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PubMed1993

Sex differences in cardiac adaptation to isolated systolic hypertension.

This study examines the association of isolated systolic hypertension with left ventricular (LV) mass and geometry in men and women. The subjects of this study were surviving members of the Framingham Heart Study and the Framingham Offspring Study who attended the index examination (between 1979 and 1983) and were aged > or = 50 years, free of clinically apparent cardiovascular disease, not taking antihypertensive medication and without diastolic hypertension (diastolic blood pressure < 90 mm Hg), and in whom LV mass could be determined by echocardiography. Examinations routinely included 12-lead resting electrocardiography, measurements of resting blood pressure, anthropometry, blood glucose levels, and M-mode echocardiography. M-mode echocardiograms adequate to assess LV hypertrophy were obtained for 1,282 normotensive subjects (538 men and 744 women) and 79 subjects with isolated systolic hypertension (26 men and 53 women). Adjusting for age, body mass index and diastolic blood pressure, the relative odds of LV hypertrophy associated with isolated systolic hypertension were 2.58 (95% confidence interval 0.97 to 6.86) in men and 5.94 (95% confidence interval 3.06 to 11.53) in women. Women with isolated systolic hypertension had increased LV wall thickness and mass without LV chamber enlargement, but men had LV dilation and increased LV mass without increased wall thickness. In conclusion, although isolated systolic hypertension was associated with increased LV mass in men and women, the geometric pattern of increased LV mass differed by sex; although women demonstrated a pattern of concentric hypertrophy, an eccentric pattern was observed in men.

Adaptation, Physiological↗
PubMed1978

Dynamic left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve in the absence of asymmetric septal hypertrophy.

Systolic anterior motion of the anterior mitral valve leaflet and asymmetric septal hypertrophy are the principal components of the dynamic subaortic stenosis in hypertrophic obstructive cardiomyopathy. Mitral valve systolic anterior motion without septal hypertrophy or left ventricular outflow tract obstruction has been described, but asymmetric septal hypertrophy is supposedly a consistent feature of dynamic subaortic stenosis. We describe two patients with syncope, chest pain and the typical systolic murmur of hypertrophic subaortic stenosis whose echocardiograms showed mitral valve systolic anterior motion but not asymmetric septal hypertrophy. Normal septal thickness on echo was confirmed by intravenous indocyanine green to identify the right septal endocardium. At catheterization, left ventricular outflow tract gradients were provoked, and neither patient had interventricular septal hypertrophy on biventricular cineangiography. These findings in two cases suggest that mitral valve systolic anterior motion can be the only definable anatomic abnormality associated with symptomatic dynamic left ventricular outflow tract obstruction and that asymmetric septal hypertrophy is not a necessary component of this condition.

Adult↗
PubMed1987

Prevalence of systolic anterior motion of the mural (posterior) leaflet of the mitral valve in hypertrophic cardiomyopathy: an echocardiographic study.

Cross-sectional echocardiography was used to identify systolic anterior motion of the mural (posterior) leaflet of the mitral valve from a group of 53 patients with hypertrophic cardiomyopathy. This type of systolic anterior motion was identified in parasternal long axis, apical four-chamber and/or long-axis cross-sections and was characterized by an elongation of the mural leaflet and an abnormal coaptation with the aortic (anterior) leaflet. At end-diastole, the aortic leaflet coapted at the basal or mid portion of the mural leaflet, leaving its distal "residual" segment in the left ventricle. Subsequently, during systole this "residual" segment approached or touched the ventricular septum. Systolic anterior motion of the mural leaflet was present in 6 (12%) of our patients with hypertrophic cardiomyopathy. Lengthening of the leaflet and an abnormal coaptation were associated with increased thickening of the posterior wall of the left ventricle and narrowing of the left ventricular outflow tract. All these elements contribute to the occurrence of systolic anterior motion and left ventricular tract obstruction.

Adolescent↗
PubMed1987

Effect of myocardial contraction on systolic coronary resistance in conscious dogs.

