Color M-mode Flow Propagation Velocity Research Articles

Exploring the prospect of intrinsic wave propagation in evaluating myocardial stiffness among patients with type 2 diabetes.

Diabetes predisposes affected individuals to impaired myocardial perfusion and ischemia, leading to cardiac dysfunction. Increased myocardial stiffness is an independent and significant risk factor in diastolic dysfunction. This study sought to estimate myocardial stiffness in Type 2 diabetes (T2DM) patients using the intrinsic wave velocity propagation (IVP) along the longitudinal wall motion during late diastole and evaluate the value of IVP in assessing cardiac function and structure. 87 and 53 participants with and without T2DM (control group) were enrolled. Of the 87 T2DM patients (DM group), 43 were complicated with hypertension (DM + H group), and 44 were not (DM-H group). Ultrasound parameters were measured and analyzed, including color M-mode flow propagation velocity, global longitudinal systolic strain (GLS), and IVP. IVP was higher in the DM group than in the control group (1.62 ± 0.25 m/s and 1.40 ± 0.19 m/s, P < 0.001). After stratification for hypertension, IVP in both DM + H (1.71 ± 0.25 m/s) and DM-H (1.53 ± 0.20 m/s) groups were found to be significantly higher than that in the control group (1.40 ± 0.19 m/s); also, the difference of IVP between DM + H and DM-H group reached statistical significance. Moreover, IVP was significantly correlated with flow propagation velocity during early diastole (Pve) (r = -0.580, P < 0.001), flow propagation velocity during late diastole (Pva) (r = 0.271, P < 0.001), GLS (r = 0.330, P < 0.001), interventricular septal thickness at end-diastole (IVSd) (r = 0.321, P < 0.001), blood glucose (r = 0.246, P < 0.003), systolic blood pressure (r = 0.370, P < 0.001) and diastolic blood pressure (r = 0.389, P < 0.001). The results indicated the application potential of IVP in assessing the early detection of cardiac function changes noninvasively and sensitively. The correlation with myocardial stiffness warrants further studies to substantiate its potential clinical utility.

Assessment of left ventricular systolic function by tissue Doppler imaging in controlled versus uncontrolled type 2 diabetic patients.

AimTo detect and quantify early subtle left ventricular (LV) systolic dysfunction using Tissue Doppler Imaging in type 2 diabetic patients with apparently normal LV ejection fraction.MethodsNinety age and sex matched subjects were enrolled in the study, sixty of them were suffering from type 2 diabetes mellitus (DM) whom were divided according to HbAlc into 2 groups, 30 uncontrolled diabetic patients with HbAlc > 8% and 30 controlled diabetic patients with HbAlc < 8% and a third group of 30 normal subjects served as controls. We excluded patients with inadequate Doppler signal, all structural heart diseases, systemic disorders with cardiac involvement and patients with false positive HbAlc. Assessment of diastolic function was done by Pulsed Doppler through mitral flow and by propagation flow velocity. Assessment of left ventricular systolic function was done by conventional echocardiography by 2D Simpson method and by Tissue Doppler Imaging (TDI) through detection of mitral annular peak systolic velocities.ResultsLeft ventricular diastolic function was compared between the studied groups and showed that the mean peak early mitral inflow velocity E wave and the color M-mode flow propagation velocity of early diastolic flow (Vp) were significantly lower, and the mean peak late mitral inflow velocity A wave was significantly higher in uncontrolled diabetics versus controlled diabetic patients and control group with highly significant statistical difference (p < 0.001). Assessment of global systolic function by conventional Simpson’s modified biplane method didn’t show significant difference between uncontrolled diabetic patients, controlled diabetic patients and normal individuals. However, evaluation of systolic function by Tissue Doppler Imaging showed that the mean peak longitudinal systolic velocity was significantly decreased in uncontrolled diabetic patients when compared to controlled diabetic patients and normal individuals, with highly significant statistical difference (p < 0.001). A cut-off value for systolic dysfunction detected by TDI in uncontrolled diabetic patients was calculated. The peak systolic velocities < 7 cm/s for medial mitral annulus and < 8.2 cm/s for lateral mitral annulus indicated systolic dysfunction in diabetic patients with sensitivity and specificity of 96% and 67% respectively for medial mitral annulus while 98% and 71% respectively for lateral annulus.ConclusionTDI is a simple and effective method for detection of subtle LV systolic dysfunction in type 2 uncontrolled diabetic patients.

