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Tissue Doppler in Spectral and Color ModeMethodological ConsiderationsNon-invasive Estimation of Left Ventricular Filling Pressures using the E/Em index
KTH, School of Technology and Health (STH), Medical Engineering. (Lars Åke Brodin)
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: Tissue Doppler (TD) in spectral mode (spectral TD) and color TD are the two modalities available today in tissue velocity echocardiography (TVE). Measurements of left ventricular (LV) myocardial velocities and displacement may yield different results depending on the employed sonographic modality and the subjective adjustments during data analysis. The ratio of transmitral early diastolic velocity (E) to early diastolic myocardial velocity (Em) has been suggested as a non-invasive estimate of LV filling pressures. The present studies aimed to evaluate the compatibility between the two TD modalities and the effect of temporal filtering and offline gain on velocity and displacement measurements obtained using these two methods. The validity of E/Em in identifying elevated LV filling pressures after acute reductions in hemodynamic LV loading was assessed.

Methods and Results: In 57 patients, longitudinal myocardial velocity profiles were acquired from the basal LV segments, using spectral and color TD. Peak systolic (Sm) and early diastolic (Em) myocardial velocities and the myocardial displacement during the ejection phase were measured offline. Spectral TD measurements were performed using three different gain settings (0%-, 50%- 100% offline gain). Color TD analysis were performed before and after the application of temporal filtering at 30, 50 and 70 ms filter width. The E/Em ratio was calculated at the different settings. The correlation between spectral- and color TD measurements was good. Changes in offline gain and filter width resulted in significant alterations on spectral and color TD derived measurements, respectively. Sm and Em were significantly higher (p < 0.001) whereas the E/Em was significantly lower (p < 0.001) for measurements performed with spectral TD compared to color TD and the discrepancy among the measurements increased at increasing filter width and gain level. In Study II the results of spectral- and color TD derived displacement were compared to anatomic M-mode. Spectral TD at different gain settings significantly overestimated M-mode derived displacement measurements, whereas the concordance between color TD and M-mode was considerably better.

In Study III, LV longitudinal systolic myocardial velocities and displacement during ejection period were quantified at the basal septal and lateral wall in 24 healthy individuals using spectral TD, color TD and M-mode. Mean spectral TD systolic velocity and displacement values were obtained from the outer and inner borders of the spectral velocity signal. The estimated mean spectral TD systolic myocardial velocities were highly concordant with corresponding color TD measurements (mean difference 0.1 ± 0.6 cm/s, septal wall; 0.1 ± 1.0 cm/s, lateral wall). Similarly, myocardial displacement obtained by integration over time of mean spectral TD velocities was in good agreement with color TD (mean difference 0.2 ± 0.7 mm, septal wall; 0.02 ± 0.86 mm, lateral wall) as well as with the corresponding M-mode measurements.

In Study IV, simultaneous LV catheterization and echocardiographic examination was performed in 68 consecutive patients referred for coronary angiography. Doppler signals of the transmitral flow and spectral TD signals at the level of mitral annulus were obtained and the E/Em was then calculated. All examinations were repeated after nitroglycerin (NTG) infusion. At baseline, the predictive ability of E/Em in identifying elevated LVDP was modest at best (area under curve [AUC] ± SE = 0.71 ± 0.08, p < 0.01). The index was more strongly associated with LVDP in patients with reduced ejection fraction (EF) < 55% (r = 0.68; p < 0.01) compared to patients with EF ≥ 55%(r = 0.4; p < 0.05). Following NTG administration, the diagnostic ability of E/Em in detecting elevated LVDP was significantly reduced (area under curve [AUC] ± SE =0.6 ± 0.08, p > 0.05). Changes in LVDP were not reliably tracked using E/Em (p > 0.05).

Conclusions: Spectral TD yields significantly higher myocardial velocity and displacement values and lower E/Em compared to color TD modality. Increasing gain and temporal smoothing significantly alters the obtained velocity and displacement information and yield greater disparity between measurements derived using the two TD methods. Spectral TD significantly overestimates myocardial displacement obtained using M-mode. On the other hand, the agreement between color TD and anatomic M-mode is considerably better. Measurements based on mean spectral TD velocities were highly concordant with those provided by color TD and M-mode. However, unfavorable limits of agreement discourage the interchangeable use of these modalities. The diagnostic ability of E/Em was poor and declined significantly following acute reduction in LV hemodynamic loading. Changes in LVDP were not predicted by alterations in E/Em. Our findings imply that E/Em might not be sufficiently robust to be employed as a single non-invasive estimate for tailoring medical therapy in patients with elevated LVDP.

