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PubMed1999

Intraventricular dispersion of E wave velocity: an alternative measure of left ventricular diastolic function in hypertensive patients?

The E/A ratio (of peak mitral blood flow velocity during early diastole to that during atrial contraction) has limitations in the assessment of diastolic function. Previous studies have suggested that peak blood flow velocity is normally maintained or increased towards the cardiac apex but that it decreases in diastolic dysfunction. We evaluated the proposal that intraventricular dispersion of E wave velocity is an effective means of assessing diastolic function in hypertensives. Fifty-five untreated hypertensive patients underwent echocardiographic examination. Pulsed-wave Doppler recordings were made from the apical four-chamber view. Peak flow velocities were measured during early diastole at the level of the mitral valve (E0), and 3 cm distally (E3), and during atrial contraction at the level of the mitral valve (A). Mean peak flow velocities were 64.4 +/- 16.1 m/s for E0, 50.6 +/- 17.9 m/s for E3 and 61.1 +/- 12.1 m/s for A. Peak flow velocity during early diastole slowed towards the cardiac apex in most patients (E3/E0 range: 0.42-1.86, mean 0.81 +/- 0.29). There was no significant difference in E3/E0 between those with and without left ventricular hypertrophy (LVH) (0.76 +/- 0.25 vs 0.82 +/- 0.29, P = 0. 39). E3/E0 did not correlate with age (r = -0.02, P = 0.89), systolic blood pressure (BP) (r = 0.17, P = 0.20), diastolic BP (r = 0.21, P = 0.12) or LVMI (r = -0.11, P = 0.40). In contrast the E/A ratio correlated strongly with age (r = -0.66, P < 0.0001) and negatively, though not significantly, with systolic BP (r = -0.24, P = 0.07), diastolic BP (r = -0.23, P = 0.09) and LVMI (r = -0.23, P = 0.08). Although there is some intraventricular dispersion of E wave velocity in this group of hypertensive patients, the ratio of E3/E0 correlates poorly with parameters which are known to influence diastolic function. In spite of its limitations, the E/A ratio appears to be a more reliable measure of diastolic function in hypertensive heart disease than intraventricular dispersion of early diastolic filling.

Adult↗
PubMed2001

[Can pathological left ventricular hypertrophy in arterial hypertension be distinguished from physiological hypertrophy caused by sports?].

BACKGROUND AND OBJECTIVE: Patients with hypertensive heart disease and left ventricular hypertrophy demonstrate impaired left ventricular diastolic filling. Aim of this study was to find out if physiological left ventricular hypertrophy induced by endurance training causes abnormal left ventricular systolic and diastolic filling. METHODS: We examined 42 athletes with left ventricular hypertrophy due to endurance training (aged 25 +/- 7 years), 31 patients with left ventricular hypertrophy due to hypertensive heart disease (aged 28 +/- 6 years) and 20 untrained, healthy subjects (controls, aged 26 +/- 8 years) by conventional echocardiography and calculated left ventricular muscle mass and fractional shortening. In addition the following Doppler-echocardiographic parameters were measured: maximal early and late velocity of diastolic filling, ratio of maximal early and late velocity of diastolic filling, acceleration and deceleration time and isovolumetric relaxation time. RESULTS: All three study groups showed normal fractional shortening. Conventional echocardiography revealed a higher left ventricular muscle mass in the two study groups as compared to the controls (controls: 119 +/- 12 g, athletes: 225 +/- 18 g*; hypertensive patients: 216 +/- 16 g*; * p < 0.01 versus controls). In the athletes with physiological left ventricular hypertrophy a normal left ventricular diastolic filling pattern was documented (VE: 0.64 +/- 0.1 m/s; VA: 0.51 +/- 0.2 m/s). In hypertensive heart disease a diastolic dysfunction in terms of a delayed relaxation pattern with a decrease of maximal early velocity of diastolic filling (VE: 0.45 +/- 0.09 m/s) and a compensatory increase of the maximal late velocity of diastolic filling (VA: 0.54 +/- 0.1 m/s) was demonstrated. CONCLUSION: In pathological left ventricular hypertrophy due to hypertensive heart disease a pathological diastolic filling pattern was documented. In athletes with physiological left ventricular hypertrophy a normal left ventricular diastolic filling pattern was revealed. Thus Doppler-echocardiographic parameters of left ventricular diastolic function can be of diagnostic importance for discriminating between pathological and physiological left ventricular hypertrophy.

