title: Quantitative assessment of alterations in regional left ventricular contractility with color-coded tissue Doppler echocardiography. Comparison with sonomicrometry and pressure-volume relations.
abstract: BACKGROUND
  Tissue Doppler imaging (TDI) is a novel method of color-coding myocardial velocity on-line. The objective of the present study was to evaluate endocardial velocity with TDI as a method of objectively quantifying alterations in regional contractility over a wide range induced by inotropic modulation.
  
  
  RESULTS
  Myocardial length crystals were used to simultaneously assess regional left ventricular (LV) function, and high-fidelity pressure and conductance catheters were used to assess global LV contractility by pressure-volume relations in nine open-chest dogs. Mid-LV M-mode and two-dimensional color TDI images were recorded during control and inotropic modulation stages with dobutamine and esmolol. Predicted significant increases in TDI indices occurred with dobutamine: peak systolic velocity of 4.41 +/- 1.07 to 6.67 +/- 1.07 cm/s*, systolic time-velocity integral (TVI) of 0.43 +/- 0.12 to 0.62 +/- 0.10 cm*, and diastolic TVI of 0.49 +/- 0.11 to 0.71 +/- 0.17 cm*. Opposing significant decreases occurred with esmolol: peak systolic velocity of 4.46 +/- 0.94 to 2.31 +/- 0.81 cm/s*, systolic TVI of 0.47 +/- 0.12 to 0.19 +/- 0.11 cm*, and diastolic TVI of 0.55 +/- 0.11 to 0.33 +/- 0.11 cm* (*all P < .001 versus control). Changes in TDI peak systolic velocity were correlated with changes in fractional shortening (r = .88) and shortening velocity (r = .87) by sonomicrometry. Changes in TDI peak velocity from multiple mid-LV sites also correlated significantly with maximal elastance (r = .85 +/- .04) from pressure-volume relations.
  
  
  CONCLUSIONS
  TDI measures reflect directional and incremental alterations in regional and global LV contractility and have the potential to quantify regional LV function.
authors.affiliation: Division of Cardiology, University of Pittsburgh (Pa), USA. gorcsan@a1.isd.upmc.edu
authors.forename: J
authors.initials: J
authors.lastname: Gorcsan
authors.forename: D P
authors.initials: DP
authors.lastname: Strum
authors.forename: W A
authors.initials: WA
authors.lastname: Mandarino
authors.forename: V K
authors.initials: VK
authors.lastname: Gulati
authors.forename: M R
authors.initials: MR
authors.lastname: Pinsky
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000818:Animals; D001794:Blood Pressure; D001810:Blood Volume; D002316:Cardiotonic Agents / Q000494:pharmacology; D004280:Dobutamine / Q000494:pharmacology; D004285:Dogs; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D004699:Endocardium / Q000502:physiology; D009200:Myocardial Contraction; D011412:Propanolamines / Q000494:pharmacology; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D011412:Propanolamines; D004280:Dobutamine; C036604:esmolol