Diastolic Mitral Flow Research Articles

0511: Intraventricular delay and cardiac dysfunction in patients with myocardial infarction

In the acute phase of myocardial infarction (AMI), ischemic phenomena may affect the strength and timing of myocardial contraction. To correlate intraventricular delays to systolic, diastolic and performance parameters of the left ventricle (LV) and to heart failure occurrence in AMI patients. A total of 372 consecutive patients (mean age: 61.6±12.4 years) who presented with an AMI were prospectively enrolled. Echocardiographic evaluation was carried out within 24-36 hours. Six basal LV segments were explored by pulsed tissue Doppler imaging (TDI) for electromechanical delays. Intraventricular mechanical delay (IMD) was then calculated from the difference between the earliest and most delayed sites. Correlations were assessed by the nonparametric Spearman rho test, and means were compared using Kruskall-Wallis and Mann-Whitney tests were used for correlations and The IMD (30.3ms±13.72ms) was not correlated to the location and extent of the AMI. The IMD was correlated to the cardiac output (Rho=-0.27, p=0.003) and to the mitral annular systolic velocity (lateral: Rho=0.18, p=0.027 and septal: Rho=-0.37, p<0.0001) but not significantly to the LV ejection fraction (Rho=-0.08, p=0.31). The IMD was also correlated to diastolic parameters: the mitral annular early diastolic velocity (E’) (Rho=-0.26, p=0.002) and the early diasolic mitral flow velocity/ late diastolic mitral flow velocity ratio (E/A) (Rho=-0.18, p=0.03). The IMD was correlated as well to the LV myocardial performance index measured by conventional Doppler (Rho=-0.29, p<0.0001) or by TDI method (Rho=-0.26, p=0.002). Patients with an IMD >42.5ms had a higher rate of in-hospital heart failure (35.0% versus 4.7%, p<0.0001) with a hazard ratio (HR) = 10.9 (95% confidence interval 3.2 to 37.2). acute dyssynchrony in patients with AMI could be a marker or a factor of cardiac dysfunction.

The Evaluation of Type 2 Diabetes Mellitus Related Changes in Diastolic Dysfunction During Exercise Using Conventional and Tissue Doppler Echocardiography.

BackgroundThe aim of this study was to evaluate the relationship between changes in diastolic functions during exercise and the exercising capacity in diabetic patients with diastolic dysfunction and to compare them with healthy individuals and diabetic patients without diastolic dysfunction.MethodsTotally 70 patients prospectively were included in the study and three groups were formed. Forty-six diabetic patients were divided into two groups: those with (group 1) and without (group 2) diastolic dysfunction. The control group (group 3) consisted of 24 patients. All patients were subjected to treadmill exercising test. Echocardiographical assessment was made before exercise and immediately after peak exercise.ResultsExercising time was dramatically decreased in group 1 compared to the other groups (group 1: 396 ± 125 second, group 2: 487 ± 66 second and group 3: 519 ± 102 second). In group 1, the diastolic mitral flow pattern at rest was transformed into pseudo-normal pattern at peak exercise from abnormal relaxation pattern (E/A ratio 0.70 ± 0.11 during rest, 1.02 ± 0.16; P < 0.0001 during peak exercise). Deceleration time (DT) and iso-volumetric relaxation time (IVRT) turned to normal values (DT 238.86 ± 39.48 millisecond during rest and 199.5 ± 23.57 millisecond during peak exercise; P = 0.001, IVRT 102.83 ± 16.22 millisecond during rest and 74.36 ± 8.67 millisecond during peak exercise; P = 0.001). In groups 2 and 3, the mitral flow pattern, DT and IVRT remained within normal limits during rest and exercise. E/Em ratio, which is one of the parameters of tissue Doppler, increased during peak exercise in the diabetic group with diastolic dysfunction (E/Em ratio 7.85 ± 3.31 during rest and 11.14 ± 3.40 after peak exercise; P < 0.0001).ConclusionsDiabetic patients with diastolic dysfunction demonstrated a reduced exercise capacity, which may be due to aggravation of pre-existing left ventricular dysfunction.

