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PubMed2006

Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography.

There are many myocardial and non-myocardial conditions that cause heart failure with normal left ventricular ejection fraction (LVEF). Among them, diastolic heart failure (heart failure due to diastolic dysfunction) is the most common cause of heart failure with normal LVEF. Diastolic heart failure easily can be diagnosed by comprehensive two-dimensional and Doppler echocardiography, which can demonstrate abnormal myocardial relaxation, decreased compliance, and increased filling pressure in the setting of normal LV dimensions and preserved LVEF. Therefore, diastolic heart failure should always be considered when LVEF is normal on two-dimensional echocardiography in patients with clinical evidence of heart failure. The diagnosis can be confirmed if Doppler echocardiography and myocardial tissue imaging provide evidence for impaired myocardial relaxation (i.e., decreased longitudinal velocity of the mitral annulus during early diastole and decreased propagation velocity mitral inflow), decreased compliance (shortened mitral A-wave duration and mitral deceleration time), and increased filling pressure (shortened isovolumic relaxation time and an increased ratio between early diastolic mitral and mitral annular velocities). Early identification of diastolic dysfunction in asymptomatic patients by the use of echocardiography may provide an opportunity to manage the underlying etiology to prevent progression to diastolic heart failure.

Blood Flow Velocity↗
PubMed2006

Systo-diastolic ventricular function in patients with hypertension: an echocardiographic tissue doppler imaging evaluation study.

BACKGROUND: Tissue Doppler imaging (TDI) has evolved to become a useful non invasive method that can complement other echocardiographic techniques in the assessment of left ventricular function in different clinical conditions. Spectral pulsed TDI can provide measurements of regional systolic and diastolic myocardial velocities and is particularly useful in detecting abnormalities of left ventricular systolic and diastolic function. We investigated the presence of systo-diastolic dysfunction in patients (pts) with hypertension compared with pts affected by hypertensive cardiomyopathy and normal control subjects. METHODS: We evaluated 214 pts with traditional echocardiography and TDI: 69 normal control subjects (Group A); 145 pts with hypertension, divided according to base echocardiographic evaluation in 74 with no evidence of hypertensive cardiomyopathy (diastolic dysfunction and ventricular hypertrophy, Group B), and 71 with evidence of hypertensive cardiomyopathy (Group C). Pts groups were matched for age, sex, heart rate, smoking status and body surface area. RESULTS: There were no significant differences in ventricular diameters, volumes, shortening and ejection fraction values; TDI showed a progressive systolic wave peak reduction from Group A to B and from Group B to C. Routinely Doppler diastolic function did not show any significant difference between Group A and B; TDI showed progressive E wave peak velocity decrease and A wave peak velocity increase from Group A to B and C and from Group B to C. CONCLUSIONS: TDI evaluation showed a ventricular systolic dysfunction in pts with hypertensive cardiomyopathy; in addition, an early mild systo-diastolic dysfunction was detected in subjects with hypertension but no evidence of hypertensive cardiomyopathy.

Cardiomyopathies↗
PubMed1989

Hypertension and left ventricular diastolic function.

In recent years, there has been increased recognition of the relative importance of abnormalities of diastolic function in patients with essential hypertension. Indeed, diastolic dysfunction may be the earliest indicator of hypertensive heart disease. In this article, the mechanisms governing normal ventricular relaxation and the factors that may cause diastolic dysfunction are reviewed. Noninvasive clinical methods, particularly Doppler echocardiography and radionuclide angiography, for determination of diastolic function are outlined, and the limited experience in the management of hypertensive patients with abnormalities of diastolic function is discussed. When congestive heart failure develops in a patient with hypertension, it is especially important to determine whether it is due primarily to systolic or to diastolic left ventricular dysfunction.

Adrenergic beta-Antagonists↗
PubMed2003

Cardiac dysfunction in portal hypertension among patients with cirrhosis and non-cirrhotic portal fibrosis.