We studied the effect of cardiac contraction on systolic coronary resistance under the conditions of maximally dilated coronary resistance vessels in six conscious dogs. Subendocardial segment length in areas supplied by the left circumflex coronary artery, left ventricular pressure and left circumflex coronary artery flow were simultaneously measured. At 5 sec after release of the first 2 min of left circumflex coronary artery occlusion, diastolic coronary blood flow revealed its peak value in association with markedly depressed regional contractile function. With collateral development induced by repeated 2 min left circumflex coronary artery occlusions, segmental dysfunction during occlusion and early reperfusion was progressively attenuated. Before and after collateral development, diastolic coronary resistance at 5 sec of reperfusion remained unchanged, but systolic coronary resistance increased by 41% secondary to restoration of regional myocardial shortening. In each animal, normalized regional shortening correlated well with changes in systolic coronary resistance. The fraction of systolic coronary resistance due to active regional myocardial contraction was 52%. These studies demonstrate that when coronary vasomotor tone is abolished, regional myocardial contraction impedes the coronary systolic flow in proportion to the extent of shortening.

Animals↗
PubMed1994

Effect of 24-h blood pressure levels and circadian blood pressure rhythm on left ventricular structure and function in isolated systolic hypertension.

Forty-one participants (mean age 69 +/- 5.6 years) were examined by fully automatic blood pressure monitor and Doppler echocardiography to gain information on the ambulatory blood pressure and the left ventricular structure and function in isolated systolic hypertension. Cumulative sum (cusum)-derived statistics was used to quantify circadian blood pressure rhythm and 24-h blood pressure levels were defined as mean blood pressure values during 24 h, waking (06:00-22:00 h) and sleeping (22:00-06:00 h) periods, respectively. Most of the derivatives of ambulatory blood pressure, including cusum-derived statistics and 24-h blood pressure levels, were significantly related with the left ventricular structural (left ventricular posterior wall and interventricular septum thickness) and functional (acceleration time in the left ventricular outflow tract and early diastolic deceleration time) indexes. Among the left ventricular structural and functional indexes, interventricular septum thickness at end diastole had the strongest correlation with sleeping diastolic mean blood pressure (r = 0.41, P < 0.01), left ventricular posterior wall at end diastole, the best with 24-h systolic mean blood pressure (r = 0.41, P < 0.01), acceleration time the strongest with systolic cusum-derived circadian alteration magnitude (r = 0.49, P < 0.01) and early diastolic deceleration time the greatest with diastolic cusum-derived trough blood pressure (r = 0.45, P < 0.01). We conclude that left ventricular structural changes rely on 24-h systolic and diastolic blood pressure levels, whereas left ventricular functional variations may be more dependent upon circadian blood pressure rhythm in elderly patients with isolated systolic hypertension.

Aged↗
PubMed1989

Assessment of myocardial systolic wall thickening using nuclear magnetic resonance imaging.

A quantitative nuclear magnetic resonance (NMR) imaging method of evaluating regional left ventricular function was compared with histochemical evidence of infarction in dogs and functional measurements in patients. Short-axis images of the heart were obtained at end-diastole and at 100 ms intervals thereafter. Regional diastolic left ventricular wall thickness and maximal percent systolic wall thickening were measured at the level of the papillary muscles in each of six segments. In six normal dogs, the mean end-diastolic wall thickness was 9 +/- 1.6 mm, and the mean maximal percent thickening was 61 +/- 11%. In eight dogs with a 4 day old infarct, maximal percent thickening was 5 +/- 8% (p less than 0.001) in the infarcted segments. In 10 normal human volunteers, the mean end-diastolic wall thickness was 10.1 +/- 1 mm, and the mean maximal percent systolic wall thickening was 60 +/- 18%. Reduced maximal percent systolic wall thickening was defined as a value greater than or equal to 2 SD below the mean value obtained in normal volunteers. Seven patients with regional wall motion abnormalities were independently assessed by NMR imaging and biplane ventriculography. With a sensitivity of 94% and a specificity of 80%, NMR imaging demonstrated reduced maximal percent systolic wall thickening in the same segments identified as akinetic or dyskinetic by biplane ventriculography. Thus, abnormalities of regional systolic wall thickening are accurately identified with this quantitative imaging technique.

