Color M-mode Propagation Velocity Research Articles

AORTIC FLOW PROPAGATION VELOCITY AND ITS RELATION TO MAGNITUDE OF SHUNT IN PATIENTS WITH ISOLATED PATENT DUCTUS ARTERIOSUS

Background: Patent ductus arteriosus (PDA) is normally associated with hyperdynamic status. Given the presence of a vascular shunt between the aorta and pulmonary artery, intrinsic aortic changes occur (aortic stiffness). Arterial stiffness is currently regarded as an independent predictor of cardiovascular morbidity and mortality. There is a close relationship between arterial stiffness and aortic flow propagation velocity (AFPV). Objective: To assess aortic stiffness in patients with isolated PDA using Doppler-derived AFPV, assess shunt magnitude i.e. pulmonary to systemic blood flow ratio (QP/QS) in patients with isolated PDA by echocardiography, compare AFPV values in patients with isolated PDA and apparently healthy individuals, and to correlate AFPV with PDA size and shunt magnitude. Patients and Methods: Our study was performed at Bab EL-Sha'riya Hospital, Al-Azhar University during the period from September 2019 and August 2020, and consisted of twenty-five patients with isolated PDA, and twenty healthy controls. Detailed history, physical examination was performed and conventional two-dimensional echocardiography was done to all cases then echocardiographic assessment of PDA including magnitude of the shunt by measuring QP/QS ratio. Aortic flow propagation velocity (AFPV) was measured in all cases. Results: Patients with PDA exhibited significantly lower AFPV than the control (p < 0.001). AFPV was significantly correlated with systolic blood pressure (r= -0.29 &p= 0.01). Also, there was significant correlation (r=-0.426) between AFPV and PDA size, mainly pulmonary end (p=0.03), and magnitude of the shunt QP/QS (r= 0.723 & p < 0.001). Conclusion: Transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple, non-invasive practical surrogate method in identifying arterial stiffness in patients with PDA and is related to effective orifice of PDA and magnitude of the shunt.

Empagliflozin Ameliorates Diastolic Dysfunction and Left Ventricular Fibrosis/Stiffness in Nondiabetic Heart Failure: A Multimodality Study

ObjectivesThe purpose of this study was to investigate the effect of empagliflozin on diastolic function in a nondiabetic heart failure with reduced ejection fraction (HFrEF) scenario and on the pathways causing diastolic dysfunction. BackgroundThis group demonstrated that empagliflozin ameliorates adverse cardiac remodeling, enhances myocardial energetics, and improves left ventricular systolic function in a nondiabetic porcine model of HF. Whether empagliflozin also improves diastolic function remains unknown. Hypothetically, empagliflozin would improve diastolic function in HF mediated both by a reduction in interstitial myocardial fibrosis and an improvement in cardiomyocyte stiffness (titin phosphorylation). MethodsHF was induced in nondiabetic pigs by 2-h balloon occlusion of proximal left anterior descending artery. Animals were randomized to empagliflozin or placebo for 2 months. Cardiac function was evaluated with cardiac magnetic resonance (CMR), 3-dimensional echocardiography, and invasive hemodynamics. In vitro relaxation of cardiomyocytes was studied in primary culture. Myocardial samples were obtained for histological and molecular evaluation. Myocardial metabolite consumption was analyzed by simultaneous blood sampling from coronary artery and coronary sinus. ResultsDespite similar initial ischemic myocardial injury, the empagliflozin group showed significantly improved diastolic function at 2 months, assessed by conventional echocardiography (higher e′ and color M-mode propagation velocity, lower E/e′ ratio, myocardial performance Tei index, isovolumic relaxation time, and left atrial size), echocardiography-derived strain imaging (strain imaging diastolic index, strain rate at isovolumic relaxation time and during early diastole, and untwisting), and CMR (higher peak filling rate, larger first filling volume). Invasive hemodynamics confirmed improved diastolic function with empagliflozin (better peak LV pressure rate of decay (–dP/dt), shorter Tau, lower end-diastolic pressure-volume relationship (EDPVR), and reduced filling pressures). Empagliflozin reduced interstitial myocardial fibrosis at the imaging, histological and molecular level. Empagliflozin improved nitric oxide signaling (endothelial nitric oxide synthetase [eNOS] activity, nitric oxide [NO] availability, cyclic guanosine monophosphate (cGMP) content, protein kinase G [PKG] signaling) and enhanced titin phosphorylation (which is responsible for cardiomyocyte stiffness). Indeed, isolated cardiomyocytes exhibited better relaxation in empagliflozin-treated animals. Myocardial consumption of glucose and ketone bodies negatively and positively correlated with diastolic function, respectively. ConclusionsEmpagliflozin ameliorates diastolic function in a nondiabetic HF porcine model, mitigates histological and molecular remodeling, and reduces both left ventricle and cardiomyocyte stiffness.

