On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging.

To provide an approach suitable for on-line analysis of ventricular function, a conventional two-dimensional ultrasound imaging system was modified to detect and track blood-tissue interfaces in real time based on their quantitative acoustic properties. This modification permitted on-line display of the left ventricular cavity area, fractional area change, volumes and ejection fraction on a beat by beat basis. Images were obtained from 54 patients and 12 normal subjects with broad ranges of ventricular dimensions and systolic function. On-line measurements of cavity areas were compared with off-line measurements of cavity areas (analysis of videotaped conventional images). Left ventricular cavity areas measured on-line from short-axis views correlated closely with off-line views as did areas from apical views. On-line fractional area change correlated well with ejection fraction calculated off-line. More than 70% of patients could be studied adequately with the approach developed. Thus, automatic boundary detection based on quantitative assessment of tissue acoustic properties permits on-line quantitation of ventricular cavity areas and indexes of function.

Echocardiographic characterization of the improvement in right ventricular function in patients with severe pulmonary hypertension after single-lung transplantation.

OBJECTIVES: This study was designed to characterize immediate, early and long-term changes in right ventricular structure and function, as defined by two-dimensional and Doppler echocardiography, after single-lung transplantation in patients with severe pulmonary hypertension. BACKGROUND: Single-lung transplantation has recently been shown to dramatically improve hemodynamics in patients with primary pulmonary hypertension who had unsuccessful medical therapy. METHODS: Fourteen patients with severe pulmonary hypertension who underwent single-lung transplantation were studied with transthoracic and transesophageal two-dimensional and Doppler echocardiography. Right ventricular dimensions were measured in the apical four-chamber view. Right ventricular ejection and acceleration times and peak velocity of tricuspid regurgitation were measured by Doppler study. Results of right heart catheterization were available early (< 3 months) after transplantation in 10 of 13 patients and late after transplantation (6 months to 2 years) in 11 patients. RESULTS: In the early posttransplantation studies, right ventricular dimensions decreased and fractional area change and ejection fraction increased in all patients, but right ventricular wall thickness did not change significantly. Tricuspid regurgitation lessened markedly in all patients. Long-term decreases in right ventricular dimension and improvement in systolic function were sustained. Right ventricular wall thickness significantly decreased compared with the early postoperative value (0.76 +/- 0.1 cm compared with 0.63 +/- 0.14 cm, p < 0.02). CONCLUSIONS: Two-dimensional echocardiography demonstrates sustained improvement in right ventricular function after single-lung transplantation for severe pulmonary hypertension despite severe preoperative dysfunction.

Abnormal myocardial acoustic properties in diabetic patients and their correlation with the severity of disease.

Although patients with diabetes mellitus may be afflicted by cardiomyopathy, its prevalence and nature are controversial. Studies have shown that fibrosis alters the acoustic properties of the heart in animals and humans and that the changes are detectable by cardiac tissue characterization with ultrasound. The present study was performed to characterize myocardial acoustic properties in patients with insulin-dependent diabetes to determine whether ultrasound tissue characterization could detect changes potentially indicative of occult cardiomyopathy. The magnitude of cyclic variation of myocardial ultrasound integrated backscatter and its phase delay with respect to the onset of the cardiac cycle in the septum and posterior wall of the left ventricle were measured in 54 patients with diabetes who had no overt cardiac disease. Conventional echocardiography documented normal ventricular systolic function in 96%. As compared with results in age-matched patients without diabetes studied previously, cyclic variation of integrated backscatter was reduced (4.6 +/- 0.8 vs. 3.6 +/- 1.4 dB; p less than 0.001). In addition, delay was significantly increased (0.86 +/- 0.09 vs. 0.99 +/- 0.15). The primary analysis of the data focused on differences among the diabetic patients. Reduction of cyclic variation of backscatter was greatest in patients with diabetes who had neuropathy (3.2 +/- 1.0 dB; p less than 0.001) as was the increase in delay (1.04 +/- 0.16, p less than 0.001 vs. values in patients without neuropathy). Retinopathy and nephropathy were associated with abnormal myocardial acoustic properties as well. Thus, abnormalities that may reflect fibrosis or other occult cardiomyopathic changes in diabetic patients without overt heart disease are readily detectable by myocardial tissue characterization with ultrasound and parallel the severity of noncardiac diabetic complications.

Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction.

Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Electrocardiographic sites of infarction were: 35 anterior, 49 inferoposterior and 11 nonlocalized. Abnormal motion of the anterior wall, septum or apex was seen in 97 and 100% of anterior infarctions by radionuclide ventriculography and echocardiography, respectively. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r = 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 +/- 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days. In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score less than or equal to 0.50 versus greater than 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above (0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique. Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period.

Dobutamine stress echocardiography predicts surgical outcome in patients with an aortic aneurysm and peripheral vascular disease.

OBJECTIVES: This study was conducted to assess the utility of dobutamine stress echocardiography for determining the presence of significant coronary artery disease and for predicting surgical outcome and long-term prognosis in patients scheduled to undergo peripheral vascular or aortic aneurysm surgery. BACKGROUND: Assessment of coronary artery disease in patients scheduled to undergo peripheral vascular surgery can avoid perioperative complications. METHODS: Dobutamine stress echocardiography was performed in 98 consecutive patients scheduled to undergo aortic or peripheral vascular surgery. Intravenous dobutamine was infused in a graded fashion, with two-dimensional digital echocardiographic monitoring of ventricular function and segmental wall motion. Group 1 (n = 70) consisted of patients who exhibited a normal response to dobutamine infusion (negative dobutamine study); group 2 (n = 23) comprised those patients with an abnormal response to dobutamine, characterized by the development of new or worsening wall motion abnormalities at rest, indicating the presence of myocardial ischemia (positive dobutamine study). Five patients with an inconclusive dobutamine study (because of inadequate heart rate) were excluded from analysis. RESULTS: No major adverse effects occurred with testing in any patient. Sixty-eight of 70 patients with a negative study had peripheral vascular or aortic surgery performed without perioperative cardiac events (2 patients refused surgery). Nineteen of 23 patients with a positive study underwent coronary angiography and all had > 50% lumen narrowing in one or more major coronary artery distributions; 13 underwent coronary artery bypass grafting or angioplasty before peripheral vascular or aortic surgery and all had an uneventful perioperative period. Four of the 10 patients from group 2 who did not undergo coronary revascularization had a perioperative cardiac event (myocardial infarction in 2, an ischemic episode requiring urgent coronary bypass grafting in 1 and congestive heart failure in 1). CONCLUSIONS: Positive and negative dobutamine study results are significant predictors of the presence or absence of perioperative events (20% vs. 0%, p = 0.003). A positive test warrants coronary angiography and further medical or surgical intervention, or both, but a negative test indicates a low likelihood of perioperative cardiac complications of aortic or peripheral vascular surgery. During the long-term follow-up period in this study (group 1 mean, 24 months; group 2 mean, 15 months), two patients (3%) from group 1 and three (15%) from group 2 developed cardiac complications (p = 0.038). Thus, dobutamine stress echocardiography is safe and can predict surgical outcome in patients undergoing aortic aneurysm repair or surgery for occlusive disease of the peripheral arteries. In addition, a negative test result is a strong predictor of decreased perioperative and long-term cardiac morbidity and mortality.

Right and left ventricular area and function determined by two-dimensional echocardiography in adults with the Eisenmenger syndrome from a variety of congenital anomalies.

The Eisenmenger syndrome has been associated with right ventricular (RV) enlargement and systolic dysfunction. However, little attention has been directed toward potentially characteristic changes in left ventricular (LV) dimensions or function. Therefore, 2-dimensional echocardiography (short-axis-papillary muscle level) was performed in 24 adults (mean age 33 +/- 7 years) with Eisenmenger syndrome to evaluate RV and LV size and function. A significant correlation was found between RV and LV end-diastolic areas (r = 0.96; regression slope 1.06), and fractional area change (r = 0.88; regression slope 1.03) in patients with a nonrestrictive ventricular septal defect (VSD) (n = 15). In contrast, in patients with Eisenmenger syndrome but no VSD (n = 9), RV and LV end-diastolic areas (r = 0.68; regression slope 0.10), and fractional area change (r = 0.08; regression slope -0.09) were discordant. RV function was preserved in most patients with a VSD, and mean RV fractional area change was significantly greater than in those without a VSD (0.50 +/- 0.13 vs 0.18 +/- 0.08; p < 0.001). No significant difference was apparent in these 2 groups (patients with and without a VSD) with respect to age, pulmonary artery systolic pressure, partial arterial oxygen pressure or hematocrit. Thus, the results indicate a relation between biventricular chamber dimensions and systolic function that is dependent on the nature and locus of the primary intracardiac defect responsible for the Eisenmenger syndrome.

