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PubMedDate not supplied

Impaired left ventricle filling in slow coronary flow phenomenon: an echo-Doppler study.

Slow coronary flow (SCF) in a normal-appearing coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. The aim of the study was to evaluate echocardiographic features in patients with SCF. Thirty-four patients with angiographically proven SCF (group I) and 25 patients with normal coronary flow (group II) were enrolled in the study. The diagnosis of SCF was made with use of the "TIMI frame count (TFC)'' method. All patients underwent complete transthoracic echocardiographic examination (M-mode, 2-dimensional [2-D], and Doppler parameters such as color, continuous, pulsed wave). There were no significant differences with respect to systolic parameters between the 2 groups; in spite of these, group I showed impaired left ventricular diastolic patterns compared to group II. Group I patients had higher peak late diastolic filling velocities due to enhanced atrial systole (A), lower peak (E/A) diastolic filling velocity ratios, and longer isovolumetric relaxation times compared with group II, and these were statistically significant (p<0.001). In conclusion; the authors detected diastolic filling abnormalities and showed diastolic dysfunction in patients with SCF.

Adult↗
PubMed1996

Heart in hypothyroidism--an echocardiographic study.

55 individuals, 44 of whom served as patients and 11 as controls were included in this study. Patient group was further divided into overt and subclinical hypothyroid group each having 22 patients. Patients were examined in a prospective manner and results compared with control group with an aim to evaluate the effect of hypothyroidism subclinical and overt on cardiac status by echocardiography. Variables of heart structure and function were assessed by cross sectional and Doppler echocardiography. IVS dimensions were significantly raised in moderate subclinical and in severe overt hypothyroidism (mean 0.911 +/- 0.038 and 0.973 +/- 0.217 cm). LVPW thickness was significantly increased only in overt hypothyroidism (mean 1.378 +/- 0.246). However RVW and LVID showed no definite pattern of change. Pericardial effusion and Diastolic dysfunction was seen in significant cases only in overt hypothyroidism. To conclude, hypothyroidism both subclinical and overt is associated with cardiovascular alteration both structural and functional. IVS and LVPW thickness are markedly affected, as well as there is impairment of left ventricular function more in diastole.

Diastole↗
PubMed2006

Both ramipril and telmisartan reverse indices of early diabetic cardiomyopathy: a comparative study.

AIMS: We tested the hypothesis that renin-angiotensin system inhibition could reverse left ventricular diastolic dysfunction in patients with type 2 diabetes. METHODS AND RESULTS: Forty asymptomatic patients with type 2 diabetes were recruited in this double-blind cross-over trial. Left ventricular diastolic function was assessed at baseline with Doppler echocardiography; ratios of early to late peak flow velocity through the mitral orifice (E/A) and velocity time integral of early to late transmitral diastolic flow (VTIE/VTIA) were evaluated. In addition, plasma brain natriuretic peptide (BNP) was measured. Patients received randomly either ramipril (2.5 mg/day), or telmisartan (40 mg/day) or their combination for 3 months. Subsequently, every patient was crossed over to alternative regimens after a 2-week washout period. Measurements were repeated at the end of each treatment period. Both E/A and VTIE/VTIA ratios were increased (29 and 20% with ramipril, 25 and 23% with telmisartan and 36 and 28% with combination treatment, respectively, p < 0.001), whereas plasma BNP levels were significantly reduced with all 3 regimens (9% with ramipril, 25% with telmisartan and 36% with combination, p < 0.001). CONCLUSIONS: Both ramipril and telmisartan improve echocardiographic left ventricular diastolic indices and reduce plasma BNP levels in diabetic patients; their combination yields an even better therapeutic effect.

Analysis of Variance↗
PubMed1998

Hypertrophic remodeling: gender differences in the early response to left ventricular pressure overload.

