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Hamada M, Ogimoto A, Otani T, Ohshima K, Kono T, Watanabe Y, Tasaka T, Ikeda S. Changes of left ventricular remodeling due to increased afterload in patients with essential hypertension. Int J Cardiol 2022; 367:74-80. [PMID: 36064037 DOI: 10.1016/j.ijcard.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is unclear whether afterload mismatch occurs during the initial stage of essential hypertension (EHT). Additionally, critical left ventricular hypertrophy (LVH) between preserved and reduced systolic functions in hypertension is also unclear. Thus, we aimed to clarify these points. METHODS Forty-five normal control subjects (NCS) and 140 EHT patients participated. EHT patients were subdivided into three groups: group I, without LVH (n = 37); group II, with LVH (n = 80); and group III, with LVH and LV heart failure (LVHF) (n = 23). Routine electrocardiographic and echocardiographic parameters, V5R/V6R ratio, relative wall thickness (RWT), LV mass (LVM) index, and peak systolic wall stress (PSWS) were measured. RESULTS In group I, LV systolic functions were preserved despite the increase of PSWS. In group II, LVH advanced, but LV systolic functions remained normal. A negative T-wave was observed in 69% of group II and 100% of group III. A significant correlation between RWT and LVM index was seen in NCS and groups I and II (r2 = 0.545, P < 0.0001) but not in group III. Afterload mismatch occurred in group III due to the decrease in V5R/V6R ratio, the increase of LV end-diastolic dimension, and the LV systolic dysfunctions, which are caused by exhaustion of preload reserve. The boundary of the LVM index between groups II and III was approximately 180 g/m2. CONCLUSION Afterload mismatch did not occur in group I, but it was observed in group III due to the exhaustion of preload reserve.
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Affiliation(s)
- Mareomi Hamada
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime 798-8510, Japan.
| | - Akiyoshi Ogimoto
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime 798-8510, Japan
| | - Takashi Otani
- Hoshinooka Cardiovascular Clinic, 1-5-5, Higashi-ishii, Matsuyama, Ehime 790-0932, Japan
| | - Kiyotaka Ohshima
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime 798-8510, Japan
| | - Tamami Kono
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime 798-8510, Japan
| | - Yuta Watanabe
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime 798-8510, Japan
| | - Tatsuro Tasaka
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime 798-8510, Japan
| | - Shuntaro Ikeda
- Department of Community and Emergency Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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Hamada M, Shigematsu Y, Ikeda S, Ohshima K, Ogimoto A. Impact of cibenzoline treatment on left ventricular remodelling and prognosis in hypertrophic obstructive cardiomyopathy. ESC Heart Fail 2021; 8:4832-4842. [PMID: 34713615 PMCID: PMC8712831 DOI: 10.1002/ehf2.13672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/03/2021] [Accepted: 10/01/2021] [Indexed: 12/14/2022] Open
Abstract
Aims This study aimed to elucidate the long‐term effect of cibenzoline therapy on cardiovascular complications and prognosis in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods and results Eighty‐eight patients with HOCM were treated with cibenzoline (Group A), and 41 patients did not receive cibenzoline (Group B). The changes in left ventricular (LV) remodelling, incidences of cardiovascular complications and deaths, were examined. The mean follow‐up period was 15.8 ± 5.6 years in Group A and 17.8 ± 7.2 years in Group B. In Group A, the LV pressure gradient (LVPG) decreased immediately after treatment, and the reduction was maintained throughout the study. In Group B, the LVPG decreased gradually according to the deterioration of LV function. LV reverse remodelling was confirmed in Group A, and LV remodelling advanced in Group B. In Group A, the incidence of each cardiovascular complication was <10%. Only one patient experienced LV heart failure (LVHF). LVHF incidence and atrial fibrillation were higher in Group B than those in Group A (P < 0.0001). The incidence of death was 20.5% in Group A and 90.2% in Group B (P < 0.0001). The most frequent cause of death was sudden cardiac death (SCD) (38.9%) in Group A and LVHF (67.6%) in Group B. The incidence of SCD showed no significant difference between the two groups. The cumulative cardiac survival rate was higher in Group A than that in Group B (P < 0.0001). Conclusions Cibenzoline treatment significantly reduced all cardiovascular complications and death due to LVHF and may be a promising treatment in patients with HOCM.
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Affiliation(s)
- Mareomi Hamada
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, 798-8510, Japan
| | - Yuji Shigematsu
- Fundamental and Clinical Nursing, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shuntaro Ikeda
- Department of Community and Emergency Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kiyotaka Ohshima
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, 798-8510, Japan
| | - Akiyoshi Ogimoto
- Division of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, 798-8510, Japan
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Long YX, Cui DY, Kuang X, Hu S, Hu Y, Liu ZZ. Effect of Levosimendan on Ventricular Systolic and Diastolic Functions in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol 2021; 77:805-813. [PMID: 34001722 DOI: 10.1097/fjc.0000000000001010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
ABSTRACT Levosimendan, a calcium sensitizer, exerts inotropic action through improving left ventricular ejection fraction. We noticed that only few clinical studies are published in which the effects of levosimendan on cardiac function are studied by echocardiography. When screening the literature (PubMed, Embase, and CENTRAL, from inception to August 2020), we found 29 randomized controlled trials on levosimendan containing echocardiographic data. We included those studies, describing a total of 574 heart failure patients, in our meta-analysis and extracted 14 ultrasonic parameters, pooling the effect estimates using a random-effect model. Our analysis of the diastolic parameters of the left ventricle shows that levosimendan reduce the early/late transmitral diastolic peak flow velocity ratio [standardized mean difference (SMD) -0.45 to 95% confidence interval (CI) (-0.87 to -0.03), P = 0.037] and E/e' (e': mitral annulus peak early diastolic wave velocity using tissue-doppler imaging) [SMD -0.59, 95% CI (-0.8 to -0.39), P < 0.001]. As it regards the systolic parameters of the right ventricle, levosimendan increased tricuspid annular plane systolic excursion [SMD 0.62, 95% CI (0.28 to 0.95), P < 0.001] and tricuspid annular peak systolic velocity [SMD 0.75, 95% CI (0.35 to 1.16), P < 0.001], and reduced systolic pulmonary artery pressure [SMD -1.02, 95% CI (-1.32, -0.73), P < 0.001]. As it regards the diastolic parameters of the right ventricle, levosimendan was associated with the decrease of Aa (peak late diastolic tricuspid annular velocity using tissue-doppler imaging) [SMD -0.38, 95% CI (-0.76 to 0), P = 0.047] and increase of Ea (peak early diastolic tricuspid annular velocity using tissue-doppler imaging) [SMD 1.03, 95% CI (0.63 to 1.42), P < 0.001] and Ea/Aa [SMD 0.86, 95% CI (0.18 to 1.54), P = 0.013]. We show that levosimendan is associated with an amelioration in the diastolic and systolic functions of both ventricles in heart failure patients.
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Affiliation(s)
- Yu-Xiang Long
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Mitter SS, Shah SJ, Thomas JD. A Test in Context: E/A and E/e' to Assess Diastolic Dysfunction and LV Filling Pressure. J Am Coll Cardiol 2017; 69:1451-1464. [PMID: 28302294 DOI: 10.1016/j.jacc.2016.12.037] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 12/09/2016] [Accepted: 12/13/2016] [Indexed: 02/08/2023]
Abstract
Diastolic dysfunction represents a combination of impaired left ventricular (LV) relaxation, restoration forces, myocyte lengthening load, and atrial function, culminating in increased LV filling pressures. Current Doppler echocardiography guidelines recommend using early to late diastolic transmitral flow velocity (E/A) to assess diastolic function, and E to early diastolic mitral annular tissue velocity (E/e') to estimate LV filling pressures. Although both parameters have important diagnostic and prognostic implications, they should be interpreted in the context of a patient's age and the rest of the echocardiogram to describe diastolic function and guide patient management. This review discusses: 1) the physiological basis for the E/A and E/e' ratios; 2) their roles in diagnosing diastolic dysfunction; 3) prognostic implications of abnormalities in E/A and E/e'; 4) special scenarios of the E/A and E/e' ratios that are either useful or challenging when evaluating diastolic function clinically; and 5) their usefulness in guiding therapeutic decision making.
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Affiliation(s)
- Sumeet S Mitter
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D Thomas
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Karvounis HI, Papadopoulos CE, Zaglavara TA, Nouskas IG, Gemitzis KD, Parharidis GE, Louridas GE. Evidence of Left Ventricular Dysfunction in Asymptomatic Elderly Patients with Non-insulin-dependent Diabetes Mellitus. Angiology 2016; 55:549-55. [PMID: 15378118 DOI: 10.1177/000331970405500511] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Diabetic cardiomyopathy is a distinct entity in diabetic patients with congestive heart failure, who have no angiographic evidence of significant coronary artery stenosis. The aim of this study was to evaluate left ventricular (LV) function in 24 elderly patients (mean age 67 ±2 years) with type 2 diabetes, who were asymptomatic and had no history of hypertension, or coronary or valvular heart disease. LV systolic indices (ejection fraction [EF] and fractional shortening [FS]), diastolic indices (E wave, A wave, E/A ratio, isovolumic relaxation time [IVRT] and deceleration time [DT]) and the myocardial performance index (MPI) were evaluated with echocardiography. Compared to controls (24 age- and gender-matched normal subjects), the E wave was reduced (0.60 ±0.10 m/sec vs 0.72 ±0.08 m/sec, p<0.05), the A wave was increased (0.77 ±0.07 m/sec vs 0.68 ±0.06 m/sec, p<0.05), the E/A ratio was decreased (0.78 ±0.20 vs 1.06 ±0.18, p<0.001) and both IVRT and DT were prolonged (0.115 ±0.01 sec vs 0.09 ±0.01 sec, p<0.001 and 0.240 ±0.04 sec vs 0.180 ±0.03 sec, p<0.001, respectively). The MPI was significantly increased (0.640 ±0.170 vs 0.368 ±0.098, p<0.001). LV diastolic function and the MPI are markedly impaired in asymptomatic elderly patients with type 2 diabetes.