Investigation of elastic features of aorta and color M-mode flow propagation velocity (APV) of descending aorta in the patients with ischemic and non-ischemic dilated cardiomyopathy.

Aortic flow propagation velocity (APV) is a novel echocardiographic parameter used in coronary artery disease. It has also been used for the evaluation of aortic stiffness. In the present study, APV was measured in patients with ischemic and non-ischemic dilated cardiomyopathy (DCM) and was compared with the parameters of aortic stiffness such as aortic distensibility (AD) and aortic strain (AS). A total of 140 patients who had undergone coronary angiographic imaging were included in the study. Out of these patients, 44 had ischemic DCM, 46 had non-ischemic DCM, and 50 had normal coronary angiography (control group). AS, AD, and APV were calculated echocardiographically. One-way analysis of variance (ANOVA) and the Kruskal-Wallis test were used to compare continuous variables between the groups, while the categorical variables were compared using Pearson's Chi square test. Pearson's correlation test was used to investigate the parameters associated with APV, AS, and AD. Ischemic DCM and non-ischemic DCM groups differed significantly. The comparison of these groups with the control group, in terms of AS, AD, and APV values (ANOVA p < 0.001 for all) also showed a significant difference. APV was found to be significantly correlated with AS (r = 0.645, p < 0.001) and AD (r = 0.604, p < 0.001). In ROC analysis, the area under the curve (AUC) value for APV was 0.999 (p = 0.000) for detection of patients ischemic DCM and non-ischemic DCM. APV may be considered to be a novel and a simple echocardiographic marker, for both, distinguishing ischemic from non-ischemic DCM as well as for the presence of dilated cardiomyopathy with or without critical coronary artery disease.

Epicardial fat, rather than pericardial fat, is independently associated with diastolic filling in subjects without apparent heart disease

Background and aimEpicardial and pericardial fat are separate fat depots surrounding the heart. Previous studies found epicardial fat to be associated with diastolic dysfunction, but they had some limitations. Pericardial fat association with diastolic dysfunction was not examined. Our aim was to assess the relation of epicardial and pericardial fat with diastolic filling. Methods and resultsIn 73 volunteers without known heart disease or complaints, using echocardiography, we measured epicardial and pericardial fat thickness from long(LAX) and short(SAX) axis views and assessed diastolic filling: mitral inflow (E/A ratio, E wave deceleration time[DT]), pulmonary vein flow (systolic/diastolic ratio [S/D], systolic filling fraction[SFR], late retrograde velocity[Ar]), color M-mode flow propagation velocity [Vp], and tissue Doppler derived mitral early annular velocities at the septum [e′ sep] and lateral wall [e′-lat]. By Spearman's correlation, epicardial fat from LAX had a weak, but statistically significant correlations with several diastolic filling indices (SFR{rs = 0.29, P = 0.02}, Ar{rs = 0.3, P = 0.01}, Vp{rs = −0.3, P = 0.01}, e′ sep{rs = −0.23, P = 0.04}, e′ lat{rs = −0.26, P = 0.03}). In multivariate logistic regression model adjusting for age, gender, diabetes, systolic blood pressure and left ventricle mass index, epicardial fat thickness from LAX (and not from SAX) was the only independent predictor of e′ [e′ sep < 8: OR = 1.8, 95%CI = 1.1–2.9; e′ lat<10: OR = 1.6, 95%CI = 1.01–2.6]. After adjustment, Pericardial fat measured from LAX was independent predictor of e′ lat only[e′ lat < 10:OR = 1.3, 95% CI 1.03–1.6). ConclusionsEpicardial fat measured from LAX is an independent predictor of myocardial relaxation. Pericardial fat independent association with diastolic filling is uncertain.