OBJECTIVES: To identify gender differences in left ventricular remodeling, hypertrophy, and function in response to pressure overload due to ascending aortic banding in rats. BACKGROUND: Gender may influence the adaptation to pressure overload, as women with aortic stenosis have greater degrees of left ventricular hypertrophy and better left ventricular function than men. METHODS: Fifty-two weanling rats underwent ascending aortic banding (16 males, 18 females), or sham surgery (9 males, 9 females). At 6 and 20 weeks, rats underwent transthoracic echo Doppler studies, and closed-chest left ventricular pressures with direct left ventricular puncture. Perfusion-fixed tissues from eight rats were examined morphometrically for myocyte cross-sectional area and percent collagen volume. RESULTS: At 6 weeks after aortic banding, left ventricular remodeling, extent of hypertrophy, and function appeared similar in male and female rats. At 20 weeks, male but not female rats showed an early transition to heart failure, with onset of cavity dilatation (left ventricular diameter=155% vs. 121% of same-sex sham), loss of concentric remodeling (relative wall thickness=102% vs. 139% of sham), elevated wall stress (systolic stress=266% vs. 154% of sham), and diastolic dysfunction (deceleration of rapid filling=251% vs. 190% of sham). Left ventricular systolic pressures were higher in female compared with male rats (186+/-20 vs. 139+/-13 mm Hg), while diastolic pressures tended to be lower (14+/-4 vs. 17+/-4 mm Hg). CONCLUSIONS: Gender significantly influences the evolution of the early response to pressure overload, including the transition to heart failure in rats with aortic stenosis.

Adaptation, Physiological↗
PubMed1998

Left ventricular diastolic properties of hypertensive patients measured by pulsed tissue Doppler imaging.

Examination of left ventricular (LV) diastolic dysfunction in hypertensive patients has been based on parameters obtained from the transmitral flow velocity during pulsed Doppler echocardiography. However, these parameters are affected by loading conditions. We evaluated LV diastolic function along the longitudinal and transverse axes by pulsed tissue Doppler imaging (TDI) in 50 hypertensive (HT) patients and 36 age-matched healthy volunteers (N). Transmitral flow velocity was recorded by pulsed Doppler echocardiography. LV posterior wall motion velocity along the longitudinal and transverse axes also was recorded by pulsed TDI. In both groups, peak early diastolic velocity of the LV posterior wall (Ew) along the transverse axis (N: 15.8+/-5.2 cm/s, HT: 12.2+/-4.4 cm/s) was higher than that along the longitudinal axis (N: 12.7+/-3.1 cm/s, HT: 9.5+/-3.3 cm/s). Peak atrial systolic velocity of the LV posterior wall (Aw) along the longitudinal axis (N: 9.1+/-1.8 cm/s, HT: 9.7 +/-2.6 cm/s) significantly exceeded that along the transverse axis (N: 8.0+/-2.2 cm/s, HT: 8.4+/-2.4 cm/s) in both groups. The Ews were lower and the Aws were higher along both axes in the patient group than in the control group. The time intervals from the aortic component of the second heart sound to the peak of the early diastolic wave (IIA-Ews) along both the transverse (N: 142+/-18 ms, HT: 154+/-19 ms) and longitudinal (N: 151 16 ms, HT: 162+/-20 ms) axes were longer in the patient group. In 29 patients, Ews along both axes correlated negatively (transverse: r = -0.80, P < .0001; longitudinal: r = -0.71, P < .0001) and IIA-Ews correlated positively (transverse: r = 0.81, P < .0001; longitudinal: r = 0.74, P < .001) with the time constant of the LV pressure decay during isovolumic diastole. The Aws along both axes in the 24 patients without pseudonormalization in transmitral flow velocity correlated positively (transverse: r = 0.60, P < .001; longitudinal: r = 0.74, P < .0001) with the LV end-diastolic pressure. In conclusion, LV relaxation and filling along the longitudinal and transverse axes were impaired in many patients with hypertension. Pulsed TDI was useful for evaluating LV diastolic dynamics in this disease.

