Use of M-Mode Echocardiography in Clinical Pharmacology

  • D. G. Gibson


M-mode echocardiography is a method of using pulsed ultrasound to detect the position and movement of intracardiac structures. The technique itself, and its use in the study of left ventricular disease has been described in a number of recent monographs and reviews (Feigenbaum, 1976; Roelandt, 1977; Mason and Fortuin, 1978). It allows a number of aspects of left ventricular function to be studied. Of these, the simplest is the measurement of the transverse dimension of the left ventricular cavity at the level of the mitral valve apparatus. The technique has considerable potential advantages for clinical pharmacological studies in that it is non-invasive, has a repetition rate of 1000/s, compared with 50/s for angiography, or even less for nuclear methods. It shows endo- and epicardial surfaces of the posterior left ventricular wall unequivocally throughout the cardiac cycle, and allows septal movement to be studied. In addition, it is totally safe, so that it can be used on normal volunteers. Performing echocardiography, however, is difficult, and at least 6 months’ practice is likely to be required before records of adequate technical quality are obtained.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. AWAN, N.A., MILLER, R.R. & MASON, D.T. (1978). Comparison of the effects of nitroprusside and prazosin on left ventricular function and the peripheral circulation in chronic refractory heart failure. Circulation, 57, 152–159.PubMedCrossRefGoogle Scholar
  2. BRENNER, J.T. & WAUGH, R.A. (1978). Effect of phasic respiration on left ventricular dimensions and performance in a normal population. An echocardiographic study. Circulation, 57, 122–127.PubMedCrossRefGoogle Scholar
  3. BURGGRAF, W. & PARKER, J.O. (1974). Left ventricular volume changes after amyl nitrite and nitroglycerin in man, as measured by ultrasound. Circulation, 49, 136–143.PubMedCrossRefGoogle Scholar
  4. BAKER, D.W. (1978). The present role of Doppler techniques in cardiac diagnosis. Progress in Cardiovascular Diseases, 21, 79.PubMedCrossRefGoogle Scholar
  5. COOPER, R., KARLINER, J.S., O’ROURKE, R.A. (1971). Ultrasound determination of mean fiber shortening rate in man. Am. J. Cardiol., 29, 257.CrossRefGoogle Scholar
  6. CRAWFORD, M.H., KARLINER, J.S. & O’ROURKE, R.A. (1976). Favorable effects of oral maintenance digoxin therapy on left ventricular performance in normal subjects. An echocardiographic study. Am. J. Cardiol., 38, 843–847.PubMedCrossRefGoogle Scholar
  7. CRAWFORD, M.H., O’ROURKE, R.A., GARZA, G. & KARLINER, J.S. (1975). Oral propranolol, effects on left ventricular function in normal subjects (abstract). Circulation, 52, II – 172.Google Scholar
  8. DELGADO, C.E., FORTUIN, N.J. & ROSS R.S. (1975). Acute effects of low doses of alcohol on left ventricular function by echocardiography. Circulation, 51, 535–540.PubMedCrossRefGoogle Scholar
  9. DEMARIA, A.N., VISMARA, L.A., AUDITORE, K. & AMSTERDAM, E.A., ZELIS R. & MASON D.T. (1974). Effects of nitroglycerin on left ventricular cavitary size and cardiac performance determined by ultrasound in man. Am. J. Med., 57, 754–760.PubMedCrossRefGoogle Scholar
  10. DUMESNIL, J.G., RITMAN, E.L. & FRYE, R.L. (1974). Quantitative determination of regional left ventricular wall dynamics by Roentgen videometry. Circulation, 50, 700–708.PubMedCrossRefGoogle Scholar
  11. FEIGENBAUM, H., POPP, R.L., WOLFE, S.B., TROY, B.L., POMBO, J.F., HAINE, C.L. & DODGE, H.T. (1972). Ultra-sound measurements of the left ventricle. A correlative study with angiography. Arch. int. Med., 129, 461–467.CrossRefGoogle Scholar