Early changes in left ventricular diastolic function and left atrial function in chagas disease identified by tissue doppler and speckle tracking

Purpose: Up to 20 to 30% of chronic Chagas' disease patients are expected to develop the cardiac form of the disease. The identification of left ventricular (LV) diastolic dysfunction or left atrial (LA) dysfunction may yield a strategy to recognize early cardiac involvement. Our aim was to analyze these parameters in Chagas' disease patients with normal LV systolic function using new echocardiographic techniques. Methods: Echocardiograms from 52 Chagas' disease patients with the indeterminate form, 29 patients at the stage A of the cardiac form (changes limited to the electrocardiogram) and 25 controls were consecutively acquired. LV diastolic function was analyzed by interrogation of the mitral inflow, pulmonary vein flow, color M-mode flow propagation velocity, LV untwist and tissue Doppler of the mitral annulus. LA function was analyzed by real-time 3 dimensional echocardiography and LA strain (ɛ) analysis including global peak positive LA ɛ (ɛ pos peak), peak negative LA ɛ and total LA ɛ. Results: All groups presented similar age, gender distribution, chamber diameters, LV mass and LV systolic function. Diastolic dysfunction was more prevalent in stage A patients. While all controls presented normal LV diastolic function, 11.5% of the patients with the indeterminate form presented delayed relaxation and 2% pseudo-normal LV diastolic function and 35.5% of the patients at the stage A of the cardiac form presented delayed relaxation and 13.5% pseudo-normal LV diastolic function (p=0.0001). Tissue Doppler was the best index to discriminate the presence of diastolic dysfunction. E/E' ratio was progressively higher (C: 5.8±1.6; indeterminate: 7.0±1.7; stage A: 8.0±2.9; p=0.0008) and E'/A' ratio was progressively lower (C: 1.5±0.3; indeterminate: 1.2±0.5; stage A: 1.0±0.3; p=0.0004) from controls towards stage A patients. LA volumes were higher in stage A patients than in controls, but LA emptying fractions did not differ among the groups. LA ɛ pos peak was lower in stage A patients (15.1±4.2%) than in patients with the indeterminate form (17.9±4.8%) and controls (17.8±4.3%; p=0.02), while the other LA ɛ parameters did not differ among the groups. Conclusions: Patients with Chagas' disease and normal LV systolic function present LV diastolic dysfunction, which is more prevalent in patients at the stage A of the cardiac form. Tissue Doppler was the best index to discriminate the presence of diastolic dysfunction and routine evaluation of E'/A' ratio may enable its early recognition. Depression of LA conduit function in stage A patients was observed only by LA strain analysis.

Intraoperative cardiac assessment with transesophageal echocardiography for decision-making in cardiac anesthesia

Transesophageal echocardiography is an invaluable hemodynamic monitoring modality. Extended and anatomically based evaluation of cardiac function with transesophageal echocardiography is essential to prompt and accurate decision-making in anesthetic management during cardiac surgery. Fractional shortening and fractional area changes are indices widely used to assess the global systolic performance of the left ventricle. Monitoring regional function using semi-quantitative scoring has been demonstrated to be a more sensitive indicator of myocardial ischemia. Assessment of left ventricular diastolic function should be performed in a systematic way, measuring transmitral flow, pulmonary venous flow, transmitral color M-mode flow propagation velocity, and mitral annulus tissue Doppler imaging. The unique anatomical features of the right ventricle make echocardiographic evaluation complicated and therefore less frequently employed. Right ventricular fractional area change, tricuspid annular plane systolic excursion, maximal systolic tricuspid annular velocity with tissue Doppler imaging, and myocardial performance index are indices successfully incorporated into intraoperative right ventricular assessment. Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve may develop after cardiac procedures. Transesophageal echocardiography plays a central role in prevention as well as diagnosis of systolic anterior motion. Transesophageal echocardiography is extremely useful not only for detecting and locating intracardiac air, but also for guiding and evaluating the procedures to remove air. Air is likely to persist in the right and left superior pulmonary vein, left ventricular apex, left atrium, right coronary sinus of Valsalva, and ascending aorta. Accurate evaluation of cardiac function depends on performing TEE examination properly and obtaining optimal images.