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Affiliation(s)
- Haralampos I Karvounis
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA General Hospital, Greece
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Kaya MG, Simsek Z, Sarli B, Buyukoglan H. Myocardial performance index for detection of subclinical abnormalities in patients with sarcoidosis. J Thorac Dis 2014; 6:429-37. [PMID: 24822099 DOI: 10.3978/j.issn.2072-1439.2014.03.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/10/2014] [Indexed: 01/12/2023]
Abstract
AIM The aim of this study was to evaluate ventricular functions in patients with sarcoidosis without an obvious heart disease by using tissue Doppler-derived left and right ventricular myocardial performance index (MPI). METHODS The study population included 45 patient with sarcoidosis (29 men, 16 women; mean age, 44±10 years, mean disease duration, 4.2±2.7 years) and 45 healthy control subjects (31 men, 14 women; mean age, 41±8 years). Cardiac functions were determined using echocardiography, consisting of standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Myocardial tissue Doppler velocities [peak systolic (Sa), early diastolic (Ea), and late diastolic velocities (Aa)] were recorded using spectral pulsed Doppler from the LV free wall, septum, and RV free wall from the apical four chamber view. MPI was also calculated by TDI. RESULTS The conventional echocardiographic parameters and tissue Doppler measurements were similar between the patients and controls. Left ventricular MPI (0.490±0.092 vs. 0.396±0.088, P=0.010) and right ventricular MPI (0.482±0.132 vs. 0.368±0.090, P=0.006) were significantly higher in patients with sarcoidosis than the control subjects. There was a correlation between the disease duration and right and left ventricular MPI (r=0.418, P=0.005; r=0.366, P=0.013, respectively). There was also a correlation between the systolic pulmonary arterial pressure and right ventricular MPI but not left ventricular MPI (r=0.370, P=0.012; r=0.248, P=0.109, respectively). In receiver operating characteristics curve analysis, the cutoff value of left ventricular MPI >0.46 had 92% sensitivity and 64% specificity in predicting left ventricular diastolic dysfunction. CONCLUSIONS We have demonstrated that tissue Doppler-derived myocardial left and right ventricular MPI were impaired in sarcoidosis patients, although systolic function parameters were comparable in the patients and controls, showed a subclinic impaired ventricular functions in patients with sarcoidosis.
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Affiliation(s)
- Mehmet Gungor Kaya
- 1 Department of Cardiology, 2 Department of Respiratory Disease, Erciyes University School of Medicine, Kayseri, Turkey
| | - Zuhal Simsek
- 1 Department of Cardiology, 2 Department of Respiratory Disease, Erciyes University School of Medicine, Kayseri, Turkey
| | - Bahadir Sarli
- 1 Department of Cardiology, 2 Department of Respiratory Disease, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hakan Buyukoglan
- 1 Department of Cardiology, 2 Department of Respiratory Disease, Erciyes University School of Medicine, Kayseri, Turkey
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Pinamonti B, Merlo M, Nangah R, Korcova R, Di Lenarda A, Barbati G, Sinagra G. The progression of left ventricular systolic and diastolic dysfunctions in hypertrophic cardiomyopathy: clinical and prognostic significance. J Cardiovasc Med (Hagerstown) 2010; 11:669-77. [PMID: 20216227 DOI: 10.2459/jcm.0b013e3283383355] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The significance of the progression of systolic and diastolic dysfunctions in hypertrophic cardiomyopathy (HCM) is still an open issue. We sought to evaluate the clinical and prognostic implications of the progression of left ventricular systolic and diastolic dysfunction in HCM. METHODS One hundred one HCM patients were studied by echo-Doppler at baseline and during follow-up. RESULTS During a follow-up of 109 + or - 67 months, 28% of patients showed a progression to left ventricular diastolic dysfunction, defined as restrictive filling pattern (RFP), and 16% to left ventricular systolic dysfunction (left ventricular ejection fraction <50%). The 10-year heart transplant-free survival rate was 45% in patients with RFP at follow-up vs. 82% in the patients without RFP (P < 0.001), and 52% in patients with left ventricular systolic dysfunction at follow-up vs. 75% in the patients with left ventricular ejection fraction of at least 50% (P = 0.001). Baseline predictors of death/transplantation were New York Heart Association class III-IV, indexed left atrial diameter, and RFP. When RFP and left ventricular systolic dysfunction were added at follow-up, both emerged as prognostic predictors (RFP: hazard ratio 8.92, 95% confidence interval 2.5-31.86; systolic dysfunction: hazard ratio 25.35, 95% confidence interval 3.57-179.88) with a significant increase of area under the receiver-operating characteristic curves (0.81 vs. 0.70, P = 0.03) with respect to the baseline model. CONCLUSION Left ventricular diastolic and/or systolic dysfunction at follow-up are relatively frequent in HCM and are associated with a poor prognosis.
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Affiliation(s)
- Bruno Pinamonti
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Italy
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Nguyen VT, Ho JE, Ho CY, Givertz MM, Stevenson LW. Handheld echocardiography offers rapid assessment of clinical volume status. Am Heart J 2008; 156:537-42. [PMID: 18760138 DOI: 10.1016/j.ahj.2008.04.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 04/09/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessment of volume status is vital for successful management of patients in heart failure (HF) programs. Bedside determination of elevated left-sided filling pressure (LFP) can be challenging and frequently inaccurate; therefore, incorporating technology such as handheld echocardiography, to aid in estimation of LFP, may improve patient care. In this study, we evaluated the feasibility and accuracy of handheld echocardiography by a nonexpert for potential use in the point of care evaluation of compensation. METHODS Subjects were recruited from the HF clinic or inpatient service at a single center. Each subject underwent a focused handheld transthoracic echocardiogram by a medical resident trained for 10 hours. Subjects were assigned to 1 of 4 filling patterns (1 = normal, 2 = abnormal relaxation, 3 = pseudonormal, 4 = restrictive) based on measurements by pulsed wave and tissue Doppler. A 3-step echocardiography test for congestion in HF (TEC-HF) was devised for estimation of LFP. The gold standard for determining elevated LFP was clinical evaluation by a HF specialist, who classified subjects as being euvolemic or hypervolemic. RESULTS A total of 100 consecutive subjects (72% male) were recruited, with average age of 60 years and left ventricular ejection fraction of 27%. All subjects had evaluable echocardiographic data. Based on TEC-HF, filling patterns 3 and 4 predicted hypervolemia and patterns 1 and 2 predicted euvolemia, with sensitivity and specificity of 86% and 92%, respectively, and positive and negative predictive values of 86% and 92%, respectively. CONCLUSIONS Applying TEC-HF with handheld echocardiography accurately reflects clinical LFP as assessed by HF specialists. This procedure was easily taught to nonexpert medical staff who obtained adequate images in all patients. Handheld echocardiography could be a useful tool for assessing volume status in nonspecialized community settings.
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Sekine T, Daimon M, Hasegawa R, Teramoto K, Kawata T, Tanaka N, Takei Y, Takazawa K, Yoshida K, Komuro I. Cibenzoline improves coronary flow velocity reserve in patients with hypertrophic obstructive cardiomyopathy. Heart Vessels 2006; 21:350-5. [PMID: 17143709 DOI: 10.1007/s00380-006-0917-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 03/02/2006] [Indexed: 10/23/2022]
Abstract
The effect of cibenzoline, a class-Ia antiarrhythmic drug, on coronary flow velocity reserve (CFVR) was examined in patients with hypertrophic cardiomyopathy using transthoracic Doppler echocardiography. Coronary flow velocity reserve was assessed in 11 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 12 patients with hypertrophic nonobstructive cardiomyopathy (HNCM), before and after the intravenous administration of cibenzoline (1 mg/kg). Coronary hyperemia was induced by an intravenous infusion of adenosine triphosphate and CFVR was calculated as the ratio of hyperemic to basal mean coronary diastolic flow velocity. At baseline, CFVR was significantly correlated with left ventricular outflow tract pressure gradient (LVPG) in patients with HOCM (r = 0.67, P < 0.03). In patients with HOCM, administration of cibenzoline significantly improved impaired CFVR (2.0 +/- 0.8 to 3.0 +/- 1.0, P < 0.001), and reduced LVPG (55 +/- 30 to 23 +/- 18 mmHg, P < 0.001), while CFVR remained unchanged in patients with HNCM (2.6 +/- 0.9 to 2.9 +/- 0.8, P not significant). Cibenzoline not only reduces LVPG but also improves CFVR in patients with HOCM. In addition left ventricular outflow obstruction plays an important role in impaired coronary circulation in patients with HOCM.
