Diastolic Filling Research Articles

The Predictive Value of the Mitral Diastolic Filling Velocity Ratio for All-Cause Mortality and Cardiovascular Morbidity in African Americans: The Atherosclerotic Risk in Communities Study

The Predictive Value of the Mitral Diastolic Filling Velocity Ratio for All-Cause Mortality and Cardiovascular Morbidity in African Americans: The Atherosclerotic Risk in Communities Study

The Prevalence of Preoperative Diastolic Filling Abnormalities in Geriatric Surgical Patients

Survey of Anesthesiology: August 2004 - Volume 48 - Issue 4 - p 181 doi: 10.1097/01.sa.0000132006.17610.de

Effect of Aerobic Exercise on Left Ventricular Diastolic Filling and Arterial Compliance in Older Hypertensives

Effect of Aerobic Exercise on Left Ventricular Diastolic Filling and Arterial Compliance in Older Hypertensives

Effect of Aerobic Exercise on Left Ventricular Diastolic Filling and Arterial Compliance in Older Hypertensives

0583 Left ventricular diastolic dysfunction (LVDD) and impaired arterial compliance (IAC) may be subtle, early indices of vascular dysfunction with aging, sedentary lifestyle and hypertension. LVDD and IAC may impair exercise performance in those at risk who engage in therapeutic exercise training; while exercise testing may “unmask” LVDD and IAC among those starting such training programs and be used as a marker of risk improvement in addition to blood pressure lowering. PURPOSE: To evaluate the effect of aerobic exercise on LVDD and IAC in older hypertensive patients prior to starting and following an 8 week exercise training program. METHODS: Eight subjects participated in the study. Measures of LVDD (early filling flow velocity (E), late filling flow velocity (A), E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT)) and IAC (compliance (C) and distensibility (D) in carotid and brachial arteries) were assessed using VingMed-5 cardiac imaging system at rest before and following an 8 week exercise training program. RESULTS: LVDD indices (E, A, E/A, IVRT and DT) remained unaltered throughout the study (0.68 ± .13 vs 0.68 ± .15m/s, 0.82 ± .19 vs 0.89 ± .16m/s, 0.81 ± .24 vs 0.76 ± .05, 92.6 ± 1.0 vs 86.9 ± 7.6msec and 288.9 ± 59.6 vs 279.7 ± 75.1msec, respectively). None of IAC indices (C and D) in carotid artery changed during the exercise program (0.70 ± .12 vs 0.77 ± .08 cm2/mmHgx10−3, 0.18 ± .02 vs 0.24 ± .03 1/mmHgx10−2, respectively); however, IAC indices (C and D) in brachial artery changed significantly following the exercise program (0.20 ± .02 vs 0.29 ± .05 cm2/mmHgx10−3, 0.18 ± .02 vs 0.22 ± .02 1/mmHgx10−2, p<.05, respectively). CONCLUSION: These data suggest that in older hypertensives 8 week exercise training significantly improves the peripheral (brachial artery) artery compliance whereas no improvement in more “central” (left ventricle and carotid artery) artery compliance. Supported by A.M Anderson Award, Lawson Health Research Institute.

TGF-β1 Overexpression: A Mechanism of Diastolic Filling Dysfunction in the Aged Population

The prevalence of cardiovascular disease in the United States dramatically increases with age. A hallmark feature of the aged myocardium is increased fibrosis resulting in diastolic dysfunction. Moreover, the survival of patients subsequent to a myocardial infarction is inversely related to age because of a certain extent to maladaptive remodeling mediated by cardiac fibroblasts. Our hypothesis is that cardiac fibroblast (CF) dysfunction results in overexpressed TGF-β1 leading to increased cardiac collagen content in the aged population. TGF-β1 stimulates the synthesis of the extracellular matrix proteins, including collagen in the cardiac tissues. The RT–PCR analysis of mRNA expression of TGF-β1 of the CF was increased by 43% in the aged mice as compared to the younger. The stiffness of the left ventricle is expressed with the slope of the end-diastolic pressure-volume relationship parameter, (mmHg/L). In a mouse model, we demonstrated that was 0.30 ± 0.05 in the young as compared to 0.52 ± 0.10 in the aged (p &lt; .05). The ventricular stiffness was associated with the myocardial collagen content; namely, young versus the aged was 9.5 ± 4.0 as compared to 16.4 ± 2.3% of total protein, respectively (p &lt; .05). In conclusion, the gene structure–function relationships support our hypothesis that cardiac fibroblast disregulation contributes to diastolic filling dysfunction in elderly persons. These data provide a potential contributory mechanism for diastolic dysfunction that may be vital in caring for the aged open-heart surgical patient.

