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 (S-2D, E-2D, A(2D)), and it is unknown if they are comparable with color tissue Doppler imaging (TDI). Predictors of E/E-2D ratios are unknown and E/E-2D 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/E-2D 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 E-2D was lower but mean S-2D and A(2D) 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 S-2D, E-2D, and A(2D) higher than TDI (all p < 0.05). Age, systolic blood pressure, LV ejection fraction, and mean S-2D were independent correlates of E/E-2D. Receiver-operator characteristic analysis showed E/E-2D (P = 0.03), not E/Em, identified elevated LVEDP (>= 12 mm Hg). E/E-2D 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/E-2D. Only E/E-2D identifies elevated LVEDP, and an E/E-2D Of 11.6 has the optimal sensitivity and specificity. (C) 2008 Elsevier Inc. All rights reserved.