Objective. We investigated whether pulsed tissue Doppler imaging could be useful to detect sensitively a decrease in left ventricular (LV) contractile force and development of systolic asynchrony during an increase in afterload in healthy individuals.
Methods. We recorded LV wall motion velocities before and after angiotensin II infusion by pulsed tissue Doppler imaging in 16 healthy individuals and evaluated the differences in the responses in systolic LV function along the short- and long-axes between the basal and apical regions during an acute increase in afterload.
Results. After angiotensin II infusion, the systolic blood pressure and LV end-systolic dimension were increased significantly, and the LV ejection fraction was significantly decreased. The peak first and second systolic velocities and the times from the beginning of the Q wave of the electrocardiogram to the peak first systolic velocity of the LV walls along both the short- and long-axes were markedly decreased and prolonged, respectively, in the apical region compared to the basal region.
Conclusions. LV systolic asynchrony is induced, even in normal hearts, during an increase in afterload. Pulsed tissue Doppler imaging provides incremental diagnostic information on regional LV systolic function.

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Background. Although pulsed Doppler echocardiography, particularly recordings of the transmitral and pulmonary venous flow (TMF and PVF, respectively) velocities, could recently serve as a useful tool in the evaluation of left ventricular (LV) diastolic function, the mechanisms underlying the relation of atrial function to ventricular filling are incompletely understood.
Methods. We performed transthoracic and transesophageal pulsed Doppler echocardiography during lower body negative pressure (LBNP, -20 and -40 mm Hg) in 14 healthy volunteers, and assessed the changes in superior vena cava (SVC) flow, transtricuspid flow (TTF), TMF, and PVF velocity patterns during preload reduction.
Results. During LBNP, there were no significant changes in heart rate and mean blood pressure. The LV end-diastolic and maximal left atrial dimensions were decreased, whereas there were no significant changes in percent LV fractional shortening. The peak early diastolic velocity (E) and the initial time-velocity integral between the onset and the time of peak flow velocity of the early diastolic filling (IEa) of the TTF and TMF velocities were decreased. The peak second systolic velocity (S₂) of the SVC flow and PVF velocities, and time-velocity integral of the second systolic wave (IS₂) of the PVF velocity were decreased. There was a positive correlation between the changing IEa (ΔIEa) of the TMF velocity and the changing IS₂ (ΔIS₂) of the PVF velocity during preload reduction. There were no significant changes in atrial systolic parameters of the TTF and TMF velocities.
Conclusions. Atrial passive emptying contributes to the former-part of the early diastolic ventricular filling, particularly in the left heart side, in normal subjects.

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Coronary artery fistulas are uncommon entities with communication between the coronary artery and cardiac structure. We encounter a 70-year-old, asymptomatic woman with a large right coronary artery to left ventricle fistula. Non-invasive echocardiogram was helpful in detecting an enlarged right coronary that drained from the aorta into the left ventricle. Clinical importance of coronary artery fistula is due to an increased risk of heart failure, myocardial ischemia, and rupture. Treatment of asymptomatic patients without significant shunting is controversial. We decided to follow-up on her medically without surgical closure of the fistula because her hemodynamics are stable.
Echocardiogram is very useful to diagnose and evaluate these diseases.

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