Adult↗
PubMed1990

Hemodynamic importance of systolic ventricular interaction, augmented right atrial contractility and atrioventricular synchrony in acute right ventricular dysfunction.

To delineate the determinants of right ventricular performance with acute right ventricular dysfunction, surgical electrical isolation of the right ventricular free wall was produced in 13 dogs. During atrioventricular (AV) pacing, hemodynamic and wall motion measurements were normal. When not paced, the right ventricular free wall became asystolic, resulting in a depressed and bifid right ventricular systolic pressure (33 +/- 5 to 18 +/- 4 mm Hg) and decreased left ventricular systolic pressure (100 +/- 18 to 80 +/- 18 mm Hg) and stroke volume (14 +/- 4 to 10.3 +/- 3.5 ml) (all p less than 0.05). Ultrasound demonstrated right ventricular free wall dyskinesia, increased right ventricular end-diastolic size (155 +/- 13% of control), but decreased left ventricular size (69 +/- 11% of control) (both p less than 0.05). Right atrial pressure increased (5.8 +/- 2.5 to 7.6 +/- 2.8 mm Hg, p less than 0.05) with an augmented A wave and blunted Y descent, indicating pandiastolic right ventricular dysfunction. The septum demonstrated reversed curvature in diastole and bulged paradoxically into the right ventricle during early systole, generating the initial peak of right ventricular pressure and reducing its volume. Later, posterior septal motion coincided with maximal left ventricular pressure and the second peak of the right ventricular waveform. Left ventricular pacing alone led to further decreases in right ventricular systolic pressure and size, left ventricular systolic pressure and stroke volume. The previously augmented A wave was replaced by a prominent V wave. Therefore, when contractility of its free wall is acutely depressed, right ventricular performance is dependent on left ventricular-septal contractile contributions transmitted by the septum.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Mild systolic dysfunction in heart failure (left ventricular ejection fraction >35%): baseline characteristics, prognosis and response to therapy in the Vasodilator in Heart Failure Trials (V-HeFT)

OBJECTIVES: This analysis sought to evaluate the clinical characteristics and outcome in heart failure with mild systolic dysfunction. BACKGROUND: Although heart failure with mild systolic dysfunction occurs commonly, this is an understudied area because clinical trials have usually excluded patients with ejection fraction >35%. METHODS: The 422 patients with left ventricular ejection fraction </=35% were compared with 172 with a left ventricular ejection fraction >35% in the Vasodilator in Heart Failure Trial (V-HeFT I), whereas in V-HeFT-II 554 patients with a left ventricular ejection fraction </=35% were compared with 218 patients with a left ventricular ejection fraction >35% for mortality and clinical care. For a left ventricular ejection fraction >35%, treatment with hydralazine/isosorbide dinitrate was compared with prazosin and placebo therapy in V-HeFT I, and hydralazine/isosorbide dinitrate was compared with enalapril in V-HeFT II for mortality, clinical course and change in physiologic variables: ejection fraction, plasma norepinephrine levels, ventricular tachycardia and echocardiographic variables. RESULTS: In both studies, patients with a left ventricular ejection fraction >35% differed principally in hypertensive history, higher functional capacity and radiographic and echocardiographic cardiac dimension from patients with a left ventricular ejection fraction </=35%, and plasma norepinephrine levels differed in V-HeFT II (p < 0.01). Patients with a left ventricular ejection fraction >35% had a lower cumulative mortality than those with a left ventricular ejection fraction </=35% (p < 0.0001) and less frequent hospital admissions for heart failure (p < 0.014, V-HeFT I; p < 0.005, V-HeFT II). Although cumulative mortality and morbidity did not differ between treatment groups in V-HeFT I, enalapril decreased overall mortality versus hydralazine/isosorbide dinitrate (p < 0.035) in V-HeFT II. For physiologic variables in V-HeFT II, enalapril decreased ventricular tachycardia at follow-up (p < 0.05). CONCLUSIONS: In V-HeFT, heart failure with mild systolic dysfunction was associated with different characteristics and a more favorable prognosis than heart failure with more severe systolic dysfunction. Enalapril decreased overall mortality and sudden death compared with hydralazine/isosorbide dinitrate. Prospective trials are needed to address therapy for heart failure with mild systolic dysfunction.