BACKGROUND/AIMS: In cirrhosis, diastolic dysfunction of heart is well documented. Contribution of portal hypertension towards cardiac changes in cirrhosis is difficult to assess. We examined the patients of non-cirrhotic portal fibrosis who have portal hypertension without liver insufficiency to understand the contribution of portal hypertension in causing cardiac changes. METHODS: Cardiac function was studied in four groups of patients: normal controls, patients with non-cirrhotic portal fibrosis (having portal hypertension without liver dysfunction) and cirrhotics with and without ascites. Cardiac function was evaluated by echocardiography. Additional measurements of plasma renin activity and aldosterone levels were performed. RESULTS: Diastolic function as assessed by the ratio between E wave and A wave (E/A ratio), was significantly lower in patients with non-cirrhotic portal fibrosis (median 1.3) compared to normal controls (median 1.52). However, even lower values were observed in cirrhotics without ascites (median 1.05) and with ascites (median 0.94). There was a significant correlation (r=-0.75) between plasma aldosterone levels and the E/A ratio in cirrhotics. CONCLUSIONS: Diastolic dysfunction is not only present in cirrhosis but also in non-cirrhotic portal fibrosis. It indicates that portal hypertension is an important factor in the genesis of cardiac dysfunction.

Adult↗
PubMed1987

[Electrocardiographic and angiographic follow-up of patients with hypertrophic cardiomyopathy].

Electrocardiographic follow-up was conducted for 17 patients with hypertrophic cardiomyopathy including six cases who received left ventriculographic follow-up. 1. Serial ECG changes were as follows: 1) In seven patients negativity of the T wave appeared or increased concomitantly with increased voltage of SV1 + RV5 (A-1 group). 2) In four patients, negativity of the T wave decreased or disappeared with the decreased voltage of SV1 + RV5 (A-2 group). 3) In six patients, there were insignificant changes of both T wave and SV1 + RV5 (B group). 2. Results of serial left ventriculography and biventriculography were as follows: 1) Two patients (A-1 group) showed an increased voltage of SV1 + RV5 (25 mm----48 mm, 42 mm----54 mm), and increased thickness of the apical wall (10 mm----12 mm, 8 mm----11 mm) and the anterior wall (13 mm----16 mm, 10 mm----16 mm). However, the thickness of the posterior and interventricular septal walls did not change. The configuration of the end-diastolic left ventriculogram (RAO 30 degrees) changed from a round configuration to the so-called "beak" configuration. 2) Two patients (A-2 group) showed a decreased voltage of SV1 + RV5 (81 mm----26 mm, 73 mm----53 mm), decreased thickness of the apical wall (18 mm----10 mm, 21 mm----15 mm) and the anterior wall (12 mm----9 mm, 17 mm----12 mm). The end-diastolic left ventriculogram changed from a spade-like configuration to a round configuration. In the analysis of diastolic function measured by digitized cineangiograms using a picture-analyzer, diastolic dysfunction was already present at the initial observation. The diastolic and systolic dysfunction progressed during serial observations. These patients showed the clinical pictures of dilated cardiomyopathy at the final observation. 3) Two patients with no remarkable changes of the T wave (B group) showed insignificant changes in configuration of the left ventriculogram and wall thickness. In conclusion, serial changes in configuration of the left ventricle and wall thickness, especially of the anterior and apical walls, are compatible with the serial changes of the ECG in hypertrophic cardiomyopathy. The patients whose negative T waves decreased or disappeared had diastolic dysfunction at the initial observation, and deterioration of both diastolic and systolic dysfunctions during serial observations.

Adult↗
PubMed1991

Diastolic function in valvular heart disease.

Diastolic dysfunction in patients with valvular heart disease is characterized by an impaired isovolumic relaxation, a normal or even enhanced early diastolic filling rate and an increased myocardial stiffness. These abnormalities do not depend on coexisting systolic dysfunction but are often combined. Several mechanisms are responsible for the occurrence of diastolic dysfunction, such as increased wall stress, altered myocardial structure, subendocardial hypoperfusion and/or diastolic calcium overload. Postoperative regression of myocardial hypertrophy is beneficial in regard to wall stress, subendocardial hypoperfusion and calcium overload but diastolic dysfunction might become worse after valve replacement due to a relative increase in interstitial fibrosis consequent to the decrease in myocyte mass (= myocardial remodeling). Persisting diastolic dysfunction with a substantial rise in left ventricular filling pressure can be observed during dynamic exercise in postoperative patients with preoperative severe pressure overload hypertrophy. Thus, diastolic dysfunction can be present as a primary derangement of cardiac function and can be unmasked as an abnormal response of diastolic filling pressure during exercise.

Cardiomegaly↗
PubMed1991

Congestive heart failure in the elderly. The therapeutic challenge of atypical presentations.