Effects of Altered Volume Loading on Left Ventricular Hemodynamics and Diastolic Filling During Hemodialysis

Background. Changes in the circulating volume associated with hemodialysis (HD) resulted in alternations of left ventricular (LV) filling. However, previous studies offered conflicting findings. This study thus evaluated the impact of HD on LV diastolic filling indices and hemodynamics. Materials and Methods. Forty patients with end‐stage renal disease were studied by Doppler echocardiography immediately before and after HD. The cardiac size, volume and mass were determined by M‐mode and two‐dimensional echocardiography. LV diastolic filling parameters and hemodynamics were assessed from mitral inflow using Doppler echocardiography. Results. Left atrial and LV dimension, LV volume, and LV mass decreased significantly after HD (p < 0.001). Cardiac output declined from 5.74 ± 1.37 to 4.98 ± 1.27 L/min (p < 0.001), whereas, the ejection fraction remained unchanged. HD elicited marked changes in the early diastolic E (95.1 ± 20.5 to 70.3 ± 18.2 cm/s, p < 0.001) and late atrial filling A velocities (104.3 ± 20.9 to 88.9 ± 16.9 cm/s, p < 0.001). In addition, correction of the deceleration time of E and isovolumic relaxation time prolonged significantly (p = 0.011 and p < 0.001, respectively). Conclusions. Findings in this study indicate that HD altering the loading condition significantly influenced the LV diastolic function and hemodynamics. Moreover, Doppler echocardiography provides an effective means of assessing the effects on LV diastolic filling and hemodynamics during HD.

Acute Effects of Diltiazem on Regional Left Ventricular Diastolic Filling Dynamics in Patients With Hypertrophic Cardiomyopathy as Assessed by Color Kinesis

The effect of calcium antagonists on regional left ventricular (LV) filling dynamics in patients with hypertrophic cardiomyopathy (HCM) is not well known, so the present study evaluated the results of echocardiography with color kinesis (CK) analysis during diltiazem infusion. Nineteen patients (16 men, 3 women; mean age 55+/-15 years) underwent echocardiography with CK analysis during intravenous diltiazem (10 mg/2 min). Using the quantitative CK software the LV short-axis image was divided into 6 segments and the percent endocardial expansion at the early, mid- and late-diastolic filling time was averaged for all segments, with the standard deviation of the mean used as an index of diastolic asynchrony (asynchrony index). The regional mean filling time was also measured for the corresponding segments. As global diastolic parameters, the global filling time, peak filling rate, and the time-to-peak filling were calculated. After the administration of diltiazem, the asynchrony index was decreased for all three diastolic filling times. Diltiazem shortened the mean filling time overall, especially in the posterior and lateral wall segments. These findings were associated with significant improvement in the CK-derived global diastolic parameters. Diltiazam has a favorable effect on LV diastolic asynchrony, which may account for the acute changes in global LV relaxation.