Place, publisher, year, edition, pages
Stockholm: KTH , 2010. , x, 77 p.
Series
Trita-STH : report, ISSN 1653-3836 ; 2010:3
Keyword [en]
Tissue Doppler
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:kth:diva-12950ISBN: 978-91-7415-671-3 (print)OAI: oai:DiVA.org:kth-12950DiVA: diva2:319808
Public defence
2010-06-11, 3-221, Alfreds Nobels allé 10, Huddinge, 09:00 (English)
Opponent
Supervisors
Note
QC20100702Available from: 2010-05-24 Created: 2010-05-19 Last updated: 2010-07-02Bibliographically approved
List of papers
1. Comparison between colour-coded and spectral tissue Doppler measurements of systolic and diastolic myocardial velocities: effect of temporal filtering and offline gain setting
Open this publication in new window or tab >>Comparison between colour-coded and spectral tissue Doppler measurements of systolic and diastolic myocardial velocities: effect of temporal filtering and offline gain setting
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2009 (English)In: European Journal of Echocardiography, ISSN 1525-2167, E-ISSN 1532-2114, Vol. 10, no 3, 406-413 p.Article in journal (Refereed) Published
Abstract [en]

Colour tissue Doppler (TD) has been reported to underestimate the longitudinal myocardial motion velocities measured with spectral TD. This study evaluates the effect of temporal smoothing and offline gain settings on the results of velocity measurements with these two methods and the difference between them. In 57 patients, 2D data and left ventricular velocity profiles were acquired using spectral and colour TD for a subsequent offline analysis. Longitudinal myocardial velocities were measured at unsaturated, 50%-saturated and fully saturated gain, and before and after temporal smoothing using 30, 50, and 70 ms filters, respectively. Gain level and filter width altered significantly the measured velocities. Peak systolic and early diastolic velocities were significantly higher (P < 0.001) and E/E' ratio was significantly lower (P < 0.001) with spectral TD than with colour TD, although there was a good correlation between the results of both TD modalities. The differences between the methods increased at increasing filter width and gain level. Despite good correlation of the results, spectral TD produces significantly higher myocardial velocity values and lower E/E' ratio than colour TD modality. Increasing gain and temporal smoothing alter significantly the results of velocity measurements and accentuate the difference between the two TD methods.

Keyword
Spectral Doppler, Colour Doppler, Temporal filtering, Offline gain, Myocardial velocity, VENTRICULAR-FUNCTION, FILLING PRESSURES, ECHOCARDIOGRAPHY, WALL, ABNORMALITIES, INFARCTION, MOTION, RELAXATION, EJECTION, DISEASE
Identifiers
urn:nbn:se:kth:diva-13911 (URN)10.1093/ejechocard/jen298 (DOI)000264889300011 ()2-s2.0-64749091583 (Scopus ID)
Note
QC20100702Available from: 2010-07-02 Created: 2010-07-01 Last updated: 2010-07-02Bibliographically approved
2. Measurements of left ventricular myocardial longitudinal systolic displacement using spectral and colour tissue Doppler: time for a reassessment?
Open this publication in new window or tab >>Measurements of left ventricular myocardial longitudinal systolic displacement using spectral and colour tissue Doppler: time for a reassessment?
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2009 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, Vol. 7, 12- p.Article in journal (Refereed) Published
Abstract [en]

Background: Echocardiographic measurements of left ventricular (LV) myocardial displacement may produce different results depending on the choice of employed modality and subjective adjustments during data acquisition and analysis. Methods: In this study, left ventricular longitudinal systolic displacement was quantified in 57 patients (31 women and 26 men, 50 +/- 16 years) using colour (colour TD) and spectral tissue Doppler (spectral TD) before and after temporal filtering (30 to 70 milliseconds in 20-millisecond steps) and changed offline gain saturation (0%, 50% and 100%), respectively. The results were compared with those obtained with anatomic M-mode. Results: Whereas only minor differences occurred between the results of colour TD and anatomic M-mode measurements, spectral TD significantly overestimated the results obtained with both these methods. However, the limits of agreement between the results produced by all three studied methods were not clinically acceptable in any of the cases. The spectral TD displacement values increased along with increasing offline gain saturation whereas the effect of temporal filtering on colour Doppler measurements was insignificant. Conclusion: Measurements of LV myocardial longitudinal displacement employing spectral TD, colour TD or anatomic M-mode produce different results, thus discouraging interchangeable use of these modalities. Whereas the results of spectral TD measurements can be significantly altered by changing offline gain setting, the effect of temporal filtering on colour TD measurements is insignificant, a fact that increases clinical practicality of the latter method.

