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Akashi J, Iwataki M, Nabeshima Y, Onoue T, Hayashi A, Tanaga T, Nishino S, Kimura T, Yano M, Watanabe N, Tsuda Y, Araki M, Shibata Y, Nishimura Y, Otsuji Y, Kataoka M. Potential Effects of Mild Atrial Secondary Mitral Regurgitation in Patients With Isolated Atrial Fibrillation. Circ Cardiovasc Imaging 2024; 17:e016239. [PMID: 38415386 DOI: 10.1161/circimaging.123.016239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Patients with only moderate atrial secondary mitral regurgitation (asMR) frequently develop heart failure (HF). Mechanisms of HF with moderate asMR and the impact of mild asMR remain unclarified. Although mild/moderate primary mitral regurgitation is compensated by left ventricular (LV) dilatation, the LV is not dilated in asMR. We hypothesized that patients with mild asMR without LV dilatation may have impaired hemodynamics and higher risks of subsequent symptomatic HF deterioration. METHODS Stroke volume, cardiac output, and systolic pulmonary artery pressure were measured by echocardiography in 142 patients with isolated atrial fibrillation and 30 healthy controls. The prognosis of patients with isolated atrial fibrillation was followed up. RESULTS In the 142 patients with isolated atrial fibrillation, asMR was no/trivial in 55, mild in 83, moderate in 4, while none had severe asMR. Compared with controls and patients with no/trivial asMR, LV end-diastolic volume index was not increased and hemodynamic parameters were abnormal in patients with mild asMR (LV end-diastolic volume index, 65±6 versus 58±8 versus 60±8 mL/m²; stroke volume index, 42±4 versus 35±4 versus 29±6 mL/m²; P<0.001 versus other 2 groups; cardiac output index, 2.8±0.4 versus 2.8±0.5 versus 2.3±0.6 L/min per m²; P<0.001; systolic pulmonary artery pressure, 21±3 versus 26±5 versus 37±9 mm Hg; P<0.001). Although the event-free rate of HF symptomatic deterioration or hospitalization in patients with no/trivial asMR during a median 13.9 months follow-up was 86.9% and 100%, the rate in mild asMR was 59.4% and 85.0% (P<0.001 or P=0.032), respectively. CONCLUSIONS In the presence of isolated AF and no compensatory LV dilatation, impaired hemodynamics and higher risks of symptomatic HF deterioration were associated with mild asMR, requiring further studies of causalities.
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Affiliation(s)
- Jun Akashi
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Mai Iwataki
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Yosuke Nabeshima
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Takeshi Onoue
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Atsushi Hayashi
- Division of Cardiovascular Medicine, Shiga University of Medical Science, Japan (A.H.)
| | - Tetsuo Tanaga
- Departments of Clinical Laboratory (T.T.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Shun Nishino
- Cardiology (S.N., T.K., Y.S.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Toshiyuki Kimura
- Cardiology (S.N., T.K., Y.S.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Mitsuhiro Yano
- Cardiovascular Surgery (M.Y.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Nozomi Watanabe
- Cardiovascular Physiology, Faculty of Medicine, University of Miyazaki, Japan (N.W.)
| | - Yuki Tsuda
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Masaru Araki
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Yoshisato Shibata
- Cardiology (S.N., T.K., Y.S.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Yosuke Nishimura
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan (Y. Nishimura)
| | - Yutaka Otsuji
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Masaharu Kataoka
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
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Lulić F, Virag Z. Doppler mitral inflow variables time course after treadmill stress echo with and without ischemic response. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1751-1759. [PMID: 35218466 DOI: 10.1007/s10554-022-02568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/12/2022] [Indexed: 11/05/2022]
Abstract
This study evaluated Doppler mitral inflow variables changes from rest to post-exercise among 104 subjects with and without echocardiographic evidence of ischemic response (IR) to exercise (63.9 ± 11 years, 54% male, 32% with IR) who underwent a clinically indicated treadmill stress echo (TSE) test. The time from exercise cessation to imaging (TIME) was recorded. The changes (after TSE minus baseline values) in the peak E-wave velocity (∆E) [34.2 vs. 24.2, p = 0.024] and E-wave deceleration rate (∆DR) [348.0 vs. 225.7, p = 0.010] were bigger in ischemic than in nonischemic subjects, while the changes in the peak A-wave velocity (∆A) did not differ [7.9 vs. 15.0, p = 0.082]. The correlations between Doppler variables and IR, TIME, and TIME × IR interaction were analyzed. We observed a significant interaction between TIME and IR regarding ∆E and ∆DR. The differences in the regression line slopes of time courses for ∆E and ∆DR based on IR were significant: ∆E (- 0.09 vs. - 8.17, p = 0.037) and ∆DR (11.23 vs. - 82.60, p = 0.022). Main findings: (1) Time courses after exercise of ∆E and ∆DR in subjects with and without IR were different. (2) ∆E and ∆DR did not differ between subjects with and without IR at exercise cessation (TIME = 0). (3) The simple main effect of ischemia on ∆E and ∆DR was significant at TIME of ≥ 3 min. Divergent time courses of ∆E and ∆DR after exercise might be promising for detecting diastolic dysfunction caused by ischemia. After the cessation of exercise, ΔE and ΔDR in nonischemic but not in ischemic subjects quickly tend to zero. The differences in ΔE and ΔDR between the two groups only became significant for TIME of ≥ 3 min. At the time of exercise cessation, the values of ΔE and ΔDR (taken from the regression lines) were not significantly different between the patients with and without IR. This divergent response is promising for detecting diastolic dysfunction caused by ischemia.
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Affiliation(s)
- Fabijan Lulić
- University Hospital Center Zagreb, University of Zagreb, Jordanovac, 104, 10000, Zagreb, Croatia.
| | - Zdravko Virag
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000, Zagreb, Croatia
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Hirose M, Mandour AS, Goya S, Hamabe L, Matsuura K, Yoshida T, Watanabe M, Shimada K, Uemura A, Takahashi K, Tanaka R. Color M-Mode Echocardiography for Non-Invasive Assessment of the Intraventricular Pressure in Dogs Before and After Ductus Arteriosus Occlusion: A Retrospective Study. Front Vet Sci 2022; 9:908829. [PMID: 35903130 PMCID: PMC9315367 DOI: 10.3389/fvets.2022.908829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Novel non-invasive evaluation of the intraventricular pressure differences and gradients (IVPD and IVPG) by color M-mode echocardiography (CMME) is a promising method in diastolic function evaluation. Patent ductus arteriosus (PDA) is a congenital heart defect which is associated with increased preload. The present work provides a clinical trial for the assessment of IVPD and IVPG changes in dogs before and after surgical occlusion of PDA. Materials and Methods A total of 12 client-owned dogs were enrolled in this study. PDA was confirmed using echocardiography, and all dogs underwent PDA occlusion. Conventional echocardiography and CMME were conducted on each patient on the operation day (Pre-PDA) and 48 h after its occlusion (Post-PDA). The total IVPD and total IVPG, as well as segmental intraventricular pressure (basal, mid-to-apical, mid, and apical) were measured from Euler's equation using specific software (MATLAB). Data were analyzed for variability and for the difference between pre- and post-PDA. The effect of PDA occlusion on the measured variables was calculated using biserial ranked correlation (rc). Results There was a significant reduction in end-diastolic volume, fraction shortening, stroke volume, and mitral inflow velocities (early and late) after PDA closure. CMME was feasible in all dogs, and the CMME indices showed moderate variability, except for the apical segment of IVPD and IVPG. After PDA closure, in comparison with the pre-PDA occlusion, there was a significant reduction in total IVPD (2.285 ± 0.374 vs. 1.748 ± 0.436 mmHg; P = 0.014), basal IVPD (1.177 ± 0.538 vs. 0.696 ± 0.144 mmHg; P = 0.012), total IVPG (1.141 ± 0.246 vs. 0.933 ± 0.208 mmHg; P = 0.032), and basal IVPG (0.578 ± 0.199 vs. 0.377 ± 0.113 mmHg; P = 0.001); meanwhile, mid, mid-to-apical, and apical segments of both IVPD and IVPG showed non-significant difference. The magnitude of PDA occlusion on the measured variables was clinically relevant and associated with a large effect size on total and basal IVPD and IVPG (rc > 0.6). Conclusion The current clinical study revealed matched response of IVPD and IVPG to the reduced preload rather than left ventricular relaxation. This result is an initial step in the clinical utility of CMME-derived IVPD and IVPG measurements in the diastolic function evaluation in dogs with PDA that warrants further clinical studies.
