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PubMed2006

Evaluation of left ventricular systolic function in pediatric sickle cell anemia patients using the end-systolic wall stress-velocity of circumferential fiber shortening relationship.

OBJECTIVES: The aim of this work was to evaluate myocardial contractility using the end-systolic wall stress (ESSm)-velocity of circumferential fiber shortening (VCFc) relationship in sickle cell anemia (SCA) patients compared with a similar age group of African-American (AA) control patients. BACKGROUND: Abnormalities of myocardial function have been documented in SCA patients using load-dependent echocardiographic indexes. Whether the systolic dysfunction results from impaired myocardial contractility or altered loading conditions is unknown because controlled studies using a load-independent measure of contractility have not been performed. METHODS: Fifty healthy AA patients and 57 SCA patients age 3 months to 18 years were studied. Simultaneous indirect arterial pulse tracing, phonocardiogram, electrocardiogram, and M-mode tracing of the left ventricular (LV) short-axis were recorded. The LV dimensions, corrected ejection time (ETc), percent fractional shortening (%FS), VCFc, and ESSm were determined. The ESSm-VCFc relationship was calculated and compared between groups. Duration and severity of anemia and effects of exchange transfusion on the ESSm-VCFc relationship were determined. RESULTS: The SCA patients had increased LV dimensions in systole and diastole, and increased indexed LV mass. Load-dependent measurements of LV function (ETc, %FS, and VCFc) were lower in SCA patients, and afterload, as measured by ESSm, was increased. The ESSm-VCFc relationship demonstrated reduced contractility in SCA patients compared with control subjects. Degree and duration of anemia along with exchange transfusions did not impact contractility. CONCLUSIONS: Sickle cell anemia patients have significant LV dilatation and increased LV mass due to abnormal loading conditions. Contractility, measured by the ESSm-VCFc index, is lower in SCA patients and was not negatively impacted by severity or duration of anemia, or exchange transfusions. The underlying mechanism explaining these findings requires further investigation.

Adolescent↗
PubMed2004

Attenuation of biologic compensatory action of cardiac natriuretic peptide system with aging.

Although plasma B-type natriuretic peptide (BNP) levels increase with age, the mechanisms responsible for this increase are unknown. We investigated the predictors of elevated BNP in older subjects without cardiac systolic dysfunction and overt renal dysfunction. Furthermore, we analyzed the relations between BNP and its second messenger, cyclic guanosine monophosphate (cGMP), to aging. In 252 subjects (mean age 69 +/- 12 years) with left ventricular ejection fraction >/=50% and creatinine levels <==1.5 mg/dl, plasma levels of BNP, cGMP, blood urea nitrogen, creatinine, and beta2-microglobulin (an endogenous marker of renal function), estimated glomerular filtration rate, and echocardiographic data were prospectively evaluated. Plasma BNP levels increased with age (r = 0.4, p <0.0001). With use of multivariate analysis, predictors of elevated BNP levels were age, use of beta blockers, and serum beta2-microglobulin levels. The molar ratio of cGMP to BNP significantly decreased with aging (r = 0.55, p <0.0001). Elevated BNP in older subjects with normal cardiac systolic function may be due in part to renal impairment. With aging, biologic compensation of the cardiac natriuretic peptide system may be attenuated.

Adult↗
PubMed2005

[Dilated cardiomyopathy in tachycardiac atrial flutter].

HISTORY AND CLINICAL FINDINGS: We present a 38-year-old male patient with progressive exertional dyspnoea and intermittent palpitations. The initial examination detected a regular tachycardia with a heart rate of 160 bpm. EXAMINATIONS, DIAGNOSIS: In association with intermittent palpitations the 12-lead ECG detected a typical type of atrial flutter. A transthoracic echocardiography and cardiac catheterization revealed a left ventricular dilation and marked systolic dysfunction (EF 39 %) with normal coronaries. The diagnosis of dilated cardiomyopathy was made on these findings. TREATMENT AND COURSE: On the basis of this diagnosis, we treated our patient by radiofrequency catheterablation, which successfully terminated atrial flutter. Three month after ablation the echocardiography was normal with an increase of the shortening fraction from 18 to 37 % and the patient was asymptomatic. Retrospectively the diagnosis of tachycardia-induced cardiomyopathy was made. CONCLUSION: Tachycardia-induced cardiomyopathy is a rare, but reversible form of dilated cardiomyopathy. The cornerstone in the management of these patients is to achieve a normal ventricular beating rate. Radiofrequency catheterablation is a curative therapeutic option that can terminate tachyarrhythmias and lead to significant improvement of left ventricular diameters, systolic function and symptoms in patients with tachycardia-induced cardiomyopathy.

