Background - Myocardial longitudinal shortening play an important role in cardiac contraction. Tissue velocity imaging (TVI) is an ultrasonographic technique that measure myocardial motion and providing a quantitative agreement of left ventricular regional myocardial function in different modalities. The present review discusses the most recent development in the application of TDI in coronary artery disease.Methods - Seventy patients with myocardial infarction (transmural and nontransmural) were included in the study. These subjects were diagnosed with recent myocardial infarction according to electrocardiography, cardiac enzymes and history. The basal segments of septal wall (septal side of mitral annulus) and basal segment of base of RV free wall were examined for tissue Doppler study with complete transthoracic echocardiography study.Results - Mean age in group of inferior MI, anterior MI and non Q wave MI are as follows: 61.87±10.7, 57.04±10.7, 58.45±9.2. Sm was significantly reduced in anterior MI groups than non Q wave MI (PV=0.01).In patients with inferior myocardial infarction 88% of patients had left ventricular ejection fraction (LVEF)>45% and in patients with anterior MI 18.2% patients had EF>45%.In non Q wave MI groups 60% patients had LVEF>45%.Conclusion-Except for Sm, other TDI parameters had no significant difference between two groups (transmural and nontransmural infarction) but it has significant changes in reduced left ventricle function and could be of determinants for prognosis.

Background: The aim of this study was to echocardiographically assess the effects of EECP (Enhanced External Counterpulsation Therapy) therapy on systolic and diastolic cardiac function. Methods: LVEF (left ventricular ejection fraction), ESV (end-systolic volume), EDV (end-diastolic volume), Sm (myocardial systolic wave), Ea (myocardial early diastolic wave), Vp (propagation velocity), E/Ea (peak early diastolic transmitral flow velocity/Ea), E/Vp and diastolic function grade were studied in twenty-five patients before and after 35 hours of EECP. Results: EECP reduced ESV and EDV and increased EF significantly (p=0.018, 0.013, 0.002, respectively) in patients with baseline LVEF≤50%, but not in patients with baseline LVEF>50%. Patients with E/Ea≥14 had a significant reduction in EDV and ESV (p=0.038 and 0.32, respectively) and an increase in LVEF (p=0.007) after EECP, whereas patients with baseline E/Ea<14 had no significant change in these parameters. Similarly, EECP significantly improved ESV, EDV and LVEF (p=0.014, 0.032, 0.027 respectively) in patients with grades II and III of diastolic dysfunction (decreased compliance) at baseline, but not in patients with normal diastolic function or grade I diastolic dysfunction (impaired relaxation). Patients with Ea<7 cm/sec prior to EECP showed significant improvement in EDV, ESV and LVEF after therapy (p=0.024, 0.015, 0.001), while patients with Ea≥7cm/sec showed no significant change. Similarly, patients with Sm<7cm/sec prior to EECP showed significant improvement in EDV, ESV and LVEF after EECP (p=0.016, 0.017, 0.006), while patients with Sm ≥7cm/sec did not. Conclusion: These results provide new insight into the hemodynamic effectiveness and potential clinical applications of EECP.

Background: Neonatal period is the most critical stage in the life of newborn babies and neonatal sepsis is one of the most common causes for mortality at this age. Cardiovascular complications, myocyte damage and modification of cardiac blood flow induced by inflammatory mediators are among the consequences of neonatal sepsis on newborns. Nevertheless only a limited number of echocardiographic studies have been performed to investigate the pathologic effects of neonatal sepsis on heart. Tissue doppler echocardiography is a useful method for the assessment of regional heart systolic and diastolic functions. In this study, we aimed to determine the myocardial performance during neonatal sepsis by tissue echocardiography in term and preterm newborns.Methods: This study was a descriptive research and the information was collected through questionnaires and sampling on 61 preterm and term neonates. Tissue echocardiography (TDE) and doppler echocardiography were performed. TDE was done at the level of mitral and tricuspid valve annulus and intraventrivular septum level. The results were then statistically analyzed and evaluated. Findings: In this study, 30 neonates were term and the rest were preterm with the age of 1 to 9 days. We have not observed significant difference between the tissue echocardiographic indices of mitral and tricuspid valves and interventricular septum between healthy and septic newborns. Our results, however, revealed significant difference in A & E waves at the level of tricuspid and mitral valves between sepsis and none sepsis group (p<0.001).Conclusion: Doppler echocardiography is a useful tool to evaluate the myocardial function during neonatal sepsis. It is also possible to investigate the myocardial modifications during sepsis by Tissue Doppler Imaging (TDI).

