Key result
Tissue Doppler imaging showed reduced systolic velocities in all CHF patients compared to controls, with IVRT and S peak accurately identifying CHF with preserved ejection fraction (AUC 0.93 and 0.89).
Why the study?
Does Tissue Doppler imaging identify systolic impairment in patients with diastolic heart failure?
Cross-Sectional (n=178)
Does Tissue Doppler imaging identify systolic impairment in patients with diastolic heart failure?
Tissue Doppler imaging demonstrates that left ventricular systolic function is impaired even in patients with diastolic heart failure, with S peak and IVRT being useful diagnostic parameters.
Answers are grounded in this paper and cite their sources.
TDI suggests systolic impairment in HFpEF; leaves open diagnostic adoption pending prospective validation.
Background: Tissue Doppler imaging (TDI) is a new tool in the evaluation of the systolic and diastolic function. We sought to compare TDI findings in patients with chronic heart failure (CHF) due to systolic and diastolic dysfunction as well as to assess its usefulness for diagnosing diastolic CHF. Methods and Results: One hundred and ten outpatients with CHF and 68 controls were prospectively included. Ejection fraction (EF) was obtained by two‐dimensional echocardiography and systolic and diastolic wall motion velocities were recorded for basal septum. Patients without CHF were classified as Group A (controls); those with CHF were classified according to EF in Group B1: > 45% and B2: £ 45%. In groups A, B1, and B2 the mean peak S was 7.74; 5.45 and 4.89 cm/sec (p < 0.001); the mean peak E was 8.56; 5.72, and 6.1 cm/sec (p < 0.001); and the mean A peak was 10.2; 7.3 and 5.3 cm/sec (p < 0.001). Control and CHF groups were different in all terms except E/A ratio (p = 0.001), the E peak and IVRT among groups with CHF were comparable (p = ns). The most useful parameters for identifying diastolic CHF were IVRT and S peak, with area under ROC curves of 0.93 and 0.89. The cut‐off of 115 msec for IVRT and 5.8 cm/sec for S peak showed a sensitivity of 94% and 97%, with a specificity of 82% and 73%, respectively. Parameter Group A (n = 68) Group B1 (n = 37) Group B2 (n = 73) p value EF (%) 66.1 ± 7.9 57 ± 7.8 28.8 ± 9.7 0.001 E peak 8.56 ± 2.4 5.72 ± 2.2 6.1 ± 1.9 0.001 A peak 10.2 ± 1.9 7.3 ± 2.9 5.3 ± 2.8 0.001 S peak 7.74 ± 1.4 5.45 ± 1.6 4.89 ± 1.2 0.001 E/A ratio 0.87 ± 0.3 0.96 ± 0.6 1.7 ± 1.5 0.001 IVTR 98 ± 26 166 ± 38 153 ± 42 0.001 IVTC 67 ± 18 110 ± 34 132 ± 47 0.001 Conclusion: TDI velocities were reduced in CHF compared with normal subjects, there were not differences among CHF with preserved or reduced EF in E peak and IVRT. In addition, the systolic velocity as well as IVRT were useful to diagnose CHF with preserved EF. These findings suggest that impairment of left ventricular systolic function is present even in those with diastolic heart failure, and that abnormalities may have an important role to identify that condition.
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García et al. (2004) conducted a cross-sectional in Chronic heart failure (n=178). Chronic heart failure vs. Controls without chronic heart failure was evaluated on Systolic and diastolic wall motion velocities (S peak, E peak, A peak, IVRT) (p=<0.001). Tissue Doppler imaging showed reduced systolic velocities in all CHF patients compared to controls, with IVRT and S peak accurately identifying CHF with preserved ejection fraction (AUC 0.93 and 0.89).
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