Saline contrast enhancement of tricuspid regurgitant jets detected by Doppler color flow imaging.

Contrast techniques have been used to improve detection of peak velocities by Doppler spectral analysis. To define the effect of contrast enhancement on the tricuspid regurgitation (TR) jet area and length, 29 patients were studied (25 transthoracic, 4 transesophageal) with 2-dimensional color flow imaging. Three- to 5-ml of agitated saline was injected and images were obtained from 4-chamber views at 12- or 16-cm depth setting. Color gain was optimized to display TR jet at baseline and then reduced to minimal settings before injection. Measurements of TR jet area and length were made in 3 to 5 consecutive cycles. A ratio of TR jet area to 2-dimensional area was derived. TR jet area at baseline was 4.7 +/- 3.6 cm2 and increased significantly (p less than 0.0001) in 26 patients to 8.1 +/- 6.3 cm2 after contrast enhancement. Jet length at baseline was 3.4 +/- 1.7 cm and increased significantly (p less than 0.0001) in 20 patients to 4.1 +/- 1.8 cm after contrast enhancement. The ratio of TR jet area to right atrial area also increased significantly (p less than 0.0001) to greater than 0.20 in 18 of 28 patients after enhancement. Increases in jet area and length were not associated with changes in TR jet or diastolic inflow velocities measured by continuous wave Doppler at baseline and after contrast. Thus, contrast enhancement increases the amplitude of Doppler signals responsible for transvalvular and regurgitant flow. By reducing the effect of attenuation and improving signal-to-noise ratio, it improves delineation of the TR jet using color flow imaging.

Quantitative ultrasonic tissue characterization of myocardium in cyanotic adults with an unrepaired congenital heart defect.

Adults with nonrestrictive ventricular septal defects have chronic hypoxemia that may lead to alterations in myocardial structure and function. Ultrasonic integrated backscatter provides quantitative assessment of myocardial acoustic properties that are altered by myocardial ischemia, fibrosis, and edema. Sixteen patients (age 31 +/- 10 years) with a nonrestrictive ventricular septal defect were studied using 2-dimensional and M-mode echocardiography with integrated backscatter imaging to determine the cyclic variation of integrated backscatter in the right ventricular free wall, ventricular septum, and left ventricular posterior wall. Cyclic variation of integrated backscatter in the right ventricular free wall and interventricular septum in patients was significantly less than that in control subjects (4.1 +/- 0.8 vs 4.9 +/- 1.0 decibels [dB], p = 0.02, and 3.8 +/- 1.2 vs 4.8 +/- 1.1 dB, p = 0.004, respectively). There was no difference between mean cyclic variation of integrated backscatter in the left ventricular posterior wall in patients and that in control subjects (4.7 +/- 1.3 vs 4.8 +/- 1.1 dB, p = NS, respectively). However, values < 4.0 dB were noted in 38% of patients compared with 15% of control subjects. Biventricular systolic function was normal in all but 1 patient. There was no correlation between backscatter and either wall thickness or percent wall thickening from the 3 regions. Histologic analysis of myocardial tissue in 3 patients revealed interstitial and replacement fibrosis. Adults with nonrestrictive ventricular septal defects exhibit alterations in tissue-acoustic properties detectable by integrated backscatter imaging despite preserved systolic function and wall thickening.

Frequency and significance of intrapulmonary right-to-left shunting in end-stage hepatic disease.