  12. FEIGENBAUM, H. (1976). Echocardiography. New York: Lea and Feabiger.Google Scholar
  13. FORTUIN, N.J., HOOD, W.P., SHERMAN, M.E. & CRAIGE, E. (1971). Determination of left ventricular volumes by ultrasound. Circulation, 44, 575–584.CrossRefGoogle Scholar
  14. FRISHMAN, W., SMITHEN, C., BEFLER, C., KLIGFIELD, J. & KILLIP, T. (1975). Noninvasive assessment of clinical response to oral propranolol therapy. Am. J. Cardiol., 35, 635–644.PubMedCrossRefGoogle Scholar
  15. GIBSON, D.G. (1973). Estimation of left ventricular size by echocardiography. Br. Heart J. 35, 128–134.PubMedCentralPubMedCrossRefGoogle Scholar
  16. GIBSON, D.G., DORAN, J.H., TRAILL, T.A. & BROWN, D.J. (1978). Regional abnormalities of left ventricular wall movement during isovolumic relaxation in patients with ischemic heart disease. Eur. J. Cardiol., 7, Suppl. 251–264.PubMedGoogle Scholar
  17. GOMES J.A., CALDERON, J., ZAMAN, Q., MARINO, N.D. & FRIEDMAN, H.S. (1975). Improvement in cardiac performance after maintenance digoxin in alcoholic cardiomyopathy. Circulation, (abstract) 52, II - 49.Google Scholar
  18. GOMES, J.A.C., CARAMBAS, C.R. & MORAN, H. (1978). The effect of isorbide dinitrate on left ventricular size, wall stress and left ventricular function in chronic refractory heart failure. Am.J. Med., 65, 794–802.PubMedCrossRefGoogle Scholar
  19. GORWIT, J., CRAWFORD, M., KARLINER, J.S. & O’ROURKE, R.A. (1975). Echocardiographic assessment of left ventricular performance in normal subjects receiving quinidine (abstract). Circulation, 52, 11–191.Google Scholar
  20. HARDARSON, T. & WRIGHT, K.E. (1976). Effect of sublingual nitroglycerin on cardiac performance in patients with coronary artery disease and non-dyskinetic left ventricular contraction. Br. Heart J., 38, 1272–1277.PubMedCentralPubMedCrossRefGoogle Scholar
  21. HARDARSON, T., HENNING, H. & O’ROURKE, R.A. (1977). Prolonged salutary effects of isorbide dinitrate and nitroglycerin ointment on regional left ventricular function. Am. J. Cardiol., 40, 90–98.PubMedCrossRefGoogle Scholar
  22. HIRSCHLEIFER, J., CRAWFORD, M., O’ROURKE, R.A. & KARLINER, J.S. (1975). Influence of acute alterations of heart rate and systemic arterial pressure on echocardiographic measurements of left ventricular performance in human subjects. Circulation 52, 835–841.CrossRefGoogle Scholar
  23. KISSLO, J.A., ROBERTSON, D., GILBERT, B.W., VON RAMM, O. & BEHAR, V.S. (1977). A comparison of real-time two dimensional echocardiography and cineangiography in detecting left ventricular asynergy. Circulation, 55, 134–141.PubMedCrossRefGoogle Scholar
  24. LEWIS, R.P. & S&LER, H. (1971). Relationship between changes in left ventricular dimensions and ejection fraction in man. Circulation, 44, 548–557.PubMedCrossRefGoogle Scholar
  25. LINHART, J.W., MINTZ, G.S., SEGAL, B.L., KAWAI, N. & KOTLER, M.N. (1975). Left ventricular volume measurement by echocardiography: fact or fiction? Am. J. Cardiol., 36, 114–118.PubMedCrossRefGoogle Scholar
  26. MASON, S.J. & FORTUIN, N.J. (1978). The use of echocardiography for the quantitative evaluation of left ventricular function. Progress in Cardiovascular Diseases, 21, 119–132.PubMedCrossRefGoogle Scholar
  27. MIRSKY, I. (1974). Review of various theories for the evaluation of left ventricular wall stresses. In Cardiac Mechanics, eds Mirsky, I., Ghista, D.N. and Sandler, H., p. 388. New York: John Wiley and Sons.Google Scholar
  28. POMBO, J.E., TROY, B.L. & RUSSELL, R.O. (1971). Left ventricular volumes and ejection fraction by echocardiography. Circulation, 43, 480–490.PubMedCrossRefGoogle Scholar