Effects of Lung Volume Reduction Surgery on Left Ventricular Diastolic Filling and Dimensions in Patients With Severe Emphysema

Data on the influence of lung volume reduction surgery (LVRS) on cardiac function and hemodynamics are scarce and controversial. Previous studies have focused mainly on right ventricular function and pulmonary hemodynamics. Here, we evaluated the effects of LVRS on left ventricular (LV) end-diastolic filling pattern, dimensions, stiffness, and performance, as well as pulmonary and systemic hemodynamics. A prospective, open, controlled study. Patients with severe emphysema undergoing LVRS (10 patients). Patients scheduled for pulmonary lobectomy due to carcinoma (ie, the lobectomy group) served as control subjects (10 patients). LV dimensions and mitral flow velocities were measured by transesophageal, two-dimensional, Doppler echocardiography, and central hemodynamics were measured by a pulmonary artery thermodilution catheter. Measurements were performed during anesthesia in the supine position, before and after surgery, without and with passive leg elevation. Baseline cardiac index (CI) [- 21%], stroke volume index (SVI) [- 31%], stroke work index (SWI) [- 26%], and LV end-diastolic area index (EDAI) [- 15%] were significantly (p < 0.001) lower, whereas LV end-diastolic stiffness (LVEDS) did not differ in the LVRS group compared to the lobectomy group. The time from peak early diastolic filling to zero flow (E-dec time) [58%] and the deceleration slope of early diastolic filling (E-dec slope) [45%] were significantly higher (p < 0.01), whereas peak early diastolic filling velocity (E-max) [- 31%; p < 0.01] and the proportion of E-max vs peak late diastolic filling velocity (A-max) [ie, the E/A ratio] (- 27%; p < 0.001) were significantly lower compared to the lobectomy group. LVRS significantly increased CI (40%; p < 0.001), SVI (34%; p < 0.001), SWI (58%; p < 0.001), LV EDAI (18%; p < 0.001), E-max (44%; p < 0.01), A-max (15%; p < 0.05) and E/A ratio (28%; p < 0.01), decreased E-dec time (- 31%; p < 0.05) and E-dec slope (- 98%; p < 0.01), and had no effect on LVEDS. In the lobectomy group, surgery affected none of these variables. LV function is impaired in patients with severe emphysema due to small end-diastolic dimensions. LVRS increases LV end-diastolic dimensions and filling, and improves LV function.

Left Ventricular Flow Propagation During Early Diastolic Filling in Patients With Left Bundle-Branch Bloc

PURPOSE: Color M-mode Doppler determination of left ventricular (LV) early diastolic flow (Vp) is useful in assessing LV diastolic performance. Left bundle-branch block (LBBB) is associated with impaired systolic and diastolic function as well as abnormal depolarization and repolarization. In patients with LBBB, measurements of Vp have not been well studied. The objectives of this study were to characterize Vp in patients with LBBB and to establish whether Vp is influenced by altered electrical activation of the LV or by underlying heart disease.

Sibling resemblance for left ventricular structure, contractility, and diastolic filling.

Although there is evidence that left ventricular (LV) function is genetically controlled, the contribution of familial factors to variation and covariation of LV diastolic filling, contractility, and structure is unknown. Single- and cross-trait sibling correlations were estimated using bivariate familial correlation models in 200 white (400 pairs) and 374 black (539 pairs) hypertensive sibships. LV transmitral early and late peak filling velocities, isovolumic relaxation time, atrial filling fraction, stress-corrected midwall shortening, and LV mass and structure were measured and adjusted for important covariates in race-specific linear regression models. Single-trait sibling correlation was strongest for early peak filling velocity. Significant cross-trait sibling correlation was detected between early and late peak filling velocities. In whites, early peak filling velocity and atrial filling fraction, and isovolumic relaxation time and end-diastolic posterior wall thickness, were also significantly correlated. Familial factors common to early and late peak filling velocities contributed to 64% and 54% of sibling resemblance in early peak filling velocity and to 76% and 77% in late peak filling velocity in blacks and whites, respectively. In whites, 100% of sibling resemblance in isovolumic relaxation time was shared by posterior wall thickness, whereas 75% of sibling influence in posterior wall thickness was common to isovolumic relaxation time. In conclusion, significant cross-trait sibling resemblance was detected between (1) early and late filling parameters and (2) isovolumic relaxation time and posterior wall thickness, suggesting pleiotropy and/or common environment on these traits. These data have potential importance in understanding heritability of LV diastolic function in hypertension.