COLOR M-MODE PROPAGATION VELOCITY (VP) TO ASSESS THE LEFT VENTRICULAR DIASTOLIC FUNCTION IN HYPERTENSION PATIENTS

Objective: To evaluate the color M-mode (Vp) propagation velocity parameter and the correlation between Vp and left ventricular diastolic function parameters in hypertension patients. Subjects and Methods: A echocardiography study of 51 hypertensive patients, admitted to the Department of Cardiology of Hue University of Medicine and Pharmacy Hospital. This is a cross-sectional study. Results: The Vp value was 63.34 ± 28.22 cm/s. In the left ventricular hypertrophy group, the Vp was lower (62.68 ± 28.08 cm/s) than Vp of the left ventricular non hypertrophy group but not significative (p &gt; 0.05). We found clearly a diminution of the Vp in the groupe with degree 2 of diastolic dysfunction (Vp = 36.18 ± 4.17 cm/s) in comparison with degree 1 (55.65 ± 21.43 cm/s). Vp was positively correlated with the left ventricular peak E-wave velocity (r = 0.304, p &lt; 0.05) and the E/A wave ratio (r = 0.319, p &lt; 0.05). In addition, Vp was inversely correlated with ventricular septal thickness (r = - 0.372, p &lt; 0.01) and left ventricular post wall (r = -0.347; p &lt; 0.01). Conclusion: The Vp parameter may be used as a complement parameters to assess the left ventricular diastolic function in hypertensive patients. This parameter is valuable in patients with 2 stage or more of diastolic function disorder. Key words: Hypertension, ventricular diastolic function, color M-mode propagation velocity

A quantitative study of ventricular diastolic function in the normal fetuses using color M-mode propagation velocity

Objective To establish the reference ranges of color M-mode propagation velocity (Vp) in second and third trimester fetuses, and assess the relationships between Vp and gestational age. Methods One hundred ninety-two normal fetuses from 21 to 39 weeks of gestation were recruited in the study. Color M-mode Vps of the right ventricular (RV) and left ventricular (LV) were measured, and early diastolic inflow velocities (E) of the atrioventricular valves were assessed by pulsed-wave Doppler. The ratio of E/Vp was calculated. These data were compared with 52 normal neonates age 2~5 days. Results In normal fetuses, the RV Vp was (14.8±4.7)cm/s with a range of 11.2~37.4 cm/s and the LV Vp was (24.3±6.7)cm/s with a range of 5.6~24.0 cm/s, each of which was uncorrelated with gestational age. The RV Vp was significantly lower than the LV Vp (P<0.001). Normal values of Vp in fetuses were significantly lower than those of normal neonates. In addition, the ratio of E/Vp in fetuses were significantly higher than those of neonates for either ventricle. Conclusions Vp of fetuses from 21 to 39 weeks of gestation can be quantitatively measured by using color M-mode echocardiogram. The reference ranges provide a reliable quantitative standard to estimate ventricular diastolic function of fetuses, which may be clinically useful in prenatal detecting early cardiac failure. Key words: Echocardiography; Fetus; Ventricular function

Ventricular Diastolic Function in Normal Fetuses and Fetuses with Hb Bart's Disease Assessed by Color M-Mode Propagation Velocity using Cardio-STIC-M (Spatio-Temporal Image Correlation M-Mode).

