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PubMed2004

Associations among plasma adiponectin, hypertension, left ventricular diastolic function and left ventricular mass index.

OBJECTIVE: The purpose of this study was to characterize the relationships among plasma adiponectin, essential hypertension, left ventricular diastolic function and left ventricular hypertrophy. METHODS AND RESULTS: Plasma adiponectin concentration was assessed by radioimmunoassay, and body mass index (BMI) was measured in 275 patients (138 women and 137 men). Various echocardiographic parameters such as deceleration time (DT) and isovolumetric relaxation time (IVRT) were measured by using echocardiograms. The authors calculated left ventricular mass index (LVMI) and E/A ratio. Pulse wave velocity (PWV) was calculated by dividing the distance between the left subclavian artery ostium and the tip of the femoral sheath with the time interval between two pulse waves. The plasma adiponectin concentration of the hypertensive group was significantly lower than that of the non-hypertensive group (9.9 +/- 9.8 microg/ml vs. 12.9 +/- 9.5 microg/ml, p = 0.019). PWV in the hypertensive group was 12.0 +/- 3.9 m/s compared with 9.3 +/- 2.8 m/s in the normotensive group (p < 0.001). LVMI in the hypertensive group was 135.1 +/- 35.4 g/m2 compared with 100.5 +/- 18.7 g/m2 in the normotensive group (p < 0.001). E/A ratio (0.8 +/- 0.3 vs. 1.1 +/- 0.4, p = 0.041) was lower in the hypertensive group. DT (200.0 +/- 61.2 ms vs. 177.3 +/- 40.8 ms, p = 0.048) and IVRT (106.9 +/- 25.4 vs. 91.3 +/- 27.6 ms, p = 0.243) were higher in the hypertensive group. Plasma adiponectin showed an inverse correlation with LVMI (r = -0.525; p < 0.001) and PWV (r = -0.557; p < 0.001), IVRT (r = -0.485; p = 0.008), and showed a positive correlation with E/A ratio (r = 0.359; p < 0.001). Multiple regression analyses showed that PWV and plasma adiponectin were able to explain the 73.3% of LVMI variability (r = 0.856; p < 0.001). CONCLUSION: The results suggest that a decrease in plasma adiponectin concentration is associated with the progression of left ventricular hypertrophy with diastolic dysfunction.

Adiponectin↗
PubMed1997

Impact of size mismatch and left ventricular function on performance of the St. Jude disc valve after aortic valve replacement.

BACKGROUND: The hemodynamic function of the St. Jude valve may change relative to changes in left ventricular function after aortic valve replacement for aortic stenosis. From theoretical reasons one may hypothesize that prosthetic valve hemodynamic function is related to left ventricular failure and mismatch between valve size and patient/ventricular chamber size. METHODS: Forty patients aged 24 to 82 years who survived aortic valve replacement for aortic stenosis with a standard St. Jude disc valve (mean size, 23.5 mm; range, 19 to 29 mm) were followed up prospectively with Doppler echocardiography and radionuclide left ventriculography preoperatively and 9 days, 3 months, and 18 months after the operation with assessment of intravascular hemolysis at 18 months. Follow-up to a maximum of 7.4 years (mean, 6.3 years) was 100% complete. RESULTS: Left ventricular muscle mass index decreased from 198 +/- 62 g.m-2 preoperatively to 153 +/- 53 g.m-2 at 18 months (p < 0.001), paralleled by a significant increase in left ventricular ejection fraction, peak ejection rate, and peak filling rate; only 18% of the patients had normal left ventricular muscle mass index and only 32% normal ventricular function (normal left ventricular ejection fraction, peak ejection rate, peak filling rate, early filling fraction, and late filling fraction during atrial contraction) at 18 months. Prosthetic valve peak Doppler gradient dropped from 20 +/- 6 mm Hg at 9 days to 17 +/- 5 mm Hg at 18 months (p < 0.05). Reduction of left ventricular muscle mass index was unrelated to peak gradient and size of the valve. Peak gradient at 18 months rose with valve orifice diameter of 17 mm or less (by 6 mm Hg), orifice diameter/body surface area of 9 mm.m-2 or less (by 5 mm Hg), left ventricular enddiastolic dimension (by 23 mm Hg per 10 mm increase), and impaired ventricular function (by 3 mm Hg). All but 2 patients (5%) had intravascular hemolysis; none had anemia. Two patients with moderate paravalvular leak had the highest serum lactic dehydrogenase levels; 4 patients with trivial leak had higher serum lactic dehydrogenase levels than those without leak. Serum lactic dehydrogenase levels rose with moderate paravalvular leak, impaired ventricular function, and valve orifice diameter. Six patients with trivial or moderate paravalvular leak had a cumulative 7-year freedom from bleeding and thromboembolism of 44% +/- 22% compared with 87% +/- 5% for those without leak (p < 0.05). CONCLUSIONS: The peak gradient of the St. Jude aortic valve dropped marginally over the first 18 postoperative months in association with incomplete left ventricular hypertrophy regression and marginal improvement of ventricular function. Mismatch between valve size and ventricular cavity size or patient size and impaired function of a dilated ventricle significantly compromised the performance of the St. Jude valve. Probably explained by platelet destruction or activation, paravalvular leak was related to bleeding and thromboembolic complications.

