Tissue Doppler e′ sampling (septal and lateral annulus)
Read more:ASE 2019 · Comprehensive TTE examination
Quick reference:↑ Diastolic function and filling pressures
| View | Apical four-chamber, pulsed tissue Doppler at the septal (medial) and lateral mitral annulus, beam as parallel as possible to annular motion. |
|---|---|
| Timing | Early diastolic annular velocity (e′); sweep speed 100 mm/s. |
| Caliper / trace | Large 5–10 mm sample volume at the annulus; scale at or below about 25 cm/s; peak e′ measured; lateral and medial values averaged for E/e′ and also reported individually. |
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Correct example
A system-specific DTI preset, gate covering annular motion, scale reduced to enlarge the signal, and both annular sites recorded so the averaged e′ can be used.
Common error
Using a conventional PW preset, a small gate that drops out of the annulus, an angulated beam, or only one annular site when the average is required.
Effect on interpretation
Absolute e′ and the E/e′ ratio are major parts of the non-invasive filling-pressure criteria, so sampling errors move patients across grading cut-offs.
Why
Tissue Doppler measures low-velocity, high-amplitude wall motion, which is why the filter, scale and gate differ from blood-flow Doppler.