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Affiliation(s)
- Miki Hirose
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Ahmed S. Mandour
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
- Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Seijirow Goya
- Department of Bioresource Sciences, Nihon University, Fujisawa, Japan
| | - Lina Hamabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Katsuhiro Matsuura
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Tomohiko Yoshida
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Momoko Watanabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Kazumi Shimada
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akiko Uemura
- Division of Veterinary Research, Department of Veterinary Surgery, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
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4
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Arques S. Current clinical applications of spectral tissue Doppler echocardiography (E/e' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved ejection fraction. Revisited 15 years later. Ann Cardiol Angeiol (Paris) 2021; 70:245-252. [PMID: 34130807 DOI: 10.1016/j.ancard.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
It is currently well established that more than half of heart failure patients have preserved ejection fraction. The diagnosis of heart failure with preserved ejection fraction is complex in clinical practice despite ESC recommendations issued in 2019. In this context, the demonstration of increased left ventricular filling pressures at rest or during exercise allows a definite diagnosis of heart failure with preserved ejection fraction in patients with signs and/or symptoms compatible with the diagnosis and a preserved ejection fraction. The spectral tissue Doppler-derived E/e' ratio by transthoracic Doppler echocardiography has been validated in the noninvasive assessment of left ventricular diastolic pressures at rest and during exercise. Several studies report the validity of E/e' in the diagnosis of heart failure with preserved ejection fraction in patients with both isolated exertional and acute dyspnea, as well as in risk stratification. In light of the current literature, E/e' deserves to be included on every transthoracic Doppler echocardiography report in patients with suspected heart failure with preserved ejection fraction. This updated review provides an overview of the diagnostic relevance of E/e' in patients in its two modes of clinical presentation, isolated exertional dyspnea and the decompensated congestive form.
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Affiliation(s)
- S Arques
- Department of Cardiology, Centre hospitalier Edmond Garcin, Avenue des Soeurs Gastine, 13400 Aubagne, France.
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5
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Haines PG, Dickey JB, Chambers AB, Ogunsua A, Wu W, Aurigemma GP. Evaluating a decision tool for diagnosing diastolic dysfunction and estimation of left ventricular filling pressures in the presence of mitral annular calcium. Echocardiography 2020; 37:1757-1765. [DOI: 10.1111/echo.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Philip G. Haines
- Division of Cardiology Department of Medicine Warren Alpert School of Medicine of Brown University Providence RI USA
| | - John B. Dickey
- Division of Cardiovascular Medicine Department of Medicine University of Massachusetts Medical School Worcester MA USA
| | - Alison B. Chambers
- Department of Medicine Rhode Island Hospital Warren Alpert School of Medicine of Brown University Providence RI USA
- Lifespan Biostatistics Core Rhode Island Hospital Providence RI USA
| | - Adedotun Ogunsua
- Division of Cardiovascular Medicine Department of Medicine University of Massachusetts Medical School Worcester MA USA
| | - Wen‐Chih Wu
- Division of Cardiology Department of Medicine Warren Alpert School of Medicine of Brown University Providence RI USA
| | - Gerard P. Aurigemma
- Division of Cardiovascular Medicine Department of Medicine University of Massachusetts Medical School Worcester MA USA
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Lancellotti P, Galderisi M, Edvardsen T, Donal E, Goliasch G, Cardim N, Magne J, Laginha S, Hagendorff A, Haland TF, Aaberge L, Martinez C, Rapacciuolo A, Santoro C, Ilardi F, Postolache A, Dulgheru R, Mateescu AD, Beladan CC, Deleanu D, Marchetta S, Auffret V, Schwammenthal E, Habib G, Popescu BA. Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. Eur Heart J Cardiovasc Imaging 2018; 18:961-968. [PMID: 28444160 DOI: 10.1093/ehjci/jex067] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 11/13/2022] Open
Abstract
Aims The present Euro-Filling report aimed at comparing the diagnostic accuracy of the 2009 and 2016 echocardiographic grading algorithms for predicting invasively measured left ventricular filling pressure (LVFP). Method and results A total of 159 patients who underwent simultaneous evaluation of echo estimates of LVFP and invasive measurements of LV end-diastolic pressure (LVEDP) were enrolled at nine EACVI centres. Thirty-nine (25%) patients had a reduced LV ejection fraction (<50%), 77 (64%) were in NYHA ≥ II, and 85 (53%) had coronary artery disease. Sixty-four (40%) patients had elevated LVEDP (≥15 mmHg). Taken individually, all echocardiographic Doppler estimates of LVFP (E/A, E/e', left atrial volume, tricuspid regurgitation jet velocity) were marginally correlated with LVEDP. By using the 2016 recommendations, 65% of patients with normal non-invasive estimate of LVFP had normal LVEDP, while 79% of those with elevated non-invasive LVFP had elevated invasive LVEDP. By using 2009 recommendations, 68% of the patients with normal non-invasive LVFP had normal LVEDP, while 55% of those with elevated non-invasive LVFP had elevated LVEDP. The 2016 recommendations (sensitivity 75%, specificity 74%, positive predictive value 39%, negative predictive value 93%, AUC 0.78) identified slightly better patients with elevated invasive LVEDP (≥ 15 mmHg) as compared with the 2009 recommendations (sensitivity 43%, specificity 75%, positive predictive value 49%, negative predictive value 71%, AUC 0.68). Conclusion The present Euro-Filling study demonstrates that the new 2016 recommendations for assessing LVFP non-invasively are fairly reliable and clinically useful, as well as superior to the 2009 recommendations in estimating invasive LVEDP.
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Affiliation(s)
- Patrizio Lancellotti
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Centre of Cardiological Innovation, Oslo, Norway
| | - Erwan Donal
- Cardiologie, CHU Rennes and LTSI-INSERM U 1099, Université Rennes 1, France
| | - Georg Goliasch
- Division of Cardiology, Second Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Nuno Cardim
- Multimodality Cardiac Imaging Department, Sports Cardiology and Cardiomyopathies centre Hospital da Luz, Lisbon, Portugal
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Pôle Coeur-Poumon-Rein, Cardiology Department, Limoges, France
| | - Sara Laginha
- Multimodality Cardiac Imaging Department, Sports Cardiology and Cardiomyopathies centre Hospital da Luz, Lisbon, Portugal
| | - Andreas Hagendorff
- Echokardiographie-Labore des Universitätsklinikums AöR, Department of Cardiology-Angiology, University of Leipzig, Leipzig, Germany
| | - Trine F Haland
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Centre of Cardiological Innovation, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Centre of Cardiological Innovation, Oslo, Norway
| | - Christophe Martinez
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Adriana Postolache
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium
| | - Raluca Dulgheru
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium
| | - Anca D Mateescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Carmen C Beladan
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Dan Deleanu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Stella Marchetta
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium
| | - Vincent Auffret
- Cardiologie, CHU Rennes and LTSI-INSERM U 1099, Université Rennes 1, France
| | - Ehud Schwammenthal
- Heart Center, Sheba Medical Center, Tel Hashomer, and Tel Aviv University, Ramat Aviv, Israel
| | - Gilbert Habib
- URMITE, Aix Marseille Université UM63, CNRS 7278, IRD 198, INSERM 1095 IHU - Méditerranée Infection.,APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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Left atrial compliance: an overlooked predictor of clinical outcome in patients with mitral stenosis or atrial fibrillation undergoing invasive management. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:120-127. [PMID: 30008763 PMCID: PMC6041835 DOI: 10.5114/aic.2018.76402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/29/2018] [Indexed: 01/06/2023] Open
Abstract
In the assessment of cardiovascular disease, the clinical significance of left atrial (LA) pressure-volume relations has largely been overlooked in contrast to left ventricular (LV) compliance. However, LA compliance has recently gained more attention. Net atrioventricular compliance (Cn), a joint measure of LA and LV compliance, can be calculated non-invasively by a previously validated method using parameters from standard echocardiography. Compliance measurement may be of relevance in selected clinical settings. First, subjects with low Cn are more likely to have their mitral valve area overestimated by the traditional mitral pressure half-time method. Consequently, low Cn in mitral stenosis, usually resulting from reduced LA compliance, can be mistaken for mild mitral stenosis. Second, low Cn independently predicted pulmonary hypertension and disease progression in medically treated mitral stenosis, and late cardiovascular complications after successful percutaneous mitral valvuloplasty. Decreased LA compliance also accounts for stiff LA syndrome, a rare complication of radiofrequency catheter ablation for atrial fibrillation, manifesting as otherwise unexplained heart failure with elevated LA pressure and pulmonary hypertension. Finally, depressed pre-ablation LA stiffness index, i.e. the ratio of the change in LA pressure to the corresponding change in LA volume during passive LA filling, was an independent predictor of arrhythmia recurrence. Thus, LA stiffening translates into adverse clinical outcomes in patients with mitral stenosis or atrial fibrillation undergoing interventional procedures. Whether reduced LA compliance after LA appendage occlusion can result in the LA stiff syndrome, has not been reported so far.
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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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Abstract
Aging is characterized by heterogeneity, both in health and illness. Older adults with heart failure often have preserved ejection fraction and atypical and delayed clinical manifestations. After diagnosis of heart failure is established, a cause should be sought. The patient's comorbidities may provide clues. An elevated jugular venous pressure is the most reliable clinical sign of fluid volume overload and should be carefully evaluated. Left ventricular ejection fraction must be determined to assess prognosis and guide therapy. These 5 steps, namely, diagnosis, etiologic factor, fluid volume, ejection fraction, and therapy for heart failure may be memorized by mnemonic: DEFEAT-HF.