The relation of color m-mode flow propagation with cardiac iron load in patients with thalassemia major

Myocardial iron overload remains an important problem and results in cardiac dysfunction in patients with thalassemia major (TM). The ratio of color M-mode flow propagation velocity to early diastolic transmitral flow velocity (E/Vp) in echocardiography is a marker of increased left ventricular filling pressure, which is independent of preload, afterload, and heart rate. We examined the relationship between E/Vp and iron loading in patients with TM using cardiac magnetic resonance imaging (MRI). Twenty-one TM patients and 21 age-matched healthy controls were enrolled in the study. Transmitral flow, pulmonary vein velocities, and Vp were obtained by two blinded echocardiographers. Left ventricular isovolumetric relaxation time (IVRT) was measured in the apical long axis by echocardiography. All patients also underwent MRI for cardiac T2* evaluation of iron overload. An increased E/Vp was defined as > 1.5. The E/Vp ratio was increased in TM patients compared with control subjects (1.7±0.4 and 1.2±0.2, P < 0.01, respectively). There was no correlation between E/Vp and cardiac T2* value. E/Vp was significantly correlated with IVRT (r=0.51, P = 0.02). In addition, the cardiac T2* value was comparable in patients with an E/Vp > 1.5 and E/Vp ≤1.5 (21.1±9.8 ms vs. 22.3±8.0 ms, P = 0.80, respectively). E/Vp may be a marker of diastolic abnormality that is independent from myocardial iron load in TM patients with preserved left ventricular function.

Abstract 2466: Increased Plasma Concentrations of N-Terminal Pro Brain Natriuretic Peptide is a More Sensitive Marker of Subclinical Diastolic Dysfunction and Arterial Remodeling in Hypertension: Analytical Performance Comparison with BNP

Concentrations of plasma N-terminal pro brain natriuretic peptide (NT-proBNP) is inversely related to metabolic cardiovascular risk factors and is a valuable prognostic marker of cardiovascular events in arterial hypertension. Whether NT-proBNP levels are connected with diastolic function and arterial function was determined in hypertension. NT-proBNP was measured in 40 untreated patients with hypertension (mean BP 166/96 mmHg) without heart failure and 20 age and gender matched healthy, controls. Hypertensive patients were studied by pulsed Doppler and color M-mode Doppler echocardiography to evaluate LV diastolic function. Plasma NT-proBNP was significantly elevated in patients with hypertension (75.1 ± 75.2 [SD] pg/ml compared with 37.9 ± 38.5 in controls p &lt; 0.05). In hypertensive patients, NT-proBNP values were negatively correlated with the ratio of color M-mode flow propagation velocity to transmitral E velocity (r=−0.33, p&lt;0.05) while those of BNP had no correlation, suggesting that higher plasma NT-proBNP is indicative of subclinical diastolic dysfunction. Moreover, hypertensive patients with higher NT-proBNP values above the mean value in the control group (NT-proBNP &gt; 38 pg/ml) had significantly increased brachial intimal-medial thickness (0.36 ± 0.08 mm vs. 0.32 ± 0.05, p &lt; 0.05) and reduced wall stress (112.4 ± 29.5 kPa vs. 142.2 ± 30.8, p &lt; 0.05) compared with those with lower NT-proBNP, suggesting that the reference value of NT-proBNP plasma concentrations in uncomplicated hypertensives is 38pg/ml and higher NT-proBNP levels were associated with favorable remodeling of the peripheral arteries. Elevation of plasma NT-proBNP can be useful to identify subclinical LV diastolic dysfunction and peripheral arterial remodeling in asymptomatic patients with hypertension.

Is There Any Relationship between Metabolic Parameters and Left Ventricular Functions in Type 2 Diabetic Patients without Evident Heart Disease?

