Role of transmitral blood flow velocity by Doppler echocardiography in the evaluation of coronary artery disease

Strain echocardiography identifies impaired longitudinal systolic function in patients with septic shock and preserved ejection fraction

Background

Myocardial dysfunction is recognized in sepsis. We hypothesized that mechanical left (LV) and right (RV) ventricular function analysed using 2-dimensional speckle-tracking echocardiography in a cohort of early severe sepsis or septic shock patients, would be different to that of a group of critically ill, non-septic patients.

Methods

Critically ill adult patients with early, severe sepsis/septic shock (n = 48) and major trauma patients with no sepsis (n = 24) were included retrospectively, as well as healthy controls (n = 16). Standard echocardiographic examinations, including right (RV) left (LV) volumes and mitral, aortic and pulmonary vein Doppler flow profiles, were retrospectively identified and the studies were then reanalysed for assessment of myocardial strain using speckle-tracking echocardiography. Endocardial tracing of the LV was performed in apical four-chamber (4-Ch), two-chamber (2-Ch), apical long-axis (3-Ch) and apical views of RV determining the longitudinal LV and RV free wall strain in each subject.

Results

In septic patients, heart rate was significantly higher (p = 0.009) and systolic (p < 0.001) and mean arterial pressures (p < 0.001), as well as systemic vascular resistance (p < 0.001) were significantly lower when compared to the non-septic trauma group. Ninety-three per cent of the septic patients and 50 % of the trauma patients were treated with norepinephrine (p < 0.001). LV ejection fraction (LVEF) was lower in the septic patients (p = 0.019). In septic patients with preserved LVEF (>50 %, n = 34), seventeen patients (50 %) had a depressed LV global longitudinal function, defined as a LV global strain > −15 %, compared to two patients (8.7 %) in the non-septic group (p = 0.0014). In septic patients with preserved LVEF, LV global and RV free wall strain were 14 % (p = 0.014) and 17 % lower (p = 0.008), respectively, compared to the non-septic group with preserved LVEF. There were no significant differences between groups with respect to LV end-diastolic or end-systolic volumes, stroke volume, or cardiac output. There were no signs of diastolic dysfunction from the mitral or pulmonary vein Doppler profiles in the septic patients.

Conclusions

LV and RV systolic function is impaired in critically ill patients with early septic shock and preserved LVEF, as detected by Speckle-tracking 2D echocardiography. Strain imaging may be useful in the early detection of myocardial dysfunction in sepsis.

Electronic supplementary material

The online version of this article (doi:10.1186/s12947-015-0025-4) contains supplementary material, which is available to authorized users.

Effects of adenosine infusion on systolic and diastolic left ventricular function after coronary artery bypass surgery: evaluation by computer-assisted quantitative 2-D and Doppler echocardiography

The effects of adenosine on central hemodynamics, ST-segment changes, and left ventricular (LV) systolic and diastolic function, determined by transesophageal 2-D and Doppler echocardiography, were investigated in 20 patients shortly after coronary surgery. After control measurements, adenosine was infused at incremental infusion rates (30, 60, and 120 micrograms.kg-1.min-1). Adenosine caused dose-dependent increases in heart rate (68.0 +/- 11.2-74.0 +/- 15.7 bpm), cardiac output (3.23 +/- 0.76-4.17 +/- 0.67 L/min), and stroke volume (48.8 +/- 12.5-56.7 L/min), and stroke volume (48.8 +/- 12.5-56.7 mL), decreases in arterial pressure (84.8 +/- 16.6-63.3 +/- 15.2 mm Hg), and systemic and pulmonary vascular resistances (1994 +/- 510-1106 +/- 309 and 209 +/- 54-116 +/- 58 dyne.s.cm-5, respectively), but no changes in cardiac filling pressures. The mean ST segment was slightly but significantly depressed by adenosine (from 0.003 to 0.019 mV). Analysis of LV wall motion showed that adenosine caused no changes in the global area ejection fraction (GAEF), the segmental area ejection fraction (SAEF), or in the SAEF/GAEF ratio, indicating that no regional wall motion abnormalities appeared. Maximum early and late diastolic flow rates (Emax, Amax), determined by mitral Doppler analysis, increased (from 30.1 +/- 14.8 to 40.1 +/- 24.1 and from 37.8 +/- 15.7 to 46.4 +/- 31.3 cm/s, respectively), as did the deceleration slope of the early diastolic filling (from -151 +/- 67 to -210 +/- 107 cm/s-2), whereas no changes were found in the ratio between Emax and Amax, the deceleration time of early diastolic filling, or the velocity time integrals of early or late diastolic filling.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-related hemodynamic changes during diastole: a combined M-mode and Doppler echo study

To determine the effect of aging on the diastolic function of the left ventricle (LV) echo examination was performed in 115 subjects (47 women, 68 men) without any evidence of organic heart disease (2D and Doppler echo; exercise electrocardiography) aged 21 to 72 (mean +/- SD: 41 +/- 14) years. Transmitral flow with the characteristic early and late diastolic E-wave (E) and A-wave (A) was derived by pulsed Doppler ultrasound, whereas isovolumetric relaxation period (IVRP) was assessed by simultaneous M-mode registration of the aortic and mitral valve. Significantly increased values in older individuals (41 to 72 years; n = 57) as compared to younger subjects (21 to 40 years; n = 58) were found for the A/E ratio of the peak velocities (PAV/PEV) (90 versus 64%; p less than 0.001) and the velocity-time integrals (VTI-A/E) (79 versus 36%; p less than 0.001), atrial contribution to LV filling (AFF) (45 versus 26%; p less than 0.001) and isovolumic relaxation period (IVRP) (81 versus 72 ms; p less than 0.001). Age significantly correlated with PAV/PEV (r = 0.74; p less than 0.001), VTI-A/E (r = 0.83; p less than 0.001), AFF (r = 0.81; p less than 0.001) and IVRP (r = 0.74; p less than 0.001). Thus, age-related hemodynamic changes during diastole are characterized by a prolongation of IVRP and an increase of atrial contribution to LV filling.