Purpose: To determine whether ventricular diastolic dysfunction contributes to the pathogenesis of fetal cardiac failure due to fetal anemia using fetal Hb Bart's disease as a live model and cardio-STIC-M as a diagnostic tool. Materials and Methods: Color cardio-STIC volume datasets were acquired from fetuses at risk for Hb Bart's disease during 18 - 22 weeks of gestation and normal pregnancies and pregnancies with hydrops fetalis caused by Hb Bart's disease at 28 - 32 weeks. The volumes were analyzed off-line for velocity propagation (Vp) of the right and left ventricles to assess ventricular diastolic function using color cardio-STIC-M. Results: The Vp for the right and left ventricles was studied in fetuses at 18 - 22 weeks, including 64 normal fetuses (group 1) and 22 fetuses with Hb Bart's disease (group 2), and in fetuses at 28 - 32 weeks, including 22 normal fetuses (group 3) and 16 fetuses with Hb Bart's hydrops fetalis (group 4). The Vp of the fetuses in group 1 and group 2 was not significantly different. However, the Vp for the right and left ventricles in group 4 was significantly lower than in group 3 (19.02 vs. 9.78, p < 0.001; and 20.24 vs. 13.40, p < 0.001, respectively). The inter-observer variability had fair agreement with the intra-class correlation coefficient of 0.531 (95 % CI 0.393 - 0.646, p < 0.001). Conclusion: Hydrops fetalis secondary to fetal anemia is initially caused by hypervolemia rather than ventricular diastolic dysfunction while ventricular diastolic compromise is a late occurring consequence of persistent hypervolemia, different from the mechanism of hydropic changes caused by cardiac causes.

Doppler Tissue Imaging Is More Sensitive Than Other Echocardiographic Markers in Identifying Abnormal Relaxation in Subclinical Hypertensive Disease and Normal Ejection Fraction

This report describes the use of echocardiographic measurements for the assessment of left ventricular diastolic function in two young patients with newly diagnosed hypertension. Measurements for the assessment of left ventricular relaxation and filling pressures included mitral inflow, Doppler tissue imaging (DTI), color M-mode propagation velocity slope, and the isovolumic relaxation time. The mitral inflow, propagation velocity, and isovolumic relaxation time measurements were all within normal limits; however, DTI measurements of the E′ velocity at the septal and lateral annulus were significantly reduced in both patients. Further visual inspection demonstrated discrete proximal septal wall thickening that is thought to be modulated by pressure loading (i.e., increased afterload due to hypertension) and ejection. These findings may represent a “transitional state” of early ventricular remodeling and organ failure in the development of hypertensive disease. In summary, DTI appears to be more sensitive compared to other markers in identifying abnormal relaxation in subclinical hypertensive disease and normal ejection fraction.

A new echocardiographic parameter of arterial stiffness in end-stage renal disease

Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). Arterial stiffness is an independent predictive parameter of overall and cardiovascular mortality in these patients. However, the defined procedures for the measurement of arterial stiffness are time consuming and not practical in daily practice. The study population included 50 patients with ESRD who were treated with hemodialysis (HD; n=23) or peritoneal dialysis (PD; n=27) and 70 age- and sex-matched control subjects. Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and color M-mode propagation velocity of the descending aorta (aortic propagation velocity, APV) were measured. Compared to the control group, the patients with ESRD had significantly lower APV (46.4 ± 12.4 vs. 58.5 ± 8.5, p < 0.01) and higher PWV (10.5 ± 2.5 vs. 9.2 ± 1.2, p < 0.01) and CIMT (0.66 ± 0.15 vs. 0.43 ± 0.06, p < 0.01) measurements. There were significant correlations between APV and CIMT (r = - 0.769, p < 0.001), APV and PWV (r = - 0.682, p < 0.001), and PWV and CIMT (r = 0.564, p < 0.001). There were no significant differences in APV and PWV between the PD and HD patients. Arterial stiffness is an important indicator of atherosclerosis and arterial aging in patients with ESRD. The measurement of APV is an easy and practical new echocardiographic method and may be used to identify arterial stiffness in these patients.