Adult↗
PubMed1978

Echocardiographic left ventricular function in mitral stenosis.

Left ventricular function was measured by echocardiography in 22 patients with pure mitral stenosis. Thirteen patients underwent closed transventricular mitral valvulotomy and nine underwent open mitral valvulotomy using cardiopulmonary bypass. Preoperative left ventricular function was normal in most patients but was depressed in older subjects (P less than 0.05) and in those undergoing a second operation on the mitral valve (P less than 0.001). The decrease in left ventricular function was probably related to the duration of mitral valve disease, with fibrosis and rigidity of the subvalvar apparatus and posterobasal left ventricular wall. There was no change in ventricular dimensions or in left ventricular function as measured by percentage shortening of the left ventricular diameter and ejection fraction 7 to 12 days after open or closed mitral valvulotomy.

Adult↗
PubMed1982

Angiocardiography with the seven-pinhole collimator: evaluation of methodology and accuracy in assessing global and regional left ventricular function.

Determination of left ventricular function with tomographic radionuclide angiocardiography using a seven-pinhole collimator was evaluated by comparing results of invasive contrast studies and planar multigated blood pool imaging to the tomographic study of 25 patients. LAO, seven-pinhole multigated blood pool acquisition was reconstructed to produce eight slices from apex to base in each of eight segments of the cardiac cycle. After applying an edge detection routine, three-dimensional reconstruction of perimeters allowed cyclic viewing of the left ventricular angiogram in any projection. When planar and tomographic radionuclide techniques were compared to contrast studies, sensitivity and specificity for identification of segmental wall motion abnormalities were not different (93% and 90% for both). Ejection fraction was determined from tomography by integration of slices to produce a noncalibrated volume and from planar blood pool imaging and contrast ventriculograms by standard techniques. Ejection fraction as compared to contrast studies was accurately determined on the planar angiogram (R = .87, P less than .001) with tomographic analysis showing similar significant correlation (R = .79, P less than .001). Methodologic evaluation indicated that the tomographic study was readily positioned and acquired and provided the advantage of requiring little operator interaction. It suffers, however, from the disadvantage of long reconstruction times with current software and occasional difficulties in defining the superior extent of the left ventricle.

Evaluation Studies as Topic↗
PubMed1998

[Coronary artery bypass grafting in cases with poor left ventricular function].

From January 1987 through June 1992, 18 patients with poor left ventricular function (left ventricular ejection fraction [LVEF] less than 0.3) underwent elective isolated primary coronary artery bypass surgery. The mean age was 56.4 years (range, 46 to 72 years), and 15 were males and 3 were females. Mean pre-operative LVEF measured by ventriculography was 0.26 +/- 0.03 (range, 0.19 to 0.30). Sixteen patients (88.9%) had a prior myocardial infarction and 9 (50%) had a history of congestive heart failure. Complete revascularization was the goal for all patients, and the mean number of bypass grafts was 3.0 +/- 0.8 per patient. The left anterior descending coronary artery (LAD) was revascularized in all patients. There were no operative deaths. Post-operative LVEF improved significantly from 0.26 +/- 0.03 to 0.42 +/- 0.11 (p = 0.0002), and the regional left ventricular wall motion improved in the diaphragmatic and posterobasal regions (p < 0.01). The patency of the grafts was 93.9% in all, and 100% for LAD. The mean follow-up period was 77 months, and the overall actuarial survival rate was 88.9% at 10 years. During follow-up periods, two patients died of congestive heart failure (CHF), and two required three rehospitalizations because of CHF. The overall cardiac event free rate was 75.8% at 10 years. In patients with poor left ventricular function, surgical revascularization can be performed safely, but congestive heart failure sometimes occurs during follow-up periods and may be the cause of death. Therefore alternate forms of therapy such as cardiac transplantation and/or TMLR should be considered in selected patients.

