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KMID : 0385920070180040313
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Journal of the Korean Society of Emergency Medicine
2007 Volume.18 No. 4 p.313 ~ p.319
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Evaluation of Left Ventricular Systolic Function by Tissue Doppler Imaging
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Lee Young-Joo
Baek Kwang-Je
Lee Kyeong-Ryong
Hong Dae-Young
Kim Jin-Yong
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Abstract
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Purpose: Accurate determination of left ventricular ejection fraction (LVEF) is important in the emergency management of patients with cardiovascular disease. In 10% to 20% of patients, LVEF cannot be accurately determined by 2D echocardiography because of suboptimal endocardial definition on fundamental imaging. Measurement of mitral
annular velocity is advantageous because it is not dependent on endocardial definition.
Methods: One hundred fifty-four consecutive patients with acute dyspnea who visited our emergency medical center from September 2005 to March 2007 were prospectively recruited. Patients with atrial fibrillation, valvular disease
and regional wall motion abnormality were excluded. Mitral annular peak systolic velocity was obtained from the medial
site with apical 4-chamber view by pulsed wave tissue Doppler imaging. LVEF was calculated by modified Simpson’s method for apical 4- and 2-chamber views.
Results: The mean mitral annular peak systolic velocity was 7.2±1.8 cm/s (range 2.9 to 12.1), and the mean ejection fraction was 57.9±14.6% (range 17.9 to 83.9). The mitral annular peak systolic velocity correlated linearly with
the ejection fraction (r=0.72, p<0.001): LVEF = 15+6× mitral annular peak systolic velocity(%). The optimal cutoff value of mitral annular peak systolic velocity for identifyng LV systolic dysfunction (LVEF <55%) was 6.7 cm/s. At this cutoff value, the sensitivity, specificity, and accuracy were 84%, 85% and 85%, respectively. The area under the receiver operating characteristic curve was 0.91 (95% CI:0.85-0.96). The intra-observer variability was±0.4 cm/s (3%) and the inter-observer variability was±0.6 cm/s (5%).
Conclusion: Simple measurement of mitral annular systolic velocity by pulsed wave tissue Doppler imaging can be easily applied to patient care and can be used to quantify LVEF accurately and with a high level of reproducibility.
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KEYWORD
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Ventricular function, Left, Ventricular ejection fraction, Doppler echocardiography
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