Skip to main content

The utility of newly derived Doppler echocardiographic variables in the diagnosis and management of patients with heart failure

Current Cardiology Reports volume 6, pages 217–224 (2004)Cite this article

Abstract

Doppler echocardiography, because of its noninvasive nature, is an ideal tool to evaluate patients with heart failure (HF), offering the potential to improve early identification and management of these patients. Although traditional Doppler indices have allowed characterization of diastolic filling abnormalities associated with various HF states, important limitations are recognized. More refined Doppler techniques such as analysis of color M-mode flow propagation velocity, tissue Doppler imaging, and strain parameters can add to the ability of the noninvasive laboratory to improve the identification and management of this group of patients. These newer techniques as well as the traditional Doppler assessment of transmitral left ventricular inflow and pulmonary venous inflow velocities are reviewed as methods to improve the diagnosis and management of patients with HF.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. 2002 Heart and Stroke Statistical Update. Dallas: American Heart Association; 2001.

  2. Levy D, Kenchiak S, Larson M, et al.: Long term trends in the incidence of and survival with heart failure. N Engl J Med 2002, 347:1397–1402.

    PubMed  Article  Google Scholar 

  3. Hunt SA, Baker DW, Chin MH, et al.: ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1995 guidelines for the evaluation and management of heart failure); http://www.acc.org/clinical/ guidelines/failure/hf_index.htm2001.

  4. Vasan RS, Benjami EJ, Levy D: Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995, 26:1565–1574.

    PubMed  Article  CAS  Google Scholar 

  5. Redfield MM, Jacobsen SJ, Burnett JC, et al.: Burden of systolic and diastolic ventricular dysfunction in the community. JAMA 2003, 289:194–202. Comprehensive assessment of a population-based cohort of both systolic and diastolic dysfunction and impact on patient survival.

    PubMed  Article  Google Scholar 

  6. Ishikura F, Redfield M: Doppler echocardiographic assessment of diastolic function in congestive heart failure: emphasis on clinical utility. Heart Fail 1998, 14:78–94.

    Google Scholar 

  7. Nishimura RA, Tajik AJ: Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta stone. J Am Coll Cardiol 1997, 30:8–18. Important article that reviews the pathophysiology of abnormalities of diastolic filling and associated Doppler patterns.

    PubMed  Article  CAS  Google Scholar 

  8. Oh JK, Appleton CP, Hatle LK, et al.: The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 1997, 10:246–270.

    PubMed  Article  CAS  Google Scholar 

  9. Nagueh SF, Zoghbi WA: Clinical assessment of LV diastolic filling by Doppler echocardiography. ACC Curr J Rev 2001:45–49.

  10. Garcia MJ, Thomas JD, Klein AL: New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998, 32:865–875.

    PubMed  Article  CAS  Google Scholar 

  11. Rakowski H, Appleton C, Chan K, et al.: Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography. J Am Soc Echocardiogr 1996, 9:736–760.

    PubMed  Article  CAS  Google Scholar 

  12. Pinamonti B, Lenarda AD, Sinagra G, et al.: Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by Doppler echocardiography: clinical, echocardiocardiographic and hemodynamic correlations and prognostic implications. J Am Coll Cardiol 1993, 22:808–815.

    PubMed  CAS  Article  Google Scholar 

  13. Giannuzzi P, Temporelli PL, Bosimini E, et al.: Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction. J Am Coll Cardiol 1996, 28:383–390.

    PubMed  CAS  Article  Google Scholar 

  14. Pinamonti B, Zecchin M, Lenarda AD, et al.: Persistence of restrictive left ventricular filling pattern in dilated cardiomyopathy: an ominous prognostic sign. J Am Coll Cardiol 1997, 29:604–601.

    PubMed  Article  CAS  Google Scholar 

  15. Temporelli PL, Corra U, Imparato A, et al.: Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure. J Am Coll Cardiol 1998, 31:1591–1597.

    PubMed  Article  CAS  Google Scholar 

  16. Hansen A, Haas M, Zugck C, et al.: Prognostic value of Doppler echocardiographic mitral inflow patterns: implications for risk stratification in patients with chronic congestive heart failure. J Am Coll Cardiol 2001, 37:1049–1055.

    PubMed  Article  CAS  Google Scholar 

  17. Rihal CS, Nishimura RA, Hatle LK, et al.: Systolic and diastolic dysfunction in patients with a clinical diagnosis of dilated cardiomyopathy. Circulation 1994, 90:2772–2779.

    PubMed  CAS  Google Scholar 

  18. Appleton CP, Hatle LK, Popp RI: Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1998, 12:426–440.

    Article  Google Scholar 

  19. Temporelli PL, Scapellato F, Corra U, et al.: Estimation of pulmonary wedge pressure by transmitral Doppler in patients with chronic heart failure and atrial fibrillation. Am J Cardiol 1999, 83:724–727.