Color M-mode propagation velocity as a valuable but neglected parameter

Color M-mode propagation velocity as a valuable but neglected parameter

One Year of Endurance Exercise Training Does Not Improve Left Ventricular Relaxation in Sedentary Seniors

BACKGROUND: Life-long endurance exercise training may attenuate the age-related changes in left ventricular (LV) relaxation. However, it is unclear whether endurance exercise training started later in life can improve LV relaxation in previously sedentary healthy seniors. PURPOSE: To determine the effect of one year of endurance exercise training on LV relaxation in sedentary healthy seniors. METHODS: Nine well-screened sedentary healthy seniors (71±3 years) who were not taking any cardiovascular medications and had no provocable ischemia during exercise were enrolled into the study. Pulmonary capillary wedge pressure (PCWP) and echocardiographic LV diastolic variables were measured at supine rest. Global LV diastolic function was assessed by the ratio of early-to-late mitral inflow velocity (E/A ratio), while LV relaxation was assessed by tissue Doppler velocities of the septal and lateral mitral annulus (Em), isovolumic relaxation time (IVRT) and color M-mode propagation velocity (Vp). LV filling pressure was assessed by PCWP. All subjects completed the one year of training, which increased maximal aerobic power (VO2 max) by ∼19% (22.8±3.4 vs. 27.2±4.3 ml/kg/min, p<0.001). Measurements were repeated after one year of exercise training. RESULTS: Heart rate was decreased (59±8 vs. 55±11 beats/min, p=0.003), while systolic (p=0.30) and diastolic blood pressure (p=0.57) were unaffected by exercise training The E/A ratio was increased after training (0.81±0.16 vs. 0.99±0.25, p=0.022). Em was decreased (9.8±1.8 vs. 8.3 ±1.0 cm/s, p=0.006), while Vp was unaffected by training (34.3±8.3 vs. 33.5±9.3, p=0.75). In contrast, IVRT was shortened after training (145±17 vs.114±11 ms, p=0.012). There was a small training-related increase in PCWP (11.4±1.7 vs. 12.5±2.8 mmHg, p=0.26). CONCLUSIONS: These results suggest that one year of exercise training does not improve LV relaxation assessed by Em or Vp in previously sedentary seniors. The effect of training on IVRT likely reflects the small increase in left atrial pressure as measured from PCWP. Based on Em and Vp, the increased E/A ratio after exercise training is more likely due to changes in driving pressure, but not likely due to improved LV relaxation.

The Relation between the Color M‐Mode Propagation Velocity of the Descending Aorta and Coronary and Carotid Atherosclerosis and Flow‐Mediated Dilatation

To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 +/- 8.1 vs. 47.5 +/- 16.8 cm/sec, P < 0.001) and FMD (5.3 +/- 1.9 vs. 11.4 +/- 5.8%, P < 0.001) and higher CIMT (0.94 +/- 0.05 vs. 0.83 +/- 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =-0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =-0.530, P < 0.001). The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function.