Aged↗
PubMed2002

Three-dimensional myocardial strains at end-systole and during diastole in the left ventricle of normal humans.

This paper presents the three-dimensional strains in the normal human left ventricle (LV) at end-systole and during diastole. Magnetic resonance tissue tagging was used to measure strain in the left-ventricular heart wall in 10 healthy volunteers aged between 28 and 61 years. The three-dimensional motion was calculated from the displacement of marker points in short- and long-axis cine images, with a time resolution of 30 msec. Homogeneous strain analysis of small tetrahedrons was used to calculate deformation in 18 regions of the LV over a time span of 300 msec starting at end systole. End-systolic radial strain was largest near the heart base, and circumferential and longitudinal strains were largest near the apex. During diastole, the circumferential-longitudinal shear strain (associated with LV torsion) was found to recover earlier than the axial strains. Assessment of three-dimensional diastolic strain is possible with MR tagging. Comparison of patient strain against normal strain may permit early detection of regional diastolic dysfunction.

Adult↗
PubMed2003

Cardiac performance and morphology in end-stage renal disease.

Patients with end-stage renal disease (ESRD) experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in cardiac performance and morphology. High cardiac output related to renal anemia, hypertension, volume overload, and the arteriovenous fistula (in patients on hemodialysis) predispose to eccentric left ventricular (LV) hypertrophy. Hypertension, aortic stiffness, and aortic stenosis predispose to concentric LV hypertrophy. Most ESRD patients have a hybrid form of LV hypertrophy. LV hypertrophy is commonly accompanied by LV diastolic dysfunction. LV systolic dysfunction is less common. Newer dialytic techniques, excellent control of hypertension, and correction of renal anemia produce regression of LV hypertrophy. The effect of these interventions on LV systolic and diastolic function is less well established. Alterations in serum calcium, choice of dialysate base, hypoxia, and comorbid conditions may influence the effects of dialysis (particularly hemodialysis) on LV function. A variety of negative inotropic drugs may depress LV function in patients with ESRD.

Anemia↗
PubMed1999

Myocardial diastolic impairment caused by left ventricular hypertrophy involves basal septum more than other walls: analysis by pulsed Doppler tissue imaging.

OBJECTIVE: To assess regional diastolic function in patients with hypertension with or without left ventricular hypertrophy using Doppler tissue imaging, a new tool that analyzes myocardial wall motion 'on-line'. METHODS: Ten normotensive subjects, 20 hypertensive patients without hypertrophy and 20 with hypertrophy (left ventricular mass index >50 g/m2.7), all men, underwent Doppler echocardiography and Doppler tissue imaging, which was performed in apical view by placing pulsed sample volume at the level of the basal and middle septum, basal and middle lateral wall, and infero-posterior wall. Peak velocities and time-velocity integrals of myocardial early (Em) and late (Am) waves and their ratios, regional deceleration time and regional relaxation time were measured in each segment. RESULTS: Transmitral peak E/A ratio was 1.37 in normotensive subjects, 1.01 in hypertensive patients without hypertrophy and 0.77 in those with hypertrophy (P < 0.00001). The myocardial diastolic indexes derived by Doppler tissue imaging worsened at all levels in hypertensive patients without hypertrophy compared with normotensive subjects. In hypertensive patients with hypertrophy, the majority of myocardial diastolic indexes were further impaired at the basal septal level, but only marginal differences were found in other regions, compared with indexes in hypertensive patients without hypertrophy. The main diastolic indexes were found, using separate intra-group analyses, to be more compromised at the basal septum than at other levels only in hypertrophic hypertensive patients. The prevalence of regions having peak Em/Am ratios < 1 increased significantly from normotensive subjects to hypertensive patients without hypertrophy, but not significantly from these to the hypertrophic group. Among pooled hypertensive patients, after adjusting for heart rate and diastolic blood pressure using multivariate models, the septal wall thickness was shown to be an independent determinant of the diastolic indexes of the basal and middle septum. CONCLUSIONS: In hypertensive patients without hypertrophy, diastolic dysfunction is uniform along the ventricular walls, whereas in those with hypertrophy it is more evident at the basal septal level than in other walls. Overall among hypertensive patients, the diastolic properties of the interventricular septum worsen as the thickness of the septal wall increases, in the presence and in the absence of hypertrophy.