The aim of the present study was to evaluate left ventricle (LV) systolic and diastolic function, using tissue Doppler echocardiography (TDE) and color M-mode flow propagation velocity, in relation to blood glucose status in normotensive patients with type 2 diabetes mellitus (T2DM) who had no clinical evidence of heart disease. Seventy-two patients with T2DM (mean age 49.1 +/- 9.8 years) without symptoms, signs or history of heart disease and hypertension, and 50 ages matched healthy controls (mean age 46.1 +/- 9.8 years) had echocardiography. Systolic and diastolic LV functions were detected by using conventional echocardiography, TDE and mitral color M-mode flow propagation velocity (V(E)). Fasting blood glucose level (FBG) after 8 hours since eating a meal, postprandial blood glucose level (PPG), and HbA(1C) level were determined. The association of FBG, PPG and HbA(1C) with the echocardiographic parameters was investigated. It was detected that although systolic functions of two groups were similar, diastolic functions were significantly impaired in diabetics. No relation of FBG and PPG with systolic and diastolic functions was determined. However, HbA(1C) was found to be related to diastolic parameters such as E/A, Em/Am, V(E) and E/V(E) (beta=-0.314, P = < 0.05; beta=-0.230, P < 0.05; beta=-0.602, P < 0.001, beta= 0.387, P < 0.005, respectively). In addition to HbA(1C), LV, diastolic functions were also correlated with age and diabetes duration. Diastolic LV dysfunction may develop even in absence of ischemia, hypertension, and LVH in T2DM. FBG and PPG have no effect on LV functions, but HbA(1C) levels may affect diastolic parameters.

Adverse Cardiovascular Effects of Acute Salt Loading in Young Normotensive Individuals

We sought to explore the effects of salt loading in young normotensives on vascular endothelial function, echocardiographic left ventricular diastolic function, and electrocardiographic QT dispersion. Sixteen healthy normotensive male volunteers were randomized in a double-blind crossover fashion to 5-day treatment periods with either placebo or salt tablets (200 mmol/d of sodium) separated by a 2-week washout period. Throughout the study the volunteers were asked to maintain a low-salt diet. Forearm venous occlusion plethysmography and intraarterial infusions of acetylcholine (ACh), sodium nitroprusside (SNP), and N(G)-monomethyl-l-arginine (L-NMMA) were used to assess vascular reactivity. Baseline and postsalt loading 12-lead ECGs and echocardiograms were also obtained. Twenty-four-hour ambulatory systolic blood pressure rose (117+/-11 to 121+/-8 mm Hg) significantly with salt loading. The endothelium-dependent responses to ACh were significantly blunted with salt compared to placebo (DeltaFBF% 403 [50] versus 296 [31]; P<0.05) and L-NMMA (DeltaFBF% -47.2 [4] versus -31 [3]; P<0.01). In contrast, the endothelium-independent response to SNP was not different between treatments. Color M-mode flow propagation velocity (CMMFPV), a preload index of left ventricular diastolic function, was significantly reduced with salt (64 [6] versus 59 [16] cm/s; P<0.05) suggesting increased ventricular stiffness. QT dispersion was also significantly increased with salt (58 [16] versus 48 [17] ms; P=0.02). Salt loading impaired vascular endothelial function, left ventricular mechanical relaxation, and electric repolarization in young healthy normotensives.

Assessment of Left Ventricular Diastolic Function and Tei Index by Tissue Doppler Imaging in Patients with Cushing's Syndrome

The aim of this study was to assess left ventricular (LV) function and the Tei index by tissue Doppler imaging (TDI), and also to evaluate the relationship of serum cortisol level with the Tei index and LV function in patients with Cushing's Syndrome (CS). We prospectively evaluated 22 patients with CS and 23 control subjects. LV function was assessed by echocardiography. Early diastolic (Em), late diastolic (Am), peak systolic (Sm), mitral annular velocities, Em/Am, the Tei index, and E/Em were calculated by TDI. Mitral inflow velocities, color M-mode flow propagation velocity (Vp), relative wall thickness (RWT), and LV mass index (LVMI) were assessed by two-dimensional echocardiography. Peak (E) velocity and the ratio of E to peak late (A) velocity (E/A) were lower in those with CS than in those without. Patients with CS had significantly higher RWT, IVRT, and LVMI than those controls. Vp was lower in the CS-patients than that in control subjects. Em and Em/Am were lower in patients with CS than those in controls. In patients with CS, the Tei index was significantly higher than control subjects. Serum cortisol level was positively correlated with the Tei index and E/Em ratio but negatively correlated with Em, Sm, and EF only in patients with CS. Serum cortisol level positively correlated with the Tei index and E/Em ratio but negatively correlated with Em, EF, and Sm. The parameters obtained from lateral mitral annulus by TDI can be used for identification of LV diastolic dysfunction in patients with CS.

