Pulsed Tissue Doppler Imaging of Left Ventricular Systolic and Diastolic Wall Motion Velocities to Evaluate Differences Between Long and Short Axes in Healthy Subjects,☆☆

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Abstract

Our objective was to evaluate in healthy subjects the left ventricular (LV) wall motion velocities along the long and short axes by means of pulsed tissue Doppler imaging (TDI) to clarify the differences in the LV systolic and diastolic function between both axes. Wall motion velocities were recorded at the mid-wall portion of the middle site of the LV posterior wall in the parasternal long-axis view, and at the subendocardial portion of the middle site of the LV posterior wall in the apical long-axis view by pulsed TDI in 35 healthy subjects (mean age 26 ± 10 years, mean heart rate 72 ± 7 bpm). In all subjects, the LV pressure curve, its first derivative (dP/dt), the LV wall motion velocity, the phonocardiogram, and the electrocardiogram were simultaneously recorded. The systolic wave of the LV posterior wall motion velocity exhibited 2 peaks: the first and second systolic waves (Swl and Sw2 , respectively). The diastolic wave also exhibited 2 peaks, the early diastolic and atrial systolic waves. The Swl along the long axis was greater than either the Sw1 and Sw2 along the short axis or the Sw2 along the long axis. The peak Sw1 along the long axis coincided with the peak dP/dt and was slightly earlier than the peak Swl along the short axis. The onset of Sw1 along the long axis coincided with the onset of the first heart sound. The Sw2 along the short axis was greater than that along the long axis. The early diastolic wave along the short axis was greater than that along the long axis, whereas the atrial systolic wave along the long axis was greater than that along the short axis. Thus, in healthy subjects, shortening of the longitudinal fibers predominated over that of the circumferential fibers during early systole, whereas shortening of the circumferential fibers predominated over the longitudinal fibers during the ejection phase. During diastole, the circumferential fibers predominated in the LV wall expansion at early diastole, whereas the longitudinal fibers predominated at atrial systole. In conclusion, pulsed TDI provided information that is useful in understanding the characteristics of LV wall motion along the long and short axes. (J Am Soc Echocardiogr 1999;12:308-13.)

Section snippets

Study Population

We enrolled 35 consecutive subjects (23 men, 12 women; mean age 26 ± 10 years; range 16 to 38 years) in normal sinus rhythm (mean heart rate 72 ± 7 bpm, range 67 to 79 bpm). These subjects had presented with various disorders (eg, chest pain, dyspnea, heart murmurs, or arrhythmia) and were evaluated by phonocardiography, routine echocardiography, and cardiac catheterization. None showed evidence of clinically significant cardiovascular disease. Also, no medical history of any underlying

Transmitral Flow Velocity

The peak early diastolic velocity (E: 72 ± 14 cm/s) was greater than the peak atrial systolic velocity (A: 44 ± 8 cm/s). Their ratio was greater than 1 (E/A: 1.7 ± 0.5).

LV Wall and Mitral Annulus Motion Velocities

Systolic motion velocities at the LV posterior wall and mitral annulus consisted of 2 peaks: Sw1 and Sw2 (Figure 2). Diastolic motion velocities at the LV posterior wall and mitral annulus also consisted of 2 peaks: Ew and Aw. During recording of the systolic motion velocity at the LV posterior wall and mitral annulus along the

DISCUSSION

LV systolic function has been investigated widely, both experimentally and clinically. It is known that the LV myocardium generally consists of circumferential fibers in the mid-wall and longitudinal fibers in the subendocardial and subepicardial walls.1, 2 It is also recognized that LV systolic function is the sum of the shortening of these fibers.6 Circumferential fibers are generally larger than longitudinal fibers,1, 4 and LV ejection is essentially the result of the shortening of the

References (30)

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    Citation Excerpt :

    The number of patients in this study was relatively small; however, we were able to reach several significant observations. TDI velocities in our patients were lower than values reported by other authors [22,36,37,38]. One possible explanation could be that our study included patients referred for clinically indicated left heart catheterization representing a group with high proportion of severe cardiac diseases.

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Reprint requests: Takashi Oki, MD, Second Department of Internal Medicine, School of Medicine, The University of Tokushima, 2-50 Kuramoto-cho, Tokushima 770-8503, Japan.

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