Adolescent↗
PubMed2001

Echocardiographic evaluation of left and right ventricular diastolic function in patients with chronic obstructive pulmonary disease.

The aim of this study was to investigate the effects of chronic obstructive pulmonary disease (COPD) on left ventricular and right ventricular diastolic and systolic functions. Forty-eight patients with severe COPD were studied. Patients were divided into 2 subgroups according to pulmonary artery pressures: 25 patients with pulmonary hypertension (group 1) and 23 patients with normal pulmonary artery pressure (group 2). As a control group, 59 normal subjects were studied (group 3). Patients in group 1 had higher tricuspid peak A velocity, lower tricuspid E velocity, longer isovolumetric relaxation time, higher mitral A wave, lower mitral E wave, and slower color propagation velocity than groups 2 and 3. There was no significant difference between left ventricular diastolic filling parameters between groups 2 and 3. Patients with COPD and pulmonary hypertension have left and right ventricular diastolic dysfunction. However, patients with COPD and normal pulmonary artery pressure have normal left and right ventricular diastolic function.

Coronary Circulation↗
PubMedDate not supplied

[Effects of underwater massage douche on left ventricular diastolic function in patients with chronic cardiac failure and postinfarction cardiosclerosis].

78 patients with postmyocardial infarction cardiosclerosis and moderate chronic cardiac failure (NYHA functional class 0-2) were given standard medication (enalapril, aspirin, atenolol) and took underwater massage douche. The effects of the latter on diastolic dysfunction of the left ventricular myocardium were studied. The above hydrotherapy changed parameters of left ventricular diastolic filling in 64% of the examinees: in 40% these parameters improved, in 23%--deteriorated. Clinical and device criteria essential for hydrotherapy outcomes are described.

Adult↗
PubMed1991

[Digitalis therapy in patients with heart failure and sinus rhythm].

The role of digitalis therapy in patients with sinus rhythm and mild to moderate heart failure has been a subject of controversy. This review critically examines the relevant literature and specifically evaluates trials in this patient population. The pharmacokinetics and the pharmacodynamics of the most commonly prescribed agents are briefly discussed. The available evidence supports the use of this agent in patients with sinus rhythm and clinical signs of systolic dysfunction. Digitalis is not recommended as a routine when the primary cause of heart failure is diastolic dysfunction. The use of digitalis therapy in combination with diuretics and vasodilator therapy deserves further attention.

Arrhythmia, Sinus↗
PubMed1992

[Diastolic function of the right ventricle in patients with lung diseases as evidenced by Doppler echocardiography].

The study was undertaken to examine the most informative Doppler echocardiographic parameters to determine right ventricular diastolic function in 46 pulmonological patients with pulmonary hypertension and right ventricular failure and 11 healthy individuals. The patients exhibited the highest blood velocity in the rapid filling phase, as compared to the healthy persons. They also demonstrated increased maximum blood velocities in the rapid filling phase on atrial systole and prolonged late blood flow in the rapid filling phase. Thus, Doppler echocardiography may be useful in the non-invasive diagnosis of right ventricular diastolic dysfunctions.

Adult↗
PubMed2002

Real-time three-dimensional echocardiography for improved evaluation of diastolic function using volume-time curves.