Noninvasive Assessment of Atherosclerosis in Patients with Isolated Hypertension

Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been used to assess endothelial dysfunction. An impaired FMD response may reflect a vascular phenotype prone to atherosclerosis. The thickness of the common carotid intima-media (CIMT) as measured by ultrasound represents a marker of structural atherosclerosis. Recently, it has been shown that color M-mode propagation velocity measured along the origin of descending thoracic aorta (AVP) may reflect atherosclerosis. In this study, the effects of isolated hypertension on these atherosclerosis markers are investigated. Fifty patients with newly diagnosed hypertension and forty healthy people were enrolled. Patients were evaluated with transthoracic echocardiography. Diastolic functions were evaluated by transmitral filling parameters of deceleration time (DT), E/A ratio, and isovolumetric relaxation time (IVRT). Carotid intima-media thickness, FMD, and AVP were measured. Age, gender, and BMI of both groups were similar. Compared to control group CIMT, DT and IVRT values were significantly higher, and FMD and AVP values were significantly lower in hypertensive patients. There were significant correlations between AVP and CIMT (r =-0.699, P < 0.001), AVP and FMD (r = 0.400, P < 0.001), and FMD and CIMT (r =-0.600, P < 0.001). Carotid intima-media thickness, AVP, and FMD were significantly correlated with systolic and diastolic blood pressures and DT and IVRT. In patients with isolated hypertension, AVP and FMD decrease and CIMT increases. In addition, CIMT is inversely correlated with AVP and FMD, and AVP is directly correlated with FMD.

Acute effects of positive end-expiratory pressure on left ventricle diastolic function in healthy subjects

We evaluated the acute effect of the application of positive end-expiratory pressure (PEEP) on LV diastolic function in 10 healthy subjects. We assessed load dependent diastolic function by Doppler examination of transmitral flow and load independent diastolic function by color M-mode propagation velocity of early flow into the LV cavity (Vp). During the application of PEEP in comparison to the baseline, we found a significant reduction of the E wave peak velocity [79 (64-83) vs. 65 (57-72) cm/s; p = 0.028] and a significant reduction in Vp [84 (73-97) vs. 53 (48-66); p = 0.012]. Moreover, we found a significant reduction in left atrial area [15 (13-18) vs. 12 (10-14) cm(2); p = 0.018] and right atrial area [12 (11-15) vs. 11 (9-12) cm(2); p = 0.015]. No difference was found in global LV systolic function. The application of PEEP acutely modifies the diastolic flow pattern across the mitral valve, and reduces atrial dimensions.

NON-INVASIVE MEASUREMENT OF LEFT VENTRICULAR END-DIASTOLIC PRESSURE BY COLOR M-MODE ECHOCARDIOGRAPHY AND DOPPLER PRE-EJECTION FLOW WAVE VELOCITY

Background --- The pre-ejection flow wave seen on Doppler study of the left ventricular (LV) outflow tract as described in previous study and the information obtained from the color M-mode propagation velocity of the transmitral flow have been suggested as indexes of ventricular relaxation. We sought to determine the applicability of combined information obtained from LVOT pre-ejection velocity and color M-mode flow propagation velocities in estimating Left Ventricular End Diastolic Pressure (LVEDP). Method --- This is a prospective study involving seventy five patients in sinus rhythm with adequate systolic function who underwent Doppler measurement of pre-ejection wave and propagation velocity by color M-mode followed by LVEDP determination by cardiac catheterization. Validity measures were determined. A p value 0.3 accurately predicts the presence of elevated LVEDP compared with an E/Vp ratio of > 1.5. (sensitivity 87 % vs 54%, specificity of 70% vs 63%, positive predictive value of 65% vs 51%, and negative predictive value of 88% vs. 66%.

Color M‐mode propagation velocity, but not its ratio to early diastolic inflow velocity, changes throughout gestation in normal human fetuses