Congestive heart failure (CHF) is a common cause of morbidity and mortality in the elderly. Symptoms and signs of CHF in the elderly often differ from those in younger patients. Careful attention to these subtle differences helps in detection of concomitant illnesses that mimic or mask heart failure. The therapeutic approach to CHF in elderly patients is similar to that in younger patients. However, in the elderly, increased attention should be paid to the side effects and interactions of the drugs commonly prescribed. Diastolic dysfunction is a recently recognized factor in the pathogenesis of CHF. Because diastolic dysfunction is treated differently than systolic dysfunction, evaluation of CHF should include a search for both entities.

Aged↗
PubMed1990

Ventricular diastolic function of the heart in systemic hypertension.

Abnormalities in left ventricular (LV) diastolic function in hypertension have been more extensively investigated in recent years because of the availability of reliable noninvasive methods applicable to this type of ventricular functional analysis. Moreover, such approaches allowed investigation of the factors influencing LV diastolic function indexes and permitted development of correction or normalization indexes. More research has been done recently aiming at understanding the physiologic importance of LV diastolic dysfunction in hypertension; the preliminary results in this area suggest that LV diastolic dysfunction may be linked to alterations in the regional cardiopulmonary dynamics and in cardiopulmonary receptor activity. More questions, however, need to be answered with regard to the relative and integrative role of the various aspects of LV diastolic function and about the sequential alterations in the various indexes of LV diastolic function in hypertension.

Diastole↗
PubMed2003

[Diastolic function of the heart in patients with chronic heart failure and methods of diagnosis of its impairment by tissue Doppler echocardiography].

Negative role of diastolic dysfunction in the heart failure formation is out of doubt now. But the problem of complex diagnostics of this dysfunction is still open. New scientific and technical developments widen our understanding of diastolic function of the heart and possibilities of its assessment in patients with chronic heart failure. One of these possibilities is the use of tissue doppler imaging. Modern concepts of the role of diastolic dysfunction in heart failure as well as detailed characteristics of the novel noninvasive method of its diagnosis are presented in this review.

Chronic Disease↗
PubMedDate not supplied

Doppler assessment of left ventricular diastolic function: a review.

Two-dimensional echocardiography provides valuable information for the assessment of left ventricular function. Traditionally, evaluation has focused on determination of systolic performance. However, recent investigations indicate diastolic dysfunction may also contribute to symptoms of congestive heart failure in many patients despite normal systolic function. Pulsed Doppler echocardiography complements two-dimensional imaging for assessment of left ventricular filling properties that are often altered in the setting of diastolic dysfunction. The concept of diastolic function and recognition of abnormal filling patterns detected by pulsed Doppler echocardiography are reviewed.

Blood Flow Velocity↗
PubMed1989

Alterations in diastolic function in response to progressive left ventricular hypertrophy.

To examine the time course of the functional consequences of progressive left ventricular hypertrophy, diastolic left ventricular inflow and wall thinning variables were analyzed in 13 dogs before and 2, 4, 8 and 12 weeks after creation of perinephritic hypertension. Left ventricular echocardiograms were digitized for dimensions, mass and peak rates of wall thinning (-dh/dt/h) and cavity enlargement (dD/dt/D). Doppler recordings of left ventricular inflow were analyzed for peak early (E) and late (A) diastolic inflow velocities, their ratio and atrial filling fraction. At 2 weeks, systolic blood pressure increased from 151 to 233 mm Hg, wall stress from 52 to 80 kdynes/cm2 and posterior wall thickness from 0.68 to 0.84 cm (all p less than 0.05). Left ventricular mass increased from 90 to 115 g over 12 weeks (p less than 0.05). Heart rate, cavity size and systolic shortening were unchanged at all data points. Diastolic abnormalities accompanied the developing hypertrophy and included impairment of early function, as demonstrated by a peak rate of wall thinning, from -13.4 to -8.9 l/s at 2 weeks (p less than 0.05), increased dependence on atrial systolic filling, a decrease in E/A from 1.68 to 1.29 at 4 weeks (p less than 0.05) and an increase in atrial filling fraction from 30% to 43% at 8 weeks (p = NS). Thus, diastolic dysfunction is an early consequence of experimental left ventricular hypertrophy. Different aspects of diastolic impairment are sensitively reflected by echocardiographic Doppler recordings, suggesting that these methods should be useful for the detection of diastolic dysfunction in human patients.

Animals↗
PubMedDate not supplied

[Character of central hemodynamics in hypotensive type autonomic vascular dysfunction in juveniles].

