Cytologic analysis of pericardial effusion complicating extracardiac malignancy

Abstract

The ratio of the motion due to atria1 systole to the total diastolic AV plane displacement can therefore be considered to represent the contribution of atria1 systole to left ventricular filling. In our study, all but 3 control subjects had an atria1 contribution of 150%. According to Starling’s law of the hearC the ventricular contraction is dependent on the end-diastolic fiber length and pressure. The atrium, by virtue of its active contraction, can modify ventricular end-diastolic pressure and end-diastolic fiber length, and thereby is capable of modifying the performance of the ventricle. In this study, younger subjects showed a relatively mild atria1 systole, compared with older groups, as judged from the decreased ratio between atria1 AV and total AV plane displacement. These findings reflect the phenomenon of decreased left ventricular compliance with advancing age with a concomitant compensatory augmentation of active atria1 emptying as reflected by an increase in atria1 AV plane displacement in older age groups. This was further supported by the finding of a good linear correlation of age with the atria1 contribution to AV plane displacement. Using different techniques, others have also demonstrated a decrease in diastolic function with advanced age.lOyl l The ratio of the height of the “A” wave to the “E” wave in the Doppler velocity curve across the mitral valve is frequently used to express the contribution of atria1 systole to left ventricular filling. With increasing age, this ratio also increases because of a larger contribution of atria1 systole to overall left ventricular filling.rO In this study there was a good linear correlation between A/E waves and the contribution of atria1 AV plane displacement, which further supports the usefulness of the new echocardiographic parameter for the assessment of diastolic function. Right ventricular systolic descent of the AV plane is related to systolic function in a way similar to that of the left ventricle. However, the displacement was significantly greater than left ventricular AV plane displacement. This is in agreement with Rushmer et al** and reflects the predominance of longitudinal shortening of the right ventricular free wall with little shortening of its width. This is probably due to different patterns of muscle structure in the right ventricle. Although the right atria1 AV plane displacement was significantly increased compared with the left atria1 AV plane displacement, the percentage of atria1 contribution to right ventricular filling was quite similar to that of the left ventricle. However, in calculating AV plane displacement of the right ventricular free wall, we probably underestimated the absolute excursion because of a slightly arc-like movement of the recording site, causing a narrow angle with the ultrasound beam. In conclusion, this study provides a simple echocardiographic means of assessing left ventricular diastolic function in a series of healthy subjects. The method is highly reproducible with low inter- and intraobserver variabilities. Normal values of atria1 AV plane displacement in relation to total AV plane displacement for different age groups of healthy subjects provide further information regarding the age-related changes in diastolic function. Further studies, however, are needed to assess its significance, especially in patients with pathologic impairment in diastolic function.