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Affiliation(s)
- Tai Sekine
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Akgül F, Yalçin F, Babayiğit C, Seyfeli E, Seydaliyeva T, Gali E. Right ventricular and pulmonary function in sickle cell disease patients with pulmonary hypertension. Pediatr Cardiol 2006; 27:440-6. [PMID: 16835804 DOI: 10.1007/s00246-006-1257-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 02/11/2006] [Indexed: 10/24/2022]
Abstract
The effects of sickle cell disease (SCD) on right ventricular (RV) and pulmonary function in SCD patients with pulmonary hypertension is not well-known. The aim of this study was to investigate RV and pulmonary functions in patients suffering from SCD with or without pulmonary hypertension using color tissue Doppler imaging and spirometry. We evaluated 48 asymptomatic patients with SCD. All patients underwent echocardiography with tissue Doppler imaging and pulmonary function test. Patients were divided into two groups: Group 1 consisted of 27 patients (age, 18.1 +/- 7.1 years) with normal pulmonary artery pressure, and group 2 consisted of 21 patients (age, 21.4 +/- 7.4 years) with pulmonary hypertension. Both groups were compared with a sex- and age-matched control group including 24 normal healthy subjects (age, 19.8 +/- 9.2 years). Tricuspid lateral annular systolic (S (m)) and early diastolic velocity (E (m)) were higher in group 1 than group 2 and the control group (p < 0.05). Tricuspid lateral annular late diastolic velocities (A (m)), isovolumetric contraction time, and myocardial performance index (MPI) were higher and the E (m)/A (m) ratio was lower in group 2 than group 1 and the control group (p < 0.05). However, no differences were found in the tricuspid lateral annular E (m) deceleration time, ejection time, and isovolumetric relaxation time between group 1, group 2, and the control group. Tricuspid lateral annular S (m) and E (m) were similar in group 2 and the control group. Forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and the diffusion capacity of the lung for carbon monoxide were decreased in both groups of patients compared to the control group (p < 0.05). However, there was no difference in respiratory rate, FEV(1)/FVC ratio, peak expiratory flow, and total lung capacity between group 1, group 2, and the control group. There were no differences in any indices of lung function between the two groups of patients. MPI is useful index to evaluate RV function in patients with SCD. RV diastolic function was disturbed in only SCD patients with pulmonary hypertension. On the other hand, the restrictive pattern of pulmonary function abnormalities had developed in both groups of patients.
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Affiliation(s)
- Ferit Akgül
- Department of Cardiology, Faculty of Medicine, Mustafa Kemal University, Bagriyanik Mah., Antakya, Turkey.
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Cacciapuoti F, Galzerano D, Capogrosso P, Arciello A, Liberti D, Cacciapuoti F, Lama D. Impairment of Left Ventricular Function in Systemic Lupus Erythematosus Evaluated by Measuring Myocardial Performance Index with Tissue Doppler Echocardiography. Echocardiography 2005; 22:315-9. [PMID: 15839986 DOI: 10.1111/j.1540-8175.2005.04015.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In 44 patients affected by systemic lupus erythematosus (SLE) without any clinical signs of heart disease (group I) the myocardial performance index (MPI) was calculated to investigate left ventricular function. The index, as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by ejection time (ET), was measured by tissue Doppler echocardiography (TDE). Results achieved show a prolonged MPI with respect to the values recorded in healthy controls (group II). Its prolongation is due to a significant increase of IRT, whereas ICT and ET were within the normal limits. In patients with SLE without an evident cardiac engagement, this outcome seems to depend on a prevalent diastolic left ventricular dysfunction, perhaps due to a subclinical myocarditis. TDE is more precise than the conventional Doppler method in evaluating MPI and single time intervals, because their measurements are accomplished in concomitance of left ventricular wall motion rather than the flow movement.
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Affiliation(s)
- Federico Cacciapuoti
- Division of Internal Medicine and Metabolic Disease, Second University of Naples, Naples, Italy
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Schmidt AG, Gerst M, Zhai J, Carr AN, Pater L, Kranias EG, Hoit BD. Evaluation of left ventricular diastolic function from spectral and color M-mode Doppler in genetically altered mice. J Am Soc Echocardiogr 2002; 15:1065-73. [PMID: 12373248 DOI: 10.1067/mje.2002.121863] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Doppler indices of transmitral flow are commonly used to assess noninvasively left ventricular (LV) diastolic function in species larger than mice. The objective of our study was to characterize patterns of LV diastolic function in 2 genetically altered mouse models using Doppler- and color M-mode echocardiography. Phospholamban (PLB) reversibly inhibits the sarcoplasmic reticulum Ca(2+) ATPase (SERCA) and is a key regulator of myocardial relaxation. Twelve-week-old PLB knockout mice (PLB/KO) were examined in parallel with age-matched transgenic mice expressing a mutant form of PLB (PLB/N27A) that exhibited superinhibition of SERCA. Transmitral Doppler flow indexes, including isovolumic relaxation time, the ratio of peak early-to-late filling velocities, and deceleration time of peak early transmitral velocity indicate impaired diastolic filling in the PLB/N27A mutants, but improved LV diastolic function in the PLB/KO mice. In addition, a relatively load-independent parameter of LV relaxation measured by color M-mode Doppler, the propagation velocity of early flow into the LV cavity confirmed the observed differences. We conclude that transmitral filling patterns and color M-mode flow propagation velocity reflect changes in myocardial relaxation in mice with genetically altered levels of PLB and may be useful tools to characterize LV diastolic function in other mouse models of disease.
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Affiliation(s)
- Albrecht G Schmidt
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, USA
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Schannwell CM, Schneppenheim M, Plehn G, Marx R, Strauer BE. Left ventricular diastolic function in physiologic and pathologic hypertrophy. Am J Hypertens 2002; 15:513-7. [PMID: 12074352 DOI: 10.1016/s0895-7061(02)02265-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with hypertensive heart disease and left ventricular hypertrophy demonstrate an impaired left ventricular diastolic filling pattern. The aim of this study was to find out whether physiologic left ventricular hypertrophy induced by endurance training causes disturbances in left ventricular systolic and diastolic filling. METHODS We examined 49 athletes with left ventricular (LV) hypertrophy due to endurance training, 49 patients with LV hypertrophy due to arterial hypertension, and 26 untrained healthy control subjects by conventional echocardiography. Parameters of LV diastolic filling using pulse wave and color flow Doppler were also assessed. RESULTS All three study groups showed normal fractional shortening and mid-wall fractional shortening. Conventional echocardiography revealed a higher LV muscle mass index in the two study groups compared with the controls (athletes, 99 +/- 10 g; hypertensive patients, 95 +/- 11 g: controls: 52 +/- 7 g; P < .01 for athletes and hypertensive patients). In patients with arterial hypertension, a diastolic dysfunction consisting of a delayed relaxation pattern with a decrease in maximal early velocity of diastolic filling (0.44 +/- 0.1 m/sec) and a compensatory increase of the maximal late velocity of diastolic filling (0.53 +/- 0.1 m/sec) was demonstrated. In athletes with physiologic LV hypertrophy, a normal LV diastolic filling pattern was documented. CONCLUSIONS Doppler echocardiographic parameters of LV diastolic function can be of diagnostic importance for discrimination between pathologic and physiologic LV hypertrophy.
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15
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Santilli RA. Editorial. J Vet Cardiol 2002; 4:5-6. [PMID: 19081340 DOI: 10.1016/s1760-2734(06)70017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Albarrán A, Hernández F, Alonso M, Andreu J, Hernández P, Lázaro M, Gascueña R, Tascón JC, Coma R, Rodríguez J. Miocardiopatía hipertrófica obstructiva y estimulación secuencial auriculoventricular. Resultados agudos y seguimiento a largo plazo. Siete años de experiencia. Rev Esp Cardiol 2000. [DOI: 10.1016/s0300-8932(00)75206-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Santilli RA, Bussadori C. Doppler echocardiographic study of left ventricular diastole in non-anaesthetized healthy cats. Vet J 1998; 156:203-15. [PMID: 9883088 DOI: 10.1016/s1090-0233(98)80124-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study: (1) describes the Doppler technique for the assessment of diastolic function in feline patients; (2) reports normal Doppler diastolic values; and (3) determines the effect of ageing on these parameters. Doppler echocardiography was performed on 20 non-anaesthetized healthy cats. Each diastolic parameter was correlated with age, body weight, body surface area and R-R interval. To assess the isovolumetric relaxation phase of diastole, isovolumetric relaxation time was measured. To assess the filling phase of diastole, we measured peak flow velocities of the E and A waves, diastolic filling time, acceleration and deceleration time of the E wave and the E/A ratio of transmitral flow, peak flow velocity of the S, D and the A retrograde waves, as well as the S/D ratio and the systolic fraction of pulmonary venous flow. We found a significant correlation between age and peak flow velocity of the A wave, normalized peak flow velocity of the A wave, the E/A ratio, the acceleration time of the E wave, the diastolic filling time, the velocity time integral of the E wave, the peak flow velocity of the S wave and the systolic fraction. It was concluded that Doppler echocardiographic analysis of diastole is possible in the cat and that age has most effect on filling parameters.
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Affiliation(s)
- R A Santilli
- Clinica Veterinaria Malpensa, Samarale, Varese, Italy.
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18
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Abstract
Doppler echocardiography is one of the most useful clinical tools for the assessment of left ventricular (LV) diastolic function. Doppler indices of LV filling and pulmonary venous (PV) flow are used not only for diagnostic purposes but also for establishing prognosis and evaluating the effect of therapeutic interventions. The utility of these indices is limited, however, by the confounding effects of different physiologic variables such as LV relaxation, compliance and filling pressure. Since alterations in these variables result in changes in Doppler indices of opposite direction, it is often difficult to determine the status of a given variable when a specific Doppler filling pattern is observed. Recently, color M-mode and tissue Doppler have provided useful insights in the study of diastolic function. These new Doppler applications have been shown to provide an accurate estimate of LV relaxation and appear to be relatively insensitive to the effects of preload compensation. This review will focus on the complementary role of color M-mode and tissue Doppler echocardiography and traditional Doppler indices of LV filling and PV flow in the assessment of diastolic function.
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Affiliation(s)
- M J Garcia
- Cardiovascular Imaging Center, Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
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19
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van Son JA, Anderson RH, Mohr FW. Cephalad resuspension of aortic leaflet of the mitral valve in hypertrophic obstructive cardiomyopathy. Ann Thorac Surg 1998; 66:242-4. [PMID: 9692473 DOI: 10.1016/s0003-4975(98)00363-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A young child with hypertrophic obstructive cardiomyopathy, who was reoperated on for recurrent left ventricular outflow tract obstruction, underwent myectomy with patch augmentation of the ventricular septum. Cephalad resuspension of the aortic leaflet of the mitral valve resulted in abolishment of residual obstruction occurring secondary to its systolic anterior motion.