Aged↗
PubMed1982

Clinical evaluation of left ventricular function in acute myocardial infarction--analysis of factors affecting left ventricular function.

The clinical significance of the possible factors which may affect the cardiac function and prognosis of the patients with acute myocardial infarction were evaluated in 112 patients with this disease. Patients were subdivided into 4 groups according to the levels of pulmonary capillary wedge pressure (PCWP) and left ventricular stroke work index (SWI): Group I (52 patients) PCWP less than 18 mmHg, SWI less than or equal to 30 g.m/m2; Group II (18 patients) PCWP greater than or equal to 18 mmHg, SWI greater than or equal to 30 g.m/m2; Group III (15 patients) PCWP less than 18 mmHg, SWI less than 30 g.m/m2; Group IV (27 patients) PCWP greater than or equal to 18 mmHg, SWI less than 30 g.m/m2. Immediate mortality rate (4 weeks after the onset of myocardial infarction) was 17.0% in all patients and Group IV had the highest mortality rate (48.1%), in contrast to the lowest mortality rate (3.8%) in Group I. The episodes of previous myocardial infarction were noted more frequently in Group IV (74.1%) than in Groups I (7.7%) and II (11.1%) (p less than 0.001). Mean age in Group IV (68.0 +/- 5.2 (SE) years) was also significantly higher than those of the remaining 3 groups (p less than 0.001). In 55 patients without previous myocardial infarction, mean infarct size estimated from total released creatine phosphokinase (CPK) (sigma CPK) in Group IV was largest among the 4 groups, although it was similar to that in Group II: 919.0 +/- 70.0 (SE) IU/ml in Group I, 1470.0 +/- 126.0 in Group II, 958.0 +/- 107.0 in Group III and 1493.0 +/- 145.0 in Group IV. The number of involved coronary arteries differed significantly between Groups I and IV: in Group I involved coronary artery (75% narrowing) was absent or one at most, while in Group IV all 9 patients had at least one coronary lesion and 3 of 9 had triple vessel disease. In this study no significant difference was observed between the incidence of anterior and inferior myocardial infarctions in Groups I, III and IV. Thus, we conclude that age, previous myocardial infarction, infarct size and the number of involved coronary arteries may determine the cardiac function in acute phase of myocardial infarction and hence, immediate mortality of this disease.

Adult↗
PubMed2005

Assessment of right and left ventricular function by tissue Doppler echocardiography in patients after biventricular repair of pulmonary atresia with intact ventricular septum.

BACKGROUND: Survival of patients with PAIVS has improved significantly with adoption of a selective management approach based on RV and coronary arterial anatomy. We sought to determine the right (RV) and left ventricular (LV) function of patients with pulmonary atresia and intact ventricular septum (PAIVS) long-term after biventricular repair. METHODS: The regional ventricular function of 22 patients (11 males) aged 12.8+/-5.6 years with PAIVS after biventricular repair was assessed by tissue Doppler echocardiography (TDE). The results were compared to those of 22 age-matched controls. RESULTS: When compared with controls, patients had significantly reduced myocardial tissue velocities, systolic and diastolic strain rate, and peak systolic strain in the basal, mid-, and apical segments of the RV free wall, interventricular septum and LV lateral wall (all with p<0.01). Heterogeneity of systolic and diastolic strain rate was observed in the RV free wall and interventricular septum in patients but not in controls. CONCLUSION: Impairment of RV and LV regional longitudinal myocardial function occurs in patients with PAIVS late after biventricular repair.

Adolescent↗
PubMed2000

Effects of amlodipine on exercise tolerance, quality of life, and left ventricular function in patients with heart failure from left ventricular systolic dysfunction.

