title: Assessment of left ventricular ejection fraction using long-axis systolic function is independent of image quality: a study of tissue Doppler imaging and m-mode echocardiography.
abstract: BACKGROUND
  Quantitative assessment of left ventricular ejection fraction (LVEF) is technically difficult in patients with poor image quality (IQ). Mitral annulus velocity assessed by pulsed tissue Doppler imaging (TDI) and mitral annulus motion assessed by M-mode echocardiography has been shown to correlate with LVEF. Furthermore, mitral annulus sites are easy to identify even in patients with poor IQ. The purpose of this study was to determine whether these methods are useful for estimating LVEF in patients with poor IQ.
  
  
  METHODS
  One hundred ten patients underwent TDI and M-mode echocardiography simultaneously. Mitral annulus velocity and mitral annulus motion were obtained from each of the four mitral annulus sites. Mean mitral annular peak systolic velocities (Sm) and mean mitral annular motions (MAM) were calculated by averaging at each site. IQ was defined according to a previous report.
  
  
  RESULTS
  Both Sm and MAM were successfully measured in all patients. Mean Sm and mean MAM correlated with LVEF. These correlations were observed not only in patients with good IQ (p < 0.001, r = 0.61 for mean Sm; p < 0.001, r = 0.61 for mean MAM) or fair IQ (p < 0.001, r = 0.58 for mean Sm; p < 0.001, r = 0.68 for mean MAM) but also in patients with poor IQ (p < 0.05, r = 0.42 for mean Sm, p < 0.001, r = 0.61 for mean MAM). Using optimal cutoff values of mean Sm and mean MAM in each IQ group, sensitivity and specificity for identifying LVEF < 50% were comparable among three IQ groups.
  
  
  CONCLUSIONS
  Assessment of long-axis systolic function by TDI and M-mode echocardiography enables estimation of LVEF even in patients with poor IQ.
authors.affiliation: Department of Diagnostic Ultrasound and Medical Electronics, Sapporo Medical University School of Medicine, Sapporo, Japan. yuda@sapmed.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yuda
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Inaba
authors.forename: Sakiko
authors.initials: S
authors.lastname: Fujii
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kokubu
authors.forename: Takuji
authors.initials: T
authors.lastname: Yoshioka
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Sakurai
authors.forename: Kimio
authors.initials: K
authors.lastname: Nishizato
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Fujii
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Kikuya
authors.initials: K
authors.lastname: Uno
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nakata
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Miura
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Natori
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimamoto
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D004452:Echocardiography; D015150:Echocardiography, Doppler; D018619:Echocardiography, Doppler, Pulsed; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D015588:Observer Variation; D015203:Reproducibility of Results; D012107:Research Design; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013599:Systole; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left