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Affiliation(s)
- J A van Son
- Department of Cardiovascular Surgery, Herzzentrum, University of Leipzig, Germany
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20
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Minniti G, Jaffrain-Rea ML, Moroni C, Baldelli R, Ferretti E, Cassone R, Gulino A, Tamburrano G. Echocardiographic evidence for a direct effect of GH/IGF-I hypersecretion on cardiac mass and function in young acromegalics. Clin Endocrinol (Oxf) 1998; 49:101-6. [PMID: 9797853 DOI: 10.1046/j.1365-2265.1998.00493.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The interpretation of echocardiographic abnormalities in acromegalic patients is complicated by non-specific age-related diseases, many of which are commoner in acromegaly. We have therefore investigated the cause-effect relationship between GH/IGF-I hypersecretion and precocious cardiovascular abnormalities in a series of young acromegalic patients. DESIGN An open prospective study. PATIENTS 20 acromegalic patients aged under 30 years, with normal blood pressure and glucose tolerance, and 20 age-matched control subjects. MEASUREMENTS Cardiac morphological parameters and indices of systolic and diastolic function at rest were studied by Doppler echocardiography. RESULTS Left ventricular mass (LVM) and LVM index (LVMi) were higher in acromegalics than in control subjects (215.0 +/- 15.4 g vs 140.8 +/- 8.5 g, P = 0.0002 and 109.8 +/- 5.9 g/m2 vs 82.1 +/- 3.7 g/m2, P = 0.0008, respectively), reaching values of left ventricular hypertrophy in 4 patients (20%). Both ejection fraction and fractional shortening were normal (66.4 +/- 2.1% vs 62.2 +/- 1.9% and 37.5 +/- 1.5% vs 35.8 +/- 1.3%, respectively), indicating normal left ventricular systolic function. Abnormalities of left and right diastolic ventricular filling were found, which consisted of an increased isovolumic relaxation time (99.2 +/- 2.7 ms vs 89.0 +/- 2.7 ms, P = 0.01) and impaired mitral and tricuspidal flow velocity curves. CONCLUSIONS An increase in cardiac mass and subclinical biventricular diastolic dysfunction were observed in young acromegalic patients. These findings argue for a direct cause-effect relationship between GH/IGF-I hypersecretion and myocardial abnormalities, and indicate that careful cardiological evaluation is mandatory in all acromegalics, whatever their age.
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Affiliation(s)
- G Minniti
- University of Rome La Sapienza, Italy
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21
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Hamada M, Shigematsu Y, Ikeda S, Hara Y, Okayama H, Kodama K, Ochi T, Hiwada K. Class Ia antiarrhythmic drug cibenzoline: a new approach to the medical treatment of hypertrophic obstructive cardiomyopathy. Circulation 1997; 96:1520-4. [PMID: 9315541 DOI: 10.1161/01.cir.96.5.1520] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The class Ia antiarrhythmic drug disopyramide relieves the outflow tract obstruction of hypertrophic obstructive cardiomyopathy (HOCM). Disopyramide, however, has several adverse effects, such as dysuria and thirst, resulting from its anticholinergic activity. A new class Ia antiarrhythmic drug, cibenzoline, has little anticholinergic activity. The aim of this study is to elucidate whether cibenzoline attenuates left ventricular pressure gradient (LVPG) in patients with HOCM. METHODS AND RESULTS Ten patients with HOCM (mean age, 59+/-12 years) participated in this study. LVPG and left ventricular functions were measured before and 2 hours after administration of a single oral dose of 150 or 200 mg cibenzoline. LVPG decreased from 123+/-60 to 39+/-33 mm Hg (P=.0026). The E/A ratio in transmitral Doppler flow increased from 1.20+/-0.84 to 2.00+/-1.72 (P=.029). Isovolumic relaxation time increased from 73+/-16 to 101+/-23 ms (P=.0026). Left ventricular diastolic dimension remained unchanged, but left ventricular systolic dimension enlarged significantly, from 21.6+/-2.4 to 26.2+/-3.3 mm (P=.0004). Fractional shortening decreased from 47.6+/-6.1% to 34.6+/-8.8% (P=.0007). Left ventricular ejection time index decreased significantly, and preejection period index increased in all the patients. Decreased LVPG remained maintained even in the long-term treatment with cibenzoline. Conclusions These results indicate that cibenzoline can markedly attenuate LVPG in patients with HOCM. A decrease in myocardial contractility seems to be closely related to a marked decrease in LVPG.
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Affiliation(s)
- M Hamada
- Second Department of Internal Medicine, Ehime University School of Medicine, Japan
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22
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Keren G, Maron BJ. Patterns of pulmonary venous and transmitral flow velocity in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 1995; 8:494-502. [PMID: 7546786 DOI: 10.1016/s0894-7317(05)80337-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study determines the characteristics of left atrial filling from the pulmonary veins in 80 patients with hypertrophic cardiomyopathy by transthoracic echocardiography. Patients in sinus rhythm (n = 72) showed a typical triphasic pattern with a systolic phase (J) and diastolic phase (K) and a retrograde surge of flow during atrial contraction. In sinus rhythm, three characteristic patterns of pulmonary venous flow in hypertrophic cardiomyopathy were observed: (1) an increased peak J wave relative to the K wave with J/K ratios greater than 1 (n = 43; 60%), (2) equal peak J and K phases (n = 7; 10%), and (3) decreased J wave relative to K ratios and J/K less than 1 (n = 22; 30%). The J/K ratio correlated inversely with the E/A ratio (r = -0.64; p < 0.01). In eight patients with atrial fibrillation, left atrial filling occurred primarily in diastole (K phase). Combined use of mitral and pulmonary venous flow may be optimal for the noninvasive detection of abnormal left ventricular filling in patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- G Keren
- Division of Cardiology, Tel Aviv Medical Center, Israel
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23
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Voutilainen S. Effects of head-up and head-down tilt on the transmitral flow velocities in relation to age: a Doppler echocardiographic study in healthy persons. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 1994; 14:561-7. [PMID: 7820980 DOI: 10.1111/j.1475-097x.1994.tb00414.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To assess whether age modifies the effects of preload on the Doppler indexes of left ventricular filling, 10 younger (mean age 31 years) and 10 older (mean age 53 years) healthy subjects underwent transmitral flow velocity measurements following acute changes of venous return produced by head-up and head-down tilts. In the horizontal supine position, almost all Doppler indexes differed significantly between the groups. As venous return increased from the head-up to the head-down position, the peak early and late transmitral velocities, their ratio, and the acceleration and deceleration of the early flow increased while the relaxation time shortened. These changes did not differ significantly between the younger and older subjects. In conclusion, both age and preload have strong effects on the Doppler transmitral velocity indexes. The preload-induced changes are not modified by age.
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Affiliation(s)
- S Voutilainen
- Department of Medicine, Päijät-Häme Central Hospital, Lahti, Finland
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24
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Voutilainen S, Kupari M, Hippeläinen M, Karppinen K, Ventilä M. Age-dependent influence of heart rate on Doppler indexes of left ventricular filling. J Intern Med 1994; 235:435-41. [PMID: 8182399 DOI: 10.1111/j.1365-2796.1994.tb01100.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVE The Doppler indexes of left ventricular filling are related to age and heart rate. The aim of this study was to assess whether the influences of heart rate and age interactions (that is, whether the effect of heart rate on the Doppler indexes) is modified by age. SUBJECTS AND METHODS The effects of atropine-induced heart rate increases on the transmitral velocities were compared in 10 younger healthy subjects aged 26-38 years and 12 older healthy subjects aged 50-67 years. RESULTS With a comparable total rise in heart rate (on average 20 beats min-1), the peak early diastolic velocity decreased likewise in both groups (from 66 +/- 9 to 57 +/- 9 cm s-1 in the younger age group and from 58 +/- 15 to 47 +/- 13 cm s-1 in the older age group). The peak atrial velocity remained unaltered in the older group (53 +/- 16 vs. 52 +/- 14 cm s-1) but rose from 33 +/- 6 to 44 +/- 12 cm s-1 in the younger (P = 0.02). The early-to-atrial peak velocity ratio decreased from 1.2 +/- 0.6 to 1.0 +/- 0.4 cm s-1 in the older subjects and from 2.0 +/- 0.5 to 1.4 +/- 0.5 cm s-1 in the younger subjects (P = 0.01). Changes in the other Doppler indexes were similar in both groups. CONCLUSIONS The effect of heart rate on certain Doppler indexes of left ventricular filling is age-dependent. The peak velocity ratio cannot be interpreted without adjusting for heart rate in younger subjects, whilst in older people heart rate variation is of less importance.
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Affiliation(s)
- S Voutilainen
- Department of Medicine, Päijät-Häme Central Hospital, Lahti, Finland
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25
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Affiliation(s)
- E K Louie
- Department of Medicine, Loyola University Medical Center, Maywood 60153
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26
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Völler H, Uhrig A, Spielberg C, von Ameln H, Schröder K, Brüggemann T, Schröder R. Acute alterations of pre- and afterload: are Doppler-derived diastolic filling patterns able to differentiate the loading condition? INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1993; 9:231-40. [PMID: 8133120 DOI: 10.1007/bf01137149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The net effects of acute changes in pre- and afterload on left ventricular filling, were examined by altering loading conditions in normal subjects. The specific purpose of this study was to investigate whether Doppler-derived transmitral flow patterns are able to differentiate the type of loading conditions. In 24 normal subjects (13 females, 11 males, mean age 44.1 +/- 11.5 years), the following Doppler variables were determined at baseline, after rapid volume infusion (preload increase), after nitroglycerin administration (preload decrease), during isometric exercise (afterload increase), and after application of a converting enzyme inhibitor (afterload decrease): the peak and integrated early (E, Ei) and late (A, Ai) diastolic flow velocities, their ratios (E/A, Ei/Ai), the percentage of atrial contribution (ACON), and the acceleration and deceleration times (Ac, Dc) of early filling. Reduced preload and increased afterload led to similar filling patterns characterized by a significant E and Ei decrease (p < 0.05, compared to baseline) accompanied by an A and Ai increase with a resultant reduction of E/A and Ei/Ai. Both changes increased the atrial contribution to filling and reduced Ac and Dc. Increased preload only significantly increased E and Ei, while reduced afterload did not induce any significant changes. Different loading conditions alter Doppler-derived diastolic filling patterns. However, the transmitral flow profile is not specific enough to distinguish the manner in which loading conditions have been altered.
