title: Two-dimensional transesophageal echocardiographic characterization of ventricular filling in real time by acoustic quantification: comparison with pulsed Doppler echocardiography.
abstract: Little is known about the accuracy of acoustic quantification (AQ) in the assessment of left ventricular diastolic filling. Therefore the objective of this study was to determine the ability of AQ applied to two-dimensional echocardiography to characterize left ventricular diastolic filling compared with Doppler echocardiography. In 80 unselected patients, AQ of left ventricular diastolic filling was performed during two-dimensional transesophageal echocardiography. Pulsed Doppler transthoracic echocardiography was performed at the tips of the mitral valve leaflet and the mitral annulus level. In 53 patients with synchronous systolic wall motion, significant correlations were found between AQ-derived versus Doppler-derived indexes obtained from the level of the mitral annulus of peak rate of increase in left ventricular diastolic area versus peak early filling velocity (r = 0.78; p < 0.0001), peak early/peak atrial rate of change in left ventricular area ratio versus peak early/peak atrial filling velocity ratio (r = 0.80; p < 0.0001), and percent atrial contributions to filling (r = 0.80; p < 0.0001). Correlations between acceleration time and deceleration time derived by AQ versus Doppler echocardiography were poor. Acoustic quantification-derived acceleration and deceleration times significantly underestimated analogous times derived by Doppler echocardiography at the mitral annulus level. Correlations obtained between AQ-derived indexes and Doppler echocardiography were better with pulsed Doppler performed at the mitral annulus level compared with the leaflet tips. In 27 patients with asynchronous systolic wall motion, the correlations between AQ-derived indexes and Doppler-derived indexes of the relative distribution of filling were similar to those of the group of subjects with synchronous wall motion. However, in patients with asynchronous wall motion the correlations between indexes of peak early filling velocity and rate worsened. In addition, no correlations were found between acceleration and deceleration times derived by the two techniques in subjects with asynchronous systolic wall motion. Acoustic quantification assessment of left ventricular diastolic filling accurately characterizes the distribution of diastolic filling compared with Doppler echocardiography. The presence of asynchronous systolic wall motion decreases the accuracy of the AQ method in assessing peak filling rate. The ultimate clinical application of AQ in the assessment of left ventricular diastolic filling is yet to be determined but appears promising.
authors.affiliation: Division of Cardiology, University of Louisville, KY.
authors.forename: M F
authors.initials: MF
authors.lastname: Stoddard
authors.forename: D L
authors.initials: DL
authors.lastname: Keedy
authors.forename: R A
authors.initials: RA
authors.lastname: Longaker
mesh_terms: D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009862:Online Systems; D012815:Signal Processing, Computer-Assisted; D016277:Ventricular Function, Left / Q000502:physiology*