Aged↗
PubMed1996

Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis.

OBJECTIVES: This study was designed to determine the clinical value of a Doppler-derived index of combined systolic and diastolic myocardial performance in the assessment of cardiac amyloidosis. BACKGROUND: Cardiac amyloidosis is an infiltrative disease with diastolic and systolic dysfunction. Therefore, the index of myocardial performance combining systolic and diastolic time intervals could be a useful predictor of clinical outcome in cardiac amyloidosis. METHODS: The study included 45 patients with biopsy-proved amyloidosis and 45 age-matched normal subjects. All patients had typical echocardiographic features of amyloid cardiac involvement. A Doppler-derived index, defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time, was measured from left ventricular outflow and mitral inflow Doppler velocity profiles recorded during routine echocardiography. The index as well as conventional systolic or diastolic echocardiographic/Doppler variables were related to subsequent outcome. RESULTS: The isovolumetric contraction and relaxation times were prolonged and ejection time was shortened (p < 0.001) in patients with amyloidosis compared with that in normal subjects, resulting in a marked increase of the index from normal values (p < 0.001). In the amyloid group the index was highest in patients with a low stroke index or with both shortened mitral deceleration time and lower ejection fraction. By univariate analysis, New York Heart Association functional class, the index, ejection fraction and mitral deceleration time were significant predictors of outcome. However, by multivariate stepwise regression analysis, functional class and the index were the only independent predictors of survival. CONCLUSIONS: The Doppler-derived index of combined systolic and diastolic myocardial performance correlates with global cardiac dysfunction and is a useful predictor of clinical outcome in patients with cardiac amyloidosis.

Adult↗
PubMed1989

In vitro flow characteristics of the Jarvik-7 prosthesis with respect to filling pressure, stroke frequency, and systolic duration.

The Jarvik-7 total artificial heart (TAH), as an implantable substitute for the natural heart, has become the most widely used prosthesis. Although the performance of the Jarvik-7 prosthesis has been described experimentally as well as clinically, the interrelationship between cardiac output, filling pressure, stroke frequency and systolic duration in a wider perspective has not been reported. Our in vitro evaluation of the pump demonstrates the relation between cardiac output and right filling pressure in the range of 2-17 mm Hg with a stroke frequency varying between 60-130 beats per minute with 40% and 50% systolic duration. With respect to complete ventricular filling, a safer and wider range of right filling pressures and stroke frequencies could be employed to produce various cardiac output values at 50% systolic duration as compared to 40% systolic duration. When complete diastolic filling was present, particularly with a high stroke frequency and a low systolic duration, an increase of the left filling pressure to an extent which in a clinical situation would probably cause pulmonary oedema, was observed. By using a right Jarvik-7/70 ml ventricle and a left Jarvik-7/100 ml ventricle, this buildup of the left filling pressure was completely avoided.

Blood Pressure↗
PubMed2006

Anemia in patients with heart failure and preserved systolic function.

