying volume/Vp; LA total emptying volume (Vmax Vmin); LA total emptying fraction LA total emptying volume/ Vmax. 10 All measurements were averaged over 3 cardiac cycles. Data are expressed as mean SD. The differences between groups were assessed with the Student’s t test. The relation between different variables was assessed with the Pearson correlation. A p value 0.05 was considered statistically significant. Athletes and members of the control group did not differ significantly in mean age and body surface area (21 4 vs 20 4 years and 1.8 0.2 vs 1.8 0.2 m, respectively, p 0.05). Heart rate was significantly lower in athletes than in controls (p 0.001). Systolic and diastolic blood pressures were similar in both groups (p 0.05). LV end-diastolic diameter and volume were significantly higher in athletes than in controls (p 0.05). LV end-systolic diameter and volume and ejection fraction were similar in the 2 groups (p 0.05). Posterior wall thickness (p 0.01), ventricular septal thickness (p 0.001), and LV mass index (p 0.001) were significantly greater in athletes than in controls. E and A transmitral flow velocity, and E/A ratio were similar in both groups (p 0.05). LA dimension was significantly greater in athletes than in controls (p 0.005) (Table 1). LA volume indexes, Vmax (p 0.005), Vmin (p 0.05), and Vp (p 0.005) were greater in athletes From the Department of Cardiology, Medical School Hospital, and Department of Physical Education and Sport, Ataturk University, Erzurum, Turkey. Dr. Erol’s address is: Ataturk University, Department of Cardiology, Medical School Hospital, 25050 Erzurum, Turkey. E-mail: mkerol@superonline.com.tr. Manuscript received April 10, 2001; revised manuscript received and accepted June 7, 2001.

Strain and Strain Rate Imaging in Evaluating Left Atrial Appendage Function by Transesophageal Echocardiography

Background: This study was planned to assess whether strain rate (Sr) and strain (S) echocardiography is a useful method for functional assessment of the left atrial appendage (LAA). Material and Methods: Fifty‐seven consecutive patients underwent a clinically indicated study. LAA late empty velocity (LAAEV) was calculated as a gold standard for left atrial appendage function. Real‐time 2‐dimensional color Doppler myocardial imaging data were recorded from the LAA at a high frame rate. Analysis was performed for LAA longitudinal strain rate and strain from midsegment of lateral wall of LAA. LAA strain determines regional lengthening expressed as a positive value or shortening expressed as a negative value. Peak systolic values were calculated from the extracted curve. Results: Spearman correlation test results showed a statistically significant positive correlation was between the S, Sr variables and LAAEV (LAAEV vs S; r = 0.886, P < 0.001; LAAEV vs Sr: r = 0.897, P < 0.001, respectively). Strain and strain rate values were also significantly lower in patients with spontaneous echocardiographic contrast when compared with those without (strain; 2.42 ± 0.98 vs 13.1 ± 5.9, P < 0.001 and strain rate: 0.97 ± 0.54 vs 3.34 ± 1.15, P < 0.001, respectively). In addition, LAA strain and strain rate values were significantly lower in the patients with LAA thrombus (strain; 2.15 ± 0.96 vs 8.35 ± 6.9, P < 0.001, strain rate; 0.79 ± 0.46 vs 2.30 ± 1.48, P < 0.001, respectively). Conclusion: S and Sr imaging can be considered a robust technique for the assessment of the LAA systolic deformation.

Effect of haemodialysis on left atrial mechanical function in patients with chronic renal failure.

Objective — The aim of this study was to investigate the potential effects of haemodialysis on left atrial (LA) mechanical functions in patients with chronic renal failure. Methods — Thirty-two patients with chronic renal failure (mean age 42.8 ± 19.6 years) were included in this study. LA volumes were determined echocardiographically at the time of mitral valve opening (maximal, Vmax), at the onset of atrial systole (p wave at the electrocardiography = Vp) and at the mitral valve closure (minimal, Vmin) according to the biplane area-length method in apical 4-chamber and 2-chamber view. All volumes were corrected to the body surface area, and the following left atrial emptying functions were calculated. LA passive emptying volume = Vmax – Vp, LA passive emptying fraction = LA passive emptying volume/Vvmax. Conduit volume = LV stroke volume- (Vmax – Vmin), LA active emptying volume = Vp – Vmin. LA active emptying fraction = LA active emptying volume /Vp, LA total emptying volume = (Vmax – Vmin), LA total emptying fraction = LA total emptying volume / Vmax. Results — Mean fluid removal was 1875 ± 812 milliliter. There was no difference between in the LA passive emptying volume before and after dialysis (10.83 ± 7.44 vs. 11.47 ± 7.73 cm3/m2, p > 0.05). Conduit volume (from 15.30 ± 10.68 to 10.31 ± 6.83 cm3/m2, p < 0.05), LA active emptying volume (from 12.61 ± 6.39 to 9.25 ± 4.40 cm3/m2, p < 0.005), LA total emptying volume (from 23.44 ± 8.52 to 20.72 ± 8.58 cm3/m2, p < 0.05), LA maximal volume (from 39.44 ± 14.07 to 28.89 ± 11.80 cm3/m2, p < 0.001), LA minimal volume (from 15.99 ± 9.70 to 8.17 ± 4.52 cm3/m2, p < 0.001), and the volume at the onset of atrial systole (from 28.61 ± 10.36 to 17.42 ± 7.20 cm3/m2, p < 0.001) decreased significantly after the haemodialysis session, whereas LA passive emptying fraction (from 0.27 ± 0.14 to 0.38 ± 0.14%, p < 0.001), LA active emptying fraction (from 0.46 ± 0.18 to 0.53 ± 0.17%, p < 0.05), LA total emptying fraction (from 0.61 ± 0.14 to 0.72 ± 0.09%, p < 0.001) increased significantly after haemodialysis. Conclusion — The results of this study suggest that left atrial mechanical functions improve after haemodialysis in patients with chronic renal failure.

Can Transesophageal Pulse-Wave Tissue Doppler Imaging Be Used to Evaluate Left Ventricular Function?

Background: This study aimed to evaluate the efficiency of transesophageal tissue Doppler echocardiography (TDE) in evaluation of the left ventricular functions. To this end, the data obtained by transoesophageal tissue Doppler echocardiography and by transthoracic tissue Doppler echocardiography were compared simultaneously. Methods: Nineteen consecutive patients (7 female and 12 male) underwent a clinically indicated study. In transthoracic (TTE) and transoesophageal (TEE) echocardiographic study, a Vingmed System Five Doppler echocardiographic unit (GE Vingmed) was used. For the assessment of the left ventricular function using transthoracic and transoesophageal TDE, the mitral annular peak systolic (S), early diastolic (E), late diastolic velocities (A), late to early velocity ratio (E/A), deceleration times (DT), left ventricular isovolumetric relaxation times (IVRT) were measured at the lateral, medial, anterior, and posterior corners at the mitral annulus by activating TDE mode in the transthoracic and transoesophageal apical four‐ and two‐chamber view. Bland–Altman plots were used to compare the two measurement techniques. The differences between the groups were assessed by Mann–Whitney U test. All the data were expressed as mean ± SD. A P‐value of <0.05 was considered significant. Results: There were no significant differences between two techniques in terms of blood pressure and heart rate. Two techniques were compared for the transthoracic and transoesophageal TDE parameters. Bland–Altman analysis showed comparable values for E, A, E/A, S, and mE/E, although the measurements of DT and IVRT were different. Conclusion: PW tissue Doppler echocardiographic approach during TEE may be suitable for assessment of the left ventricular function.