With an aid of an ultrasound investigation of the heart, aspects of central hemodynamics in 408 juveniles ranging in age between 11 to 14 years have been studied. Of these, 339 were diagnosed as having hypotensive type vegetovascular dysfunction, the other 69 essentially healthy juveniles formed a control group signs of systolic and diastolic dysfunction of the myocardium of the left ventricle revealed in the patients with hypotensive type vegetovascular dysfunction. Systolic dysfunction was compensated by increase in the rate of the heart's beat. Compensation of diastolic dysfunction was achieved by increase in contractility of the muscle of the left ventricle.

Adolescent↗
PubMed1981

Effects of verapamil on left ventricular systolic function and diastolic filling in patients with hypertrophic cardiomyopathy.

Verapamil improves exercise capacity in patients with hypertrophic cardiomyopathy (HCM), but its mechanism of action are unknown. We examined the effects of oral verapamil (320-480 mg/day) on resting left ventricular (LV) systolic and diastolic function in patients with HCM. High-temporal-resolution time-activity curves from gated technetium-99m radionuclide angiograms were analyzed before and after verapamil therapy in 40 patients, of whom 16 were also studied during propranolol therapy (80-960 mg/day). All but one patient had normal or supranormal systolic function, but 70% had evidence of diastolic dysfunction, defined as peak LV filling rate (PFR) less than 2.5 end-diastolic volumes (EDV)/sec or time to PFR greater than 80 msec. Verapamil did not change LV ejection fraction, peak ejection rate or ejection time, but did increase PFR (control 3.3 +/- 1.0 EDV/sec, verapamil 4.1 +/- 1.1 EDV/sec; p less than 0.001) and reduce time to PFR (control 187 +/- 56 msec, verapamil, 159 +/- 34 msec; p less than 0.001). Only 30% of patients had evidence of diastolic dysfunction during verapamil. In contrast, propranolol did not change LV ejection fraction, PFR or time to PFR, but did prolong ejection time and reduce peak ejection rate. Thus, LV diastolic filling is abnormal in a high percentage of patients with HCM, and verapamil normalizes or improves these abnormalities without altering systolic function. This mechanism may contribute to the clinical improvement of many HCM patients during verapamil therapy.

Adolescent↗
PubMed1992

[Non-invasive assessment of left ventricular diastolic function disorder using Doppler echocardiography].

Symptoms of a variety of cardiac diseases may well be caused predominantly by diastolic dysfunction, which appears to be one of the first detectable cardiac alterations. Diastole represents a complex interplay of multiple factors. Doppler echocardiography offers a noninvasive and relative simple method to assess left ventricular volumetric filling rates. The pulsed-wave Doppler method enables us to measure mitral flow velocities. Two distinct mitral flow velocity patterns have been recognized for situations with diastolic dysfunction. The pattern of delayed relaxation was reported in primary and in secondary left ventricular hypertrophy, myocardial ischemia and infarction and in dilated cardiomyopathy. The pattern of increased stiffness was described in constrictive pericarditis, restrictive processes and in heart transplant rejection. Doppler echocardiography has shown to be a helpful diagnostic tool, but a number of factors influencing mitral flow measurements have to be considered in each case, as there are age, heart rate, loading conditions and mitral regurgitation. Further studies are needed with respect to future control of therapeutic interventions and prognostic statements.

Diastole↗
PubMed2002

Doppler-echocardiographic indices of diastolic function in heart failure admissions with preserved left ventricular systolic function.

Many patients admitted to hospital with heart failure have preserved left ventricular (LV) systolic function. The incidence of isolated diastolic dysfunction as a cause of such admission remains unclear. We aimed to examine diastolic function in unselected admissions from the community with heart failure using the European Study Group on Diastolic Heart Failure (ESGDHF) Doppler-echocardiographic indices of diastolic dysfunction. Primary heart failure was confirmed in 210 of 309 sequential admissions with suspected heart failure. Doppler echocardiography was used to assess left ventricular ejection fraction, wall thickness and parameters of diastolic function including E:A ratio, E-wave deceleration time and isovolumic relaxation time. Of 210 patients studied (118 female), ejection fraction was <45% in 111, leaving a population of 99 with preserved systolic function. We excluded those with significant valvular disease, leaving 56 patients (mean age=77 years) with an ejection fraction >45% and no other relevant abnormality. Twenty were in atrial fibrillation. E-wave deceleration time was >280 ms in 42%. E:A was reversed in 30 of 36 patients in sinus rhythm, but only seven met the ESGDHF criterion of E:A<0.5. Isovolumic relaxation time was >105 ms in 38%. Wall thickness was increased in 75% of cases. The ESGDHF Doppler-echocardiographic criteria for diastolic heart failure were fulfilled in 43%. In clinically confirmed heart failure, 27% of patients had preserved systolic function and no significant valvular disease. Only 43% of this group had confirmed diastolic heart failure by these ESGDHF criteria. The pathophysiological basis of the syndrome in the remaining 57% remains unclear.