BACKGROUND: Anemia has been shown to be a predictor of mortality in patients with heart failure and impaired left ventricular systolic function (ISF). Although heart failure in the setting of preserved systolic function (PSF) is an important clinical problem, the relationship between anemia and outcomes in patients with PSF has not been carefully evaluated. METHODS: Patients undergoing diagnostic angiography from 1995 to 2003 with symptomatic heart failure (New York Heart Association class II or greater) were studied (N = 4951). Patients with primary valvular or congenital heart disease were excluded. Patients with ejection fraction < or = 0.40 (N = 1858) were considered the ISF group, and patients with ejection fraction > 0.40 (N = 3093) were classified as the PSF group. Anemia was defined by the World Health Organization criteria (hemoglobin < 13 g/dL for men and < 12 g/dL for women). Multivariable Cox proportional hazards models were used to adjust for baseline differences. The possibility of a differential effect of anemia by systolic function was tested using an interaction term in the multivariable model. RESULTS: Anemia was independently associated with adverse outcomes across the study cohort (adjusted hazard ratio = 1.53, P < .0001). There was no interaction between anemia and systolic function (ISF vs PSF) in the multivariable model (P = .31 for interaction). The hazard ratio for anemia was 1.61 for PSF patients and 1.45 for ISF patients. CONCLUSIONS: Anemia is an independent predictor of mortality in heart failure, regardless of whether patients have preserved or impaired systolic function. This is the first report of an association between anemia and increased mortality in patients with heart failure and PSF. Future investigations of therapies for anemia in heart failure should consider including patients with PSF.

Aged↗
PubMed2004

A retrospective review of isoimmunized pregnancies managed by middle cerebral artery peak systolic velocity.

OBJECTIVE: The purpose of this study was to determine the clinical outcome of isoimmunized pregnancies managed primarily by middle cerebral artery peak systolic velocity. STUDY DESIGN: A retrospective chart review was conducted of isoimmunized pregnancies that underwent ultrasound examinations from January 1, 2001, through May 1, 2003. Ultrasound reports, laboratory tests, and maternal and neonatal charts were reviewed. RESULTS: Women with a clinically significant red blood cell antibody and titer value were included. The study population consisted of 39 women (40 pregnancies, 42 fetuses). Patients with a middle cerebral artery peak systolic velocity of > or =1.5 MoM were offered amniocentesis. Seven pregnancies had an abnormal middle cerebral artery peak systolic velocity. Three of these infants had significant anemia. Six of the 7 pregnancies required an exchange transfusion. None of the 33 pregnancies (35 neonates) with normal middle cerebral artery peak systolic velocity measurements resulted in a neonate with significant anemia or severe hyperbilirubinemia. CONCLUSION: The clinical outcome of these pregnancies supports the use of middle cerebral artery peak systolic velocity measurements in the management of isoimmunized pregnancies.

Adult↗
PubMed2004

Gene polymorphisms of the renin-angiotensin system and age-related changes in systolic and diastolic blood pressure in subjects with hypertension.

BACKGROUND: Few studies have examined to what extent genes might modulate the changes of systolic and diastolic blood pressure (BP) with age although, in older populations, systolic BP and diastolic BP vary with age in opposite directions. METHODS: This study involved 205 men and 99 women with either systolic-diastolic or isolated systolic hypertension. Age was > 50 years. Using polymerase chain reaction, four gene polymorphisms related to the renin-angiotensin system were independently investigated in men and women. Adjustments to cardiovascular and renal risk factors as well to the sodium/potassium extracellular space ratio were performed. RESULTS: Regarding the angiotensin-converting enzyme (ACE) gene polymorphism, in men > 50 years of age, the slope (mm Hg per unit of age) of the age-diastolic BP (and not age-systolic BP) relationships significantly (P = .0092) differed between genotypes: - 0.79 +/- 0.15 (P < .0001) for the DD genotype, -0.53 +/- 0.10 for the ID genotype (P < .0001), and -0.23 +/- 0.11 for II genotypes (P = NS). Such findings were not observed in the female population in which the age-diastolic BP curves were substantially flatter than in men. No comparable results were observed for gene polymorphisms related either to angiotensinogen or to angiotensin II type 1 receptor. CONCLUSIONS: In men > 50 years of age, the ACE gene polymorphism modulates the physiologic age-induced reduction of diastolic BP. The D allele might contribute to enhance this reduction, a finding that needs confirmation using prospective studies.