BACKGROUND: A preliminary study suggested that the long-acting late-generation calcium-channel blocker amlodipine has favorable effects on exercise tolerance and is safe to use in heart failure, in contrast to earlier generation agents. The goal of 2 multicenter studies was to assess the effect of adjunctive therapy with amlodipine in addition to standard therapy on exercise capacity, quality of life, left ventricular function, and safety parameters in patients with heart failure and left ventricular systolic dysfunction. METHODS: Two large multicenter trials examining the effects of amlodipine on these parameters over a 12-week period of therapy were undertaken in patients with mild to moderate heart failure and left ventricular systolic dysfunction. A total of 437 patients with stable heart failure were studied in a randomized, double-blind, placebo-controlled prospective design. RESULTS: Amlodipine at a dose of 10 mg/day in addition to standard therapy in such patients was associated with no significant difference in change in exercise tolerance on a Naughton protocol compared with placebo in each trial. Among all patients taking amlodipine, exercise time increased 53 +/- 9 (SE) seconds; exercise time for those taking placebo increased 66 +/- 9 seconds (P = not significant). There were no significant differences in changes of quality of life parameters between amlodipine- and placebo-treated patients, and there were no significant differences in symptom scores or New York Heart Association classification between groups. Left ventricular function (measured as ejection fraction) improved 3. 4% +/- 0.5% in amlodipine-treated patients and 1.5% +/- 0.5% in placebo-treated patients (P =.007). There was no statistically significant excess of important adverse events (episodes of worsening heart failure in 10% amlodipine-treated vs 6.3% of placebo-treated patients) or differences in need for changes in background medication between groups. CONCLUSIONS: The addition of 10 mg of amlodipine per day to standard therapy in patients with heart failure is associated with no significant improvement in exercise time compared with placebo therapy over a 12-week period, and there was no increased incidence of adverse events. These data suggest that the addition of amlodipine to standard therapy in heart failure will not result in additional efficacy per se beyond standard therapy.

Aged↗
PubMed2005

Left ventricular functional recovery with percutaneous, transvascular direct myocardial delivery of bone marrow-derived cells.

BACKGROUND: The potential for cellular cardiomyoplasty to provide functional left ventricular recovery in the chronically injured heart remains unclear. METHODS: Yorkshire swine (n = 10; 35-50 kg) had anterolateral myocardial infarction (MI) induced by coil embolization of the left anterior descending artery. Approximately 5 weeks post-MI, a composite, intravascular ultrasound-guided catheter system (TransAccess) was used to deliver an autologous, labeled, bone marrow-derived cell sub-population (approximately 3 x 10(8) cells) or saline control (approximately 50 injections/arm) through coronary veins directly into infarct and peri-infarct myocardium. Two months post-transplant, the animals had blinded endocardial and epicardial left ventricular electrical scar mapping and biventricular electrical stimulation. Coronary angiography and quantitative biplane ventriculography were performed at baseline, transplant, and sacrifice time-points. RESULTS: Robust, viable, predominantly desmin-negative cell grafts were demonstrated post-mortem in all treatment animals. Baseline and pre-transplant global and regional wall motion was similar between groups. The cell treatment group demonstrated functional recovery with a left ventricular ejection fraction of 38.1% at the time of transplant increasing to 48.5% (p = 0.005) at sacrifice, whereas the control arm was unchanged (38.0% vs 34.3%, respectively; p = NS). The regional improvement corresponded with a reduction in percentage of hypokinetic (52.1%-42.9%, p = 0.002) and percentage of akinetic (24.8%-17.7%, p = 0.04) segments in the cell-treated animals. Epicardial scar area was not different (37 cm2 vs 23 cm2, p = 0.37) between groups. CONCLUSIONS: Percutaneous, transvascular, direct intramyocardial bone marrow cell transplantation is safe and feasible in chronically infarcted tissue. In this pilot study, cell therapy improved overall left ventricular systolic function by recruiting previously hypokinetic or akinetic myocardial tissue.

Animals↗
PubMedDate not supplied

Estimation of left ventricular function in patients with a left ventricular assist device.

Patients with profound left ventricular (LV) dysfunction supported by a left ventricular assist device (LVAD) may have recovery of LV function, but current methods for assessing this are difficult or not readily available. A new method to estimate LV performance was tested in 6 patients on LVAD (age, 47 +/- 12 years). Simultaneous measures of LV cross-sectional area (substitute for volume) using transesophageal echocardiographic automated border detection and femoral arterial pressure (substitute for LV ejection pressure) were recorded during brief periods on and off LVAD. During the LVAD off period, femoral arterial pressure and LV area signals were combined on-line to generate arterial pressure-LV area loops. The slope of the linear regression line connecting the end systolic points generated during LV filling after LVAD off was used as an estimate of end systolic elastance denoted by Ees. The average Ees was 3.8 +/- 3.1 mmHg/cm2. These values are significantly lower than those of 13 control patients (22.3 +/- 15.4 mmHg/cm2). This method of estimating Ees may be clinically useful in assessing LV recovery in patients on LVAD after extended support.