Mitral ratio of peak early to late diastolic filling velocity as a predictor of mortality in middle-aged and elderly adults: the Strong Heart Study.

With aging, left ventricular filling tends to decrease in early diastole, reducing the mitral ratio of peak early to late diastolic filling velocity (E/A). However, the prognostic significance of low or high E/A in older adults remains to be elucidated in population-based samples. Doppler echocardiograms were analyzed in 3008 American Indian participants in the second Strong Heart Study examination who had no more than mild mitral or aortic regurgitation. Participants were followed for a mean of 3 years after Doppler echocardiography to assess risks of all-cause and cardiac death associated with E/A <0.6 or >1.5; 2429 (81%) participants had normal E/A ratio, 490 (16%) had E/A <0.6, and 89 (3%) had E/A >1.5. All-cause mortality was higher with E/A <0.6 or E/A >1.5 (12% and 13% versus 6%), as was cardiac mortality (4.5% and 6.5% versus 1.6%; both P<0.001). Adjusting for age, sex, body mass index, systolic blood pressure, HDL and LDL cholesterol, smoking, hypertension, diabetes, coronary heart disease, left ventricular hypertrophy, and low ejection fraction (<40%), the relative risk of all-cause death with E/A >1.5 was 1.73 (95% CI, 0.99 to 3.03; P=0.05); the relative risk of cardiac death was 2.8 (95% CI, 1.19 to 6.75; P<0.05). E/A <0.6 was not independently associated with increased all-cause or cardiac mortality (P=0.19 and 0.31, respectively) after adjusting for covariates. In a population-based sample of middle-aged and elderly adults, mitral E/A >1.5 at baseline Doppler echocardiography is associated with 2-fold increased all-cause and 3-fold increased cardiac mortality independent of covariates; mitral E/A <0.6 was also associated with 2-fold increased all-cause and cardiac mortality but not independent of covariates.

Dynamics of Left Ventricular Diastolic Filling During Exercise: A Doppler Echocardiographic Study of Boys 10 to 14 Years Old.

Dynamics of Left Ventricular Diastolic Filling During Exercise: A Doppler Echocardiographic Study of Boys 10 to 14 Years Old.

Diastolic filling and pressure imaging: taking advantage of the information in a colour M-mode Doppler image.

The ability to derive non-invasively information on left ventricular diastolic function on one hand and pressure gradients on the other hand, makes Doppler ultrasound a very attractive tool in clinical practice. However, the limitations of the standard Doppler approaches in differentiating between normal and pseudonormal filling patterns, together with the limitations of the simplified Bernoulli equation for assessing pressure gradients, are well described. In this manuscript the role of colour M-mode Doppler echocardiography as a tool that can overcome these limitations is discussed. Relevant key concepts of the haemodynamics of left ventricular filling and its relationship with colour M-mode Doppler echocardiography are introduced.

Dynamics of Left Ventricular Diastolic Filling During Exercise: A Doppler Echocardiographic Study of Boys 10 to 14 Years Old

Factors influencing diastolic filling of the left ventricle may serve as critical determinants of both maximal cardiac output and oxygen uptake. This study was conducted to assess diastolic filling dynamics of the left ventricle during progressive upright cycle exercise in children. Twelve boys aged 10 to 14 years underwent cycle testing with determination of transmitral flow velocities and pressure gradients as well as cardiac stroke volume using Doppler echocardiography. Estimated diastolic filling period shortened from 0.479 +/- 0.043 s at rest to 0.138 +/- 0.015 s at peak exercise. The peak and mean transmitral pressure gradient rose fourfold from rest to peak exercise. Mitral flow volume per beat rose by only 40% and remained stable beyond mild-to-moderate intensity work. Increases in transmitral pressure gradient with exercise may serve principally to augment velocity of ventricular filling with the progressively shortening diastolic time period.