Adult↗
PubMed2004

Prevalence of isolated systolic and isolated diastolic hypertension subtypes in China.

BACKGROUND: Isolated systolic hypertension (ISH), more so than any other hypertension subtype, increases the risk for stroke and coronary heart disease. The prevalence of ISH versus other hypertension subtypes in the general Chinese adult population is not known. METHODS: The prevalence of isolated systolic and isolated diastolic hypertension (IDH) was examined in a representative national sample of 15,540 Chinese adults aged 35 to 74 years. Three seated blood pressure (BP) measurements taken after 5 min of rest were averaged and hypertension subtypes were defined among individuals not receiving antihypertensive therapy as follows: ISH as systolic BP >/=140 mm Hg and diastolic BP <90 mm Hg; IDH as systolic BP <140 mm Hg and diastolic BP >/=90 mm Hg; and combined systolic/diastolic hypertension (SDH) as a systolic BP >/=140 mm Hg and diastolic BP >/=90 mm Hg. RESULTS: Overall, 7.6% of the Chinese adult population had ISH, 7.4% had SDH, and 4.4% had IDH. The prevalence of ISH increased with age and was more common in older women than in older men. Stage 1 hypertension was much more prevalent than stage 2 hypertension among all hypertension subtypes. The prevalence of SDH, IDH, and ISH (women, only) were higher in northern China than southern. The prevalence of ISH and SDH (women, only) were higher among rural residents versus urban residents. CONCLUSIONS: These data document high rates of ISH in China. Given the risk of cardiovascular disease associated with ISH, our findings underscore the critical need for enhanced hypertension screening and treatment programs in China.

Adult↗
PubMed2007

High systolic blood pressure is associated with Val/Val genotype in the catechol-o-methyltransferase gene. The Nord-Trøndelag Health Study (HUNT).

BACKGROUND: The catechol-O-methyltransferase (COMT) gene contains a functional polymorphism, Val158Met. A few studies on animals have shown a relationship between the COMT gene and BP, but whether this exists in human beings is unclear. The aim of this study was to evaluate the relationship between codon 158 COMT gene polymorphism and BP in a population-based cohort. METHODS: In the 1995-97 Nord-Trøndelag Health Study (HUNT), the association between Val/Met polymorphism at the COMT gene and BP was evaluated in a group of 2966 nondiabetic individuals. RESULTS: Among the 2591 individuals without current use of antihypertensive drugs, systolic BP > or =140 mm Hg was more likely among persons with Val/Val genotype compared with the other genotypes (44.8% v 39.1%, P = .02). In the multivariate analysis the prevalence odds ratio for having the Val/Val genotype was 1.63 (95% CI = 1.18 to 2.24) among individuals with systolic BP > or =160 mm Hg compared with those with systolic BP <140 mm Hg. Val/Val genotype was also more likely (OR = 1.30, 95% CI = 1.04 to 1.63) among individuals with hypertension (as defined by use of antihypertensive medication, systolic BP > or =140 mm Hg, or diastolic BP > or =90 mm Hg) than among those with normal BP. CONCLUSIONS: Based on the study findings, the Val/Val genotype appears to be associated with a higher prevalence of increased systolic BP compared with the Met/Met or Met/Val genotypes at the COMTgene.

Adult↗
PubMed2006

Quality of life in patients with signs and symptoms of heart failure--does systolic function matter?

