J Cardiovasc Ultrasound.  2014 Mar;22(1):23-27. 10.4250/jcu.2014.22.1.23.

The Tissue Doppler Imaging Derived Post-Systolic Velocity Notch Originates at the Aortic Annulus

• Ouss AJ
• Riezebos R

• KMID: 2177452
• DOI: http://doi.org/10.4250/jcu.2014.22.1.23

Abstract

BACKGROUND
A distinct velocity pattern represented by a "notch" is observed during the time interval between the end of the systolic and the onset of the early diastolic velocity wave on longitudinal myocardial velocity curve. The origin of the post-systolic velocity notch (PSN) has not been resolved.
METHODS
The high frame rate color tissue Doppler imaging of the apical longitudinal axis was performed in 32 healthy subjects.
RESULTS
The time delays of the PSN onset at the posterior aortic wall (AW), the mid anteroseptal wall (MAS) and the posterior mitral annulus (MA) relatively to the anterior aortic annulus (AA) were found to be significantly longer than zero (5.1 +/- 2.2, 6.0 +/- 2.3, 6.8 +/- 2.8 ms; p < 0.001). The amplitude was the highest at the AA when compared to the AW, the MAS and the MA (4.77 +/- 1.28 vs. 2.88 +/- 1.11, 2.15 +/- 0.73, 2.44 +/- 1.17 cm/s; p < 0.001). A second PSN spike was identifiable in 10/32 (31%) of the studied subjects at the AA. Of these, 9 (28%) exhibited a second PSN spike at the AW, 3 (9%) at the MAS and no one at the MA.
CONCLUSION
The AA represents the site of the earliest onset and maximal amplitude of the PSN on the longitudinal velocity curve suggesting its mechanism to be that of an energy release at the instant of the aortic valve closure causing an apically directed acceleration of the myocardium. A substantial number of healthy subjects exhibit a second PSN spike predominantly at the level of the AA. Its mechanism remains to be elucidated.

Keyword

Tissue Doppler echocardiography; Myocardial velocity; Aortic valve

MeSH Terms

Acceleration
Aortic Valve
Axis, Cervical Vertebra
Myocardium

Figure

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  Fig. 1 Schematic presentation of the post-systolic velocity notch (PSN). On the left the current designation of the post-systolic negative (red) and positive (blue) velocity waves. On the right the proposed view of the PSN (green). The arrow indicates the onset of the PSN.

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  Fig. 2 The measurement levels. yellow: anterior aortic annulus, orange: posterior aortic wall, red: mid anteroseptal wall, green: posterior mitral annulus.

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  Fig. 3 The time delay of the post-systolic velocity notch (PSN) onset between the anterior aortic annulus (AA) and the posterior mitral annulus (MA). Vertical yellow dotted line represents the PSN onset at the AA, vertical blue dotted line represents the PSN onset at the MA.

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  Fig. 4 The post-systolic velocity notch at the level of the anterior aortic annulus.

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  Fig. 5 The second post-systolic velocity notch (PSN) spike at the level of the anterior aortic annulus. The arrow indicates the onset of the second PSN spike.

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  Fig. 6 The typical sequence of the centrifugal distribution of the apically directed velocity of the myocardium (red-colored area) following the aortic valve closure. Four consecutive images are shown. Panel A corresponds to the post-systolic velocity notch onset at the anterior aortic annulus. Color tissue Doppler frame rate is 166/sec.

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