Adult↗
PubMed2006

Eplerenone prevents adverse cardiac remodelling induced by pressure overload in atrial natriuretic peptide-null mice.

1. Atrial natriuretic peptide (ANP)-null mice (Nppa(-/-)) exhibit cardiac hypertrophy at baseline and adverse cardiac remodelling in response to transverse aortic constriction (TAC)-induced pressure overload stress. Previous studies have suggested that natriuretic peptides could potentially oppose mineralocorticoid signalling at several levels, including suppression of adrenal aldosterone production, inhibition of mineralocorticoid receptor (MR) activation or suppression of MR-mediated production of pro-inflammatory factors. Thus, we hypothesized that the MR blocker eplerenone would prevent the exaggerated left ventricular (LV) remodelling/fibrosis and dysfunction after TAC in Nppa(-/-). 2. In the present study, Nppa(-/-) and wild-type Nppa(+/+) mice fed eplerenone- or vehicle (oatmeal)-supplemented chow since weaning were subjected to TAC or sham operation. The daily dose of eplerenone administered was approximately 200 mg/kg. At 1 week after TAC, LV size and function were evaluated by echocardiogram and LV cross-sections were stained with picrosirius red for collagen volume measurement. Total RNA was extracted from the LV for real-time polymerase chain reaction analysis of osteopontin. 3. Eplerenone had no effect on baseline hypertrophy observed in sham-operated Nppa(-/-) compared with Nppa(+/+) mice. Eplerenone attenuated the TAC-induced increase in LV weight in both genotypes and completely prevented LV dilation, systolic dysfunction and interstitial collagen deposition seen in Nppa(-/-) mice after TAC. However, serum aldosterone levels were lower in Nppa(-/-) compared with Nppa(+/+) wild types. No interaction between eplerenone and genotype in osteopontin mRNA levels was observed. 4. Eplerenone prevents adverse cardiac remodelling related to pressure overload in ANP-deficient mice, mainly due to an antifibrotic effect. The mechanism whereby ANP deficiency leads to excess hypertrophy, fibrosis and early failure following TAC is increased profibrotic signals resulting from excess or unopposed MR activation, rather than increased levels of aldosterone.

Aldosterone↗
PubMed2003

[Effect of cordaron on systolic and diastolic functions of the left ventricle in patients with a mixed form of chronic low cardiac output and cardiac arrhythmias].

AIM: To study effects of cordaron on central hemodynamics reflecting systolic and diastolic functions of the left ventricle (LV) in patients with a mixed form of chronic cardiac failure--a systolic dysfunction and LV diastolic dysfunction type I. MATERIAL AND METHODS: 14 patients with a mixed form of chronic heart failure (CHF) and cardiac arrhythmia were followed up for 6 months. All the patients received ACE inhibitors, diuretics, nitrates and, additionally, cordaron in a supporting dose 200-300 mg/day. Control of central hemodynamics was made with echocardiography before, 1, 3 and 6 months of therapy. RESULTS: For 6 months of therapy LV ejection fraction increased by 16%. LV diastolic function improved, primarily, due to a rise of the E max (by 52% for 6 months of therapy). This reflected early diastolic filling of the LV. Improvement of LV diastolic function was associated with heart rate decrease. CONCLUSION: Cordaron used in addition to ACE inhibitors, diuretics, nitrates improves both systolic and diastolic LV function in patients with a mixed form of CHF.

Adult↗
PubMed1991

Left ventricular contractility is depressed in IgE-mediated anaphylactic shock in dogs.

To determine whether myocardial dysfunction contributes to vascular collapse in anaphylactic shock, we examined left ventricular (LV) contractility, coronary blood flow, and myocardial lactate metabolism during antigen challenge in eight dogs that were sensitized to ragweed pollen extract (anaphylaxis group). Findings in the anaphylaxis group were contrasted to those in another group of dogs in which mean blood pressure was decreased to the same extent by arteriolar vasodilation with nitroprusside. The animals were examined under nonhypoxic conditions while anesthetized and ventilated. LV mechanics were examined with subendocardial crystals placed primarily along the anterior-posterior minor axis of the LV. During antigen challenge, a depression in LV contractility was observed in the anaphylaxis group as assessed by fractional dimensional shortening, stroke volume, and the slope of the end-systolic pressure-dimension relationship. During anaphylaxis, moreover, coronary vasodilation rather than coronary vasoconstriction was observed, and evidence of myocardial ischemia as assessed by altered myocardial lactate metabolism was not found. Our results indicate that depressed LV contractility occurs in anaphylactic shock. The results further suggest that the mechanism may be due to a direct effect of mediators of anaphylaxis on the myocardium to produce systolic dysfunction.