Color M-mode propagation velocity (Vp) is a measure of diastolic function in adults and, when combined with early diastolic inflow velocity (E), the ratio E/Vp reflects ventricular filling pressure. Early detection of diastolic compromise may benefit fetal patients at risk for developing heart failure. The objectives of this study were to measure values for Vp and inflow peak E in a group of normal fetuses, to analyze age-dependent alterations in these measurements, and to evaluate the interobserver and intraobserver variability of the measurements. Thirty-two normal fetuses at between 20 and 35 weeks' gestation underwent echocardiography. Color M-mode Vp was measured from the four-chamber view for the right (RV) and left (LV) ventricles, and mitral and tricuspid inflow velocities were determined by pulsed-wave Doppler ultrasound. The values obtained were compared with previously reported findings in adults. Adequate tracings were obtainable in 23 patients for the RV and 29 for the LV. Mean Vp values for the RV (15.3 +/- 3.2 cm/s) and LV (20.8 +/- 5.6 cm/s) were lower than normal adult values, and Vp values were significantly lower for the RV than the LV (P < 0.001). Applying Bazett's heart rate correction, values for RV (23.4 +/- 4.8 cm/s) and LV (31.9 +/- 8.7 cm/s) remained lower than normal adult values. There was a linear correlation of Vp with gestational age for the RV (R = 0.69, P < 0.001), and the ratio of E/Vp corrected for heart rate for the RV (1.51 +/- 0.26) remained constant throughout gestation. Interobserver bias was high but intraobserver bias low, at 19 and 1.1%, respectively. Vp is lower in fetal than in adult life. Vp for the RV changes in a manner indicative of improving diastolic function throughout normal gestation, providing insight into the alterations in diastolic function with gestation that contribute to increases in cardiac output. The use of Vp to assess diastolic function disturbance in fetuses is feasible, but high interobserver variability is problematic.

Évaluation des pressions de remplissage ventriculaire gauche par échocardiographie-doppler

The evaluation of left ventricular (LV) filling pressures is crucial to identify a congestive heart failure in a patient presenting with an acute respiratory failure. This evaluation traditionally relies on the invasive measurement of the pulmonary artery occlusion pressure during right heart catheterization. Echocardiography Doppler is an unparalleled alternative technique to assess LV filling pressures, which also provides anatomical and functional information on the heart and great vessels. Pulsed wave Doppler of the mitral valve and pulmonary veins provides indices that are easy to measure and allow a semi-quantitative assessment of LV filling pressures. Their accuracy increases in the presence of a LV systolic dysfunction. New Doppler indices, which assess more specifically LV diastolic properties (Doppler Tissue Imaging of the mitral ring, color M-mode propagation velocity) can be combined to traditional Doppler parameters to more precisely assess LV filling pressures. In addition, echocardiography allows a comprehensive assessment of both the left and right ventricular function, the diagnosis of an underlying cardiopathy, or the identification of an acute condition of the heart or great vessels that precipitated the acute respiratory failure. Accordingly, echocardiography Doppler is a cornerstone in the evaluation of patients presenting to the intensive care unit with a respiratory failure and a high index of suspicion of pulmonary venous congestion. This imaging modality is particularly valuable for the evaluation of patients with a medical history of chronic respiratory failure and cardiac failure, to confirm or confidently rule out a cardiogenic pulmonary edema, or to identify a cardiac source of ventilator weaning failure.

No evidence for left ventricular diastolic dysfunction in asymptomatic normotensive type 2 diabetic patients: a case-control study with new echocardiographic techniques

Objective We sought to determine whether abnormalities of left ventricular structure and function could be detected in asymptomatic type 2 diabetic patients free of cardiovascular complications. Research design and methods We compared 48 subjects with type 2 diabetes (34 men, 50 ± 6 years) without hypertension, coronary artery disease and microangiopathic complications with 30 age-matched healthy controls. Left ventricular diastolic function was assessed by conventional Doppler echocardiography and new echocardiographic techniques (tissue Doppler imaging, color M-mode propagation velocity). A pseudonormal (PN) pattern of left ventricular filling was screened by several methods including Valsalva maneuver. Results Systolic function was normal in all patients. There was no significant difference in conventional and new echocardiographic Doppler indices of diastolic function between patients and control subjects. A PN diastolic function frequently suggested by the Valsalva maneuver (20 patients) was excluded using the new parameters. Conclusions Diastolic dysfunction is not as frequent as previously described in selected patients with type 2 diabetes free of microangiopathic complications. New Doppler echocardiographic methods provide, in contrast with the Valsalva maneuver, a reliable estimate of diastolic function and should be incorporated in the non-invasive screening for diabetic cardiomyopathy.