BACKGROUND: Accurate assessment of left ventricular function is of the greatest importance in clinical cardiology for decision making. Diastolic dysfunction is getting more concern as a cause of heart failure while, currently used non-invasive modalities for diagnosing diastolic abnormalities have significant limitations. Dynamic left ventricular volume change was applied for the evaluation of diastolic function by various techniques that have been demonstrated to be of diagnostic value. However, it has not been accepted into clinical practice because existing techniques are either invasive, inaccurate, expensive or time consuming. REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY: Real-time three-dimensional (3-D) echocardiography is a new ultrasound technique that provides transthoracic volumetric images of the heart in real time. Thereby, the acquired images are ideally suited for the assessment of dynamic left ventricular volume change. Generation and analysis of left ventricular volume-time curves by real-time 3-D echocardiography has been demonstrated to be feasible in normal subjects and patients and accuracy of volume-time curves was good compared to magnetic resonance imaging. We compare the new real-time 3-D echo approach with the advantages and limitations of existing noninvasive and invasive techniques.

Cardiac Volume↗
PubMed2004

A practical approach to the echocardiographic evaluation of diastolic function.

A number of recent community-based epidemiologic studies suggest that 40% to 50% of the cases of heart failure have preserved left ventricular systolic function. Although diastolic heart failure is often not well clinically recognized, it is associated with marked increases in morbidity and all-cause mortality. Doppler echocardiography has emerged as the principal clinical tool for the assessment of left ventricular diastolic function. Doppler mitral inflow velocity-derived variables remain the cornerstone of the evaluation of diastolic function. Pulmonary venous Doppler flow indices and mitral inflow measurements with Valsalva's maneuver are important adjuncts for differentiating normal and pseudonormal mitral inflow patterns. Unfortunately, these Doppler flow variables are significantly influenced by loading conditions and, therefore, the results from these standard techniques can be inconclusive. Recently, color M-mode and Doppler tissue imaging have emerged as new modalities that are less affected by preload and, thus, provide a strong complementary role in the assessment of diastolic function. This review will discuss the diastolic properties of the left ventricle, Doppler echocardiographic evaluation, and grading of diastolic dysfunction.

Diastole↗
PubMed1995

Relation between diastolic left ventricular function and myocardial blood volume during adenosine-induced coronary hyperemia.

Adenosine infusion is accompanied by increases in coronary blood flow and myocardial blood volume. Myocardial blood volume may produce changes in diastolic left ventricular (LV) performance by increasing myocardial turgor. Diastolic dysfunction may also be the result of myocardial ischemia. The relation between changes in LV mass and diastolic function has not been previously investigated. This study examined the relation between changes in LV mass during adenosine-induced coronary hyperemia and LV diastolic function. Serial two-dimensional and Doppler echocardiographic measurements were made before, during, and after adenosine infusion (140 micrograms/min for 6 min) in 21 patients with (group 1) and 10 patients without (group 2) coronary artery disease (CAD). The LV mass and transmitral diastolic filling indexes were determined from digitized images from apical four-chamber view. Adenosine infusion produced a greater increase in LV mass in group 2 than in group 1 (29% +/- 11% vs 9% +/- 6%, p < 0.0002). The ratio of transmitral early (E) to atrial (A) filling velocity (E/A) increased 10% +/- 16% in group 2 and decreased 8% +/- 20% in group 1 (p < 0.02), and the velocity time integral of early filling increased 11% +/- 52% in group 2 and decreased 20% +/- 31% in group 1 (p < 0.04). There was a correlation between the change in E/A ratio and the LV mass (r = 0.53, p < 0.003). Thus adenosine infusion caused a greater increase in LV mass in normal subjects than in patients with CAD. There were also changes in Doppler-derived indexes of diastolic LV function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1991

Calcium antagonists and left ventricular function.