Aged↗
PubMed1992

Effect of cardiac dysfunction upon diastolic cerebral blood flow.

The transcranial Doppler (TCD) studies performed in 54 patients with various forms of cardiac dysfunction were reviewed and the results compared with those of normal individuals. There were 4 patients with aortic insufficiency, 5 being treated by intra-aortic balloon pumps, 12 patients with atrial fibrillation, 11 with syncope, and 22 undergoing cardiopulmonary resuscitation. In all instances, significantly low or even absent diastolic cerebral perfusion was found. The importance of this parameter, in the future evaluation and management of similar patients, is discussed.

Cardiovascular Diseases↗
PubMed2000

Plasma big-endothelin levels, cardiac autonomic neuropathy, and cardiac functions in patients with insulin-dependent diabetes mellitus.

BACKGROUND: The alteration of endothelin (ET) levels in diabetic patients with cardiac autonomic neuropathy (CAN) has not been studied extensively and its correlation with cardiac function parameters has not been discussed. HYPOTHESIS: The aim of the present study was to discuss the correlation between the degree of cardiac autonomic neuropathy, plasma big-ET levels, and cardiac functions in diabetic patients who were clinically free of cardiovascular disease. METHODS: Twenty subjects (32.1 +/- 7.8 years, 11 men, 9 women) with insulin-dependent diabetes mellitus (IDDM) were studied to evaluate the relationship between circulating big-endothelin (big-ET1) levels, CAN, and cardiac functions. The severity of CAN was scored according to Ewing's criteria. Cardiac functions were assessed using Doppler echocardiography. RESULTS: Left ventricular systolic function in the patient group was within normal limits and comparable with the values of the control group (n = 10). The mean E/A values of diabetics with CAN (1.15 +/- 0.33, p = 0.004) and without CAN (1.34 +/- 0.17) were significantly lower than those of controls (1.57 +/- 0.27). Diabetics with CAN had significantly higher big-ET1 values (81.1 +/- 94 pg/ml) compared with others (12.4 +/- 5.9 and 21.1 +/- 17.7 pg/ml, p = 0.04). Circulating big-ET1 levels showed a significant correlation with E/A values in the control group (p = 0.01, r = -0.7) and with peak A values (p = 0.003, r = 0.64) in diabetics. The CAN score correlated negatively with E/A values (p = 0.01, r = 0.54). CONCLUSIONS: High big-ET levels might have an important role in the pathogenesis or consequences of diastolic dysfunction in diabetics with CAN. Their role in cardiac autonomic neuropathy and diastolic dysfunction should be investigated further.

Adult↗
PubMed1991

Regional diastolic mechanics of ischemic and nonischemic myocardium in the pig heart.

To assess the role of segmental dyssynchrony as a determinant of ischemic diastolic dysfunction, systolic and diastolic mechanics of ischemic and nonischemic myocardium were compared in the open chest pig heart (n = 7). Pacing tachycardia (1.8 x heart rate at rest) was imposed for 3 to 5 min in the presence of a single critical stenosis of the left anterior descending artery (demand ischemia, n = 7). After 30 min of recovery, the left anterior descending artery was totally occluded for 1.5 min in the same pigs (primary ischemia, n = 6). Both demand and primary ischemia increased left ventricular end-diastolic pressure and prolonged the time constant of left ventricular pressure decline. Percent systolic shortening of ischemic segments (perfused by the left anterior descending artery) decreased by 32% during demand ischemia and by 120% during primary ischemia, but that of nonischemic segments (perfused by the left circumflex artery) did not change significantly during either type of ischemia. During demand ischemia (but not during primary ischemia), left ventricular diastolic pressure increased relative to segment length so that a higher diastolic pressure was needed to stretch the ischemic segment to the same length (decreased distensibility). In nonischemic areas, diastolic pressure and segment length increased commensurately during both types of ischemia, indicating no change in diastolic distensibility. During demand ischemia, peak early diastolic lengthening rates increased in nonischemic segments but remained unchanged in ischemic segments. Diastolic segmental dyssynchrony developed during both types of ischemia, but was more pronounced during primary ischemia. Therefore, segmental dyssynchrony is unlikely to account for the rise in diastolic pressure relative to segment length seen during demand ischemia.

Animals↗