Tissue Doppler Imaging in the Evaluation of the Left and Right Ventricular Diastolic Functions in Rheumatoid Arthritis

Previous studies have reported that cardiovascular involvement in rheumatoid arthritis (RA) occurs frequently. Although ventricular functions of RA have been investigated through the standard Doppler in RA, they have yet to be investigated thoroughly by means of the relatively new and advantageous tissue Doppler imaging (TDI). The present study aims to investigate left and right ventricular functions in RA patients by means of TDI and standard Doppler echocardiography. A total of 60 patients with longstanding RA and 40 control subjects were included in the study and their left and right ventricular functions were assessed by standard pulsed-wave Doppler echocardiography, the color M-mode flow propagation velocity, and TDI. The left ventricular TDI was achieved at four different sites (lateral, septal, anterior, and inferior walls), while the right ventricular TDI was achieved through the tricuspid lateral annulus. When compared with controls, the RA group showed that basal clinic and echocardiographic parameters, early (E) and late (A) diastolic velocities of atrioventricular valves, E/A ratio, and pulmonary venous Doppler parameters of these two groups were similar. It was determined that left and right ventricular E-wave deceleration times and isovolumic relaxation times of the RA patients were determined to have increased in comparison with those of the subjects in the healthy Control Group (P < 0.05). RA patients had significantly lower color M-mode flow propagation velocity (P < 0.05). While S' peak and E' peak, two of the left and right ventricular TDI parameters, were similar in both groups, A' peak, E'/A', and E/E' parameters in RA showed statistically significant differences in RA patients. A comparison between age and sex of RA patients and healthy individuals revealed that left and right ventricular TDI parameters of RA patients were impaired, which led us to conclude that both of the ventricles could have been involved.

ASSESSMENT OF THE REPEATABILITY OF FELINE ECHOCARDIOGRAPHY USING CONVENTIONAL ECHOCARDIOGRAPHY AND SPECTRAL PULSE‐WAVE DOPPLER TISSUE IMAGING TECHNIQUES

The objective of this study was to determine the intraoperator, intraobserver, and interobserver repeatability in a series of conventional echocardiographic parameters and in some of the newer measurements of diastolic function, including color M-mode flow propagation velocity, isovolumic relaxation time and pulsed-wave Doppler tissue imaging velocities. Four healthy cats were each scanned five times over a 3-day period. The repeatability of these echocardiographic analyses was compared using Bland-Altman analysis (intraoperator repeatability). After a minimum of 5 weeks, one scan was randomly selected from each cat, and was remeasured by the original observer and the results compared using a standard paired Student's t-test (intraobserver repeatability). One scan from each cat was then randomly selected and two observers, with similar levels of experience, measured each of these scans. The repeatability of these echocardiographic analyses was compared using Bland-Altman analysis (interobserver repeatability). The conventional two-dimensional (2D), M-mode and spectral Doppler measurements were repeatable in both their acquisition and measurement by a single investigator; there was a greater degree of variation between the two observers. The predominant (S', E', and A') pulsed-wave Doppler tissue imaging velocities from the left apical four-chambered view, generally had a coefficient of variation of approximately 20% (range 9.62-34.08%). However, with pulsed-wave Doppler tissue imaging, velocities recorded during the isovolumic phases, the velocity of the tricuspid annulus, and the radial fiber velocity within the interventricular septum, frequently had coefficients of variation in excess of 20% and should therefore be interpreted with caution.