    PubMed  Article  CAS  Google Scholar 

  20. Nakatani S, Yoshitomi H, Wada K, et al.: Noninvasive estimation of left ventricular end-diastolic pressure using transthoracic Doppler-determined pulmonary venous atrial flow reversal. Am J Cardiol 1994, 73:1017–1018.

    PubMed  Article  CAS  Google Scholar 

  21. Nishimura RA, Appleton CP, Redfield MM, et al.: Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol 1996, 28:1226–1233.

    PubMed  Article  CAS  Google Scholar 

  22. Yamamoto K, Nishimura RA, Burnett JC Jr., et al.: Assessment of left ventricular end-diastolic pressure by Doppler echocardiography: contribution of duration of pulmonary venous versus mitral flow velocity curves at atrial contraction. J Am Soc Echocardiogr 1997, 10:52–59.

    PubMed  Article  CAS  Google Scholar 

  23. Ommen SR, Nishimura RA, Appleton CP, et al.: Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures. Circulation 2000, 102:1788–1794.

    PubMed  CAS  Google Scholar 

  24. Takatsuji H, Mikami T, Urasawa K, et al.: A new approach for evaluation of left ventricular diastolic function spatial and temporal analysis of left ventricular filling flow propagation by color m-mode Doppler echocardiography. J Am Coll Cardiol 1996, 27:365–371.

    PubMed  Article  CAS  Google Scholar 

  25. Garcia MJ, Ares MA, Asher C, et al.: An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol 1997, 29:448–454.

    PubMed  Article  CAS  Google Scholar 

  26. Garcia MJ, Smedira NG, Greenberg NL, et al.: Color M-mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: animal and human validation. J Am Coll Cardiol 2000, 25:201–208.

    Article  Google Scholar 

  27. Firstenberg MS, Levine BD, Garcia MH, et al.: Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers. J Am Coll Cardiol 2000, 36:1664–1669.

    PubMed  Article  CAS  Google Scholar 

  28. Gonzalez-Vilchez F, Ares M, Ayuela J, et al.: Combined use of pulsed and color M-mode Doppler echocardiography for the estimation of pulmonary capillary wedge pressure: an empirical approach based on an analytical relation. J Am Coll Cardiol 1999, 34:515–523.

    PubMed  Article  CAS  Google Scholar 

  29. Ueno Y, Nakamura Y, Kinoshita M, et al.: Noninvasive estimation of pulmonary capillary wedge pressure by color M-mode Doppler echocardiography in patients with acute myocardial infarctionv. Echocardiography 2002, 19:95–102.

    PubMed  Article  Google Scholar 

  30. Møller JE, Sondergaar E, Seward JB, et al.: Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M mode Doppler echocardiography in first myocardial infarction. J Am Coll Cardiol 2000, 35:363–370.

    PubMed  Article  Google Scholar 

  31. De Sutter J, De Mey S, De Backer J, et al.: Diastolic dysfunction, infarct size, and exercise capacity in remote myocardial infarction: a combined approach of mitral E wave deceleration time and color M-mode flow propagation velocity. Am J Cardiol 2002, 89:593–595.

    PubMed  Article  Google Scholar 

  32. Mego DM, DeGeare VS, Nottestad SY, et al.: Variation of flow propagation velocity with age. J Am Soc Echocardiogr 1998, 11:20–25.

    PubMed  Article  CAS  Google Scholar 

  33. De Boeck BW, Cramer MH, Oh JK, et al.: Spectral pulsed tissue Doppler imaging in diastole: a tool to increase our insight in and assessment of diastolic relaxation of the left ventricle. Am Heart J 2003, 146:411–419.

    PubMed  Article  Google Scholar 

  34. Galiuto L, Ignone G, DeMaria AN: Contraction and relaxation velocities of the normal left ventricle using pulsed wave tissue Doppler echocardiography. Am J Cardiol 1998, 81:609–614.

    PubMed  Article  CAS  Google Scholar 

  35. Nagueh SF, Sun Huabin S, Kopelin HA, et al.: Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol 2001, 37:278–285.

    PubMed  Article  CAS  Google Scholar 

  36. Henein M, Lindqvist P, Francis D, et al.: Tissue Doppler analysis of age-dependency in diastolic ventricular behavior. Eur Heart J 2002, 23:162–171.

    PubMed  Article  CAS  Google Scholar 

  37. Tighe DA, Vinch CS, Hill JC, et al.: Influence of age on assessment of diastolic function by Doppler tissue imaging. Am J Cardiol 2003, 91:254–257.

    PubMed  Article  Google Scholar 

  38. Mungala VK, Jacobsen SJ, Mahoney DW, et al.: Association of newer diastolic function parameters with age in healthy subjects: a population-based study. J am Soc Echocardiogr 2003, 16:1049–1056.

    Article  Google Scholar 

  39. Rivas-Gotz C, Manolios M, Thohan V, et al.: Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol 2003, 91:780–784.

    PubMed  Article  Google Scholar 

  40. Nagueh SF, Mikati I, Kopelen HA, et al.: Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue Doppler imaging. Circulation 1998, 98:1644–1650.