Anaphylaxis↗
PubMed2004

QT dispersion correlates with systolic rather than diastolic parameters in patients receiving anthracycline treatment.

OBJECTIVE: The aim of this study was to investigate the relation of QT dispersion to left ventricular (LV) systolic and diastolic function in patients undergoing anthracycline therapy. METHODS: We used echocardiography to evaluate LV systolic and diastolic function and electrocardiography to evaluate QT dispersion and corrected QT dispersion (QTcD) in patients with hematological diseases, who received anthracycline therapy. PATIENTS: Seventy-two patients with hematological diseases who were receiving anthracycline treatment were enrolled in the present study. RESULTS: LV end-diastolic diameter or LV end-systolic diameter had a significant positive correlation to QTcD (r = 0.35, p < 0.01, r = 0.43, p < 0.01). Also left ventricular ejection fraction of (LVEF) or fractional shortening had a significant negative correlation to QTcD (r = -0.46, p < 0.001, r = -0.27, p = 0.02). The highest QTcD group had a significantly larger LV end-diastolic diameter or LV end-systolic diameter than the lowest QTcD [48.5 +/- 5.7 vs. 44.4 +/- 4.5 (mm), p < 0.001, 34.1 +/- 6.4 vs. 28.8 +/- 4.3 (mm), p < 0.001] and the highest QTcD group had a significantly lower LVEF than the lowest QTcD [57.5 +/- 8.0 vs. 65.5 +/- 6.4 (%), p < 0.001]. On the other hand, none of the diastolic function markers were significantly correlated with QTcD. CONCLUSION: We concluded that increased QTcD is correlated with LV dilation and systolic dysfunction induced by anthracycline therapy, and does not reflect a dispersion of ventricular repolarization or asynchronous motion.

Adolescent↗
PubMed1995

Characteristics of chronic left ventricular dysfunction induced by coronary embolization in a canine model.

We have characterized the coronary vascular reserve, left ventricular function and inotropic response in dogs with chronic heart failure consequent to intracoronary embolization (EMB) with 50 microns spheres. We conducted studies 12-39 months after embolization and contrasted the findings with normal (CON) dogs. Acute embolization produced sustained LV volume enlargement and increased wall thickness, reduction of LV ejection fraction and elevated end-diastolic pressures; resting catecholamine levels were also increased. Responses to phenylephrine, nitroprusside, and dobutamine were identical in CON and EMB and coronary vasodilator reserve was reduced despite larger coronary vascular volume. Analysis by light microscopy showed a diffuse focal and interstitial fibrosis distributed uniformly from endocardium to epicardium associated with 14% loss of myocytes. This created a functional separation of myocardial muscle bundles and a disruption of the syncytial nature of the heart. Electron microscopy of the areas of fibrosis revealed myocytes in states ranging from normal appearing, to ghosts with evidence of cytolysis and loss of the sarcolemma. This model of chronic congestive heart failure with LV systolic dysfunction and elevated LV diastolic pressures shares a number of features with the syndrome in humans.

Animals↗
PubMed1989

Central and renal hemodynamic effects of a new agonist at peripheral dopamine- and beta-2 adrenoreceptors (dopexamine) in patients with heart failure.