  29. POPP, R.L., FILLY, K., BROWN, O.R. & HARRISON, D.C. (1975). Effect of transducer placement on echocardiographic measurements of left ventricular dimension. Am. J. Cardiol., 35, 537–540.PubMedCrossRefGoogle Scholar
  30. QUINONES, M.A., GAASCH, W.H., COLE, J.S. & ALEX&ER, J.K. (1975). Echocardiographic determination of left ventricular stress-velocity relations in man. Circulation 51, 689–700.PubMedCrossRefGoogle Scholar
  31. REDWOOD, D.R., HENRY, W.L. & EPSTEIN, S.E. (1974). Evaluation of the ability of echocardiography to measure acute alterations in left ventricular volume. Circulation 50, 901–904.PubMedCrossRefGoogle Scholar
  32. ROEL&T, J., KLOSTER, F.E., TEN CATE, F.J., VAN DORP, W.G., HONKOOP, J., BOM, N. & HUGENHOLTZ, P.G. (1974). Multidimensional echocardiography. An appraisal of its clinical usefulness. Br. Heart J., 36, 29–43.PubMedCentralPubMedCrossRefGoogle Scholar
  33. ROEL&T, J. (1977). Echocardiology. Forest Grove, Oregon: Research Studies Press.Google Scholar
  34. ROEL&T, J., VAN DORP, W.G., BOM, N., LAIRD, J.D. & HUGENHOLTZ, P.G. (1975). Resolution problems in echocardiology: a source of interpretation errors. Am. J. Cardiol., 37, 256–262.CrossRefGoogle Scholar
  35. SAENZ DE LA CALZADA, C., ZIADY, G.M., HARDARSON, T., CURIEL, R. & GOODWIN, J.F. (1976). Effect of acute administration of propranolol on ventricular function in hypertrophic obstructive cardiomyopathy. Br. Heart J., 38, 798–803.CrossRefGoogle Scholar
  36. SJOGREN, A.L., HYTONEN, I. & FRICK, M.H. (1970). Ultrasonic measurement of left ventricular wall thickness. Chest, 57, 37–40.PubMedCrossRefGoogle Scholar
  37. STEFADOURAS, M.A. & CANEDO, M.L. (1977). Reproducibility of echocardiographic measurements of left ventricular dimensions. Br. Heart J., 39, 390–398.CrossRefGoogle Scholar
  38. TEICHOLZ, L.E., KREULEN, T., HERMAN, M.V. & GORLIN, R. (1976). Problems in echocardiographic volume determinations. Echocardiographic: angiographic correlations in the presence and absence of asynergy. Am. J. Cardiol., 37, 7–11.CrossRefGoogle Scholar
  39. TRAILL, T. A. & GIBSON, D.G. (1979). Study of left ventricular relaxation and filling by echocardiography. In Progress in Cardiology eds Goodwin, J. and Yu, P. (in press).Google Scholar
  40. TROY, B.L., POMBO, J. & RACKLEY, C.E. (1972). Measurement of left ventricular wall thickness and mass by echocardiography. Circulation, 40, 602–611.CrossRefGoogle Scholar
  41. UPTON, M.T. & GIBSON, D.G. (1978). Study of left ventricular function from digitized echocardiograms. Progress in Cardiovascular Diseases, 20, 359–384.PubMedCrossRefGoogle Scholar
  42. WELLS, P.T.N. (1969). Physical principles of ultrasonic diagnosis. London: Academic Press.Google Scholar
  43. WEYMAN, A.E., PESKOE, S.M., W ILLIAMS, E.S., DILLON, J.C. & FEIGENBAUM, H. (1976). Detection of left ventricular aneurysms by cross sectional echocardiography. Circulation 54, 936–944.PubMedCrossRefGoogle Scholar
  44. WINKLE, R.A., GOODMAN, D.J. & POPP, R.L. (1976). Echocardiographic evaluation of propranolol therapy for mitral valve prolapse. Br. Heart J. 38, 129–134.PubMedCentralPubMedCrossRefGoogle Scholar
  45. YIN, F.C.P., RAIZES, G.S. & GUARNIERI, T. (1978). Age-associated decrease in ventricular reponse to haemodynamic stress during beta adrenergic blockade. Br. Heart J.40, 1349–1355.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Limited 1980

Authors and Affiliations

  • D. G. Gibson
    • 1
  1. 1.Brompton HospitalLondonUK

Personalised recommendations