Tissue Doppler Imaging in Cardiac Function Assessment

Introduction to Tissue Doppler Parameters

The European Society of Cardiology recommends tissue Doppler imaging for quantitative assessment of both systolic and diastolic function, with key parameters including early diastolic velocity (e′) and systolic ejection velocity (s′) 1.

Reduced early diastolic tissue velocity (e′) is associated with impaired LV relaxation, and its reduction is influenced by preload, systolic function, and LV minimal pressure, according to the American Heart Association 2, 3, 4, 5.
The American College of Cardiology suggests that normal age-adjusted values for e′ are: septal e′ of 10 cm/s (ages 16-40), 7.6 cm/s (ages 41-60), and 6.2 cm/s (>60 years), and lateral e′ of 14 cm/s (ages 16-40), 11.5 cm/s (ages 41-60), and 5.9 cm/s (>60 years) 3, 5, 7, 8.
Severely reduced e′ values (<5 cm/s) indicate advanced diastolic dysfunction, with the European Society of Cardiology recommending consideration of restrictive cardiomyopathy patterns 3, 5, 7, 8.
Reduced systolic velocity (s′) indicates impaired longitudinal systolic function, correlating with LVEF and clinical outcomes including rehospitalization and mortality, as stated by the Heart Failure Society of America 1, 6.

In hypertensive heart disease, both e′ and s′ are reduced compared to normal, with longitudinal function impairment preceding depression of LVEF, according to the American Society of Hypertension 1, 6.
The European Association for Cardiovascular Prevention and Rehabilitation recommends that reduced tissue velocities are characteristic across all cardiomyopathy types, including dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy 1, 6, 8.

Severely reduced e′ carries significant mortality risk, with e′ <3 cm/s or <5 cm/s associated with increased hazard of adverse outcomes in patients with hypertension, as reported by the European Heart Journal 3, 5, 7.
Reduced s′ predicts adverse outcomes, correlating with rehospitalization and reduced survival, according to the American Heart Association 1, 6.

The American College of Cardiology recommends that all echocardiography reports include specific comments about diastolic function grade, left atrial volume, and LV filling pressure status (based on E/e′), with measurement of tissue Doppler at both septal and lateral mitral annulus 2, 5, 7.
For optimal assessment, the European Society of Cardiology suggests obtaining average values for global diastolic function evaluation, comparing to age-adjusted normal values, and integrating with E/e′ ratio for filling pressure estimation 2, 3, 5, 7.