The effect of dopexamine, a new dopamine analogue, on central and renal hemodynamics was evaluated in nine patients with chronic, congestive heart failure caused by severe left ventricular (LV) systolic dysfunction. The administration of the maximally tolerated dose (7.2 +/- 4 micrograms/kg/min) resulted in a significant increase in cardiac index from 1.9 +/- 0.4 L/min/m2 to 2.6 +/- 0.9 L/min/m2 (p less than 0.05). This increase in cardiac index was largely a result of increase in heart rate (from 88 +/- 20 beats/min to 104 +/- 24 beats/min, p less than 0.05), because stroke volume index demonstrated only a small change (from 23 +/- 10 ml/m2 to 27 +/- 11 ml/m2, p not significant) in spite of a significant fall in systemic vascular resistance from 1992 +/- 717 dynes.sec.cm-5 to 1361 +/- 524 dynes.sec.cm-5 (p less than 0.05) and diastolic blood pressure (from 89 +/- 15 mm Hg to 80 +/- 17 mm Hg, p less than 0.05). No change was seen during dopexamine infusion in systolic blood pressure, right and left ventricular filling pressures, and LV stroke work index. Both renal blood flow and glomerular filtration rate were impaired at baseline in most patients. Dopexamine administration resulted in a significant increase (2x coefficient of variation) in renal blood flow in two patients only. Mean values of both renal blood flow and glomerular filtration rate did not show significant change (485 +/- 183 ml/min vs 563 +/- 221 ml/min and 89 +/- 39 ml/min vs 93 +/- 34 ml/min, respectively, p not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

High-impact articles related to the pharmacotherapeutic management of systolic heart failure.

This compilation is part of a series of five articles identifying important literature in cardiovascular pharmacotherapy. This list focuses on pharmacotherapeutic management of acute decompensated and chronic heart failure. Most of the cited works present the results of landmark clinical studies that have shaped the management of patients with left ventricular systolic dysfunction. Limited primary literature is available for some topics; thus, pertinent review articles also are listed. In addition, consensus documents formed by expert panels in the United States and Europe are reviewed. This compilation may serve as a teaching tool, reference resource, or update of the literature for pharmacy clinicians, physicians, and students.

Heart Failure↗
PubMed1991

[Ventricular mechanics and cardiac arrhythmias in patients with chagasic and primary dilated cardiomyopathy. Echo-electrocardiographic follow-up].

PURPOSE: To determine the prognostic significance of several parameters of left ventricular mechanics and of complex ventricular arrhythmias. PATIENTS AND METHODS: 184 chronic chagasic and 85 primary dilated cardiomyopathy patients were submitted to non-invasive and invasive studies, including Holter monitoring and "M" mode echocardiogram and followed for a maximum of 8 years. RESULTS: Finding of a depressed left ventricle (LV) systolic function (% AC) was the most important independent prognostic factor in both groups of patients. The presence of complex ventricular arrhythmias had an additional, but very limited, independent prognostic importance, observed only in chagasic patients with depressed LV systolic function. When patients with similar degrees of left ventricular systolic dysfunction, inadequate hypertrophy or increased afterload were compared, chagasic patients had significantly worse prognosis than those with primary dilated cardiomyopathy. This is partly attributed to higher prevalence of complex ventricular arrhythmias. CONCLUSION: The higher prevalence of complex ventricular arrhythmias in patients with chronic Chagas' disease may explain the prognostic differences between the groups.

Arrhythmias, Cardiac↗
PubMed1999

Relation of atrial natriuretic peptides to left ventricular systolic and diastolic function in heart failure.

BACKGROUND: Plasma concentrations of atrial natriuretic peptides are correlated with atrial pressures, as are left ventricular ejection fraction and left ventricular filling abnormalities. AIMS: This study investigated the relation of atrial natriuretic peptides to both left ventricular systolic and diastolic function in heart failure. METHODS: Plasma concentrations of atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide were measured in 63 patients with chronic heart failure and left ventricular systolic dysfunction. According to Doppler transmitral flow measurements, 19 patients had a restrictive and 44 patients had a non-restrictive left ventricular filling pattern. RESULTS: Plasma concentrations of atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide were higher in patients with a restrictive filling pattern than in patients with a non-restrictive filling pattern (197 vs. 75 pmol/l, P<0.0001 and 1.14 vs. 0.45 nmol/l, P<0.0001). In univariate analysis, atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide correlated with deceleration time, E/A ratio and left ventricular ejection fraction. In multivariate analysis, both peptides appeared independently related to left ventricular ejection fraction and left ventricular filling pattern. CONCLUSION: In patients with chronic heart failure, atrial natriuretic peptides provide information on left ventricular systolic as well as diastolic function.

Aged↗
PubMed2002

Matrix metalloproteinase disruption of the extracellular matrix and cardiac dysfunction.