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Affiliation(s)
- Gurusher Panjrath
- Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 8-416, Washington, DC 20037, USA; Inova Heart and Vascular Institute, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Ali Ahmed
- Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 8-416, Washington, DC 20037, USA; Center for Health and Aging, Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422, USA; Department of Medicine, University of Alabama at Birmingham, 933 19th Street South, CH19 201, Birmingham, AL 35294, USA.
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10
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Farouk H, Albasmi M, El Chilali K, Mahmoud K, Nasr A, Heshmat H, Abdel-Moneim S, Baligh E. Left ventricular diastolic dysfunction in patients with chronic obstructive pulmonary disease: Impact of methods of assessment. Echocardiography 2017; 34:359-364. [PMID: 28165145 DOI: 10.1111/echo.13469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The prevalence of left ventricular (LV) diastolic dysfunction in patients with chronic obstructive pulmonary disease (COPD), using different echocardiographic parameters, varies widely in the literature. The highest prevalence of LV diastolic dysfunction was detected using the mitral inflow indexes that are commonly altered in these patients due to the associated tachycardia, reduced preload, and ventricular septal shift. In this study, we aimed at evaluating the impact of the used echocardiographic method of assessment on the prevalence of LV diastolic dysfunction in patients with COPD and normal LV systolic function. METHODS We studied 35 patients with COPD and 18 age-matched controls. A comprehensive approach to diagnose and grade the LV diastolic dysfunction was performed in accordance with the recommendations of the American Society of Echocardiography published in 2009. The results were compared with those of mitral inflow indexes. RESULTS LV diastolic dysfunction was reported in 20 patients using the mitral inflow indexes while in only 12 patients using the comprehensive approach (P=.021). Compared to the controls, LV diastolic dysfunction was significantly more common in patients using the mitral inflow indexes (P=.001), while no statistically significant difference was detected between both groups using the comprehensive approach (P=.1). CONCLUSION The prevalence of LV diastolic dysfunction in patients with COPD varies according to the used echocardiographic approach. Further studies are recommended to determine which approach is the most accurate in estimating the true prevalence of LV diastolic dysfunction among this group of patients.
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Affiliation(s)
- Heba Farouk
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Maged Albasmi
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Karim El Chilali
- Department of Cardiology, Essen University Hospital, Essen, Germany
| | - Kareem Mahmoud
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Abdo Nasr
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Hussein Heshmat
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Samah Abdel-Moneim
- Department of Pulmonary Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Essam Baligh
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
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Preza PM, Hurtado A, Armas V, Cárcamo CP. Síndrome cardiorrenal tipo 1 en la unidad de cuidados intensivos coronarios del Hospital Nacional Arzobispo Loayza. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:176-87. [DOI: 10.1016/j.acmx.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 05/05/2015] [Accepted: 05/21/2015] [Indexed: 11/29/2022] Open
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12
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Contribution of the Diastolic Vortex Ring to Left Ventricular Filling. J Am Coll Cardiol 2014; 64:1711-21. [DOI: 10.1016/j.jacc.2014.06.1205] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/20/2014] [Accepted: 06/02/2014] [Indexed: 11/22/2022]
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13
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D'Alto M, Scognamiglio G, Dimopoulos K, Bossone E, Vizza D, Romeo E, Vonk-Noordergraaf A, Gaine S, Peacock A, Naeije R. Right heart and pulmonary vessels structure and function. Echocardiography 2014; 32 Suppl 1:S3-10. [PMID: 25244348 DOI: 10.1111/echo.12227] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The right ventricle (RV) can be described in terms of 3 components: the inlet, the apex, and the infundibulum. In the normal adult, the RV shows an arrangement suited for pumping blood against low resistance, with a mass about one sixth that of left ventricle (LV) mass, and a larger volume than the LV. The RV is able to manage a progressive increase in the afterload by increasing contractility and remodeling. The gold standard measurement of contractility is maximal elastance (Emax), or the ratio between end-systolic pressure (ESP) and end-systolic volume (ESV), and the best measurement of afterload is arterial elastance (Ea), or the ratio between ESP and stroke volume (SV). The ratio Emax/Ea defines RV-arterial coupling. The optimal energy transfer from the RV to the pulmonary circulation is measured at Emax/Ea ratios of 1.5-2. In the presence of pulmonary hypertension, the SV/ESV ratio may be an acceptable surrogate of Emax/Ea. The right atrium (RA) has 3 anatomical components: the appendage, the venous part, and the vestibule. It is a dynamic structure having different functions: reservoir, conduit, and booster pump function. In case of increased afterload, the RA is enlarged, denoting high RA pressure, as a consequence of elevated RV diastolic pressure. RA area is a strong predictor of adverse clinical outcome in pulmonary arterial hypertension. In patients with severe pulmonary hypertension, in several congenital heart diseases, and in Eisenmenger syndrome, symptoms and prognosis are greatly dependent on RV function and its ability to adapt to a chronic increase in afterload.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
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14
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Yamada H, Kusunose K, Nishio S, Bando M, Hotchi J, Hayashi S, Ise T, Yagi S, Yamaguchi K, Iwase T, Soeki T, Wakatsuki T, Sata M. Pre-Load Stress Echocardiography for Predicting the Prognosis in Mild Heart Failure. JACC Cardiovasc Imaging 2014; 7:641-9. [DOI: 10.1016/j.jcmg.2014.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/04/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
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15
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Ruhui L, Jinfa J, Jiahong X, Wenlin M. Influence of hyperhomocysteinemia on left ventricular diastolic function in Chinese patients with hypertension. Herz 2014; 40:679-84. [PMID: 24863078 DOI: 10.1007/s00059-014-4098-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/06/2014] [Accepted: 03/14/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to assess the effect of plasma homocysteine (Hcy) on left ventricular (LV) diastolic function in Chinese patients with essential hypertension. PATIENTS AND METHODS A total of 74 patients with hypertension were enrolled in the present study and were divided into two groups according to the plasma levels of Hcy: high levels of Hcy (Hhcy) group (n = 37) and control group (n = 37) with normal levels of homocysteine. The study participants consisted of 37 hypertensive patients with Hhcy and 37 hypertensive patients without Hhcy. Transthoracic Doppler echocardiography was performed to assess the LV diastolic function of the patients. RESULTS The plasma level of Hcy was directly related to LV diastolic echocardiographic parameters in patients with hypertension whereby the ratio E/e' was higher (12.7 ± 2.64 vs. 8.98 ± 1.55, p < 0.01), e'/a' was lower (0.59 ± 0.13 vs. 0.83 ± 0.20, p < 0.01), and the left atrial (LA) diameter was longer (43.4 ± 3.6 mm vs. 37.6 ± 5.0 mm, p < 0.01) in the Hhcy group than in the control group. CONCLUSION The LV diastolic function was significantly deteriorated in Chinese hypertensive patients with Hhcy and there were significant correlations between LV diastolic function indices and Hcy levels.
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Affiliation(s)
- L Ruhui
- Department of Cardiology, Tongji Hospital, Tongji University, No. 389 Xincun Road, 200065, Shanghai, China
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16
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Mossahebi S, Kovács SJ. Kinematic Modeling Based Decomposition of Transmitral Flow (Doppler E-Wave) Deceleration Time into Stiffness and Relaxation Components. Cardiovasc Eng Technol 2014. [DOI: 10.1007/s13239-014-0176-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Sampaio F, Pimenta J, Bettencourt N, Fontes-Carvalho R, Silva AP, Valente J, Bettencourt P, Fraga J, Gama V. Systolic and diastolic dysfunction in cirrhosis: a tissue-Doppler and speckle tracking echocardiography study. Liver Int 2013; 33:1158-65. [PMID: 23617332 DOI: 10.1111/liv.12187] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/18/2013] [Accepted: 04/01/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Cardiac dysfunction has been described in patients with cirrhosis. Conventional echocardiographic methods are frequently unable to detect abnormalities at rest and have limitations. We aimed to evaluate cardiac function in cirrhosis patients assessing: (i) left ventricular systolic function using speckle-tracking imaging; (ii) diastolic function using a tissue-Doppler based algorithm and comparing it with previously proposed definition of diastolic dysfunction (DD). METHODS We included 109 hospitalized and ambulatory patients with cirrhosis and 18 healthy controls. Detailed echocardiographic evaluation was performed including tissue-Doppler and speckle-tracking analysis. RESULTS Peak systolic longitudinal strain (PLS) was lower in patients [-19.99% (-21.88 to -18.71) vs -22.02% (-23.10 to -21.18), P = 0.003]. Ejection fraction was similar in patients and controls [64% (59-67) vs 61% (60-65), P = 0.42)]. Based on mitral-flow pattern, DD was present in 44 patients (40.4%). Patients without DD had higher cardiac output compared with those with DD [6.4 L/min (5.4-7.2) vs 5.6 L/min (4.6-6.8), P = 0.02]. Using a tissue-Doppler based definition, the prevalence of DD was 16.5%. No differences in haemodynamic variables were found in patients with and without this definition of DD. The agreement between the two definitions of DD was weak (kappa = 0.24, P = 0.003). Echocardiographic abnormalities in systolic and diastolic function were not different in compensated vs decompensated patients in different Child-Pugh classes or cirrhosis aetiologies. CONCLUSIONS Patients with cirrhosis have systolic and diastolic cardiac dysfunction at rest. Newer echocardiographic techniques may identify patients with functional impairment more accurately than conventional methods, which are more influenced by flow conditions.