Impact of the PPARGC1A Gly482Ser polymorphism on left ventricular structural and functional abnormalities in patients with hypertension

The Gly482Ser polymorphism in the peroxisome proliferator-activated receptor gamma coactivator-1α (PPARGC1A) has been reported to contribute to the development of left ventricular (LV) hypertrophy. Little is known, however, about its possible impact on cardiac dysfunction. Enhanced myocardial fibrosis accompanying increased LV mass might represent a link with coexisting functional abnormalities. We investigated the association between the PPARGC1A Gly482Ser polymorphism and LV morphology and performance in essential hypertension, with special consideration of fibrosis intensity. A total of 205 hypertensive patients (60±8 years) underwent echocardiography with assessment of cardiac morphology, LV systolic (strain and strain rate) and diastolic function (peak early diastolic mitral flow velocity/peak late diastolic mitral flow velocity (E/A) ratio, peak early diastolic myocardial velocity (Em), and E/e' ratio (where e' is the peak early diastolic mitral annular velocity)), evaluation of serum procollagen type III amino-terminal propeptide (PIIINP) and procollagen type I carboxy-terminal propeptide (PICP)-markers of fibrosis and the PPARGC1A Gly482Ser genotyping. Subjects with the Ser-Ser genotype demonstrated more profound LV hypertrophy and diastolic function impairment, and higher PICP/PIIINP than the Ser-Gly and Gly-Gly groups. In multivariable analysis, the presence of the Ser-Ser allele was an independent correlate of E/e' (β=0.17, P<0.02), Em (β=-0.18, P<0.01) and LV mass index (β=0.28, P<0.001). In conclusion, in hypertensive patients, the PPARGC1A Gly482Ser polymorphism is associated with LV hypertrophy and diastolic dysfunction, with the presence of the Ser-Ser allele promoting these abnormalities. One of the possible mechanisms mediating the adverse effect on diastolic performance might be a relative increase in the anabolism of rigid collagen type I over that of the more elastic collagen type III, as indicated by an increased ratio of PICP to PIIINP.

Diastolic Echocardiographic Parameters in Predicting Outcome of Radiofrequency Catheter Ablation of Atrial Fibrillation

Aims: Due to frequent relapses after initial ablation, there is need to develop accurate and practical preoperative means to predict atrial fibrillation (AF) ablation outcome. Methods: We evaluated the power of diastolic echocardiographic parameters in predicting the outcome of AF ablation. Forty-nine patients with symptomatic and drug-resistant paroxysmal or persistent AF, who underwent wide circumferential pulmonary vein isolation, were included in the study. Clinical and echocardiographic (e.g., left atrial size, left ventricular size and ejection fraction and several diastolic parameters) data were collected prospectively. Results: After single ablation procedure, 18 patients (37%) were free of AF without antiarrhythmic medication (group 1), whereas 31patients had symptomatic or asymptomatic AF relapses or needed antiarrhythmic medication (group 2) during the 12 months follow-up period. There was no difference in age (52±8 vs 54± 8years), body mass index (26 ± 4 vs 28 ± 4), comorbidity and procedural factors between the groups, but history of cardioversion was more common in group 2 (73% vs 39%, P = 0.032). In multivariate analysis, elevated ratio of early diastolic mitral flow velocity and mitral annular early diastolic velocity (E/e' ratio) was the most powerful predictor of AF recurrence (OR 1.911; 95% CI 1.046-3.493, P=0.035). Conclusions: In our study, diastolic dysfunction measured by E/e' ratio was an independent predictor of AF recurrence after ablation. As a non-invasive and readily available measurement, the E/eratio may help to identify the patients in risk for treatment failure and to refine treatment strategy.

The effect of nondipping pattern on left ventricular diastolic function in hypertensive diabetic patients

Purpose: Both hypertension and diabetes are associated with the heart failure with preserved systolic function. The lack of dropping in night-time blood pressure (BP) of 10% or more (nondipping) is more closely associated with target organ damage. The aim of this study was to explore the effect of nondipping status on left ventricular (LV) diastolic function of hypertensive and diabetic patients. Methods: One hundred and twenty-three hypertensive and diabetic patients (mean age:58±9 years, 37 male) were included. All patients underwent transthoracic echocardiography to determine LV diastolic function and ambulatory BP monitoring. When the difference between diurnal and nocturnal cusum of systolic BP was <10% of diurnal systolic BP, the patient was classified as nondipper. Results: Seventy-seven patients were found as nondippers. The characteristics and echocardiographic parameters are presented in Table 1. While the left atrial volume index and LV mass index were significantly higher in nondippers, they had lower mitral E velocity, mitral E/A ratio, lateral early diastolic mitral annulus velocity (lateral e') and mitral flow propagation velocity (Vp) compared to dippers. Logistic regression analysis revealed that LA volume index was the only independent predictor of the nondipping pattern in our cohort (p=0.008, OR: 1.12, 95% confidence interval: 1.03-1.22). View this table: Table 1 Conclusion: Nondipping status is associated with impaired LV diastolic function in hypertensive diabetic patients and may facilitate the development of heart failure with preserved systolic function in these patients.