Calcium antagonists impede the entry of calcium into myocytes and inhibit myocardial contraction. Calcium antagonists differ in their relative negative inotropic potency and can provoke baroreceptor stimulation that modulates left ventricular (LV) performance. Calcium antagonists are uniformly well tolerated in patients with normal LV function. Use of these agents in patients with suspected LV function impairment has yielded results ranging from hemodynamic improvement to clinical deterioration and increased mortality. Reports of clinical deterioration when calcium antagonists were combined with beta blockers underscore the importance of reflex adrenergic support for the myocardium. Although calcium antagonists are potent vasodilators and produce short-term hemodynamic improvement, they are not useful as primary treatment in patients with congestive heart failure (CHF). They may have a place in the treatment of coexistent problems in patients with LV dysfunction. Short-term use of calcium antagonists for myocardial ischemia or rapid atrial fibrillation is probably safe in the presence of LV dysfunction and overt CHF. Calcium antagonists appear to have a role in the treatment of patients with diastolic dysfunction of diverse etiologies.

Animals↗
PubMed1995

Patterns of medication use in patients with heart failure: a report from the Registry of Studies of Left Ventricular Dysfunction (SOLVD).

To determine patterns of medication use based on clinical variables in patients with heart failure, we analyzed data from 5,999 patients participating in the Registry of Studies of Left Ventricular Dysfunction (SOLVD). The Registry comprised a broad spectrum of patients with heart failure, including some with predominantly diastolic dysfunction. Drug use was determined in a population cross-sectional manner at the time of identification (74% hospitalized). The median number of drugs per patient was four, with diuretics taken by 62%, digitalis by 45%, angiotensin-converting enzyme inhibitors (ACE-I) by 32%, calcium channel blockers by 36%, antiarrhythmics by 22%, and beta-blockers by 18%. Only 18% were on the combination of ACE-I, diuretic, and digitalis. Stratification for diagnosis, heart failure symptoms, and ejection fractions demonstrated that triple-drug therapy (digitalis, diuretic, and ACE-I) was common only in those with ejection fractions less than .20 and several signs or symptoms of heart failure. Older patients were taking diuretics frequently (73% of patients older than 70 years of age), and our European center used fewer drugs overall, while prescribing digitalis about half as frequently as North American clinics. These data serve as the baseline for analysis of evolving therapeutic practice in patients with heart failure.

Aged↗
PubMed1994

Assessment of left ventricular filling dynamics utilizing Doppler echocardiography in acute coronary syndrome.

To evaluate prolonged diastolic dysfunction in acute coronary syndrome, mitral inflow velocities and left ventricular wall motion were examined with pulsed-wave Doppler and two-dimensional echocardiography in 14 patients with successful reperfusion, 8 patients without reperfusion after acute myocardial infarction, and in 10 patients with prolonged angina. Early peak flow velocity and the ratio of early to atrial peak flow velocity increased gradually both after the onset of acute myocardial infarction with reperfusion and cessation of angina pectoris. However, in acute myocardial infarction without reperfusion, early peak flow velocity and the ratio of early to atrial peak flow velocity decreased significantly. Atrial peak flow velocity remained unchanged in acute myocardial infarction with reperfusion, while it was decreased in angina pectoris on the seventh day. Regional systolic dysfunction abated gradually in acute myocardial infarction with successful reperfusion, and regional systolic dysfunction was not detected in angina pectoris on the third day. Thus, abnormalities in left ventricular early diastolic filling persisted for several days after reperfusion in acute myocardial infarction or cessation of angina. Left ventricular late filling remained unchanged in acute myocardial infarction, whereas, in angina pectoris, a compensatory increase in late filling diminished gradually with an increase in early filling. These results indicate that there are different types of recovery process after diastolic filling abnormalities in patients with acute coronary syndrome.

Angina Pectoris↗
PubMed2003

[Diastolic heart failure].

Diastolic heart failure is predominantly a disease of the elderly: at the age of 70 years, almost half of all patients with heart failure have diastolic heart failure. Hypertension and obesity are common underlying disorders in patients with diastolic heart failure. Patients with diastolic heart failure have an equal, or only slightly better, prognosis in terms of mortality compared to patients with systolic heart failure. Echocardiography can distinguish diastolic heart failure from systolic heart failure. Patients with heart failure and a normal ejection fraction almost certainly have a diastolic dysfunction. There is a lack of reliable data about the optimal medicinal treatment strategy for patients with diastolic heart failure. Angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and (non-dihydropyridine) calcium antagonists have therapeutic potential. Digoxin may be contraindicated.