Adult↗
PubMed1996

Prediction of outcome after revascularization in patients with poor left ventricular function.

BACKGROUND: In patients with poor left ventricular function, the determinants of outcome after revascularization are unknown. METHODS: We studied prospectively 57 patients with stable coronary artery disease and poor left ventricular function (left ventricular ejection fraction, 0.28 +/- 0.04) who underwent coronary artery bypass grafting. Clinical variables were assessed as predictors of outcome in all patients, and preoperative stress thallium-201 scintigraphic data were analysed in 37 patients. RESULTS: The operative mortality was 1.7%. At 12 months after operation, 46 of the 49 survivors were angina-free and 35 had fewer heart failure symptoms, but postoperative left ventricular ejection fraction (0.30 +/- 0.09) did not change significantly. Eighteen survivors had left ventricular ejection fraction improved by 0.05 or more (0.30 +/- 0.03 preoperatively, 0.40 +/- 0.05 postoperatively; p = 0.0001). The adjusted odds ratio of large reversible thallium-201 defects in predicting such outcome was 15 (95% confidence interval, 1.6 to 140), whereas other clinical variables had no predictive value. The transplantation-free 5-year survival was 73%. CONCLUSIONS: In patients with poor left ventricular function, surgical revascularization can be performed safely, with good symptomatic relief and long-term survival. One-year survival and improvement in left ventricular function is better in patients with large reversible defects on preoperative stress thallium-201 scintigraphy.

Aged↗
PubMed1991

Radionuclide angiographic evaluation of left ventricular diastolic function.

Left ventricular diastolic function is altered in the majority of patients with cardiac diseases, especially those characterized by myocardial ischemia or hypertrophy. In many circumstances, such abnormalities related to impaired relaxation or reduced distensibility may precede evidence of left ventricular systolic dysfunction. Radionuclide angiography may be adapted to study the rapid filling phase of diastole, the duration of the isovolumic relaxation phase, the relative contributions of rapid filling and atrial systole to left ventricular stroke volume, and the relation between regional nonuniformity of left ventricular function and global filling properties. Technical aspects of data acquisition that must be considered for such studies include the effects of cardiac cycle length fluctuations, temporal resolution, temporal smoothing, and normalization parameters. As noninvasive radionuclide methods (and any other analyses using purely noninvasive techniques) do not permit assessment of the left atrial-left ventricular pressure gradient or the simultaneous evaluation of changes in left ventricular pressure and volume during relaxation and filling, complete clinical interpretation of "abnormal" left ventricular filling indexes, or changes in these indexes after interventions, is not possible. Despite the inherent limitations of noninvasive assessment of left ventricular diastolic function, radionuclide evaluation of left ventricular filling may provide clinically useful insights, especially in patients with congestive heart failure symptoms and normal left ventricular systolic function.

Aging↗
PubMed2007

Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study.

OBJECTIVE: To investigate whether weight loss after bariatric surgery (gastric bypass) is associated with changes in aortic function (an important determinant of left ventricular function) and in left ventricular function, in morbidly obese individuals 3 and 36 months after surgery. METHODS: We used echocardiography to evaluate 60 obese individuals [body mass index (BMI) > 40 kg/m2] who underwent surgery and 20 obese individuals who neither underwent surgery nor lost weight, at baseline and at 3 and 36 months of follow-up, and 40 lean individuals (BMI < 25 kg/m2) of similar age, sex and risk factors, at baseline. We measured aortic strain, distensibility, stiffness index, pressure-strain modulus and Doppler indices of left ventricular diastolic dysfunction (ratio of peak early to peak atrial flow velocities, isovolumic relaxation time and deceleration time). RESULTS: Baseline aortic function and Doppler diastolic indices were impaired in obese individuals compared with those who were lean (P < 0.05). During 3 and 36 months of follow-up, BMI and left ventricular diastolic diameter, volume, mass and wall thickness were reduced, and indices of aortic function and left ventricular diastolic function were normalized, in obese individuals after surgery [aortic distensibility (cm2 x dyn(-1) x 10(-6)): 1.9 before surgery, 3.4 at 3 months after surgery and 4.3 at 3 years after surgery, compared with 3.36 in lean controls; P < 0.01], but not in those who did not lose weight. The reduction in BMI after surgery was related to the concomitant improvement in indices of aortic function (P < 0.01) and isovolumic relaxation time (P < 0.05) after adjustment for age, sex and concomitant reduction in blood pressure, lipids and glucose concentrations. CONCLUSION: Weight reduction after bariatric surgery normalizes aortic function, reduces left ventricular hypertrophy and, thus, improves left ventricular diastolic function in morbidly obese individuals over a 3-year period of follow-up.