Complex use of trimetazidine in postmenopausal hypertensive women with moderate heart failure

Purpose: The objective of this study - comparative assessment of influence of combination of drugs with antihypertensive and metabolic activity on dynamics of structural and functional parameters of left ventricle (LV) remodeling in postmenopausal women with arterial hypertension (AH) and moderate heart failure. Metods: 86 women (age 46-64 years) with blood pressure (BP) >160/100 mm Hg and moderate heart failure (NYHA II-III class) were studied. The patients were divided into 2 groups by 43 in each. Patients of I group received zofenopril 30 mg, amlodipine 5 mg, patients of II group- zofenopril and amlodipine in the same doses plus trimetazidine 70 mg/daily. The echocardiography and Doppler-echocardiography were performed to all of them at baseline and after 12 months of treatment. End systolic volume (ESV), ejection fraction (EF), early diastolic mitral flow velocity/ atrial induced velocity ratio (E/A ratio), isovolumetric relaxation time (IVRT) and blood flow deceleration time (DT) were determined. Results: At the end of the study all patients achieved the goal level of BP<140/90 mm Hg. Regression of LV hypertrophy was observed not in all patients: in 35 patients of I group (81,4%) and 38 patients of II group (88,4%). Moreover decrease of ESV and elevation of EF were observed in both groups, but these changes were more expressed in patients of II group. In II group ESV decreased from 53,6±2,8 ml to 44,1±1.7 ml (p<0,05), in I group: from 52,3±2,4 ml to 45,0±2,1 ml (p<0,05). The elevation of EF in II group (from 40,2±2,8% to 45,8±3,0%) and I group (from 42,1±2,3% to 50,0±2,4%) was statistically non significant in both groups (p<0,05). The improvement of diastolic function was observed in both groups, but the changes were more expressed in patients of II group. E/A ratio increased in patients of II group from 0,95±0,04 to 1,21±0,06 (p<0,05) and from 0,94±0,04 to 1,10±0,03 (p<0.05) – in I group. In patients of II group IVRT decreased from 120,3±6,6 msec to 94,1±4,8 msec (p<0.05), in I group- from 120,8±4,4 msec to 102,2±4,5 msec (p<0,05), at the same time in II group DT decreased from 176,1±11,3 msec to 140,4±10,1 msec (p<0,05). The same index decreased from 174,3±8,8 msec to 150,4±7,1 msec in patients of I group (p<0,05). Conclusion: Results of the study confirm that the hypotensive effect of a combination of an ACE inhibitor (zofenopril) and a calcium antagonist (amlodipine) is followed by regression of left ventricular hypertrophy and improve diastolic function. Adding of trimetazidine to the basic treatment showed a significant improvement in LV diastolic function.

Effect of If-Channel Inhibition on Hemodynamic Status and Exercise Tolerance in Heart Failure With Preserved Ejection Fraction: A Randomized Trial

The aim of this study was to test the effects of treatment with ivabradine on exercise capacity and left ventricular filling in patients with heart failure with preserved ejection fraction (HFpEF). Because symptoms of HFpEF are typically exertional, optimization of diastolic filling time by controlling heart rate may delay the onset of symptoms. Sixty-one patients with HFpEF were randomly assigned to ivabradine 5 mg twice daily (n = 30) or placebo (n = 31) for 7 days in this double-blind trial. Cardiopulmonary exercise testing with echocardiographic assessment of myocardial function and left ventricular filling were undertaken at rest and after exercise. The ivabradine group demonstrated significant improvement between baseline and follow-up exercise capacity (4.2 ± 1.8 METs vs. 5.7 ± 1.9 METs, p = 0.001) and peak oxygen uptake (14.0 ± 6.1 ml/min/kg vs. 17.0 ± 3.3 ml/min/kg, p = 0.001), with simultaneous reduction in exercise-induced increase in the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity (3.1 ± 2.7 vs. 1.3 ± 2.0, p = 0.004). Work load-corrected chronotropic response (the difference in heart rate at the same exercise time at the baseline and follow-up tests) showed a slower increase in heart rate during exercise than in the placebo-treated group. Therapy with ivabradine (β = 0.34, p = 0.04) and change with treatment in exertional increase in the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity (β = -0.30, p = 0.02) were independent correlates of increase in exercise capacity, and therapy with ivabradine (β = 0.32, p = 0.007) was independently correlated with increase in peak oxygen uptake. In patients with HFpEF, short-term treatment with ivabradine increased exercise capacity, with a contribution from improved left ventricular filling pressure response to exercise as reflected by the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity. Because this patient population is symptomatic on exertion, therapeutic treatments targeting abnormal exercise hemodynamic status may prove useful. (Use of Exercise and Medical Therapies to Improve Cardiac Function Among Patients With Exertional Shortness of Breath Due to Lung Congestion; ACTRN12610001087044).