492 LA mechanical function and LV systolic/diastolic parameters change in patients treated with ablation procedure for atrial fibrillation with no or minimal structural heart disease. A prospective 7 mont

s S77 Eur J Echocardiography Abstracts Supplement, December 2006 492 LA mechanical function and LV systolic/diastolic parameters change in patients treated with ablation procedure for atrial fibrillation with no or minimal structural heart disease. A prospective 7 mont A. Drzewiecka -Gerber 1 ; A.M. Wnuk-Wojnar 2 ; I. Wozniak-Skowerska 2 ; J. Krauze 2 ; A. Rybicka-Musialik 2 ; S. Nowak 2 ; C. Czerwinski 2 ; M. Trusz-Gluza 2 1Katowice, Poland; 2I Klinika Kardiologii, SPSK nr 7, Ziolowa 47, Katowice, Poland Background: Hemodynamics of isolated atrial fibrillation (AF) is belived to be associated with slight enlargement of left atrial (LA) size and minor degree of left ventricular (LV) diastolic dysfunction, that is presumed rather to be a result than a cause of so called „lone AF”. Positive impact of sinus rhythm restoration by catheter ablation on LA size and LV function remains unclear. Methods and results: A group of 29 consecutive patients with no or minimal structural heart disease (mean LVEF 64±5%) treated with catheter ablation according to Pappone technique were included into prospective followup study. Mean age was 47±11 yrs, 17 patients had paroxysmal and 12 persistent AF. 11 patients (37%) had mild structural disease (7 hypertension, 4 coronary artery disease). TTE was performed at baseline and after mean time of 208±73 days follow-up. Conventional parameters, such as: LVEF, left atrium end systolic area(LAs area), left atrium emptying fraction (LAEF%), left atrium filling fraction (LAFF); E/A mitral flow ratio; as well as „new” diastolic/systolic indexes such as tissue Doppler imaging peak velocity of mitral annulus motion (TDI), Tei index, tissue tracking of anterior and posterior mitral leaflet, color M-mode propagation velocity were derived at baseline and followup examination. 20 patients (68%) demonstrated no arrhythmia recurrences at follow-up (AF negative group), whereas 9 patients (32%) had AF episodes confirmed in ECG Holter monitoring. Echo baseline parameters did not differ between the groups. At follow-up examination, however, a significant LVEF improvement was observed in AF negative group versus AF positive group (68±5 versus 65±5; p=0.02); as well as significant growth in TDI peak velocity in AF negative versus AF positive group (12±2 versus 9±1 cm/s, respectively, p=0.01). Analyzing AF positive and negative group, a significant positive trend in LVEF improvement in AF negative group was observed at followup comparing to baseline (68±5% versus 65±5%, respectively, p=0.06). LAEF improved significantly in AF negative group at follow-up comparing to baseline (64±14% versus 59±10%, respectively, p=0.003) as did TDI early peak velocity (12±2 cm/s versus 10±1 cm/s, respectively, p=0.002). Propagation velocity also increased in AF negative patients (54±11 cm/s versus 46±10 cm/s, respectively, p=0.008). Conclusions: This study demonstrates , that successful restoration of sinus rhythm in patients with lone AF treated with ablation procedure results in significant improvement of LA and LV functional parameters, that can be easily measured by echocardiography.

Características de la cardiopatía hipertensiva en pacientes con hipertensión arterial no tratados previamente