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Affiliation(s)
- Francisco Sampaio
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Espinho, Portugal.
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Affiliation(s)
- Michael A. Rosenberg
- From the Departments of Medicine (Cardiovascular Division) (M.A.R., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Warren J. Manning
- From the Departments of Medicine (Cardiovascular Division) (M.A.R., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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20
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Yotti R, Bermejo J, Benito Y, Antoranz JC, Desco MM, Rodríguez-Pérez D, Cortina C, Mombiela T, Barrio A, Elízaga J, Fernández-Avilés F. Noninvasive Estimation of the Rate of Relaxation by the Analysis of Intraventricular Pressure Gradients. Circ Cardiovasc Imaging 2011; 4:94-104. [PMID: 21245360 DOI: 10.1161/circimaging.110.960369] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background—
During late ejection, myocardial relaxation causes systolic flow to decelerate and stop, and this phenomenon is coupled with the generation of a pressure gradient inside the left ventricle (LV). We hypothesized that the peak reverse ejection intraventricular pressure difference (REIVPD) between the LV apex and the outflow tract could be a useful method to improve the assessment of LV relaxation using Doppler echocardiography.
Methods and Results—
Three sets of animal experiments and 1 clinical study were designed. In 6 pigs, a close relationship between REIVPD and the intensity of the relaxation wave (
R
rm
=0.89) was demonstrated using wave intensity analysis of high-fidelity pressure-volume-velocity data. In 19 animals, REIVPD sensitively detected modifications of the lusotropic state and closely correlated with the time constant of LV relaxation (τ) within animals (
R
rm
=−0.93). Load-dependence analysis in 5 pigs showed that REIVPD remained stable up to values of 35% to 40% acute preload reduction. Clinical validation was tested in 50 patients (23 with normal systolic function) undergoing simultaneous Doppler echocardiography and high-fidelity LV pressure measurements on the same beat. REIVPD and tissue Doppler mitral annulus velocity (e′) were independently related to τ, but the REIVPD · e′ product correlated better with τ than either variable separately (bootstrap-corrected correlation coefficients:
R
=−0.84 versus −0.71, and −0.70, respectively,
P
<0.05). Area under the receiver operating characteristic curve to predict impaired relaxation (τ>50 ms) for e′ · REIVPD was 0.96 (95% confidence interval, 0.85 to 0.99).
Conclusions—
The Doppler-derived REIVPD provides a sensitive, reliable, reproducible, and relatively load-independent index of the rate of LV relaxation. Combined with tissue Doppler measurements of longitudinal function, this method improves noninvasive assessment of LV relaxation in the clinical setting.
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Affiliation(s)
- Raquel Yotti
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Javier Bermejo
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Yolanda Benito
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - J. Carlos Antoranz
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - M. Mar Desco
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Daniel Rodríguez-Pérez
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Cristina Cortina
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Teresa Mombiela
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Alicia Barrio
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Jaime Elízaga
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Francisco Fernández-Avilés
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
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Chang SA, Park PW, Sung K, Lee SC, Park SW, Lee YT, Oh JK. Noninvasive estimate of left ventricular filling pressure correlated with early and midterm postoperative cardiovascular events after isolated aortic valve replacement in patients with severe aortic stenosis. J Thorac Cardiovasc Surg 2010; 140:1361-6. [PMID: 20381086 DOI: 10.1016/j.jtcvs.2010.02.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 01/12/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether preoperative estimated left ventricular filling pressure predicts the postoperative outcome in patients with severe aortic stenosis. METHODS Two hundred ten patients who underwent isolated aortic valve replacement because of severe aortic stenosis were analyzed. Left ventricular filling pressure was noninvasively assessed based on the ratio between early diastolic mitral inflow and mitral annular velocity (E/E'), which was calculated based on results of mitral inflow and mitral annular tissue Doppler scanning. Early postoperative hospital events were reviewed. Postoperative mortality and morbidity were searched and compared according to left ventricular filling pressure. RESULTS Preoperative functional class was associated with increased E/E' values. Postoperative hospital events were higher in patients with increased preoperative E/E' values. Midterm mortality of the overall population was very low after aortic valve replacement (2%). Cardiovascular event-free survival, including hospital visits caused by heart failure symptoms, embolic cerebral infarction, and sudden cardiac death, was significantly lower in the patients with increased left ventricular filling pressure and E/E' values of greater than 12 (P = .03). Multivariable analysis showed a high hazard ratio of increased E/E' values of greater than 12 (hazard ratio, 41; P < .001). CONCLUSIONS The incidence of postoperative mortality after isolated aortic valve replacement caused by severe aortic stenosis is relatively low in the current era. E/E' representing diastolic filling pressure is the most important preoperative predictor of risk of early postoperative hospital course and postoperative morbidity.
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Affiliation(s)
- Sung-A Chang
- Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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22
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Dernellis JM, Vyssoulis GP, Zacharoulis AA, Toutouzas PK. Acute changes of left atrial distensibility in congestive heart failure. Clin Cardiol 2009; 21:28-32. [PMID: 9474463 PMCID: PMC6656021 DOI: 10.1002/clc.4960210106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Investigations of the left atrial (LA) distensibility have revealed that it plays a major role in atrial function; however, LA distensibility has not as yet been studied in congestive heart failure (CHF). HYPOTHESIS The study was undertaken to determine the effects of acute administration of esmolol, isosorbide dinitrate, dobutamine, and normal saline infusion on LA dimension, pressure, and distensibility. METHODS The study included 23 patients with CHF (18 with ischemic heart disease and 5 with idiopathic dilated cardiomyopathy). Left atrial diameters (D) and pressures (P) were recorded at rest and thereafter during acute tests. P and D data during the ascending limb of the V loop were fitted to the exponential function P = b.ead, where a is the passive elastic chamber stiffness constant and b is the elastic constant. The instantaneous diastolic LA distensibility (IDLAD) was calculated as 1/(dP/dD) = 1/a.P. RESULTS The constant, a, increased significantly after normal saline and esmolol infusion (p < 0.001), while it significantly decreased after isosorbide dinitrate (p < 0.001) and dobutamine administration (p < 0.05) compared with baseline. Instantaneous diastolic LA distensibility (in mm/Hg) was 0.16 at baseline; it significantly increased after isosorbide dinitrate (0.32) and dobutamine (0.24) administration, while it significantly decreased after normal saline (0.11) and esmolol (0.12) infusion (p < 0.001 for all). CONCLUSION In CHF, LA distensibility may acutely increase with vasodilators or inotropics or may decrease with beta blockade or volume loading.
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Affiliation(s)
- J M Dernellis
- First Cardiology Department, Amalia Fleming Hospital, Athens, Greece
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Soma J, WislØff U, Tyldum GA, Schjerve IE, Dahl K, WiderØe T. Left ventricular apical rotation is related to ambulatory blood pressure and body mass in healthy elderly females. Blood Press 2009; 17:147-55. [DOI: 10.1080/08037050802184411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hung KC, Huang HL, Chu CM, Yeh KH, Fang JT, Lin FC. Effects of Altered Volume Loading on Left Ventricular Hemodynamics and Diastolic Filling During Hemodialysis. Ren Fail 2009; 26:141-7. [PMID: 15287197 DOI: 10.1081/jdi-120038492] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Changes in the circulating volume associated with hemodialysis (HD) resulted in alternations of left ventricular (LV) filling. However, previous studies offered conflicting findings. This study thus evaluated the impact of HD on LV diastolic filling indices and hemodynamics. MATERIALS AND METHODS Forty patients with end-stage renal disease were studied by Doppler echocardiography immediately before and after HD. The cardiac size, volume and mass were determined by M-mode and two-dimensional echocardiography. LV diastolic filling parameters and hemodynamics were assessed from mitral inflow using Doppler echocardiography. RESULTS Left atrial and LV dimension, LV volume, and LV mass decreased significantly after HD (p<0.001). Cardiac output declined from 5.74+/-1.37 to 4.98+/-1.27 L/min (p<0.001), whereas, the ejection fraction remained unchanged. HD elicited marked changes in the early diastolic E (95.1+/-20.5 to 70.3+/-18.2 cm/s, p<0.001) and late atrial filling A velocities (104.3+/-20.9 to 88.9+/-16.9 cm/s, p<0.001). In addition, correction of the deceleration time of E and isovolumic relaxation time prolonged significantly (p=0.011 and p<0.001, respectively). CONCLUSIONS Findings in this study indicate that HD altering the loading condition significantly influenced the LV diastolic function and hemodynamics. Moreover, Doppler echocardiography provides an effective means of assessing the effects on LV diastolic filling and hemodynamics during HD.