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Affiliation(s)
- H Völler
- Department of Cardiopulmology, Klinikum Steglitz, University of Berlin, Germany
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27
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Kreuser ED, Völler H, Behles C, Schröder K, Uhrig A, Besserer A, Thiel E. Evaluation of late cardiotoxicity with pulsed Doppler echocardiography in patients treated for Hodgkin's disease. Br J Haematol 1993; 84:615-22. [PMID: 8217818 DOI: 10.1111/j.1365-2141.1993.tb03136.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The impact of valvular, myocardial and pericardial abnormalities on cardiac haemodynamics in patients treated for Hodgkin's disease with COPP/ABVD with and without mediastinal irradiation was determined in 49 patients 2-10 years after induction therapy. Diagnostic procedures to evaluate cardiac function consisted of history, physical examination, exercise bicycle stress test, M-mode two-dimensional and pulsed Doppler echocardiography. No patient reported symptoms related to cardiomyopathy, and only one of the 49 had evidence of coronary heart disease. Pericardial thickening was seen on echocardiograms in 19/49 patients (38.8%), valvular thickening in 21/49 (42.9%), and reduced fractional shortening in 9/49 (18.4%). The Doppler-derived mean E and A (+/- SD) of transmitral flow were 0.75 +/- 0.14 m/s and 0.56 +/- 0.09 m/s, respectively, in patients receiving chemotherapy and 0.81 +/- 0.19 m/s and 0.63 +/- 0.20 m/s in those with additional mediastinal irradiation. There was no statistically significant difference between mean E and A in transmitral flow in patients treated for Hodgkin's disease and control subjects. Furthermore, the transtricuspid and hepatic vein flow velocities did not differ significantly. Although the present study demonstrates high frequencies of pericardial and valvular thickening in patients treated for Hodgkin's disease with the COPP/ABVD regimen with or without mediastinal irradiation, it showed no impact on cardiac flow velocities. The abnormalities might thus be of minor clinical relevance in these patients.
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Affiliation(s)
- E D Kreuser
- Department of Haematology and Oncology, University of Berlin, Klinikum Steglitz, Germany
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28
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Solomon SD, Wolff S, Watkins H, Ridker PM, Come P, McKenna WJ, Seidman CE, Lee RT. Left ventricular hypertrophy and morphology in familial hypertrophic cardiomyopathy associated with mutations of the beta-myosin heavy chain gene. J Am Coll Cardiol 1993; 22:498-505. [PMID: 8335820 DOI: 10.1016/0735-1097(93)90055-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the spectrum of left ventricular hypertrophy and ventricular morphology in adults with hypertrophic cardiomyopathy due to mutations of the beta-myosin heavy-chain gene. BACKGROUND Although echocardiography is an important test in diagnosing hypertrophic cardiomyopathy, the lack of an independent diagnostic criterion has been an obstacle in determining the full echocardiographic spectrum of this disease. Mutations in the beta-myosin heavy chain gene occur in approximately 50% of familial cases; in members of families with a known mutation, the diagnosis can be made with certainty. METHODS Echocardiograms from 39 genetically affected and 30 genetically unaffected adult family members over age 16 years from 10 families were analyzed. Left ventricular wall thickness was measured at 10 separate locations, and the presence of systolic anterior motion of the mitral valve, right ventricular hypertrophy and left ventricular morphology was evaluated independently by three separate observers without knowledge of the genetic diagnosis. RESULTS The mean maximal wall thickness in the genetically affected group was 24 +/- 8 mm (range 11 to 40), compared with 11 +/- 2 mm (range 7 to 16) in the unaffected group (p < 0.0001). Systolic anterior motion of the mitral valve or chordae tendineae with or without leaflet-septal contact was present in 62% of the affected group and in none of the unaffected group. The morphologic finding of reversed septal curvature was present in 79% of the affected group and in none of the unaffected group. Seventy-seven percent of patients in the affected group had a septal/free wall ratio > or = 1.3 compared with 6% in the unaffected group, with a septal/posterior wall ratio > or = 1.3 associated with only a 55% probability of being affected. CONCLUSIONS The two-dimensional echocardiographic spectrum of hypertrophic cardiomyopathy in a genetically defined adult population is broad. Previous echocardiographic criteria may be too strict to diagnose the disease in some patients who are genetically affected and therefore at risk for adverse events related to the disease. Ultimately, genetic testing may supersede echocardiography in diagnosing hypertrophic cardiomyopathy.
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Affiliation(s)
- S D Solomon
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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29
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Tanaka Y, Nakamura K, Kuroiwa N, Odachi M, Mawatari K, Onimaru M, Sanada J, Arima T. Isovolumetric relaxation flow in patients with ischemic heart disease. J Am Coll Cardiol 1993; 21:1357-64. [PMID: 8473642 DOI: 10.1016/0735-1097(93)90309-o] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The purpose of this study was to clarify the characteristics of flow during the isovolumetric relaxation period and to analyze the relation between these flow patterns and standard hemodynamic indexes. BACKGROUND Outward motion of the left ventricle during the isovolumetric relaxation period has been observed by cineangiography. However, there is little information about blood flow during this period. METHODS Seventy-nine patients with ischemic heart disease were examined by pulsed Doppler echocardiography and cardiac catheterization. All patients were classified into three groups according to the observed patterns of isovolumetric relaxation flow: group I (n = 41), flow directed toward the apex; group II (n = 21), flow directed toward the base, and group III (n = 17), low velocity flow (< 12 cm/s) without a dominant direction. Patients in group I were further classified into group Ia (n = 19) with normal ventriculograms and group Ib (n = 22) with asynergy. RESULTS Left ventricular ejection fraction and negative first derivative of left ventricular pressure were significantly lower in group II (49 +/- 9% and 1,274 +/- 212 mm Hg/s, respectively) and group III (38 +/- 8% and 1,147 +/- 280 mm Hg/s, respectively) than in group Ia (68 +/- 7% and 1,727 +/- 358 mm Hg/s), each p < 0.01. Time constant was significantly prolonged in group II (49 +/- 6 ms) and group III (48 +/- 6 ms) compared with that in group Ia (41 +/- 6 ms), p < 0.05. On left ventriculography, patterns of outward wall motion during the isovolumetric relaxation period were associated with the patterns of isovolumetric relaxation flow. CONCLUSIONS Changes in left ventricular relaxation are accompanied by alterations in isovolumetric relaxation flow. It is therefore useful to evaluate isovolumetric relaxation flow when investigating early diastolic ventricular function.
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Affiliation(s)
- Y Tanaka
- Second Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan
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Dimitrow PP, Dubiel JS. Effects on left ventricular function of pindolol added to verapamil in hypertrophic cardiomyopathy. Am J Cardiol 1993; 71:313-6. [PMID: 8427174 DOI: 10.1016/0002-9149(93)90797-g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of the study was to assess the effect of adding pindolol to previously used verapamil monotherapy on left ventricular (LV) systolic and diastolic function in 20 patients with hypertrophic cardiomyopathy. Patients were initially treated with verapamil in maximal well-tolerated doses for 16 +/- 14 months; pindolol, 5 mg twice daily, was added. In a Doppler echocardiographic study all patients had altered LV diastolic filling despite verapamil therapy. The control examination, which consisted of echocardiographic study and New York Heart Association functional status classification, was performed after 20 days and repeated after > or = 6 months of follow-up. Combined pindolol and verapamil therapy caused an increase in LV diastolic filling manifested by beneficial changes of transmitral flow parameters. Also, inhibition of hypercontractile LV function expressed by reduction of LV outflow tract pressure gradient and ejection fraction was observed. New York Heart Association functional class was reduced in 13 patients. The magnitude and distribution of LV myocardial hypertrophy did not change significantly. It is concluded that pindolol and verapamil combined therapy is superior to verapamil monotherapy because of improved LV diastolic function (probably due to partial agonist activity of pindolol) and reduced hypercontractile function in patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- P P Dimitrow
- IInd Clinic of Cardiology, Academy of Medicine, Krakow, Poland
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31
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Lewis JF, Spirito P, Pelliccia A, Maron BJ. Usefulness of Doppler echocardiographic assessment of diastolic filling in distinguishing "athlete's heart" from hypertrophic cardiomyopathy. BRITISH HEART JOURNAL 1992; 68:296-300. [PMID: 1389762 PMCID: PMC1025074 DOI: 10.1136/hrt.68.9.296] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE In some athletes with a substantial increase in left ventricular wall thickness, it may be difficult to distinguish with certainty physiological hypertrophy due to athletic training from hypertrophic cardiomyopathy. The purpose of the present investigation was to determine whether assessment of left ventricular filling could differentiate between these two conditions. DESIGN Doppler echocardiography was used to obtain transmitral flow velocity waveforms from which indices of left ventricular diastolic filling were measured. Normal values were from 35 previously studied control subjects. SETTING Athletes were selected mostly from the Institute of Sports Science (Rome, Italy), and patients with hypertrophic cardiomyopathy were studied at the National Institutes of Health (Bethesda, Maryland). PARTICIPANTS The athlete group comprised 16 young competitive athletes with an increase in left ventricular wall thickness (range 13-16 mm; mean 14). For comparison, 12 symptom free patients with non-obstructive hypertrophic cardiomyopathy were selected because their ages and degree of hypertrophy were similar to those of the athletes. RESULTS In the athlete group, values for deceleration of flow velocity in early diastole, peak early and late diastolic flow velocities, and their ratio were not significantly different from those obtained in untrained normal subjects; furthermore, Doppler diastolic indices were normal in each of the 16 athletes. Conversely, in patients with hypertrophic cardiomyopathy, mean values for Doppler diastolic indices were significantly different from both normal subjects and athletics (p = 0.01 to 0.003), and one or more indices were abnormal in 10 (83%) of the 12 patients. CONCLUSIONS Doppler echocardiographic indices of left ventricular filling may aid in distinguishing between pronounced physiological hypertrophy due to athletic training and pathological hypertrophy associated with hypertrophic cardiomyopathy.