Adrenergic beta-Antagonists↗
PubMed1991

Cardiac abnormalities in patients with systemic lupus erythematosus.

OBJECTIVE: To determine the prevalence of cardiac abnormalities in patients with systemic lupus erythematosus. DESIGN: Prospective survey. SETTING: Rheumatic diseases unit of a university hospital. PATIENTS: Volunteer sample comprising 83% of patients with systemic lupus erythematosus followed annually in the rheumatic disease unit (93 patients; mean age 46 +/- 13 years; female 79, male 14). These patients were age-matched with 16 female control volunteers (mean age 43 +/- 5 years) recruited from hospital staff. INTERVENTIONS: Electrocardiograms, two-dimensional echocardiograms and radionuclide angiograms were performed in patients and controls. Anticardiolipin antibodies were measured by enzyme-linked immunosorbent assay in the systemic lupus erythematosus patients. MAIN RESULTS: At least one cardiac abnormality was detected in 44 of 93 systemic lupus erythematosus patients (47%). These abnormalities included: aortic valve thickening 12%; mitral valve thickening, prolapse, vegetations or stenosis 23%; left ventricular segmental dysfunction 4%; left ventricular global hypokinesis 4%; right ventricular hypokinesis 4%; left ventricular hypertrophy 14%; left ventricular diastolic dysfunction 16%; and pericardial effusion 2%. Three of the 16 controls (19%) had cardiac abnormalities consisting of mitral valve prolapse (one), right ventricular hypokinesis (one) and pericardial effusion (one). Cardiac abnormalities were more common in the systemic lupus erythematosus group compared with controls (47% versus 19%, P less than 0.05). Raised anticardiolipin antibodies were specific (88%) but not sensitive (33%) for the presence of cardiac abnormalities in systemic lupus erythematosus patients. Renal disease and prednisone therapy were more common in systemic lupus erythematosus patients with cardiac involvement than in such patients without evidence of cardiac disease (40% versus 16%, P = 0.03; and 81% versus 59%, P = 0.04, respectively). CONCLUSIONS: Cardiac abnormalities can be identified noninvasively in 47% of patients with systemic lupus erythematosus.

Adult↗
PubMed1994

[Calcium antagonists and heart failure. Critical review of the literature].

Calcium antagonists impede the entry of calcium into myocytes and inhibit myocardial contraction. Calcium antagonists differ in their relative negative inotropic potency and can provoke baroreceptor stimulation that modulates left ventricular (LV) performance. Calcium antagonists are uniformly well tolerated in patients with normal LV function. Use of these agents in patients with suspected LV function impairment has yielded results ranging from hemodynamic improvement to clinical deterioration and increased mortality. Although calcium antagonists are potent vasodilatators and produce short-term hemodynamic improvement, they are non use full as primary treatment in patients with congestive heart failure (CHF). They may have a place in the treatment of coexistent problems in patients with LV dysfunction. Short-term use of calcium antagonists for myocardial ischemia or severe hypertension is probably safe in the presence of LV dysfunction and overt CHF. Calcium antagonists appear to have a role in the treatment of patients with diastolic dysfunction of diverse etiologies.

Calcium Channel Blockers↗
PubMed1997

Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta Stone.

