Comparison of Myocardial Tissue Velocities Measured by Two-Dimensional Speckle Tracking and Tissue Doppler Imaging

      Myocardial velocities have prognostic implications, and transmitral E wave to mitral annular early diastolic tissue velocity ratio (E/Em) is utilized to estimate left ventricular (LV) end-diastolic pressure (EDP). There are no reference values for 2-dimensional (2D) speckle tracking myocardial velocities (S2D, E2D, A2D), and it is unknown if they are comparable with color tissue Doppler imaging (TDI). Predictors of E/E2D ratios are unknown and E/E2D has not been validated with LVEDP. The myocardial velocities of 142 subjects were measured by TDI and 2D speckle tracking. Mean E/Em and E/E2D were calculated as transmitral E wave to mean 6 basal early diastolic myocardial velocities using TDI and 2D speckle tracking respectively, and compared with LVEDP during catheterizations (n = 20). Mean E2D was lower but mean S2D and A2D were higher than TDI (all p <0.001). When TDI sample volume was tracked throughout the cardiac cycle, this directional difference was no longer apparent with S2D, E2D, and A2D higher than TDI (all p <0.05). Age, systolic blood pressure, LV ejection fraction, and mean S2D were independent correlates of E/E2D. Receiver-operator characteristic analysis showed E/E2D (p = 0.03), not E/Em, identified elevated LVEDP (≥12 mm Hg). E/E2D of 11.6 had 83% sensitivity and 70% specificity to predict elevated LVEDP. In conclusion, TDI and 2D speckle tracking myocardial velocities are not comparable due to angle independency and ability for tissue tracking with the latter. LV systolic function, age, and afterload are independent correlates of E/E2D. Only E/E2D identifies elevated LVEDP, and an E/E2D of 11.6 has the optimal sensitivity and specificity.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yu C.M.
        • Sanderson J.E.
        • Marwick T.H.
        • Oh J.K.
        Tissue Doppler imaging: a new prognosticator for cardiovascular diseases.
        J Am Coll Cardiol. 2007; 49: 1903-1914
        • Nagueh S.F.
        • Middleton K.J.
        • Kopelen H.A.
        • Zoghbi W.A.
        • Quinones M.A.
        Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures.
        J Am Coll Cardiol. 1997; 30: 1527-1533
        • Ommen S.R.
        • Nishimura R.A.
        • Appleton C.P.
        • Miller F.A.
        • Oh J.K.
        • Redfield M.M.
        • Tajik A.J.
        Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study.
        Circulation. 2000; 102: 1788-1794
        • Nishimura R.
        • Miller F.J.
        • Callahan M.
        • Benassi R.
        • Seward J.
        • Tajik A.
        Doppler echocardiography: theory, instrumentation technique and application.
        Mayo Clin Proc. 1985; 60: 321-343
        • Tajik A.
        • Seward J.
        • Hagler D.
        • Mair D.
        • Lie J.
        Two dimensional real-time ultrasonic imaging of the heart and great vessels: technique, image orientation, structure identification and validation.
        Mayo Clin Proc. 1978; 53: 271-303
        • Reichek N.
        • Wilson J.
        • John Sutton M.
        • Plappert T.A.
        • Goldberg S.
        • Hirshfeld J.W.
        Noninvasive determination of left ventricular end-systolic stress: validation of the method and initial application.
        Circulation. 1982; 65: 99-108
        • Reichek N.
        • Helak J.
        • Plappert T.
        • Sutton M.S.
        • Weber K.T.
        Anatomic validation of left ventricular mass estimates from clinical two-dimensional echocardiography: initial results.
        Circulation. 1983; 67: 348-352
        • Mosteller R.D.
        Simplified calculation of body-surface area.
        N Engl J Med. 1987; 317: 1098
        • Khosla T.
        • Lowe C.R.
        Indices of obesity derived from body weight and height.
        Br J Prev Soc Med. 1967; 21: 122-128
        • Yu C.M.
        • Lin H.
        • Yang H.
        • Kong S.L.
        • Zhang Q.
        • Lee S.W.-L.
        Progression of systolic abnormalities in patients with “isolated” diastolic heart failure and diastolic dysfunction.
        Circulation. 2002; 105: 1195-1201
        • Gulati V.K.
        • Katz W.E.
        • Follansbee W.P.
        • Gorcsan III, J.
        Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function.
        Am J Cardiol. 1996; 77: 979-984
        • Marwick T.H.
        Measurement of strain and strain rate by echocardiography: ready for prime time?.
        J Am Coll Cardiol. 2006; 47: 1313-1327
        • Zipes D.
        • Libby P.
        • Bonow R.
        • Braunwald E.
        Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine.
        in: 7th ed. Elsevier Saunders, Philadelphia2001: 408-409
        • Dincer I.
        • Kumbasar D.
        • Nergisoglu G.
        • Atmaca Y.
        • Kutlay S.
        • Akyurek O.
        • Sayin T.
        • Erol C.
        • Oral D.
        Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements.
        Int J Cardiovasc Imaging. 2002; 18: 155-160
        • De Sutter J.
        • De Backer J.
        • Van de Veire N.
        • Velghe A.
        • De Buyzere M.
        • Gillebert T.C.
        Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E′) and the ratio of transmitral early peak velocity to E′ (E/E′).
        Am J Cardiol. 2005; 95: 1020-1023
        • Nikitin N.P.
        • Witte K.K.A.
        • Thackray S.D.R.
        • de Silva R.
        • Clark A.L.
        • Cleland J.G.F.
        Longitudinal ventricular function: normal values of atrioventricular annular and myocardial velocities measured with quantitative two-dimensional color Doppler tissue imaging.
        J Am Soc Echocardiogr. 2003; 16: 906-921