Adult↗
PubMed2000

Prediction of improvement in global left ventricular function in patients with chronic coronary artery disease and impaired left ventricular function: rest thallium-201 SPET versus low-dose dobutamine echocardiography.

Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60 +/- 8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31% +/- 7%) were studied. Rest 201Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on 201Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at > or = 5%. In identifying viable segments, rest 201Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P<0.05), while specificity was not significantly different (86% vs 88%). In 17 patients, global ejection fraction increased > or = 5% (group 1) while in 14 it did not (group 2). A higher number of a/dyskinetic segments were viable on 201Tl SPET in group 1 than in group 2 (2.6 +/- 1.9 vs 0.6 +/- 1.2, P < 0.005), while no significant differences were observed on low-dose dobutamine echocardiography (1.7 +/- 1.6 vs 1.1 +/- 1.6). A significant correlation was found between the number of a/dyskinetic segments viable on 201Tl SPET and post-revascularization changes in ejection fraction (r = 0.52, P < 0.05), but such a correlation was not observed for low-dose dobutamine echocardiography. Using as the cut-off the presence of at least one viable a/dyskinetic segment, rest 201Tl SPET had a higher sensitivity (82% vs 53%, P = 0.07) and showed a trend towards higher accuracy and specificity (77% vs 58%, and 71% vs 64%, respectively) as compared with low-dose dobutamine echocardiography. In conclusion, these findings suggest that when severely reduced global function is present, rest 201Tl SPET evaluation of viability is more accurate than low-dose dobutamine echocardiography for the identification of patients who will benefit most from revascularization.

Adrenergic beta-Agonists↗
PubMed2002

Tissue Doppler imaging assessment of long axis left ventricular function in hypertensive patients with concentric left ventricular hypertrophy: differential diagnosis with hypertrophic cardiomyopathy.

BACKGROUND: The differential diagnosis between hypertrophic cardiomyopathy and hypertensive heart disease has clinical, therapeutic and prognostic implications, but is not always easy with conventional echocardiography. Tissue Doppler imaging of the mitral annulus allows the detailed study of long axis left ventricular function in hypertrophic cardiomyopathy and may be useful in the differential diagnosis. METHODS: 23 patients with non-obstructive hypertrophic cardiomyopathy and 25 hypertensive patients with concentric left ventricular hypertrophy with similar age, body surface and heart rate were studied with pulsed tissue Doppler imaging of the 4 sides of the mitral annulus (septal, lateral, inferior, anterior) in 4 and 2 chamber views. In each wave (systolic-s, rapid filling-e, atrial contraction-a) we analyzed velocities, time intervals and velocity-time integrals, as well as heterogeneity and asynchrony. Data were compared among the different sides in each group, between groups and with conventional Doppler data. RESULTS: In contrast to hypertensive patients, hypertrophic cardiomyopathy patients showed: 1--Systolic function: lower "s" wave velocities and integrals, higher systolic heterogeneity, longer isovolumic relaxation time and higher PEP/LVET (pre ejection period/left ventricular ejection time). 2--Diastolic function: lower "e" and "a" wave, higher "a" and "e/a" heterogeneity index, higher percentage of annular sides with e/a > or = l, longer isovolumic relaxation time and time to peak e, and higher diastolic asynchrony. Some of these abnormalities occurred in annular sides adjacent to non-hypertrophied walls. CONCLUSIONS: This study shows that: 1--Long axis systolic and diastolic left ventricular function are significantly different between hypertrophic cardiomyopathy patients and hypertensive patients with concentric left ventricular hypertrophy. 2--These functional differences occur in the velocity domain (with heterogeneity), in the time domain (with asynchrony) and also in velocity time integrals. 3--Long axis systolic and diastolic dysfunction occur in annular sides contiguous to hypertrophied and non-hypertrophied walls, enhancing the role of tissue Doppler imaging in the differential diagnosis between these diseases.

