Tissue Doppler imaging (TDI) has rapidly evolved over the last decade as a sensitive clinical tool of measuring both global and regional myocardial velocities and their relationship to the cardiac cycle with high spatial and temporal resolution. Measurement of mitral annular velocities reflects global left ventricular LV function at rest or during stress echocardiography. Regional analysis of peak segmental systolic myocardial velocities during stress improves accuracy of novice readers, of interpreting basal segments, and concordance between observers. Moreover, it has higher sensitivity and comparable specificity to standard dobutamine stress echocardiography in detecting myocardial viability. Myocardial velocity gradient, being independent of cardiac translational movement, has also shown promise for detecting resting and induced ischemia and viable myocardium. Strain rate imaging (SRI), based on tissue Doppler technology, has clinical potential of quantitative assessment of regional contractility and function during stress echocardiography. Abnormal wall motion during isovolumic contraction and relaxation periods and their clinical implications of correlating myocardial viability has been discussed. Improved data acquisition and rapid post-processing of TDI will facilitate its incorporation into standard regional myocardial assessment.

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Method Thirty-four patients affected by Ischemic Heart Failure (IHF) were evaluated by Echocardiography (E). They had reduced Ejection Fraction % (EF%) evaluated by the cube volume-formula and evident from a decrease of V.max. of E wave and an increase of V. max. of A wave of mitral doppler inflow pattern, with reversal of E/A wave ratio. In addition, an increase of Iso-Volumic Relaxation Time (IVRT) and E wave Deceleration Time (DT) were present, while the pulmonary veins flow-pattern reflected increased End Diastolic Left Ventricular Pressure (EDLVP). Patients were treated with Ramipril (Group I) or Ramipril and Carvedilol (Group II). These drugs were given concommitant with other drugs (Digitalis, Diuretics, Antiplatelets and Nitrates). M-Mode and 2D-Echo were performed one week after the end of therapy. Result The echocardiographic parameters were evaluated in all patients at baseline and compared with those obtained respectively after Ramipril (Group I) and Ramipril + Carvedilol (Group II). Results showed a rise of LVESV and a decrease of LVEDV with progressive increase of EF% (from 30 to 40%). This change was also displayed by an increase of V. max. of E and a little decrease of A waves V. max. of mitral pattern (without inversion of their ratio in the Group I) and a similar but more evident change of V. max. of both waves, with reversal of E/A ratio in Group II. Conclusion: Ramipril, given with conventional drugs, resulted in poor reduction of EDLVP whereas the combination of Ramipril + Carvedilol added to conventional therapy, induced a more evident functional reduction of this hemodynamic parameter.

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