Role of Intraventricular Dispersion of Early Diastolic Filling in Indicating Left Ventricular Diastolic Dysfunction: Assessment by Color M-Mode Inflow Propagation Velocity

The intraventricular to mitral E velocity ratio (IvE/MvE) and the color M-mode Doppler inflow propagation velocity (LVIPV) were evaluated in 36 healthy controls and 33 patients with hypertension and/or ischemic heart disease. The intraventricular E velocity was significantly lower than the mitral E velocity in the control group (52 vs. 68 cm/s, p < 0.001), but they are similar in the disease group (59 vs. 63 cm/s, p = nonsignificant). Compared with the control group, the disease group had a higher IvE/MvE (0.95 ± 0.28 vs. 0.78 ± 0.23, p < 0.01). Nevertheless, the LVIPV was not significantly different between the disease and control groups (53 ± 14 vs. 56 ± 13 cm/s, p = nonsignificant). The LVIPV did not correlate with the IvE/MvE (r = 0.202, p = nonsignificant). Therefore, an intraventricular dispersion of early diastolic filling does not seem to indicate impaired left ventricular relaxation.

Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction: Predictive Significance of Left Ventricular Diastolic Filling Pattern

Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction: Predictive Significance of Left Ventricular Diastolic Filling Pattern

Left Ventricular Diastolic Filling is Related to the Atrioventricular Plane Displacement in Patients with Coronary Artery Disease

Objective - Left atrioventricular plane displacement (AVPD) is often decreased and abnormalities in left ventricular diastolic filling are common in patients with coronary artery disease (CAD). This study was designed to assess the relationship between AVPD and diastolic filling in patients with CAD. Design

Arrhythmias: appraisal of symptoms by haemodynamic concepts

Arryhthmias can afflict any heart, even in the absence of disease. Given that Cardiac Output (CO) is a product of heart rate and stroke volume, the end-result of brady- and tachy-arrhythmias is the same: low CO with symptoms of low-output state. In bradyarrhythmias, myocardial inotropy operates maximally but the product of stroke volume and slow heart rate yields a low CO. In tacharryhthmias, myocardial inotropy is redundant because the product of low stroke volume arising from low Diastolic Filling Time (DFT) and heart rate also yields a low CO. The hallmark of extrasystole is the duplex of symptoms: dizziness followed by palpitation.

Left Ventricular Diastolic Filling and Cardiovascular Functional Capacity in Older Men

We investigated anaerobic threshold (< theta(L)) gas exchange kinetics and maximal oxygen uptake (VO2,max) among older men with reduced left ventricular end-diastolic filling (LVDF). Ten men (mean age, 73 years) with LVDF impairment and low fitness, but without other cardiovascular dysfunction were studied. Treatments compared to control included: 5 days, high intensity exercise training protocol; 5 days, calcium channel blockade (240 mg verapamil); 21 days, detraining/washout; and 5 days, combined treatments. Results indicated no changes in resting left ventricular systolic function with any treatment. Significant resting diastolic function changes included increased early:late flow velocity (control, 0.87; training, 1.28; verapamil, 1.32), and a decreased isovolumic relaxation time (control, 0.10 s; training, 0.08 s; verapamil, 0.08 s). The combined treatments were not additive. Sub-threshold oxygen uptake kinetics (tauVO2, s) were significantly faster following either training or verapamil (tauVO2,control, 62+/-12; tauVO2,training, 44+/-9; tauVO2,verapamil, 48+/-10) and combined treatments (tauVO2, 41+/- 8). V O2,max (ml kg(-1) min(-1)) was significantly increased (control, 21.8+/-2.2; training, 27.3+/-2.2; verapamil, 25.2+/-3.4; combined treatments, 26.9+/-2.3). Increasing ventricular preload with either exercise training or calcium channel blockade was coincident with faster tauVO2 and increased VO2,max.

Room A, 10/16/2000 9: 00 AM - 11: 00 AM (PS) Do Doppler Diastolic Filling Indices Differentiate among Local Anesthetic Cardiac Toxicities?

<b>Room A, 10/16/2000 9: 00 AM - 11: 00 AM (PS) Do Doppler Diastolic Filling Indices Differentiate among Local Anesthetic Cardiac Toxicities?</b>