Case-Control Studies↗
PubMed1997

Decrease in forces responsible for diastolic suction during acute coronary occlusion.

BACKGROUND: The production of left ventricular (LV) restoring forces generated during contraction, which are responsible for diastolic suction, is dependent on end-systolic volume (ESV) and systolic transmural and 3D deformation. We tested the hypothesis that acute coronary occlusion would result in loss of forces that cause suction. METHODS AND RESULTS: Ten open-chest dogs were subjected to a 10-minute acute coronary occlusion (proximal left anterior descending coronary artery). A servomotor connected to the left atrium (LA) was used to rapidly clamp LA pressure during systole below the level of the succeeding LV diastolic pressure, resulting in nonfilling diastoles during which the LV fully relaxed at its ESV. LA clamps at multiple ESVs (conductance catheter) allowed delineation of positive and negative portions of the fully relaxed LV pressure-volume relation (FRPVR). A negative fully relaxed pressure (FRP) indicates the presence of restoring forces. After 10 minutes of acute coronary occlusion, there was an upward shift of the FRPVR. Thus, for example, at matched ESVs before and during coronary occlusion, FRP was -1.1+/-1.1 (+/-SD) mm Hg before versus 0.2+/-1.2 mm Hg after 10 minutes of coronary occlusion (P<.05). CONCLUSIONS: Acute coronary occlusion results in a rapid decrease in forces responsible for suction. This phenomenon is independent of the level of ESV and may contribute to ischemic diastolic dysfunction.

Animals↗
PubMed2005

Effect of amlodipine and lacidipine on left ventricular diastolic and long axis functions in arterial hypertension and stable angina pectoris.

OBJECTIVE: Impaired left ventricular (LV) diastolic and long axis functions are common in arterial hypertension and stable angina pectoris patients despite normal LV ejection fraction. Data concerning the effect of calcium channel blockers (CCB) on the LV long axis function in this context are lacking. METHODS AND RESULTS: Fifty-nine hypertensive patients with associated coronary artery disease (stable angina pectoris) and isolated diastolic dysfunction were randomized to receive amlodipine (30 patients) or lacidipine (29 patients) for 4 weeks. Clinical investigation, exercise testing, echocardiography were performed before and after the active treatment period. LV diastolic function was analysed from transmitral flow using Doppler echocardiography. Mitral annulus motion was investigated for LV long axis function analysis using 2-D guided M-mode echocardiography (amplitudes of motion) and pulsed wave tissue Doppler (velocities). Amlodipine and lacidipine affected LV diastolic and long axis functions differently: during treatment with amlodipine isovolumic relaxation time (IVRT) and deceleration time of LV early filling (DT) decreased (IVRT--from 93 +/- 19 ms to 79 +/- 15 ms, DT--from 206 +/- 36 ms to 188 +/- 27 ms; p < 0.05), early diastolic velocity of mitral annulus motion (E') increased (from 10.0 +/- 1.9 cm/s to 10.8 +/- 1.8 cm/s after treatment; p < 0.05). Lacidipine did not significantly change these parameters (IVRT-- 88 +/- 15 ms before, 87 +/- 13 ms after treatment, DT--214 +/- 34 ms and 218 +/- 42 ms, E'-- 10.4 +/- 1.5 cm/s and 10.6 +/- 1.5 cm/s, respectively). More favourable effects of CCB on LV long axis function was found in patients with post-systolic shortening. CONCLUSIONS: Amlodipine can improve diastolic and long axis functions of the left ventricle in patients with arterial hypertension and stable angina pectoris.