Keyword
ANATOMIC M-MODE, ATRIOVENTRICULAR PLANE DISPLACEMENT, CORONARY-ARTERY-DISEASE, MITRAL ANNULUS, QUANTITATIVE ASSESSMENT, IN-VITRO, ECHOCARDIOGRAPHY, MOTION, SONOMICROMETRY, VALVE
Identifiers
urn:nbn:se:kth:diva-13912 (URN)10.1186/1476-7120-7-12 (DOI)000264915600001 ()2-s2.0-63649109632 (Scopus ID)
Note
QC20100702Available from: 2010-07-02 Created: 2010-07-01 Last updated: 2011-03-22Bibliographically approved
3. Are measurements of systolic myocardial velocities and displacement with colour and spectral Tissue Doppler compatible?
Open this publication in new window or tab >>Are measurements of systolic myocardial velocities and displacement with colour and spectral Tissue Doppler compatible?
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2009 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, Vol. 7, 29- p.Article in journal (Refereed) Published
Abstract [en]

Background: Tissue Doppler (TD) in pulsed mode (spectral TD) and colour TD are the two modalities today available in tissue velocity echocardiography (TVE). Previous studies have shown poor agreement between these two methods when measuring myocardial velocities and displacement. In this study, the concordance between the myocardial velocity and displacement measurements using colour TD and different spectral TD procedures was evaluated. Methods: Left ventricular (LV) longitudinal systolic myocardial velocities and displacement during ejection period were quantified at the basal septal and lateral wall in 24 healthy individuals (4 women and 20 men, 34 +/- 12 years) using spectral TD, colour TD and M-mode recordings. Mean, maximal and minimal spectral TD systolic velocities and the corresponding displacement values were obtained by measurements at the outer and inner borders of the spectral velocity signal. The results were then compared with those obtained with the two other modalities used. Results: Systolic myocardial velocities derived from mean spectral TD frequencies were highly concordant with corresponding colour TD measurements (mean difference 0.10 +/- 0.54 cm/sec in septal and 0.09 +/- 0.97 cm/sec in lateral wall). Similarly, the agreement between spectral and colour TD (mean difference 0.22 +/- 0.74 mm in septal and 0.02 +/- 0.86 mm in lateral wall) as well as M-mode was good when mean spectral velocities were temporally integrated and the results did not differ statistically. Conversely, displacement values from the inner or outer border of the spectral signal differed significantly from values obtained with colour TD and M-mode (p < 0.001, in both cases). Conclusion: LV systolic myocardial measurements based on mean spectral TD frequencies are highly concordant with those provided by colour TD and M-mode. Hence, in order to maintain compatibility of the results, the use of this particular spectral TD procedure should be advocated in clinical praxis.

Keyword
LEFT-VENTRICULAR FUNCTION, M-MODE ECHOCARDIOGRAPHY, WALL-MOTION, IN-VIVO, ABNORMALITIES, FLOW, TIME
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:kth:diva-13910 (URN)10.1186/1476-7120-7-29 (DOI)000268488800001 ()2-s2.0-68349145988 (Scopus ID)
Note

QC20100702

Available from: 2010-07-02 Created: 2010-07-01 Last updated: 2014-09-22Bibliographically approved
4. The value of E/Em ratio in the estimation of left ventricular filling pressures: impact of acute hemodynamic load reduction
Open this publication in new window or tab >>The value of E/Em ratio in the estimation of left ventricular filling pressures: impact of acute hemodynamic load reduction
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(English)Manuscript (preprint) (Other academic)
Keyword
filling pressures, non-invasive, tissue dopplar, echocardiography
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-13914 (URN)
External cooperation:
Note

QC 20100702

Available from: 2010-07-02 Created: 2010-07-02 Last updated: 2016-09-05Bibliographically approved

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