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Affiliation(s)
- J F Lewis
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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32
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Sasson Z, Rasooly Y, Chow CW, Marshall S, Urowitz MB. Impairment of left ventricular diastolic function in systemic lupus erythematosus. Am J Cardiol 1992; 69:1629-34. [PMID: 1598881 DOI: 10.1016/0002-9149(92)90715-b] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Left ventricular (LV) diastolic performance was evaluated with pulsed-wave Doppler echocardiography in a cross-sectional population of patients with systemic lupus erythematosus (SLE) in search of subclinical myocardial involvement. Such involvement is reported to occur infrequently, despite pathohistologic evidence of myocarditis in up to 70% of patients with SLE. Thirty-five consecutive patients with SLE were evaluated, 14 with active and 21 with inactive disease, and were compared with 30 age-matched healthy control subjects. Twenty-six patients were restudied at 7 months. All had normal LV systolic function, normal pericardial and valvular structures, and no significant valvular regurgitation on Doppler echocardiography. In SLE patients with active disease, indexes of LV diastolic function differed significantly from the inactive group and from control subjects, with marked prolongation of isovolumic relaxation time (104 +/- 18 vs 74 +/- 13 ms, p = 0.0001), as well as reduced peak early diastolic filling velocity (E) (0.69 +/- 0.19 vs 0.83 +/- 0.17 ms, p = 0.01), reduced ratio of early to late diastolic flow velocity (E/A) (1.15 +/- 0.53 vs 1.47 +/- 0.35, p = 0.02), and prolonged mitral pressure halftime (74 +/- 14 vs 65 +/- 8 ms p = 0.01). Similar significant differences were found between the active and inactive SLE patient groups. SLE patients with inactive disease differed from control subjects in only mild prolongation of mitral pressure halftime. Abnormal prolongation of isovolumic relaxation (greater than 100 ms) was found to be the most useful marker of diastolic impairment, being present in 64% of SLE patients with active disease and in 14% of patients with inactive disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- Z Sasson
- Department of Medicine, Wellesley Hospital, University of Toronto, Canada
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33
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Castini D, Mangiarotti E, Vitolo E, Conconi B, Triulzi MO. Effects of venous return reduction in hypertensive patients: is there a Doppler diastolic dysfunction index independent of preload reduction? Am Heart J 1992; 123:1299-306. [PMID: 1575149 DOI: 10.1016/0002-8703(92)91037-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to evaluate the effects of preload reduction on the Doppler transmitral flow pattern in the presence of diastolic dysfunction (hypertensive patients) and normal diastolic function (normal subjects) to identify, if present, one or more indexes of abnormal diastolic ventricular filling independent of variations in preload. For this purpose Doppler echocardiography was performed in 17 patients with hypertension and in 18 normal subjects under basal conditions and after 5 minutes of blood pressure cuff inflation at the root of the four limbs. The two groups showed a similar response to preload reduction: a significant reduction in peak velocity and the time-velocity integral of the E wave and in the ratio of peak velocities of E and A waves. Therefore the differences in left ventricular filling patterns between hypertensive and normal subjects observed under basal conditions were still present after preload reduction. The comparison between normal subjects after preload reduction and hypertensive patients in the basal state showed a higher peak velocity and time-velocity integral of the A wave in the latter (61.2 +/- 16.2 vs 46.2 +/- 9 cm/sec [p less than 0.002] and 5.4 +/- 1.8 vs 3.7 +/- 1 cm [p less than 0.002], respectively) with no differences in the ratios of peak velocities and time-velocity integrals of the E and A waves.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Castini
- Division of Cardiology, Bassini Hospital, Milano, Italy
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34
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Cacciapuoti F, D'Avino M, Lama D, Bianchi U, Perrone N, Varricchio M. Progressive impairment of left ventricular diastolic filling with advancing age: a Doppler echocardiographic study. J Am Geriatr Soc 1992; 40:245-50. [PMID: 1538043 DOI: 10.1111/j.1532-5415.1992.tb02076.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify the sequence and significance of left ventricular filling abnormalities associated with progressive aging in humans. DESIGN Cross-sectional study comparing three age groups. SETTING Department of Geriatrics at University of Naples. PARTICIPANTS Seventy-five healthy subjects in three age groups: 25 subjects from 25 to 45 years (Group I), 25 subjects from 46 to 65 years (Group II), and 25 subjects from 66 to 85 years (Group III). INTERVENTION None. MAIN OUTCOME MEASURES All underwent pulsed-doppler echocardiography under color guide to measure the following parameters: peak velocity flow for early (E wave) and late (A wave) mitral flow; A/E wave ratio; deceleration time of mitral flow (MDt); isovolumic relaxation time (IRT); ratio of velocity time integrals of the A wave to the velocity time integrals of the entire mitral spectrum (VTIA/VTIM). RESULTS Peak velocity of the E wave was slightly lower in Group II and III compared to Group I; in contrast, peak velocity of the A wave was greater (P less than 0.005) in aged individuals. Also A/E wave ratio, MDt, and IRT were significantly greater with advancing age (P less than 0.01; P less than 0.05 and P less than 0.001, respectively). Finally, VTIA/VTIM tended to be greater in the oldest group, but not significantly so. CONCLUSIONS Left ventricular relaxation is progressively impaired in late middle age and old age, presumably an early marker of cardiac aging. Increased left atrial pressure is compromised only in the oldest group, presumably representing a compensation for impaired left ventricular relaxation.
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Affiliation(s)
- F Cacciapuoti
- Cattedra di Gerontologia e Geriatria, 1st Faculty of Medicine, University of Naples, Italy
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35
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Panza JA, Petrone RK, Fananapazir L, Maron BJ. Utility of continuous wave Doppler echocardiography in the noninvasive assessment of left ventricular outflow tract pressure gradient in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1992; 19:91-9. [PMID: 1729351 DOI: 10.1016/0735-1097(92)90057-t] [Citation(s) in RCA: 142] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Subaortic obstruction is an important determinant of the clinical presentation of and therapeutic approach to patients with hypertrophic cardiomyopathy. Therefore, assessment of the presence and magnitude of the intraventricular pressure gradient is paramount in the clinical evaluation of these patients. To establish the utility of continuous wave Doppler echocardiography in assessing the pressure gradient in hypertrophic cardiomyopathy, 28 patients representing the wide hemodynamic spectrum of this disease underwent simultaneous determination of the subaortic gradient by continuous wave Doppler ultrasound and cardiac catheterization. With use of the modified Bernoulli equation, the Doppler-estimated gradient showed a strong correlation with the maximal instantaneous pressure difference measured at catheterization, both under basal conditions (r = 0.93; p less than 0.0001) and during provocative maneuvers (r = 0.89; p less than 0.0001). In 26 of the 28 patients, all assessments of the subaortic gradient were in agreement within 15 mm Hg (average difference 5 +/- 3 mm Hg). In the other two patients there were substantial differences between these measurements (under basal conditions in one patient and after provocation in another), although the Doppler technique predicted the presence of marked subaortic obstruction in each. In both patients the erroneous interpretation was due to superimposition of the mitral regurgitation signal on that of left ventricular outflow. Doppler waveforms from the left ventricular outflow tract showed variability in contour among different patients and in individual patients. Hence, continuous wave Doppler echocardiography is a useful noninvasive method for estimating the subaortic gradient in patients with hypertrophic cardiomyopathy. However, technical factors such as contamination of the outflow tract jet with that of mitral regurgitation and variability in waveform configuration may importantly influence such assessments of the subaortic gradient.
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Affiliation(s)
- J A Panza
- Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892
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36
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Lin CS, Chen KS, Lin MC, Fu MC, Tang SM. The relationship between systolic anterior motion of the mitral valve and the left ventricular outflow tract Doppler in hypertrophic cardiomyopathy. Am Heart J 1991; 122:1671-82. [PMID: 1957762 DOI: 10.1016/0002-8703(91)90286-q] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In an attempt to investigate the role of left ventricular blood outflow in the generation of systolic anterior motion (SAM) of the mitral valve in patients with hypertrophic cardiomyopathy, we precisely analyzed the temporal relation of SAM and the left ventricular outflow tract (LVOT) systolic Doppler events obtained at the maximal mitral-septal apposition or equivalent area in eight patients with severe SAM, in five patients with mild/moderate SAM, and in seven patients with no SAM, using M-mode and pulsed Doppler echocardiography; the results were compared with those in 10 normal subjects. In all 13 patients with SAM, the timing of SAM generation corresponded to the LVOT Doppler events either between the onset of SAM and the onset of Doppler (r = 0.834, p less than 0.0001) or between the peak of SAM and the peak of Doppler (r = 0.836, p less than 0.0001). The excursion rate of the development of SAM showed a correlation with the LVOT blood outflow acceleration (r = 0.828, p less than 0.0001). The timing of SAM resolution also correlated with the Doppler events, either between the offset of SAM and the offset of Doppler (r = 0.795, p less than 0.001) or the end of SAM and the end of Doppler (r = 0.859, p less than 0.0001). The LVOT blood outflow deceleration showed a correlation with the regression rate of SAM (r = 0.668, p less than 0.013). The LVOT blood outflow acceleration was significantly higher in patients with severe SAM than in patients with mild/moderate SAM or no SAM. This study suggests that the high LVOT blood outflow acceleration in early systole possibly plays an important part in the generation of the Bernoulli pressure drop and results in anterior motion of the mitral valve. At mid-systole, a drag force and/or suction effect of pressure drop produced by continuous outflow blood may sustain the anterior motion of the mitral valve. At late systole, as the blood flow decelerates, the regression of SAM then occurs.