Aged↗
PubMed1992

Right and left ventricular functional impairment and sleep apnea.

Obstructive sleep apnea may contribute to the development of pulmonary hypertension and RVF primarily through pulmonary vasoconstriction secondary to hypoxia. Several recent studies indicate, however, that intermittent apnea-related hypoxia is not sufficient to cause sustained pulmonary hypertension. These studies have been consistent in showing that pulmonary hypertension and RVF are almost invariably seen in the presence of diurnal hypoxia. Sustained pulmonary hypertension, therefore, appears to be associated with sustained hypoxia as is the case in COPD. Patients with OSA who have hypoxia while awake are, as a rule, obese and have mild-to-moderate diffuse obstructive airways disease. Thus, most cases of pulmonary hypertension in association with OSA result from a combination of OSA, obesity, and diffuse obstructive airways disease, a so-called overlap syndrome. However, from the therapeutic viewpoint, it is apparent that treatment of OSA by NCPAP or tracheostomy, in such cases, is usually sufficient to reverse pulmonary hypertension and RVF. More recent work has provided strong evidence that OSA can play a role in the pathogenesis of LV heart failure in patients with CHF of otherwise unknown etiology. It is likely that this occurs through a combination of increased LV afterload related to exaggerated negative Pit swings during obstructive apneas, to intermittent hypoxia, and to chronically elevated sympathoadrenal activity. Reversal of OSA by NCPAP in these patients may relieve LV heart failure. These findings add a new dimension to our understanding of the pathophysiologic effects of OSA on the cardiovascular system by demonstrating that the LV is a structure that may suffer functional impairment secondary to the stresses imposed by OSA. Finally, it has now become apparent that CSR in patients with CHF can cause symptoms of a sleep apnea syndrome when associated with intermittent hypoxia and arousals from sleep. Reversal of CSR during sleep by NCPAP can lead to alleviation of these symptoms and possibly to reduced cardiac dyspnea and LV systolic function as well. Taken together, this suggests that much more extensive use of polysomnography may be warranted in the investigation of cardiovascular disease. The reasons are compelling: sleep apnea disorders are common and eminently treatable conditions whose reversal can result in improved right and left heart function and symptomatic improvement in patients with impaired myocardial function.

Cheyne-Stokes Respiration↗
PubMed2005

Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging.

To evaluate the effects of substantial weight loss on tissue Doppler imaging parameters of right ventricular (RV) and left ventricular (LV) systolic and diastolic function, we performed standard echocardiography and tissue Doppler imaging in 17 patients with severe obesity before and after gastric bypass. Patients lost 39 +/- 10 kg over 7.6 +/- 3.6 months. Adjusted LV mass decreased (134 +/- 41 to 119 +/- 31 kg/m, p = 0.031). After weight loss, the ratios of early-to-late diastolic mitral and tricuspid inflow velocities increased (1.3 +/- 0.2 to 1.6 +/- 0.5, p = 0.02; 1.0 +/- 0.1 to 1.6 +/- 0.3, p = 0.003). Early diastolic tissue Doppler velocities increased at both the lateral and septal mitral annulus (7.6 +/- 1.5 to 9.3 +/- 2.5 cm/s, p = 0.009; and 6.6 +/- 1.4 to 7.7 +/- 1.7 cm/s; p = 0.028, respectively) and for their 2-site average (7.2 +/- 1.0 to 8.5 +/- 1.7 cm/s, p = 0.007). Early diastolic tricuspid annular velocity increased (7.2 +/- 2.8 to 10.6 +/- 2.3 cm/s, p <0.001) as did the ratio of early-to-late tricuspid annular diastolic velocity (0.9 +/- 0.4 to 1.1 +/- 0.2, p = 0.038). Tricuspid annular systolic velocity increased (8.6 +/- 2.5 to 10.3 +/- 2.7 cm/s, p = 0.037). In patients with severe obesity, significant weight loss results in an increase in tricuspid annular systolic and early diastolic velocities and mitral annular early diastolic velocities.

Adult↗