237 Load-independency of color M-mode flow propagation velocity and doppler tissue imaging in assessment of left ventricular diastolic function comparison with transmitral and pulmonary venous flow

237 Load-independency of color M-mode flow propagation velocity and doppler tissue imaging in assessment of left ventricular diastolic function comparison with transmitral and pulmonary venous flow

Increased plasma concentrations of N-terminal pro-brain natriuretic peptide reflect the presence of mildly reduced left ventricular diastolic function in hypertension

The potential use of assays of N-terminal pro-brain natriuretic peptide for detection of diastolic abnormalities associated with alterations in blood pressure has not been elucidated. This study was designed to determine whether increased plasma concentrations of N-terminal pro-brain natriuretic peptide sensitively reflect abnormal diastolic function associated with hypertension. Concentrations of N-terminal pro-brain natriuretic peptide in plasma were assayed in 40 previously untreated hypertensive patients without overt congestive heart failure and in 20 age and sex-matched controls. Hypertensive patients were studied with the use of pulsed Doppler and color M-mode Doppler echocardiography for the evaluation of left ventricular diastolic function. Concentrations of N-terminal pro-brain natriuretic peptide were elevated in hypertensive patients [75.1+/-75.2 (SD) pg/ml compared with 37.9+/-38.5 in controls, P<0.05]. In hypertensive patients, concentrations of N-terminal pro-brain natriuretic peptide were negatively correlated with the ratio of color M-mode flow propagation velocity to transmitral E velocity consistent with the view that increased concentrations of N-terminal pro-brain natriuretic peptide are indicative of alterations in diastolic function. Hypertensive patients with N-terminal pro-brain natriuretic peptide values above the mean value in the control group exhibited significantly increased brachial intimal-medial thickness and reduced wall stress, consistent with the view that increased N-terminal pro-brain natriuretic peptide was associated with favorable peripheral arterial remodeling. Elevated concentrations of N-terminal pro-brain natriuretic peptide in plasma reflect the presence of left ventricular diastolic abnormalities and peripheral arterial remodeling in asymptomatic patients with hypertension.

Early diastolic mitral annular velocity and color M-mode flow propagation velocity in the evaluation of left ventricular diastolic function in patients with Fabry disease

Fabry disease is an X-linked genetic disorder characterized by progressive intracellular accumulation of neutral glycosphingolipids. Cardiac involvement is frequent and left ventricular (LV) diastolic dysfunction is present in most of the affected subjects. Pulsed-wave tissue Doppler echocardiography (PW-TDE) and color M-mode are new Doppler methods for LV diastolic function evaluation. Their role in the assessment of Fabry disease-related cardiomyopathy remains to be established. In this study we aimed to determine the utility of PW-TDE and color M-mode-derived parameters in the assessment of LV diastolic function in patients with Fabry disease. Eighty-one echocardiographic examinations performed in 35 patients affected by Fabry disease were retrospectively analyzed. Early diastolic lateral mitral annular velocity (E(m)) determined by PW-TDE and color M-mode flow propagation velocity (V(p)) were measured and compared to LV filling patterns obtained using standard Doppler indexes. The receiver operating characteristics (ROC) curves method was used to determine the summary measure of relative accuracy for E(m) and V(p). A comparison of ROC curves showed a significant difference for areas under the curve in favor of E(m) (P < 0.001). Pseudonormal filling pattern, higher LV mass index, higher relative wall thickness, larger left atrial diameter, and older age were more frequent (all P < 0.001) in patients with incorrect diagnosis of normal LV diastolic function based on the measurement of V(p). E(m) appears to be superior to V(p) in the assessment of LV diastolic function in patients with Fabry disease. V(p) fails to detect abnormal LV diastolic function in subjects with pronounced concentric LV remodeling and pseudonormal filling pattern.

1144 The assessment of conventional Doppler indices and color M-mode flow propagation velocity during dobutamine stress echocardiography

1144 The assessment of conventional Doppler indices and color M-mode flow propagation velocity during dobutamine stress echocardiography

Doppler Tissue Imaging and Color M-Mode Flow Propagation Velocity: Are They Really Preload Independent?