Intrapulmonary vascular abnormalities consisting of arteriovenous malformations and capillary dilatations have been described in patients with severe liver disease. These intrapulmonary vascular abnormalities can result in intrapulmonary right-to-left shunting and hypoxemia. Twenty-five of 53 patients (47%) with end-stage hepatic disease were found to have contrast echocardiographic evidence of intrapulmonary right-to-left shunting. There was no difference in mean age, gender distribution, or severity of hepatic disease in those with and without evidence of such shunting. Although there was no difference in mean partial arterial oxygen pressure (PaO2) values in the 2 groups (82 +/- 11 vs 76 +/- 11 mm Hg), the mean PaO2 value of those with at least 2+ left ventricular opacification (2 to 4+) was significantly lower (66 +/- 3 mm Hg, n = 8; p less than 0.01). Unexpectedly, patients with evidence of intrapulmonary shunting had a lower mortality rate before transplantation (3 of 25, 12%) than those without evidence of shunting (10 of 28, 36%) resulting in a significant difference in actuarial survival (p less than 0.05) by the end of the follow-up period. It is concluded that intrapulmonary right-to-left shunting occurs frequently in patients with end-stage liver disease and may be a marker of a positive biologic process that, in some way, leads to improved short-term survival.

Two-dimensional contrast echocardiography in the detection and follow-up of congenital pulmonary arteriovenous malformations.

Pulmonary arteriovenous (A-V) malformation is frequently a manifestation of Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia). We identified 14 patients (9 men and 5 women) with A-V malformation by contrast echocardiography; 10 patients with atrial right-to-left shunt served as control subjects. Agitated saline solution (10 ml) was injected through a peripheral vein during echocardiographic imaging. The delay in the appearance of microcavitations in the left atrium was measured (in number of frames) after right atrial appearance. The degree of left ventricular opacification was graded 1 to 4+ (where 4+ = intense left ventricular endocardial outline, and 1+ = minimal opacification). Results indicated patients with A-V malformation had a significant delay (p less than 0.001) in left atrial appearance of microcavitations compared with those with atrial right-to-left shunt (66 +/- 27 vs 21 +/- 7 frames, mean +/- 1 standard deviation). In the group with A-V malformation, abnormal blood gases were present in only 6 of 14 patients and chest x-ray was positive in 7. Pulmonary angiography was performed in 11 of 14 patients with positive contrast echocardiography, and all 11 had A-V malformation identified. In patients with 3 to 4+ left ventricular opacification (n = 8), large (greater than 5 mm feeding vessel) or multiple malformations were present, whereas patients with small or isolated malformation had 1 to 2+ left ventricular opacification. Balloon occlusion of malformations was performed in all 11 of these patients; repeat contrast echocardiography revealed significant diminution of right-to-left shunt in 9, and 2 required repeat embolotherapy for an additional previously undetected A-V malformation.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative ultrasonic imaging: tissue characterization and instantaneous quantification of cardiac function.

Quantitative myocardial tissue characterization is being developed to complement and expand conventional echocardiography by delineating the physical state of myocardium under diverse pathophysiologic conditions. Real-time quantitative integrated backscatter imaging has already been applied to patients with ischemic heart disease, hypertrophic cardiomyopathy, and cardiac allograft rejection in clinical investigations performed in the United States, Europe, and Japan. A recently introduced modification of imaging processing algorithms employed for characterization of tissue facilitates automatic detection of endocardial-blood interfaces and on-line quantification of ventricular size and function. Further progress and anticipated developments in quantitative ultrasonic imaging will undoubtedly augment the clinical applications of tissue characterizations based on myocardial integrated backscatter for improved diagnosis, elucidation of pathophysiology, and assessment of cardiac function.

Importance of preoperative hypertrophy, wall stress and end-systolic dimension as echocardiographic predictors of normalization of left ventricular dilatation after valve replacement in chronic aortic insufficiency.

To define and compare predictors of postoperative normalization of diastolic left ventricular dimension after aortic valve replacement, echocardiographic indexes of left ventricular size, function, degree of hypertrophy and systolic wall stress were examined in 43 patients with chronic and 14 with acute aortic insufficiency. In all of the latter 14 patients, left ventricular diastolic dimension returned to normal (mean 5.2 +/- 0.4 cm) in the postoperative follow-up period (mean 8.0 months). In contrast, of those with chronic insufficiency, 28 (group A) had postoperative normalization of diastolic dimension whereas the remaining 15 (group B) had persistent enlarged diastolic dimension. Preoperative end-systolic dimension, diastolic radius/thickness ratio, mean radius/thickness ratio, mean wall stress and end-systolic stress were 84 to 93 percent accurate in predicting normalization versus persistence of left ventricular dilatation postoperatively, and were superior to preoperative end-diastolic dimension and shortening fraction. Postoperatively, group A had complete normalization of end-systolic dimension and of mean and end-systolic wall stresses with persistence of a normal shortening fraction. Group B continued to have increases in end-systolic dimension, mean wall stress and end-systolic stress with a reduction in shortening fraction. Postoperatively there was a 43 and 29 percent incidence rate of heart failure and death by heart failure, respectively, in group B versus none in group A (p less than 0.01). These findings support the concept that inappropriate hypertrophy in chronic aortic insufficiency is associated with progressive increases in wall stress and end-systolic dimension and a reduction in shortening fraction that eventually result in irreversible cardiac dilatation and failure. Accurate and clinically relevant determination of reversible and irreversible alterations in left ventricular size and function may be obtained with these echocardiographic indexes.