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Affiliation(s)
- C S Lin
- Department of Internal Medicine, Chung Shan Medical and Dental College Hospital, Taichung, Taiwan, Republic of China
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37
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Thomas JD, Weyman AE. Echocardiographic Doppler evaluation of left ventricular diastolic function. Physics and physiology. Circulation 1991; 84:977-90. [PMID: 1884473 DOI: 10.1161/01.cir.84.3.977] [Citation(s) in RCA: 293] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J D Thomas
- Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston 02114
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38
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Voutilainen S, Kupari M, Hippeläinen M, Karppinen K, Ventilä M, Heikkilä J. Factors influencing Doppler indexes of left ventricular filling in healthy persons. Am J Cardiol 1991; 68:653-9. [PMID: 1877483 DOI: 10.1016/0002-9149(91)90360-w] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ninety-three healthy persons aged 11 to 91 years were studied to assess the factors influencing Doppler indexes of left ventricular (LV) diastolic filling. The effects of physical activity, alcohol consumption and smoking were tested in addition to those of age, sex, heart rate, body mass index, blood pressure, left atrial diameter, and LV end-diastolic diameter, wall thickness, mass and fractional shortening. The data were fitted stepwise into multiple linear regression models both in the total population and in 3 groups aged less than 40, 40 to 60 and greater than 60 years. In the total population, age explained 45 to 68% of the variation in the peak early and late diastolic velocities, their ratio, deceleration of the early velocity, atrial filling fraction and peak filling rate normalized to mitral stroke volume. With advancing age--and with increases in either body mass index, heart rate, diastolic blood pressure or LV mass--the indexes of early filling decreased, whereas with regular modest use of alcohol or regular aerobic exercise they increased (p less than 0.05 for all). In the middle-aged subjects, gender explained 32 to 57% of the variation in the peak atrial velocity, early to atrial peak velocity ratio and atrial filling fraction; the peak velocity ratio measured 1.4 +/- 0.3 (mean +/- standard deviation) in men vs 1.0 +/- 0.2 in women (p less than 0.001). In conclusion, many constitutional and physiologic factors and even life-style can influence the Doppler indexes of LV filling. This demonstrates the exquisite sensitivity of the method but indicates also that individual measurements must be interpreted with caution.
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Affiliation(s)
- S Voutilainen
- Department of Medicine, Päjät-Häme Central Hospital, Lahti, Finland
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39
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Seiler C, Jenni R, Krayenbuehl HP. Intraventricular blood flow during isovolumetric relaxation and diastole in hypertrophic cardiomyopathy. J Am Soc Echocardiogr 1991; 4:247-57. [PMID: 1854495 DOI: 10.1016/s0894-7317(14)80024-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Forty patients with hypertrophic cardiomyopathy were investigated by Doppler echocardiography for intraventricular blood flow abnormalities. None had a bundle branch block. The patients were recruited on the basis of the presence of at least one of four different types of abnormal left ventricular blood flow movements during systole, isovolumetric relaxation, and diastole (time after mitral valve opening). The abnormal blood flow patterns were composed of the following: (1) systolic left ventricular outflow and midventricular obstruction in 20 of 40 and in 6 of 40 patients, respectively; (2) retrograde isovolumetric relaxation flow (IVRFretro; mean velocity, 0.7 +/- 0.3 m/sec), that is, flow toward the apex of the left ventricle, in 28 of 40 patients; (3) antegrade isovolumetric relaxation flow (IVRFante; mean velocity, 1.6 +/- 1.0 m/sec), that is, flow toward the left ventricular outflow tract, in 3 of 40 patients; and (4) diastolic antegrade flow (DFante; mean velocity, 0.9 +/- 0.3 m/sec), that is, flow opposite to mitral inflow, in 10 of 40 patients. There were significantly fewer patients with asymmetric septal hypertrophy (group 1) than with apical hypertrophic cardiomyopathy (group 2) showing DFante (1/29 versus 9/11, p less than 0.01). IVRFretro and DFante revealed higher velocities in patients with marked left ventricular asymmetric hypertrophy than in those with mild hypertrophy. Thus, in hypertrophic cardiomyopathy and especially in patients with marked asymmetric hypertrophy, there are different types of abnormal intraventricular blood flow movements during isovolumetric relaxation and disatole. This phenomenon is probably caused by asynchronous relaxation of the asymmetrically distributed, hypertrophied myocardium. DFante is more often observed in the apical cardiomyopathy than other forms of hypertrophic cardiomyopathy probably attributable to apically localized left ventricular cavity obliteration.
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Affiliation(s)
- C Seiler
- Medical Policlinic, University Hospital, Zurich, Switzerland
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40
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Shahi M, Nadazdin A, Foale RA. Characteristics of left ventricular filling in coronary artery disease and myocardial ischaemia after dipyridamole provocation. BRITISH HEART JOURNAL 1991; 65:265-70. [PMID: 2039671 PMCID: PMC1024628 DOI: 10.1136/hrt.65.5.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Doppler echocardiographic measurement of transmitral filling velocities seems to be a sensitive marker for resting left ventricular diastolic abnormalities in patients with coronary artery disease. The behaviour of these filling velocities during induced myocardial ischaemia, however, has not been fully studied. Left ventricular filling was assessed by pulsed Doppler ultrasound in 21 patients with angina pectoris and coronary artery disease and in five controls (patients with chest pain but without myocardial ischaemia). High dose dipyridamole infusion (0.9 mg/kg over 10 minutes) was used to provoke myocardial ischaemia, which was assessed by symptoms and electrocardiographic ST segment change. Doppler indices of diastolic filling were measured and the results expressed as percentage change from baseline values. Dipyridamole increased the heart rate and reduced systolic blood pressure equally in both groups. In the controls dipyridamole increased the peak filling velocities of both the early and atrial filling waves. In the 12 patients with coronary artery disease who did not develop evidence of myocardial ischaemia, the effect on left ventricular filling velocity resembled that in the controls though the time to peak change was delayed. Six of the nine patients with dipyridamole induced myocardial ischaemia had a significantly reduced maximum changes in early (+30% v +18%) and atrial (-0.2% v +33%) filling velocities compared with the controls. The remaining three patients had a decrease in early filling velocity (-20%) with an associated increase in atrial peak filling velocity (+21%). Dipyridamole increased diastolic filling velocities in the controls. In patients with coronary artery disease there was a variable change in diastolic filling indices which may be attributed either to the degree of myocardial ischaemia or to the different haemodynamic changes occurring during myocardial ischaemia.
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Affiliation(s)
- M Shahi
- Department of Cardiology, St Mary's Hospital, London
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41
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Hadjimiltiades S, Panidis IP, McAllister M, Ross J, Mintz GS. Dynamic changes in left ventricular outflow tract flow velocities after amyl nitrite inhalation in hypertrophic cardiomyopathy. Am Heart J 1991; 121:1143-8. [PMID: 1672573 DOI: 10.1016/0002-8703(91)90675-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Doppler echocardiography was performed in 21 patients with hypertrophic cardiomyopathy (HC), in nine patients with no evidence of left ventricular (LV) hypertrophy by two-dimensional echocardiography, and in five patients with systemic hypertension and concentric LV hypertrophy. The LV outflow tract (LVOT) peak velocity was recorded by continuous wave Doppler technique at rest and after amyl nitrite inhalation. The LVOT pressure gradient was calculated by the modified Bernoulli equation. A significant increase in heart rate and a drop in systolic blood pressure were observed in all patients after amyl nitrite inhalation; no adverse effects were encountered. The peak LVOT velocity and pressure gradient increased significantly after provocation in all patients, but the increase was much more pronounced in patients with HC (peak LVOT velocity increased from 2.2 +/- 0.8 to 4.3 +/- 1.0 m/sec and peak gradient increased from 22 +/- 17 to 78 +/- 36 mm Hg). The Doppler spectral signal in patients with HC demonstrated a characteristic contour, with peak velocity occurring in late systole. However, the observed increase in LVOT peak velocity was not statistically different between treated (with beta-blockers and calcium blockers) and untreated patients with HC. We conclude that LVOT peak velocity and pressure gradients in patients with HC can be readily assessed by Doppler echocardiography both at rest and after amyl nitrite inhalation. The dynamic changes in LVOT velocity induced by this provocation have certain characteristic features in obstructive HC but appear to be independent of the medical regimen used, at least in the dosages tested in our study.
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Affiliation(s)
- S Hadjimiltiades
- Likoff Cardiovascular Institute, Hahnemann University Hospital, Philadelphia, PA
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42
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Hüting J, Mitrovic V, Thormann J, Bahavar H, Schlepper M. Left ventricular muscle mass and diastolic function in patients with essential hypertension under long-term clonidine monotherapy. Clin Cardiol 1991; 14:134-40. [PMID: 2044242 DOI: 10.1002/clc.4960140209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
To determine whether alterations of left ventricular (LV) structure are associated with improved LV function under chronic clonidine monotherapy (300-450 g/day) of essential hypertension, 11 male patients (age range 47-61 years) were followed for 5.4 +/- 0.9 months using echocardiography and Doppler echocardiography. Blood pressure decreased from a mean of 168/105 to 150/96 mmHg (p less than 0.01), heart rate remained unchanged (73 +/- 10 vs. 71 +/- 10 beats/min). LV muscle mass decreased from 350 +/- 73 to 297 +/- 56 g (p less than 0.02), LV volume/muscle mass ratio increased from 0.58 +/- 0.13 to 0.69 +/- 0.12 ml/g (p less than 0.005). Ejection time increased from 276 +/- 17 to 296 +/- 17 ms (p less than 0.01), whereas no significant change was found for pre-ejection period, ejection fraction, cardiac index and LV dimensions. Doppler analysis revealed improved isovolumic relaxation time (116 +/- 17 vs. 84 +/- 28 ms; p less than 0.05), but no change in isovolumic contraction duration, maximal inflow velocities, time-velocity integrals and their duration, rate of acceleration and deceleration of early and atrial filling, and of their ratios. It is concluded that no reliable improvement in diastolic or systolic LV function is observed in chronic clonidine monotherapy of essential hypertension despite a normalization of blood pressure and a regression of LV hypertrophy.