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Affiliation(s)
- Kuo-Chun Hung
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
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25
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Pepi M, Guazzi M, Maltagliati A, Berna G, Tamborini G. Diastolic ventricular interaction in normal and dilated heart during head-up tilting. Clin Cardiol 2009; 23:665-72. [PMID: 11016016 PMCID: PMC6654964 DOI: 10.1002/clc.4960230907] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The normal human heart behaves as a single functional unit during preload reduction; adaptations of the left ventricle to head-up tilting is mediated through ventricular interdependence and biventricular-lung interaction. HYPOTHESIS We hypothesized that reduction of venous return in dilated cardiomyopathy is likely to have a great effect on ventricular chamber geometry and filling. The aim of this study was to evaluate the effects of gradual head-up tilting in normal subjects and in patients with dilated cardiomyopathy, addressing special attention to right (RV) and left ventricular (LV) dimensions, geometry, and filling, and to biventricular-lung interaction. METHODS Twenty normal subjects and 23 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position and after 20 degrees, 40 degrees, and 60 degrees tilting. Right ventricular and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study. Geometric changes of the LV were evaluated by measurements of volumes and diameters in the apical four-chamber view (which identifies the interventricular septum and lateral wall) and apical two-chamber view (which identifies the inferior and anterior wall of the LV). RESULTS In the two groups, tilting was associated with reduction of RV area and LV diameter and volumes; percent variations in LV diameter and volumes recorded in four-chamber view were lower at each step of tilting than with those derived from the two-chamber view in controls and in patients. In normal subjects, mitral and tricuspid peak early flow velocities were decreased at any tilting level; peak late velocities were unchanged; peak velocity of systolic forward flow of the pulmonary vein was reduced, diastolic forward flow was unchanged, and the difference in duration between reverse pulmonary flow and forward mitral A wave was reduced. Doppler findings were qualitatively similar in patients, but tilting induced a more marked redistribution of LV filling to late diastole because of a significant increase in atrial contribution. CONCLUSIONS Preload reduction by tilting induces profound effects on left and right dimensions, geometry, and filling in normal and dilated heart; reduction or RV dimensions are associated with changes in LV ventricular geometry (minimal reduction in septal-lateral diameter, marked reduction in anterior-posterior diameter), redistribution of right and left diastolic filling to late diastole, and redistribution of pulmonary venous flow to early diastole. These mechanisms are probably due to a favorable interaction between heart and lungs, which increases compliance within the pericardial space and facilitates redistribution of flow from the lungs. Even a minimal amount of preload reduction causes more marked effects in LV filling patterns in dilated cardiomyopathy than in normal hearts, confirming that ventricular interaction and pericardial constraint are increased when heart volume enlarges.
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MESH Headings
- Adult
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/pathology
- Cardiomyopathy, Dilated/physiopathology
- Diastole/physiology
- Echocardiography, Doppler
- Female
- Hemodynamics/physiology
- Humans
- Lung/physiopathology
- Male
- Middle Aged
- Observer Variation
- Tilt-Table Test/methods
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/physiopathology
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Affiliation(s)
- M Pepi
- Istituto di Cardiologia dell'Università degli Studi, Fondazione I. Monzino, IRCCS, Milan, Italy
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Seo Y, Ishizu T, Kawano S, Watanabe S, Ishimitsu T, Aonuma K. Combined approach with Doppler echocardiography and B-type natriuretic peptide to stratify prognosis of patients with decompensated systolic heart failure. J Cardiol 2008; 52:224-31. [DOI: 10.1016/j.jjcc.2008.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/29/2008] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
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Weeks SG, Shapiro M, Foster E, Michaels AD. Echocardiographic Predictors of Change in Left Ventricular Diastolic Pressure in Heart Failure Patients Receiving Nesiritide. Echocardiography 2008; 25:849-55. [DOI: 10.1111/j.1540-8175.2008.00705.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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28
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Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study. J Hypertens 2008; 26:1472-6. [DOI: 10.1097/hjh.0b013e3282ff84d7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alnabhan N, Kerut EK, Geraci SA, McMullan MR, Fox E. An approach to analysis of left ventricular diastolic function and loading conditions in the echocardiography laboratory. Echocardiography 2008; 25:105-16. [PMID: 18186790 DOI: 10.1111/j.1540-8175.2007.00542.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nabhan Alnabhan
- Division of Cardiology, University of Mississippi, School of Medicine, Jackson, Mississippi, USA
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Ahmed A. DEFEAT heart failure: clinical manifestations, diagnostic assessment, and etiology of geriatric heart failure. Heart Fail Clin 2007; 3:389-402. [PMID: 17905376 DOI: 10.1016/j.hfc.2007.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aging is characterized by heterogeneity, both in health and in disease. Older adults who have heart failure (HF) often have atypical and delayed clinical manifestations and many have diastolic HF. The assessment and management of HF in older adults may be simplified by a 5-step process called DEFEAT HF: (1) establish a clinical Diagnosis of HF; (2) establish an Etiology for HF, preferably in collaboration with a cardiologist; (3) determine Fluid status and achieve euvolemia; (4) determine left ventricular Ejection frAction; and (5) provide evidence-based Therapy.
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Affiliation(s)
- Ali Ahmed
- University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA.
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Jassal DS, Neilan TG, Picard MH, Wood MJ. Stress Echocardiography: Abnormal Response of Tissue Doppler?Derived Indices to Dobutamine in the Absence of Obstructive Coronary Artery Disease in Patients with Chronic Renal Failure. Echocardiography 2007; 24:580-6. [PMID: 17584197 DOI: 10.1111/j.1540-8175.2007.00455.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Abnormal tissue Doppler (TD)-derived indices during dobutamine stress echocardiography (DSE) can predict the presence of coronary artery disease (CAD) in patients with normal renal function. These indices include a reduction in annular systolic velocity (S'), a decrease in early diastolic annular velocity (E'), and prolongation of the time to E'. However, the ability of these indices to detect or exclude CAD in patients with chronic renal failure (CRF) is unclear. OBJECTIVE To examine the ability of TD-derived indices to detect or exclude the presence of CAD in patients with CRF. METHODS We evaluated a total of 30 patients (13 males, mean age 57 +/- 15 years) using both DSE and coronary angiography. This cohort consisted of 12 control patients with normal renal function (mean creatinine 0.5 mg/dL) and 18 patient with CRF (mean creatinine 2.5 mg/dL). At each stage of the DSE, left ventricular (LV) diastolic function was assessed using conventional (peak early (E) and late (A) transmitral, E/A ratio, E-wave deceleration time (DT), and isovolumic relaxation time (IVRT)) and TD-derived indices (lateral annular systolic (S'), early diastolic (E'), and late atrial velocities (A'), time to E' and E/E'). RESULTS All 30 patients had a normal DSE based on systolic regional function and a normal coronary angiogram. There was no difference in E, A, E/A, DT or IVRT between the two groups at each stage. Despite normal coronaries, patients with CRF demonstrated lower S' and E' velocities at peak stress compared to the control patients (8.0 +/- 2.2 cm/sec vs 15.1 +/- 2.6, P < 0.05 and 6.7 +/- 1.6 cm/sec vs 13.3 +/- 3.1, P < 0.05, respectively). During DSE, the time to E' at peak stress in CRF patients was also prolonged compared to control (400 +/- 44 ms vs 329 +/- 51, P < 0.05). Patients with CRF also had increased filling pressures (as estimated by E/E') as compared to controls at peak stress (14.7 +/- 5.2 vs 7.4 +/- 1.5, P < 0.05, respectively). CONCLUSION In patients with CRF, a reduction in TD derived indices does not predict the presence of obstructive CAD.
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Affiliation(s)
- Davinder S Jassal
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Arques S, Roux E, Luccioni R. Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function. Cardiovasc Ultrasound 2007; 5:16. [PMID: 17386087 PMCID: PMC1847510 DOI: 10.1186/1476-7120-5-16] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 03/26/2007] [Indexed: 11/10/2022] Open
Abstract
Congestive heart failure with preserved left ventricular systolic function has emerged as a growing epidemic medical syndrome in developed countries, which is characterized by high morbidity and mortality rates. Rapid and accurate diagnosis of this condition is essential for optimizing the therapeutic management. The diagnosis of congestive heart failure is challenging in patients presenting without obvious left ventricular systolic dysfunction and additional diagnostic information is most commonly required in this setting. Comprehensive Doppler echocardiography is the single most useful diagnostic test recommended by the ESC and ACC/AHA guidelines for assessing left ventricular ejection fraction and cardiac abnormalities in patients with suspected congestive heart failure, and non-invasively determined basal or exercise-induced pulmonary capillary hypertension is likely to become a hallmark of congestive heart failure in symptomatic patients with preserved left ventricular systolic function. The present review will focus on the current clinical applications of spectral tissue Doppler echocardiography used as a reliable noninvasive surrogate for left ventricular diastolic pressures at rest as well as during exercise in the diagnosis of heart failure with preserved left ventricular systolic function. Chronic congestive heart failure, a disease of exercise, and acute heart failure syndromes are characterized by specific pathophysiologic and diagnostic issues, and these two clinical presentations will be discussed separately.