Automated, on-line quantification of left ventricular dimensions and function by echocardiography with backscatter imaging and lateral gain compensation.

To provide on-line quantification of left ventricular cavity dimensions and function by echocardiography 60 control subjects and 10 patients with cardiac dysfunction were studied. A novel, ultrasound imaging system was used which was developed to detect and track, in real time, ventricular endocardial blood boundaries based on quantitative assessment of acoustic properties of tissue. In addition, lateral gain compensation, a robust and novel image enhancement procedure, was used to provide instantaneous measurement and display of cavity areas and functional indexes on a beat-by-beat basis within regions of interest drawn around the blood pool cavity. In control subjects, short-axis end-diastolic area averaged 13.1 +/- 3.7 cm2 (SD), end-systolic area 5.9 +/- 2.7 cm2, and fractional area change 55.6 +/- 11.2%. Apical views yielded corresponding values of 23.8 +/- 4.5 cm2, 15.5 +/- 3.4 cm2 and 34.7 +/- 7.8%. Instantaneous peak rate of cavity area change approximated 50 cm2/s in systole and 60 cm2/s in diastole in each view. Serial measurements of area and functional index were reproducible over intervals of 2 to 3 weeks. Patients with dilated ventricles exhibited average apical view area values of 49.1 +/- 6.1 cm2 and 43.1 +/- 4.9 cm2 in diastole and systole with a fractional area change of 12.2 +/- 3.0%. Thus, results with on-line echocardiographic backscatter imaging-assisted automated edge detection are reproducible and capable of delineating cardiac dysfunction conveniently, promptly and serially at the bedside.

Echo-phonocardiographic evaluation of obstruction of prosthetic mitral valve.

Echo-phonocardiograms of 64 patients with multiple types of prosthetic mitral valves (PMV) were evaluated. Six patients demonstrated findings suggesting valve obstruction: four had surgical confirmation of prosthetic obstruction, one reduced cardiac output and pulmonary hypertension but no prosthetic dysfunction at surgery, and one is asymptomatic. Three of four patients with confirmed obstruction had variable second sound to opening click intervals (A2-MO) with interrupted disc opening; two had interrupted disc closure with split closing clicks and three of four had reduced diastolic closure rate. In 58 clinically well patients with PMV, cycle-to-cycle A2-MO varied little: 0-10 msec in sinus rhythm and 10-25 msec in atrial fibrillation. Diastolic closure rates of five different types of PMV were similar: 21.6 mm/sec, (range 14-49). No patient had interrupted opening, closing or multiple closing clicks. Thus, delayed PMV opening or closure, altered A2-MO interval and double closing clicks are highly useful in detecting patients with obstruction of a variety of mitral prostheses.

Impaired left atrial function after heart transplantation: disparate contribution of donor and recipient atrial components studied on-line with quantitative echocardiography.

BACKGROUND: Because of a lack of noninvasive techniques, left atrial function after orthotopic heart transplantation has not been well characterized. METHODS: Global left atrial performance and the relative contributions of donor and recipient atrial components were assessed with transthoracic echocardiography with on-line automated border detection in 20 patients with normal left ventricular systolic function 1 to 6 years (mean 3.5 +/- 0.3 years [standard error]) after heart transplantation. RESULTS: The mean left atrial area at ventricular end-systole was 22.9 +/- 1.5 cm2, the mean left atrial emptying fraction ([left atrial area at ventricular end-systole--left atrial area at ventricular end-diastole]/left atrial area at ventricular end-systole) was 29.7% +/- 2.6%, and the fractional area change caused by active contraction was 27.8% +/- 3.1%. Compared with controls, patients had larger atria, depressed emptying, and reduced fractional active contraction. Although the recipient to donor area ratio was 3:2, the proportion of atrial emptying (change in area from mid-to-late ventricular diastole divided by the total left atrial change during ventricular diastole) contributed by the recipient component was greatly diminished when compared with that of the donor component (1.4% +/- 3.5% versus 31% +/- 2.7%) (p = 0.0001). CONCLUSIONS: Despite being anatomically smaller, the functional contractile contribution of the donor component dominated atrial emptying. Thus, after heart transplantation, global left atrial function is depressed, predominantly because of dysfunction of the recipient atrial component.