BACKGROUND: The impaired quality of life in patients with systolic heart failure is well described. Less is known about patients with preserved systolic function (PSF) heart failure. METHODS AND RESULTS: We aimed to compare the quality of life in patients with PSF heart failure with that of those with left ventricular systolic dysfunction (LVSD) using generic and disease-specific quality-of-life questionnaires. Four hundred patients with signs and symptoms of heart failure referred for an echocardiogram to assess left ventricular function were invited to complete quality-of-life questionnaires. A total of 278 of 400 (69.5%) responses were adequate for analysis. The mean age of respondents was 72.5 (10) years; 132 (47%) were male. A total of 189 of 278 (68%) had PSF, and 89 of 278 (32%) had left ventricular systolic dysfunction (LVSD). Both groups were well matched for age, but there were more women in the PSF group (58% vs. 40%). No significant differences were found in the quality of life between PSF and LVSD patients. Women had significantly worse quality of life compared with men in both groups. CONCLUSION: Patients with PSF are an important subgroup of heart failure patients whose quality of life is as impaired as those with systolic dysfunction. These data suggest these patients warrant more care, perhaps in specialist clinics.

Aged↗
PubMed2005

Color Doppler tissue imaging for evaluation of right ventricular systolic function in patients with congenital heart disease.

OBJECTIVE: We sought to explore the relationship of color Doppler tissue imaging-derived systolic indices of tricuspid valve annular motion and magnetic resonance imaging-derived right ventricular (RV) ejection fraction in patients with congenital heart disease. METHODS: Patients with congenital heart disease who underwent echocardiography and magnetic resonance imaging on the same day were included. The tricuspid valve annular color Doppler tissue imaging-derived parameters of peak velocity during isovolumic contraction, myocardial acceleration during isovolumic contraction, peak systolic velocity, and Tei index were compared with magnetic resonance imaging-derived RV ejection fraction. RESULTS: Peak systolic velocity and myocardial acceleration during isovolumic contraction correlated well with RV ejection fraction after adjusting for age, RV dilation, and pressure overload (r = 0.65 and 0.73, respectively). Interobserver and intraobserver reliability were excellent for peak systolic velocity (r = 0.95 and 0.97, respectively) and very good for myocardial acceleration during isovolumic contraction (r = 0.93 and 0.85, respectively). CONCLUSIONS: Color Doppler tissue imaging indices of tricuspid valve annular motion are reproducible and provide a potentially useful complementary tool for assessment of RV systolic function in patients with congenital heart disease.

Adolescent↗
PubMed2005

Characteristics of left ventricular diastolic function in patients with systolic heart failure: a Doppler tissue imaging study.

OBJECTIVE: Our aim was to characterize myocardial velocity profiles in different types of diastolic dysfunction for patients with severely decreased left ventricular (LV) systolic function. METHODS: A total of 126 patients with congestive heart failure and an LV ejection fraction of 35% or less were included. Patients underwent an echocardiographic Doppler examination, with measurement of the transmitral inflow pattern, and Doppler tissue imaging of the mitral annulus. RESULTS: Compared with age-matched control subjects, the patients had decreased systolic (9.5 vs 4.9 cm/s, P < .001) and early diastolic (11.6 vs 5.6 cm/s, P < .001) mitral annular velocities. According to the transmitral inflow pattern, 56 patients had signs of a LV restrictive pattern, 36 had a pseudonormalization pattern, and 34 had an abnormal relaxation pattern. The peak systolic and early diastolic mitral annular velocities were quite similarly reduced in different diastolic groups (systolic velocities of 4.6, 5.0, and 5.3 cm/s, and early diastolic velocities of 5.7, 5.8, and 5.1 cm/s at restrictive, pseudonormal, and abnormal relaxation, respectively). The ratio of the transmitral early wave and mitral annular early velocity, an expression of LV filling pressure, was highest in the restrictive group compared with other groups (17.0, 14.6, and 11.7 in the above 3 groups, respectively, P < .001 among groups). The ratio of the transmitral early wave and mitral annular early velocity was also higher in the pseudonormal group than in a control group of patients with ejection fraction of 35% or more with signs of a normal/pseudonormal pattern (14.6 vs 9.0, P < .001). CONCLUSION: Doppler tissue imaging may enhance the estimates of diastolic dysfunction in patients with decreased LV systolic function, and help to disclose abnormal diastolic function especially in a pseudonormal group.

Aged↗