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Affiliation(s)
| | - Emmanuel Roux
- Department of Cardiology, Aubagne Hospital, Aubagne, France
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34
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Ahmed A. Clinical manifestations, diagnostic assessment, and etiology of heart failure in older adults. Clin Geriatr Med 2007; 23:11-30. [PMID: 17126753 DOI: 10.1016/j.cger.2006.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aging is characterized by heterogeneity, both in health and in dis-ease. Older adults who have heart failure (HF) often have a typical and delayed clinical manifestations and many have diastolic HF. The assessment and management of HF in older adults may be simplified by a 5-step process called DEFEAT HF: (1) Establish a clinical Diagnosis of HF; (2) Establish an Etiology for HF, preferably in collaboration with a cardiologist; (3) Determine Fluid status and achieve euvolemia; (4) Determine left ventricular Ejection frAction; and (5) Provide evidence-based Therapy.
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Affiliation(s)
- Ali Ahmed
- Department of Medicine, School of Medicine, Geriatric Heart Failure Clinic, Center for Aging, and Center for Heart Failure Research, University of Alabama at Birmingham, 1530 3rd Avenue South, CH19-219, Birmingham, AL 35294-2041, USA.
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35
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Afshinnia F, Spitalewitz S, Chou SY, Gunsburg DZ, Chadow HL. Left Ventricular Geometry and Renal Function in Hypertensive Patients With Diastolic Heart Failure. Am J Kidney Dis 2007; 49:227-36. [PMID: 17261425 DOI: 10.1053/j.ajkd.2006.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Accepted: 10/20/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective is to define the relationship between cardiac geometry and renal function in hypertensive subjects with and without diastolic heart failure (DHF). METHODS This is a prospective observational study in a tertiary-care teaching institute in a 15-month period of consecutive hospitalized hypertensive patients. Patients on dialysis therapy or with atrial fibrillation, systolic heart failure, gross proteinuria, and glomerular diseases were excluded. Two-dimensional echocardiography was performed and stable glomerular filtration rate (GFR) was calculated by using the Modification of Diet in Renal Disease formula. Patients were classified into stage 1 to 5 chronic kidney disease (CKD). RESULTS Five hundred forty hypertensive patients were separated into 2 groups: 286 patients with DHF and 254 patients without DHF. Mean age was 69.1 +/- 13.7 (SD) years in general. In patients with DHF, from stages 1 to 5 CKD, there was a significant graded increase in left ventricular mass index (from 117.3 to 162.4 g/m(2)) and relative wall thickness (from 0.42 to 0.52) and a significant graded decrease in aortic cusp separation (from 1.85 to 1.55 cm). Among echocardiographic variables, left ventricular mass index and relative wall thickness were associated inversely and aortic cusp separation was associated directly with GFR. In the absence of DHF, only left ventricular mass index was associated inversely with GFR, suggesting a prominent role of aortic cusp separation and relative wall thickness in the variability in GFR in patients with DHF through a hemodynamic disturbance. CONCLUSION Hemodynamic alterations have a prominent role in the variability of GFR in patients with CKD with DHF. Adverse cardiac geometry is linked to the severity of CKD in hypertensive patients, raising the possibility of preserving both cardiac and renal function by means of hypertension control.
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Affiliation(s)
- Farsad Afshinnia
- Department of Internal Medicine at Memorial Medical Center, Sutter-Gould Medical Foundation Inc, Modesto, CA, USA.
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36
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Thomas JD, Popović ZB. Assessment of left ventricular function by cardiac ultrasound. J Am Coll Cardiol 2006; 48:2012-25. [PMID: 17112991 DOI: 10.1016/j.jacc.2006.06.071] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 06/02/2006] [Accepted: 06/19/2006] [Indexed: 12/27/2022]
Abstract
Our understanding of the physical underpinnings of the assessment of cardiac function is becoming increasingly sophisticated. Recent developments in cardiac ultrasound permit exploitation of many of these newer physical concepts with current echocardiographic machines. This review will first focus on the current approach to the assessment of cardiovascular hemodynamics by cardiac ultrasound. The next focus will be the assessment of global cardiac mechanics in systole and diastole. Finally, relationships between the cardiac structure and regional myocardial function, and the way regional function can be quantified by ultrasound, will be presented. This review also discusses the clinical impact of echocardiography and its future directions and developments.
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Affiliation(s)
- James D Thomas
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Abstract
OBJECTIVE To study the sequence of atrial activation and the interatrial electromechanical delay (IEmD) noninvasively in healthy subjects during sinus rhythm (SR). METHODS AND RESULTS In 66 SR healthy subjects P-wave activation was analyzed by means of vectorcardiography. The timing of atrial contractions was measured as the intervals between the P-wave and the A-wave of the Doppler right and left ventricular inflows (P-A(t) and P-A(m)), and IEmD was calculated as the algebraic difference P-A(m)- P-A(t). In the horizontal plane the vectorcardiographic P-loop was anteroposterior ("typical", 41 subjects), anterior (18), or posterior (7). IEmD (mean +/- SE 17 +/- 8 ms) was directly related to R-R and P-R intervals. IEmD was significantly shorter in anterior and posterior P loops than in the typical (6.5 +/- 5.3 and 8.1 +/- 10.1, respectively, vs 24.2 +/- 3.1 ms). In the posterior P-loop group, who exhibited longer P-A(t), mitral E-wave velocity and E/A ratio were reduced, and left atrial booster function was increased. CONCLUSION IEmD was widely variable in SR, reflecting the origin site of sinus impulse, which independently influenced ventricular filling dynamics.
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Affiliation(s)
- G Barletta
- Department of Cardiology, Careggi Hospital, University of Florence, Italy.
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38
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Notomi Y, Martin-Miklovic MG, Oryszak SJ, Shiota T, Deserranno D, Popovic ZB, Garcia MJ, Greenberg NL, Thomas JD. Enhanced ventricular untwisting during exercise: a mechanistic manifestation of elastic recoil described by Doppler tissue imaging. Circulation 2006; 113:2524-33. [PMID: 16717149 DOI: 10.1161/circulationaha.105.596502] [Citation(s) in RCA: 281] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The cascade of events by which early diastolic left ventricular (LV) filling increases with exercise is not fully elucidated. Doppler tissue imaging (DTI) can detect myocardial motion, including torsion, whereas color M-mode Doppler (CMM) can quantify LV intraventricular pressure gradients (IVPGs). METHODS AND RESULTS Twenty healthy volunteers underwent echocardiographic examination with DTI at rest and during submaximal supine bicycle exercise. We assessed LV long-/short-axis function, torsion, volume, inflow dynamics, and early diastolic IVPG derived from CMM data. LV torsion and untwisting velocity increased with exercise (torsion, 11+/-4 degrees to 24+/-8 degrees ; untwisting velocity, -2.0+/-0.7 to -5.6+/-2.3 rad/s) that was associated with an increase in IVPG (1.4+/-0.5 to 3.7+/-1.2 mm Hg). Untwisting in normal subjects occurred during isovolumic relaxation and early filling, significantly before long-axis lengthening or radial expansion. The clinical feasibility of this method was tested in 7 patients with hypertrophic cardiomyopathy (HCM); torsion was higher at rest but did not increase with exercise (16+/-4 degrees to 14+/-6 degrees), whereas untwisting was delayed and unenhanced (-1.6+/-0.8 to -2.3+/-1.2 rad/s). In concert, IVPG was similar at rest (1.2+/-0.3 mm Hg), but the exercise response was blunted (1.6+/-0.8 mm Hg). In normal subjects and HCM patients, there was a similar linear relation between IVPG and untwisting rate, with an overall correlation coefficient of r=0.75 (P<0.0001). CONCLUSIONS LV untwisting appears to be linked temporally with early diastolic base-to-apex pressure gradients, enhanced by exercise, which may assist efficient LV filling, an effect that appears blunted in HCM. Thus, LV torsion and subsequent rapid untwisting appear to be manifestations of elastic recoil, critically linking systolic contraction to diastolic filling.