Aged↗
PubMed2002

[Central hemodynamics in the remote period in children operated for extrahepatic portal hypertension].

The authors studied functional state of circulation in various terms after operation. Depending on anastomosis creation two group of patients different by visceral hemodynamics change were identified. 58 patients were examined before operation, one year and later after the operation. Functional state of central hemodynamics was evaluated with echo- and Dopplercardiography. It was revealed that after operation the number of children with hyperdynamic type of circulation decreased. A year after distal splenorenal anastomosis creation number of children with hyperdynamic type of central hemodynamics decreased by 20%. Later, regardless of anastomosis type increased cardiac index was revealed in 32.32 and 36.3% children respectively after total and selective anastomosis creation. After total bypass more severe hemodynamic disorders (diastolic dysfunction and inotropic disorders) developed. After distal splenorenal anastomosis creation hemodynamic disorders were seen later due to increase of bypass volume blood flow. Increase of venous return leads to moderate diastolic overloading and myocardial hypertrophy.

Adolescent↗
PubMed1998

Human SERCA2a levels correlate inversely with age in senescent human myocardium.

OBJECTIVES: This study sought to characterize functional impairment after simulated ischemia-reperfusion (I/R) or Ca2+ bolus in senescent human myocardium and to determine if age-related alterations in myocardial concentrations of SERCA2a, phospholamban, or calsequestrin participate in senescent myocardial dysfunction. BACKGROUND: Candidates for elective cardiac interventions are aging, and an association between age and impairment of relaxation has been reported in experimental animals. Function of the sarcoplasmic reticulum resulting in diastolic dysfunction could be dysregulated at the level of cytosolic Ca2+ uptake by SERCA2a, its inhibitory subunit (phospholamban), or at the level of Ca2+ binding by calsequestrin. METHODS: Human atrial trabeculae from 17 patients (45-75 years old) were suspended in organ baths, field simulated at 1 Hz, and force development was recorded during I/R (45/120 min). Trabeculae from an additional 12 patients (53-73 years old) were exposed to Ca2+ bolus (2-3 mmol/L bath concentration). Maximum +/- dF/dt and the time constant of force decay (tau) were measured before and after I/R or Ca2+ bolus and related to age. SERCA2a, phospholamban, and calsequestrin from 12 patients (39-77 years old) were assessed by immunoblot. RESULTS: Functional results indicated that maximum +/-dF/dt and tau were prolonged in senescent (>60 years) human myocardium after I/R (p < 0.05). Calcium bolus increased the maximum +/-dF/dt and decreased tau in younger, but not older patients (p < 0.05). SERCA2a and the ratio of SERCA2a to either phospholamban or calsequestrin were decreased in senescent human myocardium (p < 0.05). CONCLUSIONS: Senescent human myocardium exhibits decreased myocardial SERCA2a content with age, which may, in part, explain impaired myocardial function after either I/R or Ca2+ exposure.

Adult↗
PubMed2005

Closure of a moderately large atrial septal defect with a self-fabricated fenestrated Amplatzer septal occluder in an 85-year-old patient with reduced diastolic elasticity of the left ventricle.

Percutaneous closure of an atrial septal defect (ASD) in the elderly with reduced diastolic elasticity of the left ventricle poses a significant management challenge. We report on the case of an 85-year-old patient who was admitted for percutaneous device closure of a moderately large secundum atrial septal defect. Hemodynamic evaluation documented an increase in left atrial pressure from a mean of 12 mm Hg to a mean of 32 mm Hg after balloon test occlusion of the ASD. Two months later, after adequate pretreatment with diuretics and afterload-reducing substances, he underwent successful closure of the ASD using a self-fabricated fenestrated Amplatzer septal occluder, which resulted in a postimplantation left atrial pressure of a mean of 18 mm Hg. Recovery was unremarkable and the fenestration has remained patent for 3 months since implantation of the device. This unique case highlights the feasibility of using a self-fabricated fenestrated Amplatzer septal occluder to close interatrial communications in elderly patients with diastolic dysfunction of the left ventricle.