Background: Patients with liver cirrhosis suffer from various cardiac abnormalities, which may influence their outcome. Tissue Doppler recording of the mitral and tricuspid annular diastolic velocities can be used to assess diastolic function accurately. There has been very little published information regarding RV diastolic function in liver cirrhosis. This study is aimed at evaluating right and left ventricular systolic and diastolic functions in post hepatitis C liver cirrhosis patients using conventional echocardiography and tissue Doppler imaging.Methods: This study was conducted on 75 adults from inpatient and outpatient services of the Theodor Bilharz Research Institute (TBRI) hospital. They were divided into two groups: Group 1 included 50 patients with post hepatitis C liver cirrhosis; and Group 2 included 25 normal adults serving as a control group. All patients and normal volunteers were subjected to clinical examination, laboratory evaluation, abdominal ultrasonography and echocardiographic studies with tissue Doppler imaging for evaluation of left and right ventricular systolic and diastolic functions.Results: The mitral flow showed significant increase in A wave velocity, as well as DT and IVRT with a significant decrease in E/A ratio in Group 1 compared to Group 2 (P<0.01). The tricuspid flow also showed a significant increase in A wave velocity (P<0.01) and DT (P<0.05) in addition to a significant decrease in E wave velocity and E/A ratio (P<0.01) in Group 1 as compared to Group 2. At the mitral annulus, we found a significant increase in average Aa velocity, E/Ea ratio and average systolic wave velocity S, in addition to a statistically significant decrease in the average Ea velocity and average Ea/Aa (P<0.01) in Group 1 as compared to Group 2. At the tricuspid annulus, there were significant increases in the average Aa velocity (P<0.01), S velocity (P<0.01) and E/Ea (P<0.05) together with a statistically significant decrease in the average Ea/Aa and average Ea velocity (P<0.01) in Group 1 compared to Group 2.Conclusion: It is important to evaluate the cardiovascular function in every patient with cirrhosis, especially if the patient is a candidate for any intervention that may affect haemodynamics.

Background: Left ventricular twist/torsion is believed to be a sensitive indicator of systolic and diastolic performance. To obtain circumferential rotation using tissue Doppler imaging, we need to estimate the time-varying radius of the left ventricle throughout the cardiac cycle to convert the tangential velocity into angular velocity.Objective: The aim of this study was to investigate accuracy of measured LV radius using tissue Doppler imaging throughout the cardiac cycle compared to two-dimensional (2D) imaging.Methods: A total of 35 subjects (47±12 years-old) underwent transthoracic echocardiographic standard examinations. Left ventricular radius during complete cardiac cycle measured using tissue Doppler and 2D-imaging at basal and apical short axis levels. For this reason, the 2D-images and velocity-time data derived and transferred to a personal computer for off-line analysis.2D image frames analyzed via a program written in the MATLAB software. Velocity-time data from anteroseptal at basal level (or anterior wall at apical level) and posterior walls transferred to a spreadsheet Excel program for the radius calculations. Linear correlation and Bland-Altman analysis were calculated to assess the relationships and agreements between the tissue Doppler and 2D-measured radii throughout the cardiac cycle.Results: There was significant correlation between tissue Doppler and 2D-measured radii and the Pearson correlation coefficients were 0.84 to 0.97 (P<0.05). Bland-Altman analysis by constructing the 95% limits of agreement showed that the good agreements existed between the two methods.Conclusion: It can be concluded from our experience that the tissue Doppler imaging can reasonably estimate radius of the left ventricle throughout the cardiac cycle.

Background: We sought to assess right ventricular (RV) systolic and diastolic functions via tissue Doppler imaging (TDI) in order to discriminate right-to-left (bidirectional) from left-to-right intracardiac shunts.Methods: A tissue Doppler velocity study via Doppler echocardiography was performed in 20 patients with left-to-right shunt (without evidence of significant pulmonary hypertension) and 20 patients with right-to-left shunt or bidirectional shunt (with significant pulmonary hypertension) or Eisenmenger΄s complex and 20 healthy subjects as the control group. RV myocardial performance index (MPI), S wave velocity, E wave velocity, isovolumic relaxation time (IVRT), and isovolumic contraction time (IVCT) from the lateral tricuspid annulus were measured using TDI.Results: In the patients with left-to-right shunt, the tissue Doppler parameters showed higher S-wave, peak systolic(Sa)/ early contraction(Ea) , Sa/IVRT, and Sa/IVCT values; and in the patients with right-to-left or bidirectional shunt tissue, the Doppler parameters showed higher MPI and MPI/Sa value with a high specificity and sensitivity.Conclusion: We conclude that an evaluation of MPI, S wave, E wave, IVRT, and IVCT via tissue Doppler echocardiography is a useful index for the discrimination of right-to-left from left-to-right and bidirectional intracardiac shunts.