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Affiliation(s)
- Yuichi Notomi
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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39
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Rovner A, Greenberg NL, Thomas JD, Garcia MJ. Relationship of diastolic intraventricular pressure gradients and aerobic capacity in patients with diastolic heart failure. Am J Physiol Heart Circ Physiol 2005; 289:H2081-8. [PMID: 15937093 DOI: 10.1152/ajpheart.00951.2004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We sought to elucidate the relationship between diastolic intraventricular pressure gradients (IVPG) and exercise tolerance in patients with heart failure using color M-mode Doppler. Diastolic dysfunction has been implicated as a cause of low aerobic potential in patients with heart failure. We previously validated a novel method to evaluate diastolic function that involves noninvasive measurement of IVPG using color M-mode Doppler data. Thirty-one patients with heart failure and 15 normal subjects were recruited. Echocardiograms were performed before and after metabolic treadmill stress testing. Color M-mode Doppler was used to determine the diastolic propagation velocity ( Vp) and IVPG off-line. Resting diastolic function indexes including myocardial relaxation velocity, Vp, and E/ Vp correlated well with V̇o2 max ( r = 0.8, 0.5, and −0.5, respectively, P < 0.001 for all). There was a statistically significant increase in Vp and IVPG in both groups after exercise, but the change in IVPG was higher in normal subjects compared with patients with heart failure (2.6 ± 0.8 vs. 1.1 ± 0.8 mmHg, P < 0.05). Increase in IVPG correlated with peak V̇o2 max ( r = 0.8, P < 0.001) and was the strongest predictor of exercise capacity. Myocardial relaxation is an important determinant of exercise aerobic capacity. In heart failure patients, impaired myocardial relaxation is associated with reduced diastolic suction force during exercise.
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Affiliation(s)
- Aleksandr Rovner
- Department of Cardiology, Barnes Jewish Hospital, St. Louis, Missouri, USA
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40
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Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Lévy S, Linde C, López-Sendón JL, Nieminen MS, Piérard L, Remme WJ. Guías de Práctica Clínica sobre el diagnóstico y tratamiento de la insuficiencia cardíaca crónica. Versión resumida (actualización 2005). Rev Esp Cardiol 2005; 58:1062-92. [PMID: 16185619 DOI: 10.1157/13078554] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Karl Swedberg
- Sahlgrenska Academy, The Göteborg University, Göteborg, Sweden.
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41
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Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Lévy S, Linde C, Lopez-Sendon JL, Nieminen MS, Piérard L, Remme WJ. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26:1115-40. [PMID: 15901669 DOI: 10.1093/eurheartj/ehi204] [Citation(s) in RCA: 1312] [Impact Index Per Article: 69.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Karl Swedberg
- Sahlgrenska Academy at the Göteborg University, Department of Medicine, Sahlgrenska University Hospital, Sweden.
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Gaynor SL, Maniar HS, Prasad SM, Steendijk P, Moon MR. Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output. Am J Physiol Heart Circ Physiol 2005; 288:H2140-5. [PMID: 15591102 DOI: 10.1152/ajpheart.00566.2004] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to investigate the relationship between right atrial (RA) reservoir and conduit function and to determine how hemodynamic changes influence this relationship and its impact on cardiac output. In 11 open-chest sheep, RA reservoir and conduit function were quantified as RA inflow with the tricuspid valve closed versus open, respectively. Conduit function was separated into early (before A wave) and late (after A wave) components. The effects of inotropic stimulation, partial pulmonary artery occlusion, and pericardiotomy were tested. At baseline with the pericardium intact, reservoir function accounted for 0.56 (SD 0.13) of RA inflow, early conduit for 0.29 (SD 0.07), and late conduit (during RA contraction) for 0.16 (SD 0.11). Inotropic stimulation decreased conduit function and increased reservoir function, but these effects did not reach statistical significance. With partial pulmonary artery occlusion, early conduit function fell to 0.20 (SD 0.11) ( P < 0.04), and the conduit-to-reservoir ratio decreased by 41% ( P < 0.03). Similarly, after pericardiotomy, early conduit function fell to 0.14 (SD 0.09) ( P < 0.004), reservoir function increased to 0.72 (SD 0.08) ( P < 0.04), and, consequently, the early conduit-to-reservoir ratio decreased by 63% ( P < 0.006). Cardiac output was inversely related to the conduit-to-reservoir ratio ( r = 0.39, P < 0.001). This study demonstrated that the right atrium adjusts its ability to act more as a reservoir than a conduit in a dynamic manner. The RA conduit-to-reservoir ratio was directly related to the right ventricular pressure-RA pressure gradient at the time of maximum RA volume, with increased ventricular pressures favoring conduit function, but it was inversely related to cardiac output, with an increase in the reservoir contribution favoring improved cardiac output.
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Affiliation(s)
- Sydney L Gaynor
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110-1013, USA
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43
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Maurer MS, Spevack D, Burkhoff D, Kronzon I. Diastolic dysfunction: can it be diagnosed by Doppler echocardiography? J Am Coll Cardiol 2004; 44:1543-9. [PMID: 15489083 DOI: 10.1016/j.jacc.2004.07.034] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2003] [Revised: 07/06/2004] [Accepted: 07/12/2004] [Indexed: 11/18/2022]
Abstract
Heart failure with a normal ejection fraction (HFNEF) predominantly afflicts older, female individuals and is considered to be a consequence of diastolic dysfunction. Doppler echocardiography has become the standard method for identifying and characterizing diastolic function. However, the important distinction between Doppler measures of filling dynamics and true indexes of intrinsic ventricular diastolic chamber properties is not widely appreciated. Herein, we delineate physiologic measures of intrinsic ventricular diastolic function, as determined by pressure volume analysis, and compare and contrast these measures with those derived from Doppler echocardiography. Doppler-derived indexes of ventricular filling do not provide specific information on intrinsic passive diastolic properties, and thus, abnormal filling dynamics do not necessarily equate with intrinsic myocardial diastolic dysfunction. This raises a fundamental question as to whether delayed relaxation and/or stiffened passive properties are the unifying pathophysiologic mechanisms in all patients who present with HFNEF.
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Affiliation(s)
- Mathew S Maurer
- Department of Medicine, College of Physicians and Surgeons, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
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44
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Uzun M, Erinc K, Kirilmaz A, Baysan O, Sag C, Kilicarslan F, Genc C, Karaeren H, Demirtas E. A Novel Method to Estimate Pulmonary Artery Wedge Pressure Using the Downslope of the Doppler Mitral Regurgitant Velocity Profile. Echocardiography 2004; 21:673-9. [PMID: 15546367 DOI: 10.1111/j.0742-2822.2004.03174.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Continuous-wave (CW) Doppler recording of mitral regurgitation (MR) is a reflection of the left ventriculoatrial pressure gradient. Accordingly, this jet may yield information about pulmonary artery wedge pressure (PAWP). In this study, we derived and then evaluated a novel method for prediction of PAWP. Patients (n=80) with moderate to severe MR and left ventricular dysfunction were included in the study. Transthoracic echocardiography was performed in patients during pulmonary artery pressure monitoring. A satisfactory CW Doppler recording of MR was obtained in 63/80 (78%). On the late descending portion of the CW recording, the time from a velocity of 4 m/sec to the end of the jet was defined as t1, and from 3 m/sec to the end of the jet as t2. Mathematical derivation of t1/t2 as a predictor of PAWP, was performed based on Weiss' derivation. If t1/t2 was <1.30, the PAWP was normal. If t1/t2 > 1.44, the PAWP was > 16 mmHg. With this new mathematical derivation, it appears that the downslope of the CW Doppler MR waveform may be able to distinguish a normal from elevated PAWP.
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Affiliation(s)
- Mehmet Uzun
- Gulhane Military Medical Academy, Department of Cardiology, Ankara, Turkey.
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45
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Marino P, Faggian G, Bertolini P, Mazzucco A, Little WC. Early mitral deceleration and left atrial stiffness. Am J Physiol Heart Circ Physiol 2004; 287:H1172-8. [PMID: 15087288 DOI: 10.1152/ajpheart.00051.2004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left ventricular (LV) filling deceleration time (DT) is determined by the sum of atrial and ventricular stiffnesses ( KLA+ KLV). If KLA, however, is close to zero, then DT would reflect KLVonly. The purpose of this study was to quantify KLAduring DT. In 15 patients, KLVwas assessed, immediately after cardiopulmonary bypass, from E wave DT as derived from mitral tracings obtained by transesophageal echocardiography and computed according to a validated formula. In each patient, a left atrial (LA) volume curve was also obtained combining mitral and pulmonary vein (PV) cumulative flow plus LA volume measured at end diastole. Time-adjusted LA pressure was measured simultaneously with Doppler data in all patients. KLAwas then calculated during the ascending limb of the V loop and during DT. LA volume decreased by 7.3 ± 6.5 ml/m2during the first of mitral DT, whereas LV volume increased 9.4 ± 8.4 ml/m2(both P < 0.001). There was a small amount of blood coming from the PV during the same time interval, with the cumulative flow averaging 3.2 ± 2.4 ml/m2( P < 0.001). Mean LA pressure was 10.0 ± 5.1 mmHg, and it did not change during DT [from 7.8 ± 4.3 to 8.0 ± 4.3 mmHg, not significant (NS)], making KLA, which averaged 0.46 ± 0.39 mmHg/ml during the V loop, close to zero during DT [ KLA(DT): from −0.002 ± 0.08 to −0.001 ± 0.031 mmHg/ml, NS]. KLV, as assessed noninvasively from DT, averaged 0.25 ± 0.32 mmHg/ml. In conclusion, notwithstanding the significant decrement in LA volume, KLAdoes not change and can be considered not different from zero during DT. Thus KLAdoes not affect the estimation of KLVfrom Doppler parameters.