Right ventricular dysfunction in low output syndrome after cardiac operations: assessment by transesophageal echocardiography.

BACKGROUND: Low output syndrome after cardiac operations is associated with high morbidity and mortality rates. The contribution of right ventricular dysfunction to this syndrome has not been fully characterized. The purpose of this study was to evaluate the utility of transesophageal echocardiography to identify the frequency and the in-hospital mortality from right ventricular dysfunction in patients with this syndrome. METHODS: Seventy-five consecutive patients undergoing transesophageal echocardiography for low output syndrome early after cardiac operations were evaluated. The findings from transesophageal echocardiography were correlated with the type of surgical procedure, cross-clamp time, right heart hemodynamics, and coronary angiography. RESULTS: Right ventricular systolic dysfunction occurred in 36 patients (42%); in 17 patients it was isolated and in 19 patients it occurred in combination with left ventricular dysfunction. Postoperative right ventricular dysfunction was not uniformly associated with important right coronary artery disease or with prolonged ischemic time during cardiopulmonary bypass. Hemodynamic data were not useful to distinguish the group with postoperative right ventricular dysfunction. Patients with right ventricular dysfunction had a high (44%) in-hospital mortality rate. CONCLUSIONS: Right ventricular dysfunction occurs frequently in patients with low output syndrome after cardiac operations and is associated with a high in-hospital mortality rate. Better understanding of the mechanisms causing postoperative right ventricular dysfunction may provide insight for preventing this complication.

Congestive heart failure and the role of two-dimensional Doppler echocardiography: a primer for cardiac sonographers.

Congestive heart failure (CHF) has been an increasing cause of hospitalization, particularly among the elderly population, although the clinical presentation may vary in the individual patient. Two-dimensional and pulsed Doppler echocardiography can be valuable diagnostic methods for the assessment of afflicted patients and can have an impact on patient outcome. The unique advantage of echocardiographic techniques is their ability to characterize left ventricular systolic performance and diastolic filling abnormalities that are commonly present in patients with CHF. This review provides current information the cardiac sonographer can recognize in the assessment of patients with CHF.

Doppler assessment of left ventricular diastolic function: a review.

Two-dimensional echocardiography provides valuable information for the assessment of left ventricular function. Traditionally, evaluation has focused on determination of systolic performance. However, recent investigations indicate diastolic dysfunction may also contribute to symptoms of congestive heart failure in many patients despite normal systolic function. Pulsed Doppler echocardiography complements two-dimensional imaging for assessment of left ventricular filling properties that are often altered in the setting of diastolic dysfunction. The concept of diastolic function and recognition of abnormal filling patterns detected by pulsed Doppler echocardiography are reviewed.

Tissue Doppler imaging: a useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function.

Tissue Doppler imaging (TDI) has evolved to become a useful noninvasive method that can complement other echocardiographic techniques in the assessment of left ventricular myocardial velocities in a variety of clinical conditions. Color 2-dimensional and color M-mode TDI are used for quantification of systolic myocardial velocities during myocardial ischemia at rest and with pharmacologic stress testing. Spectral pulsed TDI can provide measurements of regional systolic and diastolic myocardial velocities, and it is particularly useful in the identification of abnormalities of left ventricular diastolic relaxation. This review summarizes the clinical applications of TDI to promote understanding of its utility in the evaluation of left ventricular myocardial function.

The profession of cardiac sonography and the status of professionalization of cardiac sonographers.

The role of the cardiac sonographer has evolved in the profession of cardiac ultrasonography to a level requiring rigorous education, training, and high standards. Although we want to consider ourselves professionals, further efforts are necessary to meet the various criteria conferring such a status. It is essential cardiac sonographers realize these necessary steps to achieve recognition as professionals.