The Tissue Doppler Imaging Derived Post- Systolic Velocity Notch Originates at the Aortic Annulus
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: A distinct velocity pattern represented by a “notch” is observed during the time interval between the end of thesystolic and the onset of the early diastolic velocity wave on longitudinal myocardial velocity curve. The origin of the post-systolicvelocity notch (PSN) has not been resolved. Methods: The high frame rate color tissue Doppler imaging of the apical longitudinal axis was performed in 32 healthysubjects. Results: The time delays of the PSN onset at the posterior aortic wall (AW), the mid anteroseptal wall (MAS) and theposterior mitral annulus (MA) relatively to the anterior aortic annulus (AA) were found to be significantly longer than zero (5.1 ±2.2, 6.0 ± 2.3, 6.8 ± 2.8 ms; p < 0.001). The amplitude was the highest at the AA when compared to the AW, the MAS and theMA (4.77 ± 1.28 vs. 2.88 ± 1.11, 2.15 ± 0.73, 2.44 ± 1.17 cm/s; p < 0.001). A second PSN spike was identifiable in 10/32(31%) of the studied subjects at the AA. Of these, 9 (28%) exhibited a second PSN spike at the AW, 3 (9%) at the MAS and noone at the MA. Conclusion: The AA represents the site of the earliest onset and maximal amplitude of the PSN on the longitudinal velocitycurve suggesting its mechanism to be that of an energy release at the instant of the aortic valve closure causing an apicallydirected acceleration of the myocardium. A substantial number of healthy subjects exhibit a second PSN spike predominantly atthe level of the AA. Its mechanism remains to be elucidated.
Abstract
Background: A distinct velocity pattern represented by a “notch” is observed during the time interval between the end of thesystolic and the onset of the early diastolic velocity wave on longitudinal myocardial velocity curve. The origin of the post-systolicvelocity notch (PSN) has not been resolved. Methods: The high frame rate color tissue Doppler imaging of the apical longitudinal axis was performed in 32 healthysubjects. Results: The time delays of the PSN onset at the posterior aortic wall (AW), the mid anteroseptal wall (MAS) and theposterior mitral annulus (MA) relatively to the anterior aortic annulus (AA) were found to be significantly longer than zero (5.1 ±2.2, 6.0 ± 2.3, 6.8 ± 2.8 ms; p < 0.001). The amplitude was the highest at the AA when compared to the AW, the MAS and theMA (4.77 ± 1.28 vs. 2.88 ± 1.11, 2.15 ± 0.73, 2.44 ± 1.17 cm/s; p < 0.001). A second PSN spike was identifiable in 10/32(31%) of the studied subjects at the AA. Of these, 9 (28%) exhibited a second PSN spike at the AW, 3 (9%) at the MAS and noone at the MA. Conclusion: The AA represents the site of the earliest onset and maximal amplitude of the PSN on the longitudinal velocitycurve suggesting its mechanism to be that of an energy release at the instant of the aortic valve closure causing an apicallydirected acceleration of the myocardium. A substantial number of healthy subjects exhibit a second PSN spike predominantly atthe level of the AA. Its mechanism remains to be elucidated.
참고문헌 (24)
- Isaaz K, "Quantitation of the motion of the cardiac base in normal subjects by Doppler echocardiography", J Am Soc Echocardiogr, 6, pp.166~176 (1993)
- Pai RG, "Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities: I. Their normal pattern and coupling to ventricular filling and ejection", J Am Soc Echocardiogr, 11, pp.105~111 (1998)
- Lind B, "Left ventricular isovolumic velocity and duration variables calculated from colour-coded myocardial velocity images in normal individuals", Eur J Echocardiogr, 5, pp.284~293 (2004)
- Remme EW, "Mechanisms of preejection and postejection velocity spikes in left ventricular myocardium : interaction between wall deformation and valve events", Circulation, 118, pp.373~380 (2008)
- Kanai H, "Myocardial rapid velocity distribution", Ultrasound Med Biol, 27, pp.481~498 (2001)
- Terkelsen CJ, "Does postsystolic motion or shortening predict recovery of myocardial function after primary percutanous coronary intervention?", J Am Soc Echocardiogr, 20, pp.505~511 (2007)
- Citro R, "Myocardial postsystolic motion in ischemic and not ischemic myocardium : the clinical value of tissue Doppler", Echocardiography, 22, pp.525~532 (2005)
- Galderisi M, "Tissue Doppler-derived postsystolic motion in a patient with left bundle branch block : a sign of myocardial wall asynchrony", Echocardiography, 19, pp.79~81 (2002)
- Fraser AG, "Feasibility and reproducibility of off-line tissue Doppler measurement of regional myocardial function during dobutamine stress echocardiography", Eur J Echocardiogr, 4, pp.43~53 (2003)
- Ring M, "Post-systolic motion in patients with heart failure--a marker of left ventricular dyssynchrony?", Eur J Echocardiogr, 8, pp.352~359 (2007)
- Badran HM, "Tissue velocity imaging with dobutamine stress echocardiography--a quantitative technique for identification of coronary artery disease in patients with left bundle branch block", J Am Soc Echocardiogr, 20, pp.820~831 (2007)
- Celutkiene J, "Is post-systolic motion the optimal ultrasound parameter to detect induced ischaemia during dobutamine stress echocardiography?", Eur Heart J, 25, pp.932~942 (2004)
- Garcia MJ, "Myocardial wall velocity assessment by pulsed Doppler tissue imaging : characteristic findings in normal subjects", Am Heart J, 132, pp.648~656 (1996)
- Sengupta PP, "Biphasic tissue Doppler waveforms during isovolumic phases are associated with asynchronous deformation of subendocardial and subepicardial layers", J Appl Physiol, 99, pp.1104~1111 (2005)
- Remme EW, "Response to letter regarding article, “Mechanisms of preejection and postejection velocity spikes in left ventricular myocardium: interaction between wall deformation and valve events”", Circulation, 119, pp.e205~ (2009)
- Van Steenhoven AA, "In vivo cinematographic analysis of behavior of the aortic valve", Am J Physiol, 240, pp.H286~H292 (1981)
- Smith D, "Influence of the aortic component of the second heart sound on left ventricular maximal negative dP", dt in the dog, 1985, pp.55, 205~209
- Bogren HG, "Blood flow measurements in the aorta and major arteries with MR velocity mapping", J Magn Reson Imaging, 4, pp.119~130 (1994)
- Bogren HG, "elderly normal subjects", J Magn Reson Imaging, 10, pp.861~869 (1999)
- Aase SA, "Aortic valve closure : relation to tissue velocities by Doppler and speckle tracking in normal subjects", Eur J Echocardiogr, 9, pp.555~559 (2008)
- Oh JK, "The return of cardiac time intervals : the phoenix is rising", J Am Coll Cardiol, 42, pp.1471~1474 (2003)
- Weidemann F, "A new tool to assess regional inhomogeneity in cardiac function", Basic Res Cardiol, 96, pp.595~605 (2001)
- Aase SA, "Automatic timing of aortic valve closure in apical tissue Doppler images", Ultrasound Med Biol, 32, pp.19~27 (2006)
- Aase SA, "Aortic valve closure : relation to tissue velocities by Doppler and speckle tracking in patients with infarction and at high heart rates", Echocardiography, 27, pp.363~369 (2010)