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Affiliation(s)
- J Hüting
- Kerckhoff-Klinik, Max-Planck-Society, Bad Nauheim, Germany
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43
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Affiliation(s)
- A C Pearson
- Department of Internal Medicine, Ohio State University Hospital, Columbia 43210
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44
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Berk MR, Xie GY, Kwan OL, Knapp C, Evans J, Kotchen T, Kotchen JM, DeMaria AN. Reduction of left ventricular preload by lower body negative pressure alters Doppler transmitral filling patterns. J Am Coll Cardiol 1990; 16:1387-92. [PMID: 2229791 DOI: 10.1016/0735-1097(90)90381-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The objective of this study was to evaluate the effect of alterations in preload induced by lower body negative pressure on Doppler transmitral filling patterns. Echocardiograms and Doppler recordings were performed in 18 normal young men (aged 23 to 32 years) during various levels of lower body negative pressure (0, -20 and -50 mm Hg). Lower body negative pressure induced a reduction in diastolic velocity integral (from 12.17 +/- 0.79 to 8.42 +/- 0.71 cm, p = 0.0067) and consequently left ventricular diastolic diameter (from 5.11 +/- 0.09 to 4.45 +/- 0.1 cm, p less than 0.0001). There was a significant reflex increase in heart rate from 59.9 +/- 1.9 to 77.1 +/- 2.4 beats/min (p less than 0.0001), but blood pressure was unchanged. This reduction in preload altered Doppler transmittral filling patterns as follows: 1) peak early velocity (E) decreased from 59.2 +/- 3.8 to 39.1 +/- 1.7 cm/s (p less than 0.0001); 2) atrial filing velocity (A) was unchanged (35.58 +/- 1.5 to 33.52 +/- 1.4 cm/s, p = 0.517); 3) E/A ratio decreased from 1.7 +/- 0.13 to 1.19 +/- 0.08 (p = 0.0087); 4) mean acceleration (from 482 +/- 37 to 390 +/- 27 cm/s2, p = 0.03) and mean deceleration (from 327 +/- 31 to 169 +/- 21 cm/s2, p less than 0.001) of the early filling wave were significantly reduced; and 5) peak acceleration (from 907 +/- 42 to 829 +/- 29 cm/s2) and peak deceleration (from 771 +/- 94 to 547 +/- 76 cm/s2) also decreased, but not significantly.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M R Berk
- Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington 40536-0084
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45
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Triulzi MO, Castini D, Ornaghi M, Vitolo E. Effects of preload reduction on mitral flow velocity pattern in normal subjects. Am J Cardiol 1990; 66:995-1001. [PMID: 2220624 DOI: 10.1016/0002-9149(90)90939-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the last few years, alterations in transmitral diastolic flow pattern have been used to assess changes in left ventricular diastolic properties. However, since diastolic flow primarily reflects the atrioventricular pressure gradient, loading conditions, as well as intrinsic left ventricular properties, should be able to affect this pattern. This study was selectively designed to decrease preload (a major determinant of the atrioventricular pressure gradient) in normal subjects to observe the effects on the Doppler transmitral flow pattern without pharmacologic interventions that may also affect left ventricular diastolic properties. In 12 normal subjects, preload was reduced by inflation of blood pressure cuffs placed at the level of the root of the 4 limbs. The peak velocity of early mitral flow (E wave) decreased from 62 +/- 8 to 51 +/- 7 cm/s (p less than 0.001), while no changes were found in the maximal velocity after atrial contraction; this caused a significant decrease in the ratio of these 2 velocities (the E to A ratio) from 1.5 +/- 0.3 to 1.1 +/- 0.1 (p less than 0.001). The time-velocity integral of early diastolic inflow decreased from 7.8 +/- 1.3 to 6.1 +/- 1.3 cm (p less than 0.001) with no significant changes of the time-velocity integral of inflow after atrial contraction. Therefore, preload reduction in normal subjects significantly reduces transmitral flow in early diastole with preserved late ventricular filling, producing a pattern that can mimic the changes previously described in left ventricular diastolic dysfunction.
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Affiliation(s)
- M O Triulzi
- Division of Cardiology, Bassini Hospital, Milan, Italy
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46
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Masuyama T, Nellessen U, Stinson EB, Popp RL. Improvement in left ventricular diastolic filling by septal myectomy in hypertrophic cardiomyopathy. J Am Soc Echocardiogr 1990; 3:196-204. [PMID: 2372402 DOI: 10.1016/s0894-7317(14)80434-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abnormalities in left ventricular diastolic function or filling are considered to be responsible for some of the symptoms in patients with hypertrophic cardiomyopathy. To clarify whether the abnormalities in left ventricular diastolic filling are improved by septal myectomy, 13 patients with hypertrophic cardiomyopathy and intracavitary pressure gradient were studied preoperatively and postoperatively by use of pulsed Doppler echocardiography. Peak early diastolic filling velocity (E), the ratio of peak early diastolic filling to peak atrial filling velocities (E/A ratio), and deceleration time were measured from the transmitral flow velocity pattern before and after septal myectomy. Although E and E/A ratio did not change after septal myectomy, deceleration time significantly shortened from 314 +/- 72 to 271 +/- 53 milliseconds (n = 10; p less than 0.05). Further, if seven patients with significant changes in heart rate (greater than 30%) or in the Doppler-determined severity of mitral regurgitation (more than one degree) were excluded (because these parameters may effect E and E/A ratio), there were also significant changes in E (81 +/- 21 versus 98 +/- 25 cm/sec, p less than 0.05) and in E/A ratio (0.84 +/- 0.17 versus 1.14 +/- 0.33, p less than 0.05). Because left ventricular systolic function has been demonstrated to remain constant or to decrease by most measures after septal myectomy, relief of some symptoms may be largely the result of the improvement in diastolic filling suggested by these criteria.
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Affiliation(s)
- T Masuyama
- Division of Cardiology, Stanford University School of Medicine, CA 94305
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47
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48
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Berman GO, Reichek N, Brownson D, Douglas PS. Effects of sample volume location, imaging view, heart rate and age on tricuspid velocimetry in normal subjects. Am J Cardiol 1990; 65:1026-30. [PMID: 2327338 DOI: 10.1016/0002-9149(90)91008-t] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of imaging view and sample volume location on tricuspid velocimetry and of heart rate and aging on mitral and tricuspid inflow were evaluated in 41 normal subjects aged 20 to 76 years. Pulsed Doppler recordings were obtained in the parasternal short-axis, right ventricular inflow and apical 4-chamber views at the level of the tricuspid and mitral anuli and 1 cm caudad and 1 cm cephalad to the tricuspid anulus in the 4-chamber apical view. The right ventricular filling pattern was not affected by imaging view. However, placement of the sample volume 1 cm cephalad resulted in a 16% reduction (p less than 0.01) in early velocity with a 9% increase in atrial filling fraction. Conversely, late velocity was 11% higher (p less than 0.05) at the anular level versus the other locations. Right and left ventricular filling velocities were modestly related (r = 0.50 to 0.63). Relations between age and tricuspid late velocity, velocity ratio and atrial filling fraction were weaker (r = 0.34 to 0.47; all p less than 0.05) than those between age and mitral variables (r = 0.59 to 0.74. Also, aging had a greater effect on mitral than tricuspid late velocity (i.e., a steeper slope; p less than 0.01). Tricuspid late velocity and atrial filling fraction were each modestly inversely related to RR interval (r = -0.48, r = -0.54; p less than 0.01). Thus, tricuspid velocity is affected by sample volume location, aging and heart rate, but not imaging view. Sample volume location, heart rate and age should be considered when evaluating right ventricular inflow parameters.
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Affiliation(s)
- G O Berman
- Cardiovascular Section, Hospital of the University of Pennsylvania, Philadelphia 19104
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Abstract
In this report we have emphasized the significant influence of loading conditions on LV relaxation. Changes in inotropic state, ischemia, hypertrophy, and a host of other factors were not discussed herein. Ventricular asynchrony is likewise beyond the scope of this review, but it should be recognized that complex loading interactions among fibers within the LV wall influence relaxation and filling in ventricles that contract and relax nonsynchronously. Intact heart and isolated muscle experiments indicate that changes in preload do not influence relaxation rates when systolic pressure or total load remains constant. It appears, therefore, that the relaxation changes that occur with volume loading are primarily due to changes in systolic pressure or load. Indeed, an increase in systolic pressure may cause a substantial decrease in isovolumic relaxation rate, especially if there is a slow rise and a late peak in LV pressure. By contrast, an abrupt increase in late systolic load augments relaxation rate. Intact heart studies indicate that an abrupt load increment near the end of ejection results in premature and more rapid isovolumic relaxation, while an increase in left atrial pressure increases the filling rate; isolated muscle studies indicate that a load increment at the end of isometric relaxation causes an increase in isotonic relaxation rate. Thus, loading conditions during the periods of ejection, isovolumic relaxation, and filling can influence relaxation parameters and should be considered in clinical and experimental studies of LV relaxation.
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Affiliation(s)
- M R Zile
- Department of Medicine (Cardiology), Medical University of South Carolina, Charleston
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