Abnormalities of diastolic function have a major role in producing the signs and symptoms of heart failure. However, diastolic function of the heart is a complex sequence of multiple interrelated events, and it has been difficult to understand, diagnose and treat the various abnormalities of diastolic filling that occur in patients with heart disease. Recently, Doppler echocardiography has been used to examine the different diastolic filling patterns of the left ventricle in health and disease, but confusion about diagnosis and treatment options has arisen because of the misinterpretation of these flow velocity curves. This review presents a simplified approach to understanding the process of diastolic filling of the left ventricle and interpreting the Doppler flow velocity curves as they relate to this process. It has been hypothesized that transmitral flow velocity curves show a progression over time with diseases involving the myocardium. This concept can be applied clinically to estimate left ventricular filling pressures and to predict prognosis in selected groups of patients. Specific therapy for diastolic dysfunction based on Doppler flow velocity curves is discussed.

Blood Flow Velocity↗
PubMed2003

[Symptomatic left ventricular dysfunction and Behçet disease. Report of 2 cases].

Behçet's disease is associated with cardiac complications which may affect all three cardiac layers in 1 to 6% of cases. Although pericardial and coronary disease are the most common, the myocardium may also be affected. The clinical presentation may be left ventricular dysfunction with signs of dilated cardiomyopathy. The cause of the left ventricular dysfunction is usually coronary artery disease but it can also be inflammatory, resulting in a myocarditis with normal coronary arteries. The authors report two cases of Behçet's disease with symptomatic left ventricular dysfunction presenting as dilated cardiomyopathy with normal coronary arteries in one of the cases. Recent echocardiographic studies suggest that the incidence of myocardial disease is underestimated in this pathology: 20 to 35% of patients with Behçet's disease but no cardiac symptoms had left ventricular diastolic dysfunction. A more attentive investigation of left ventricular diastolic function in these patients should enable earlier diagnosis of this complication.

Adult↗
PubMed1993

[Idiopathic restrictive cardiomyopathy].

PURPOSE: To characterize the idiopathic restrictive cardiomyopathy (RCM) through clinical manifestations and complementary tests and to analyze the surgical benefit on the correction of tricuspid regurgitation. METHODS: Five patients with RCM idiopathic were retrospectively studied, 4 female and 1 male, with ages ranging from 30 to 59 (mean 40) years. The patients presented heart failure due to restrictive syndrome and were submitted to chest X-ray, EKG, echocardiogram, right ventricular endomyocardial biopsy, hemodynamic study and surgery. RESULTS: X-ray showed heart enlargement in all patients, but only one had pulmonary venous capillary congestion. EKG presented atrial fibrillation, complex QRS with low voltage on frontal axis, abnormal ventricular repolarization, right bundle branch block, inactive area and right ventricular hypertrophy. Complete atrioventricular block was observed in one patient. The echocardiogram study showed biatrial enlargement in all patients, and left ventricular dilatation in one patient with left ventricular dysfunction. Mild tricuspid regurgitation were observed in one patient and moderate in four. Two patients had mild mitral regurgitation. Diastolic dysfunction were observed at Doppler-cardiography in all patients. Right ventricular endomyocardial biopsy showed interstitial fibrosis, myocytes hypertrophy and myofibrils disarray. The hemodynamic study disclosed right ventricular hypertension in all patients. Three patients had hypotension in left ventricle and aorta. The left ventricular end diastolic pressure and pulmonary capillary pressure (pulmonary wedge pressure) were elevated in all patients. Dilated left ventricle with mild hypokinesia and right ventricular inferior hypokinesia and diastolic restriction were observed in one patient. One patient had similar pattern without diastolic restriction. Mild tricuspid regurgitation was observed in one patient, moderate in three and severe in one. Mild mitral regurgitation were observed in two patients. The restrictive pattern (deep and plateau) was present in three patients. Surgery were performed in all patients, and confirmed the mild tricuspid regurgitation in one and the moderate in four. De Vega plastia were performed in four patients. CONCLUSION: Among the complementary methods, echocardiogram and hemodynamic study were those of higher contribution to the diagnosis of idiopathic RCM. The disease has a poor evolution, even with clinical or surgical treatment. Heart transplantation may would be the best procedure on patients with symptomatic idiopathic restrictive cardiomyopathy.

Adult↗