In the heart, collagens are the major extracellular matrix (ECM) protein. The fibrillar collagens of the heart surround and interconnect myocytes and muscle fibers to provide for muscle fiber and myocyte alignment which imparts mechanical support to the myocardium and governs tissue stiffness. Loss of collagen fibrils and struts are said to lead to myocyte slippage, ventricular dilation, and progressive contractile dysfunction. Failed human hearts examined either at autopsy or explantation invariably exhibit alterations of the ECM primarily due to changes in collagen. Modulation of the balance between matrix synthesis and degradation is important in the process of ventricular remodeling and in the pathophysiology of chronic heart failure. Support for the importance of the ECM and activity of matrix metalloproteinases (MMP) in the development of chronic heart failure has been demonstrated both in animal models of heart disease and in humans. A causative role for the ECM in this process was recently revealed in experiments using a transgenic mouse model that expresses the specific collagen-degrading enzyme, MMP-1, in the heart. These studies demonstrated that chronic expression of MMP-1 leads to dynamic changes in the heart and ultimately results in systolic dysfunction. Multiple studies in animal models have also shown that inhibition of MMP activity in animal models of heart failure have attenuated the onset of left ventricular dilatation. Future studies will determine whether inhibition of MMP activity improves morbidity and mortality in patients with heart failure.

Animals↗
PubMed1985

24-hour blood pressure recording in patients with orthostatic hypotension.

Continuous intra-arterial blood pressure measurement and electrocardiograms were obtained in two ambulatory patients with orthostatic hypotension due to autonomic dysfunction. Systolic and diastolic arterial pressure presented marked variations which took place mainly during the day and were related to several physical activities; however, marked falls in blood pressure were also observed during sleep and at the moment of arousal. A peak incidence of hypotensive events was found in the afternoon, mainly in the hours following the afternoon meal. Recording was repeated after 3 weeks of treatment with propranolol, 40 mg t.i.d. In patient 1, beta blockade drastically reduced the number and severity of hypotensive episodes, while propranolol failed to control blood pressure in patient 2, who experienced a higher number of hypotensive events during treatment. Findings of this study may be relevant to the management of patients with orthostatic hypotension and should contribute to a more accurate characterization of blood pressure profile in autonomic dysfunction.

Blood Pressure↗
PubMed2003

Heart failure: evaluation of cardiopulmonary transit times with time-resolved MR angiography.

PURPOSE: To measure cardiopulmonary transit times in patients with heart failure by using low-dose, time-resolved magnetic resonance (MR) angiography and to determine if transit curves reflect conventional MR indexes of cardiac function. MATERIALS AND METHODS: Twenty-six patients with heart failure and left ventricular (LV) systolic dysfunction (17 men and nine women; age range, 22-78 years) and thirteen control subjects (eight men and five women; age range, 23-59 years) were examined with MR imaging. The examination consisted of rapid cine MR imaging throughout the heart, followed by contrast material-enhanced time-resolved three-dimensional MR angiography of the cardiac chambers and pulmonary vasculature. Time-intensity curves for the pulmonary artery and ascending aorta were derived from the MR angiography images. Cardiopulmonary transit times and dispersions (full widths at half maximum [FWHM]) were determined from the curves. Transit times and FWHM values for the patients with heart failure were compared with control values by using two-tailed t tests, and transit time was correlated with standard LV functional parameters calculated from the cine MR images. RESULTS: Cardiopulmonary transit times and FWHM values were significantly prolonged in the patients with heart failure compared with those in the control patients (P <.001). Transit time correlated directly with LV end-diastolic and end-systolic volumes and inversely with LV ejection fraction (R > 0.60). However, transit time did not correlate strongly with age, body surface area, heart rate, LV mass, stroke volume, cardiac output, or sphericity index. CONCLUSION: Time-resolved MR angiography allows determination of cardiopulmonary transit times that are significantly prolonged in heart failure and correlate directly with LV volumes and inversely with LV ejection fraction.

Adult↗
PubMed1997

Myosin heavy chain gene expression in human heart failure.