Aged↗
PubMed1998

Left ventricular dysfunction in human immunodeficiency virus (HIV)-infected patients.

We evaluated left ventricular function by echocardiography in a prospective study that included 98 consecutive human immunodeficiency virus (HIV)-infected patients and 40 HIV-seronegative normal controls. When compared with controls, HIV patients showed increased isovolumic relaxation time (101+/-18 ms versus 71+/-10 ms; p<0.0001) and left ventricular diastolic diameters (51+/-6 mm versus 47+/-3 mm; p<0.0005), and decreased fractional shortening (31+/-6% versus 37+/-2%; p<0.0001). Diastolic dysfunction was the most frequent finding (63% of the patients). We found depressed ejection fraction in 31 (32%) patients. Only 8 (8%) patients had symptomatic congestive heart failure. Left ventricular dysfunction was not attributable to intravenous drug abuse or to therapy. It was less severe in earlier stages of the infection (fractional shortening: acquired immunodeficiency syndrome=30%+/-6%, asymptomatic HIV-seropositives 34%+/-5%; p<0.005) and in HIV-2-infected patients. Patients with opportunistic infections (all aetiologies mixed) had more frequent congestive heart failure than those without infections (16% of the patients with versus 4% of the patients without infections; p<0.05). The fact that even asymptomatic HIV-seropositives had signs of left ventricular dysfunction (fractional shortening: asymptomatic HIV-seropositives=34%+/-5%; controls=37%+/-2%; p<0.05) favours the hypothesis of the HIV being one of the causes of these abnormalities.

AIDS-Related Opportunistic Infections↗
PubMed2004

Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both.

OBJECTIVE: To evaluate aortic function and its relation to left ventricular diastolic function in patients with hypertension, diabetes, or both, without coronary artery disease. METHODS: Study groups were composed of 27 healthy participants and 25 patients with hypertension, 24 with diabetes, and 18 with hypertension and diabetes. Coronary artery disease was excluded in all of the study participants. Aortic strain and distensibility were calculated from the aortic diameters measured by echocardiography and blood pressure obtained by sphygmomanometry. RESULTS: There were significant differences between the control and the patient groups (hypertensive, diabetic, and diabetic-hypertensive) in aortic strain (mean (SD) 18 (8)% v 11 (7)%, 9 (3)%, and 8 (3)%, respectively, p < 0.001) and distensibility (10 (5.1) v 3.1 (1.5), 5.1 (2.8), and 2 (0.9) cm2/dyn/10(3), respectively, p < 0.001). In a multivariate analysis, the parameter most closely related to the deceleration time in the control group was aortic distensibility (standardised beta coefficient -0.50, p = 0.002, overall R2 = 0.25). In the patient group, the parameter most closely related to deceleration time was also aortic distensibility (standardised beta coefficient -0.36, p = 0.009, overall R2 = 0.13). Even though the study group variable was entered in to the multivariate model, aortic distensibility was found to be the parameter most closely related to deceleration time (standardised beta coefficient -0.48, p < 0.001, overall R2 = 0.22). CONCLUSION: Aortic stiffness is increased in patients with hypertension, diabetes, or both even after the exclusion of coronary artery disease. Aortic stiffness and left ventricular diastolic dysfunction are also associated in these patients.

Aorta, Thoracic↗
PubMed2001

Subclinical right ventricular dysfunction in cystic fibrosis. A study using tissue Doppler echocardiography.