    PubMed  CAS  Google Scholar 

  41. Wang M, Yip GW, Wang AY, et al.: Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol 2003, 41:820–826.

    PubMed  Article  Google Scholar 

  42. Richartz BM, Werner GS, Ferrari M, et al.: Comparison of left ventricular systolic and diastolic funtion in patients with idiopathic dilated cardiomyopathy and mild heart failure versus those with severe heart failure. Am J Cardiol 2002, 90:390–394.

    PubMed  Article  Google Scholar 

  43. Garcia MJ, Rodriguez L, Ares M, et al.: Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. J Am Coll Cardiol 1996, 27:108–114.

    PubMed  Article  CAS  Google Scholar 

  44. Rajagopalan N, Garcia MJ, Rodriguez L, et al.: Comparison of new Doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy. Am J Cardiol 2001, 87:86–94.

    PubMed  Article  CAS  Google Scholar 

  45. Abraham TP, Nishimura RA: Myocardial strain: can we finally measure contractility. J Am Coll Cardiol 2001, 37:731–734.

    PubMed  Article  CAS  Google Scholar 

  46. Edvardsen T, Skulstad H, Aakhus S, et al.: Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography. J Am Coll Cardiol 2001, 37:726–730.

    PubMed  Article  CAS  Google Scholar 

  47. Greenberg NL, Firstenberg MS, Castro PL, et al.: Dopplerderived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation 2002, 105:99–105.

    PubMed  Article  Google Scholar 

  48. Kukulski T, Jamal F, Herbots L, et al.: Identification of acutely ischemic myocardium using ultrasonic strain measurements. J Am Coll Cardiol 2003, 41:810–819.

    PubMed  Article  Google Scholar 

  49. Edvardsen T, Gerber B, Garot J, et al.: Quantitative assessment of intrinsic regional myocardial deformation by Doppler strain rate echocardiography in humans. Circulation 2002, 106:50–56. Clinical validation of Doppler echocardiography strain and strain rate imaging assessment of LV function when compared with tagged magnetic resonace imaging studies

    PubMed  Article  Google Scholar 

  50. Abraham TP, Nishimura RA, Holmes DR, et al.: Strain rate imaging for assessment of regional myocardial function. Results from a clinical model of septal ablation. Circulation 2002, 105:1403–1406.

    PubMed  Article  Google Scholar 

  51. Voight J, Exner B, Schmiedehausen K, et al.: Strain rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 2003, 107:2120–2126.

    Article  Google Scholar 

  52. Hoffman R, Altiok E, Nowak B, et al.: Strain rate measurement by Doppler echocardiography allows improved assessment of myocardial viability in patients with depressed left ventricular function. J Am Coll Cardiol 2002, 39:443–449.

    Article  Google Scholar 

  53. Abraham W, Fisher W, Smita A, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002, 346:1845–1853. Prospective randomized trial demonstrating that biventricular pacing in patients with LV dysfunction and intraventricular conduction delay improves functional status and HF symptoms.

    PubMed  Article  Google Scholar 

  54. Yu, C, Chau E, Sanderson JE, et al.: Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneous delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002, 105:438–445.

    PubMed  Article  Google Scholar 

  55. Sogaard P, Egeblad H, Kim WK, et al.: Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long term cardiac resynchronization therapy. J Am Coll Cardiol 2002, 40:723–730.

    PubMed  Article  Google Scholar 

  56. Breithardt A, Stellbrink C, Herbots L, et al.: Cardiac resynchronization therapy can reverse abnormal myocardial strain distribution in patients with heart failure and left bundle branch block. J Am Coll Cardiol 2003, 42:486–494.

    PubMed  Article  Google Scholar 

  57. Sogaard P, Egeblad H, Pedersen AK, et al.: Sequential versus simultaneous biventricular resynchronization for severe heart failure. Evaluation by tissue Doppler imaging. Circulation 2002, 106:2078–2084.

    PubMed  Article  Google Scholar 

  58. Ansalone G, Giannantoni P, Ricci R, et al.: Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing. J Am Coll Cardiol 2002, 39:489–499.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, 01655, Worcester, MA, USA

    Dennis A. Tighe MD, FACC

Authors
  1. Andrew D. Feingold MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dennis A. Tighe MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerard P. Aurigemma MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey C. Hill RDCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Craig S. Vinch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Feingold, A.D., Tighe, D.A., Aurigemma, G.P. et al. The utility of newly derived Doppler echocardiographic variables in the diagnosis and management of patients with heart failure. Curr Cardiol Rep 6, 217–224 (2004). https://doi.org/10.1007/s11886-004-0027-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-004-0027-6

Keywords

  • Pulmonary Vein
  • Cardiac Resynchronization Therapy
  • Pulmonary Capillary Wedge Pressure
  • Tissue Doppler Imaging
  • Doppler Echocardiography