Two isoforms of myosin heavy chain (MyHC), alpha and beta, exist in the mammalian ventricular myocardium, and their relative expression is correlated with the contractile velocity of cardiac muscle. Several pathologic stimuli can cause a shift in the MyHC composition of the rodent ventricle from alpha- to beta-MyHC. Given the potential physiological consequences of cardiac MyHC isoform shifts, we determined MyHC gene expression in human heart failure where cardiac contractility is impaired significantly. In this study, we quantitated the relative amounts of alpha- and beta-MyHC mRNA in the left ventricular free walls (LVs) of 14 heart donor candidates with no history of cardiovascular disease or structural cardiovascular abnormalities. This group consisted of seven patients with nonfailing (NF) hearts and seven patients with hearts that exhibited donor heart dysfunction (DHD). These were compared with 19 patients undergoing cardiac transplantation for chronic end-stage heart failure (F). The relative amounts of alpha-MyHC mRNA to total (i.e., alpha + beta) MyHC mRNA in the NF- and DHD-LVs were surprisingly high compared with previous reports (33.3+/-18.9 and 35.4+/-16.5%, respectively), and were significantly higher than those in the F-LVs, regardless of the cause of heart failure (2.2+/-3.5%, P < 0.0001). There was no significant difference in the ratios in NF- and DHD-LVs. Our results demonstrate that a considerable amount of alpha-MyHC mRNA is expressed in the normal heart, and is decreased significantly in chronic end-stage heart failure. If protein and enzymatic activity correlate with mRNA expression, this molecular alteration may be sufficient to explain systolic dysfunction in F-LVs, and therapeutics oriented towards increasing alpha-MyHC gene expression may be feasible.

Adult↗
PubMed2004

Tissue Doppler properties of the left atrial appendage in patients with mitral valve disease.

OBJECTIVE: The purpose of this study was to compare the left atrial appendage (LAA) tissue Doppler imaging (TDI) with the classical LAA function parameters in patients with mitral valve disease. METHODS: Twenty patients who had pure mitral regurgitation (group 1), 20 patients who had pure rheumatic mitral stenosis (group 2), and 20 healthy patients (group 3) were included in this study. All the cases were sinus rhythm. In order to determine the LAA functions, LAA late filling (LAALF), and late emptying (LAALE) flow velocities and LAA fractional area change (LAAFAC) were measured. LAA tissue Doppler evaluations were obtained from the PW Doppler, which was placed on the LAA lateral wall in a transverse basal short-axis approach. LAA late systolic (LAALSW) and late diastolic (LAALDW) wave velocities were obtained from TDI records transesophageal echocardiography (TEE). RESULTS: There were no significant differences among groups 1, 2, and 3 in terms of age, left ventricular (LV) ejection fraction, gender, and heart rate. No differences were observed between group 1 and the control group with respect to LAALE, LAALF, and LAAFAC. LAALE velocity and LAAFAC were significantly decreased in group 2 than group 1. LV diastolic diameter was significantly greater, whereas LAALSW and LAALDW velocities were significantly decreased in group 1 compared with group 3. There were no differences between groups 1 and 2 regarding to LAALSW and LAALDW velocities. LAALE, LAALF, LAALSW, LAALDW velocities, and LAAFAC were significantly decreased in group 2 than group 3. CONCLUSION: The TDI method may detect the LAA systolic dysfunctions, which cannot be detected using classical methods, on tissue level in patients with mitral regurgitation. In addition, the deterioration of the LAA functions at tissue level in patients with rheumatic mitral stenosis was also detected.

Adult↗
PubMed2002

[Use of myocardial tissue Doppler imaging in cardiology].

Tissue Doppler imaging is a new promising method of non-invasive assessment of cardiac function. This method has heralded a renaissance of interest in longitudinal ventricular function. There is evidence that long-axis function is a more sensitive index of myocardial contractility than conventional echocardiographic parameters, and that therefore, this technique could contribute to early diagnosis of systolic dysfunction. Tissue Doppler imaging can be successfully applied in the assessment of regional myocardial function. It has been proven that myocardial velocities truly reflect structural myocardial changes (the degree of myocardial fibrosis) and beta-adrenoreceptor density. The use of tissue Doppler imaging in concert with stress echocardiography is also extremely encouraging and is considered as the most likely solution to the problem of quantitative analysis of stress echocardiography. The method additionally opens new horizons in non-invasive assessment of diastolic function of the heart. Myocardial velocities have been shown to have important advantages over conventional Doppler indices of left ventricular diastolic filling. Frustration among cardiologists caused by unreliability of the traditional approach in the assessment of diastolic properties of the heart seems to have been overcome. Tissue Doppler imaging allows the examination of right ventricular systolic and diastolic function, the differentiation between constrictive pericarditis and restrictive cardiomyopathy and the estimation of pressures in cardiac chambers and in the pulmonary artery. It can also establish the presence of accessory conduction pathways, the diagnosis of rejection of transplanted hearts and can be used for identification of indications for biventricular pacing. Although many clinicians believe that tissue Doppler imaging is still an experimental technique, it can now be introduced into the routine practice of echocardiographic laboratories. The wider use of the method will help to develop its benefits and better understand and overcome limitations.

Cardiology↗