Patients with severe cystic fibrosis can develop cor pulmonale, but little is known about the function of the right ventricle (RV) early in the disease. We hypothesized that such patients might have subclinical RV dysfunction, detectable by tissue Doppler echocardiography, and related to the severity of lung disease. We studied 21 clinically stable patients (Group 1), five patients with severe lung disease (Group 2), and 23 age-matched healthy subjects. Patients had impaired RV systolic function. The mean (SD) systolic velocities of the RV free wall were 8.9 (1.7) cm/s in Group 1, 7.7 (1.0) in Group 2, and 10.8 (1.9) in healthy subjects (p < 0.001). The velocities of the tricuspid annulus were less in patients (p < 0.0001). Patients had a greater isovolumic relaxation time (p < 0.001), indicating RV diastolic dysfunction. RV wall thickness was greater in patients (0.4 [0.1] versus 0.3 [0.1] cm/m(2), p < 0.01). RV systolic function was related to C-reactive protein (r = - 0.66, p < 0.001) and FEV(1) (r = 0.62, p = 0.003) and diastolic function to interleukin-6 (r = 0.64, p < 0.005). Patients with cystic fibrosis have subclinical RV dysfunction, which correlates with the severity of lung disease. Tissue Doppler echocardiography provides a quantifiable indicator useful for detection and monitoring of disease progression.

Adult↗
PubMed1996

Normalization of left ventricular nonuniformity late after valve replacement for aortic stenosis.

The aim of the present study was to evaluate nonuniformity in pressure overload hypertrophy due to aortic stenosis. Twenty patients were included in the present analysis. Ten patients with severe aortic stenosis were studied preoperatively as well as early (21 +/- 8 months) and (89 +/- 21 months) after aortic valve replacement (AVR) using left ventricular biplane angiograms, high-fidelity pressure measurements and endomyocardial biopsies. Ten normal subjects served as controls. LV systolic function was assessed from biplane ejection fraction, and diastolic function from the time constant of relaxation, the peak filling rate and the constant of myocardial stiffness. Nonuniformity was evaluated from the coefficient of variation of the time to end-systole (systolic asynchrony) and peak filling rate (diastolic asynchrony) of 12 regions in right anterior oblique and left anterior oblique projection. Ejection fraction was comparable in patients with aortic stenosis and in controls, whereas preoperatively diastolic dysfunction with prolonged relaxation and increased stiffness was present in patients with aortic stenosis and was normalized late after AVR. LV systolic asynchrony was present (>25D of controls) in 7 and diastolic asynchrony in 10 of 10 patients with aortic stenosis. Early as well as late after AVR systolic asynchrony was normalized in 9 of 10 patients. Diastolic asynchrony was present early AVR in all but one patient, although there was a significant improvement with respect to the preoperative evaluation. Late after AVR there was a normalization of diastolic asynchrony in 9 of 10 patients with aortic stenosis. Thus, it is concluded that systolic asynchrony is normalized early after AVR probably due to its load-sensitivity, whereas diastolic asynchrony persists probably due to residual LV hypertrophy with increased interstitial fibrosis and myocardial stiffness. Late after AVR, diastolic asynchrony is normalized due to structural remodeling with regression of both myocardial hypertrophy and interstitial fibrosis.

Aortic Valve↗
PubMed1991

The effects of blood pressure reduction on abnormal left ventricular diastolic function in hypertensive patients.

To investigate whether reduction in blood pressure has a beneficial effect on left ventricular diastolic function, we investigated 20 hypertensive patients with evidence of diastolic dysfunction at baseline and at 3 and 6 months after initiation of captopril therapy. Two-dimensional echocardiography was used to determine left ventricular mass index and Doppler ultrasound to assess diastolic function. Fifteen of the 20 patients had a significant reduction in blood pressure at 3 and 6 months and left ventricular mass index remained unchanged during the study period. Despite reduction in blood pressure, no difference in isovolumic relaxation time, early and atrial filling velocities or their ratio was observed. Our results suggest that a direct relationship between blood pressure and left ventricular diastolic function does not exist and that other factors such as alterations in muscle or collagen composition of the left ventricle may be more important in determining abnormal diastolic function in hypertension.

Adult↗