This study investigated the change in new diastolic indexes in patients with uremia who undergo regular hemodialysis (H/D). We studied 81 patients with uremia (41 men and 40 women) receiving regular H/D. All patients were in sinus rhythm before H/D. They had normal left ventricular systolic performance without regional wall-motion abnormality. Three patients were excluded because of atrial fibrillation after H/D. Patients were separated by the amount of body fluid removed during H/D procedure: 30 patients with H/D amount less than 2 kg (group 1), 33 patients with H/D amount between 2 and 3 kg (group 2), and 18 patients with H/D amount larger than 3 kg (group 3). They received complete transthoracic echocardiographic examinations. Flow propagation velocity (FPV) was measured by color M-mode echocardiography in apical 4-chamber view. Mitral annulus Doppler tissue velocities (peak systolic [Sa], early diastolic [Ea], and late diastolic [Aa]) were measured from septal, lateral, inferior, and posterior walls. All these parameters were obtained immediately before and after H/D. Paired data were compared. In patients with removed fluid amount less than 2 kg (group 1), the change of all diastolic parameters showed insignificant change except FPV (peak mitral E, P = .14; peak mitral A, P = .916; FPV, P = .009; septal Sa, P = .173; septal Ea, P = .295; septal Aa, P = .649). In patients with H/D amount between 2 and 3 kg, the change of all diastolic parameters showed statistically significant difference except Sa (peak mitral E, P = .001; peak mitral A, P = .001; FPV, P = .001; Sa, P = .589; Ea, P = .001; Aa, P = .015). In patients with H/D amount larger than 3 kg, Sa still showed insignificant change. Ea, Aa, and FPV showed significant difference after H/D (peak mitral E, P = .001; peak mitral A, P = .035; FPV, P = .008; septal Sa, P = .777; septal Ea, P = .014; septal Aa, P = .048). In patients with normal left ventricular systolic function, FPV was preload dependent. Diastolic phase mitral annulus Doppler tissue velocities (Ea and Aa) behaved differently according to the amount removed during H/D. They were preload independent when the amount removed during H/D was less than 2 kg. When the amount removed during H/D was larger than 2 kg, diastolic phase mitral annulus Doppler tissue velocities changed significantly. That is to say, diastolic phase mitral annulus Doppler tissue velocities were not totally preload independent. For systolic phase mitral annulus Doppler tissue velocity index (Sa), it was preload independent.

Color M‐Mode Flow Propagation Velocity and Conventional Doppler Indices in the Assessment of Diastolic Left Ventricular Function during Isometric Exercise

Color M-mode flow propagation velocity (Vp) was shown to be a preload-independent measure of diastolic function. To study the effects of an increase in afterload induced by isometric handgrip exercise on diastolic function assessment in patients with cardiomyopathy, we measured Vp and conventional Doppler indices at baseline and at 30% of predetermined maximum handgrip strength. Twenty-four patients with systolic dysfunction were divided into two groups: Group I comprising 12 patients with E/A < 1 (early filling velocity/atrial contraction velocity) and Group II comprising 12 patients with E/A > 1. All the patients underwent measurement of Vp, E velocity, its deceleration time (DT), A velocity, isovolumic relaxation time (IVRT), and pulmonary atrial flow reversal velocity (PFR) at baseline and at 30% of predetermined maximum handgrip strength. Twelve healthy controls underwent these same measurements. When comparing baseline to peak echocardiographic data, no significant changes were noted in Vp in any of the groups while a shift of pulsed Doppler indices of Group I toward a pattern closer to that of Group II was noted and a decrease in E velocity and E/A ratio with an increase in IVRT occurred in healthy controls. Color M-mode flow propagation velocity seems to be an afterload-independent measure of diastolic function in patients with moderate to severe cardiomyopathy while pulsed Doppler indices are more sensitive to loading conditions induced by isometric exercise.

Which echocardiographic Doppler left ventricular diastolic function measurements are most feasible in the clinical echocardiographic laboratory?

Numerous measures of left ventricular diastolic function are currently in clinical use. To determine which echo-Doppler left ventricular diastolic function measurements are most feasible in the clinical echocardiographic laboratory, the success rate, recording time taken by the sonographer, and inter-reader variability were calculated for transmitral valve inflow, pulmonary vein flow, tissue Doppler imaging, and color M-mode flow propagation velocity in 80 inpatients.