Although impaired diastolic function is frequently found in systemic hypertension, the diagnosis of hypertensive heart disease (HHD) is based on the demonstration of left ventricular (LV) growth. The aim of the current work was to investigate the potential interactions between diastolic function and LV growth in patients with arterial hypertension. One hundred and sixteen never-treated asymptomatic hypertensives underwent an echocardiographic evaluation. Classification of diastolic dysfunction (DD) was based on alterations in parameters assessing transmitral inflow, Doppler tissue imaging of mitral annular motion, and color M-mode propagation velocity. Classification of LV growth was based on alterations in left ventricular mass index and/or relative will thickness. Ninety-four patients (81%) exhibited DD and 22 (19%) exhibited normal diastolic function. Amongst patients with DD, 79 (84%) exhibited a pattern of impaired relaxation and 15 (16%) a pseudonormal pattern. The presence of LV growth was documented in 41% of patients without DD and 75% of patients with DD (p < 0.05). None of the studied patients exhibited echocardiographic signs of systolic dysfunction. These findings indicate that DD is an early and highly frequent cardiac alteration in arterial hypertension. In addition, our data show that one fifth of hypertensive patients have DD in the absence of LV growth. It is thus suggested that the diagnosis of HHD can not be further based exclusively on morphologic criteria and should include also the evaluation of alterations in LV filling.

Mitral valve leaflet excursion velocity in the pediatric population: A comparable diastolic index to the color M-mode propagation velocity

Color M-mode (CMM) Doppler flow propagation velocity (Vp) is a reliable diastolic index, but may be difficult to define. We hypothesized that because the valve is opened by flow, the anterior mitral leaflet excursion velocity (MEVApex ), interrogated from the cardiac apex, may be similar to the CMM-Vp. We investigated the MEVApex by apical M-mode echocardiography in 49 children and adolescents with normal echocardiograms, and compared it with the CMM-Vp and other indices. The mean CMM-Vp and MEVApex were similar (41.5 +/- 6 vs 40 +/- 5.7, respectively, mean +/- SD; P = .5) and correlated positively ( r = 0.71, P < .0001, Bland-Altman analysis). The peak velocity of mitral inflow (E wave) divided by the Vp (E/Vp) and E/MEVApex correlated well (2.54 +/- 0.58 vs 2.52 +/- 0.58, respectively, mean +/- SD; r = 0.857, P < .001, Bland-Altman analysis). The MEVApex is comparable with the CMM-Vp and the E/MEVApex with E/Vp. The Vp may be assessed either by CMM or conventional M-mode from the apex. In our experience, the latter is easier to do. Study in other populations is warranted.

Relation of hemoglobin A 1c to left ventricular relaxation in patients with type 1 diabetes mellitus and without overt heart disease

Previous studies using Doppler and M-mode echocardiography have demonstrated that abnormalities of left ventricular (LV) diastolic relaxation are sensitive markers of early myocardial dysfunction. Tissue Doppler echocardiography and color M-mode propagation velocity (Vp) are novel noninvasive techniques that provide an estimate of LV relaxation 1–3 and are less dependent on preload. 4,5 Furthermore, mitral infl ow early fi lling (E) can be used in conjunction with tissue Doppler echocardiography early diastolic velocity (EM) and Vp to estimate LV fi lling pressures. 3,4 The present study examines whether subclinical diastolic dysfunction is found in asymptomatic type 1 diabetic patients, and evaluates the relation between diastolic dysfunction and glycemic control using novel echocardiographic techniques.  The study group included 25 type 1 diabetic patients who were compared with 26 age- and gendermatched normal volunteers. Exclusion criteria were any history of hypertension, myocardial infarction, unstable angina pectoris, or congestive heart failure. Subjects were also excluded if they had any evidence of global or regional LV dysfunction, valvular stenosis, or regurgitation, or abnormal end-diastolic or endsystolic dimensions on transthoracic echocardiography. All participants had normal electrocardiograms. The study protocol was approved by an institutional review board, and all participants provided informed consent. Participants were examined in the supine position by 2-dimensional– guided transthoracic standard pulsed, color Doppler, and tissue Doppler echocardiography using an Acuson Sequoia (Mountain View, California) echocardiographic machine equipped with tissue Doppler echocardiographic technology. Recordings were acquired with a 1.7 to 3.5 harmonic Doppler transducer. Recordings of myocardial wall velocities, transmitral Doppler fl ow, and 2-dimensional images were obtained from the apical acoustic window. M-mode and 2-dimensional echocardiographic images of the left ventricle were obtained for evaluation of ventricular septal and posterior wall