Doppler tissue imaging in congestive heart failure patients due to diastolic or systolic dysfunction: a comparison with Doppler echocardiography and the atrio-ventricular plane displacement technique

Background: Doppler tissue imaging (DTI) is an echocardiographic technique by which regional contractility, relaxation properties and time intervals are obtained easily. DTI has been reported to be relatively pre-load independent and could, in comparison with the commonly used mitral pulse wave Doppler (MPWD) method, be of clinical interest for identification of patients with diastolic dysfunction. The atrio-ventricular plane displacement (AVPD) method is an established technique to assess left ventricular systolic function. Aims: To determine the pulsed Doppler DTI-pattern in patients with heart failure and to examine whether it has a similar capacity as MPWD and AVPD to diagnose diastolic dysfunction. Methods: We studied 15 controls without congestive heart failure (CHF), 15 patients with diastolic (EF > 45% + CHF) and 15 patients with systolic (EF < 35% + CHF) left ventricular dysfunction and CHF. Results: The DTI maximal velocities during systole (s), early filling wave (e) and atrial filling wave (a), decrease with reduced left Ventricular ejection fraction, r = 0.75, r = 0.56 and r = 0.66 (P < 0.001) and regional isovolumetric contraction and intraventricular relaxation time measured by DTI are prolonged, r = 0.59 and r = 0.73, respectively (P < 0.001). The 15 patients with diastolic heart failure were identified by MPWD or DTI but only 11 by AVPD with 8, 10 and 9 false-positive, respectively (P < 0.01, P < 0.05 and NS). Conclusions: Regional DTI show a consistent pattern in patients with left ventricular dysfunction and heart failure. Regional DTI has similar accuracy as MPWD in identifying diastolic heart failure patients and is superior to the AVPD technique. DTI may be a useful diagnostic tool in diastolic heart failure patients. (C) 2000 European Society of Cardiology. All rights reserved.