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Affiliation(s)
- Paolo Marino
- Cardiology Service, Policlinico G. B. Rossi, University of Verona, Verona 37134, Italy.
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Bolognesi R, Tsialtas D, Zeppellini R, Barilli AL, Cucchini F, Manca C. Early and subtle abnormalities of left ventricular function in clinically stable coronary artery disease patients with normal ejection fraction. J Card Fail 2004; 10:304-9. [PMID: 15309696 DOI: 10.1016/j.cardfail.2003.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND It has been reported that, in the initial phase of ischemic cardiomyopathy, the earliest alterations of left ventricular function are detected during the relaxation phase. The aim of this study was to look for precocious abnormalities in the early stage of ischemic cardiomyopathy in both left ventricular systolic and diastolic phases. METHODS AND RESULTS Using simultaneous left ventricular catheterization and echo-Doppler techniques, we studied both systolic and diastolic function in 44 (37 males and 7 females, mean age 55.7+/-8) normotensive, clinically stable, coronary artery disease patients with normal left ventricular ejection fraction in comparison to 9 age- and sex-matched normal control subjects (7 males and 2 females, mean age 54.7+/-9). Mean values of E deceleration time, tau, left ventricular end-diastolic volume and pressure, and end-systolic volume and lowest diastolic pressure were significantly higher (from P<.05 to P<.01), whereas mean dP/dt/P values significantly lower (P<.05) in coronary artery disease patients than in controls. A strict relationship (P<.001) between dP/dt/P and tau, left ventricular lowest and end-diastolic pressure was found in all subjects studied. CONCLUSION Early and subtle abnormalities in parameters of both systolic and diastolic function can be found in the majority of coronary artery disease patients with normal ejection fraction.
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Affiliation(s)
- R Bolognesi
- Cattedra di Cardiologia, Università degli Studi di Parma, Parma, Italy
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Pepi M, Tamborini G, Maltagliati A, Guazzi M, Berna G, Susini F, Muratori M, Celeste F. Effects of acute angiotensin-converting enzyme inhibition on diastolic ventricular interaction in the dilated heart. Clin Cardiol 2004; 26:424-30. [PMID: 14524600 PMCID: PMC6654519 DOI: 10.1002/clc.4960260909] [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: 11/11/2022] Open
Abstract
BACKGROUND The normal and dilated heart behaves as a single functional unit during preload reduction: volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling. HYPOTHESIS We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin-converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction. METHODS Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position (B) and after 40 degrees of head-up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mg s.l.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study. RESULTS In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal-lateral diameter and anterior-posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior-posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic forward flow of pulmonary venous flow decreased, the diastolic forward flow did not change, and the difference in duration between reverse pulmonary flow and mitral peak late flow decreased: C and CT induced similar changes. CONCLUSION Preload reduction induced by tilting or by ACE inhibitors induces profound and similar effects on LV and RV dimensions, LV geometry, and biventricular filling. Reduction of RV dimension is associated with adaptation of LV geometry and decrease of LV diastolic pressure, which facilitates LV filling and pulmonary venous drainage: ACE inhibition associated with tilting exerts an additional effect on these changes. These data confirm the role of ventricular interaction in modulating LV filling in heart failure.
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Affiliation(s)
- Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia dell'Università degli Studi, Milan, Italy.
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Onose Y, Fukuda N, Shinohara H, Sakabe K, Nada T, Tamura Y. Pseudonormalization of the TEI Index in Patients With Left Ventricular Systolic Dysfunction and Congestive Heart Failure. J Echocardiogr 2004. [DOI: 10.2303/jecho.2.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Jörgensen K, Houltz E, Westfelt U, Nilsson F, Scherstén H, Ricksten SE. Effects of lung volume reduction surgery on left ventricular diastolic filling and dimensions in patients with severe emphysema. Chest 2003; 124:1863-70. [PMID: 14605061 DOI: 10.1378/chest.124.5.1863] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Data on the influence of lung volume reduction surgery (LVRS) on cardiac function and hemodynamics are scarce and controversial. Previous studies have focused mainly on right ventricular function and pulmonary hemodynamics. Here, we evaluated the effects of LVRS on left ventricular (LV) end-diastolic filling pattern, dimensions, stiffness, and performance, as well as pulmonary and systemic hemodynamics. DESIGN A prospective, open, controlled study. PATIENTS Patients with severe emphysema undergoing LVRS (10 patients). Patients scheduled for pulmonary lobectomy due to carcinoma (ie, the lobectomy group) served as control subjects (10 patients). MEASUREMENTS LV dimensions and mitral flow velocities were measured by transesophageal, two-dimensional, Doppler echocardiography, and central hemodynamics were measured by a pulmonary artery thermodilution catheter. Measurements were performed during anesthesia in the supine position, before and after surgery, without and with passive leg elevation. RESULTS Baseline cardiac index (CI) [- 21%], stroke volume index (SVI) [- 31%], stroke work index (SWI) [- 26%], and LV end-diastolic area index (EDAI) [- 15%] were significantly (p < 0.001) lower, whereas LV end-diastolic stiffness (LVEDS) did not differ in the LVRS group compared to the lobectomy group. The time from peak early diastolic filling to zero flow (E-dec time) [58%] and the deceleration slope of early diastolic filling (E-dec slope) [45%] were significantly higher (p < 0.01), whereas peak early diastolic filling velocity (E-max) [- 31%; p < 0.01] and the proportion of E-max vs peak late diastolic filling velocity (A-max) [ie, the E/A ratio] (- 27%; p < 0.001) were significantly lower compared to the lobectomy group. LVRS significantly increased CI (40%; p < 0.001), SVI (34%; p < 0.001), SWI (58%; p < 0.001), LV EDAI (18%; p < 0.001), E-max (44%; p < 0.01), A-max (15%; p < 0.05) and E/A ratio (28%; p < 0.01), decreased E-dec time (- 31%; p < 0.05) and E-dec slope (- 98%; p < 0.01), and had no effect on LVEDS. In the lobectomy group, surgery affected none of these variables. CONCLUSIONS LV function is impaired in patients with severe emphysema due to small end-diastolic dimensions. LVRS increases LV end-diastolic dimensions and filling, and improves LV function.
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Affiliation(s)
- Kirsten Jörgensen
- Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Abd-El-Rahim AR, Otsuji Y, Yuasa T, Zhang H, Takasaki K, Kumanohoso T, Yoshifuku S, Kuwahara E, Toyonaga K, Murayama T, Koriyama C, Kisanuki A, Hegazy A, Minagoe S, Tei C. Noninvasive differentiation of pseudonormal/restrictive from normal mitral flow by Tei index: a simultaneous echocardiography-catheterization study in patients with acute anteroseptal myocardial infarction. J Am Soc Echocardiogr 2003; 16:1231-6. [PMID: 14652601 DOI: 10.1067/j.echo.2003.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Differentiation of pseudonormal/restrictive from normal mitral flow is still clinically problematic. Pseudonormal/restrictive flow is usually associated with left ventricular dysfunction, which can be detected by Doppler Tei index, combining systolic and diastolic function. Therefore, the purpose of this study was to test the feasibility of the Tei index to differentiate pseudonormal/restrictive from normal mitral flow. METHODS In 26 patients with anteroseptal acute myocardial infarction and early diastolic mitral flow velocity (E) to late diastolic mitral flow velocity (A) ratio (E/A) > or = 1, left ventricular volumes; E and A; deceleration time of E; and the Tei index, defined as the sum of the isovolumic contraction and relaxation time divided by ejection time, were evaluated by Doppler echocardiography, and pulmonary capillary wedge pressure was measured by catheterization. Pseudonormal/restrictive mitral flow was defined as E/A > or = 1 associated with pulmonary capillary wedge pressure > 12 mm Hg. RESULTS There were 19 and 7 patients with pseudonormal/restrictive and normal mitral flow, respectively. Among the indices of left ventricular function, the Tei index achieved the best correlation with pulmonary capillary wedge pressure (r(2) = 0.66, P <.0001). By setting the Tei index > or = 0.55 as the criteria for pseudonormal/restrictive mitral flow, this diagnosis had the sensitivity, specificity, and accuracy of 84%, 100%, and 88%, respectively. CONCLUSION The Tei index allows noninvasive differentiation of pseudonormal/restrictive from normal mitral flow.
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