Relationship Between Augmentation Index and Left Ventricular Diastolic Function in Healthy Women and Men

The aim of this study was to investigate the effect of sex on the correlation between arterial stiffness and left ventricular (LV) diastolic function in a healthy population without significant atherosclerosis. Subjects (n = 446) who had simultaneous echocardiography and arterial stiffness recordings were enrolled. From these subjects, 95 men and 72 age-matched women without atherosclerotic risk factors (hypertension, dyslipidemia, and diabetes mellitus) were included in the analysis. We measured brachial-ankle pulse wave velocity (baPWV) and carotid augmentation index (AIx) as arterial stiffness parameters. Peak early diastolic mitral annular velocity (e') was significantly correlated with baPWV (men: r = -0.428, P < 0.001; women: r = -0.515, P < 0.001) and carotid AIx (men: r = -0.295, P = 0.004; women: r = -0.558, P < 0.001). The ratio of early diastolic mitral flow velocity to e' (E/e') was significantly correlated with both arterial stiffness parameters in women but not men. Multivariable regression analysis revealed carotid AIx (β = -0.257; P = 0.02) was a significant independent predictor of e' in women but not men. These results suggest that the correlation between AIx and LV diastolic function is stronger in women than men in a healthy population.

Left Atrial Responses to Acute Right Ventricular Apical Pacing in Patients with Sick Sinus Syndrome

Chronic right ventricular apical (RVA) pacing can lead to an increased risk of heart failure and atrial fibrillation, but the acute effects of RVA pacing on left atrial (LA) function are not well known. Twenty-four patients with sick sinus syndrome and intact intrinsic atrioventricular conduction were included. All patients received dual-chamber pacemaker implants with the atrial lead in the right atrial appendage and the ventricular lead in the right ventricular (RV) apex. Transthoracic standard and strain echocardiography (measured by tissue Doppler imaging and speckle tracking image) were performed to identify functional changes in the left ventricle (LV) and LA before and after 1hour of RVA pacing. The LA volume index did not change after pacing; however, the ratio of peak early diastolic mitral flow velocity (E) to peak early diastolic mitral annular velocity (Ea) was significantly increased and peak systolic LA strain (Sm), mean peak systolic LA strain rate (SmSR), peak early diastolic LA strain rate (EmSR), and peak late diastolic LA strain rate (AmSR) were significantly reduced after RV pacing. LV dyssynchrony, induced by RV pacing, had a significant correlation with E/Ea, Sm, and SmSR after pacing. E/Ea also had a negative correlation with Sm and SmSR after pacing. Multivariate regression analysis identified LV dyssynchrony and E/Ea as important factors that affect Sm, SmSR, EmSR, and AmSR after acute RVA pacing. Acute RVA pacing results in LA functional change and LV dyssynchrony and higher LV filling pressures reflected by E/Ea are important causes of LA dysfunction after acute RVA pacing.

Influencing factors on cardiac structure and function beyond glycemic control in patients with type 2 diabetes mellitus

BackgroundWe hypothesized that clinical factors other than glycemic control may influence abnormal cardiac function in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the independent factors for abnormal cardiac function among clinical factors in T2DM.MethodsWe studied 148 asymptomatic patients with T2DM without overt heart disease. Echocardiographic findings were compared between diabetic patients and 68 age-matched healthy subjects. Early (E) and late (A) diastolic mitral flow velocity and early diastolic mitral annular velocity (e’) were measured for assessing left ventricular (LV) diastolic function. We evaluated insulin resistance, non-esterified fatty acid, high-sensitive CRP, estimated glomerular filtration rate, waist/hip ratio, abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and other clinical characteristics in addition to glycemic control. VAT and SAT were quantified by computed tomography.ResultsIn T2DM, E/A and e’ were significantly lower, and E/e’, left atrial volume and LV mass were significantly greater than in control subjects. In multivariate liner regression analysis, VAT was an independent determinant of left atrial volume (β =0.203, p=0.011), E/A (β =−0.208, p=0.002), e’ (β =−0.354, p<0.001) and E/e’ (β=0.220, p=0.003). Age was also an independent determinant, whereas fasting plasma glucose and hemoglobin A1c levels were not. In addition to systolic blood pressure, waist-hip ratio (β=0.173, p=0.024) and VAT/SAT ratio (β=0.162, p=0.049) were independent determinants of LV mass.ConclusionExcessive visceral fat accompanied by adipocyte dysfunction may play a greater role than glycemic control in the development of diastolic dysfunction and LV hypertrophy in T2DM.

The Role of Matrix Metalloproteinases 2 and 9 in Vascular and Ventricular Remodelling in Patients with Heart Failure with Preserved Ejection Fraction

Imbalance of activation and inhibition of matrix metalloproteinases (MMPs) lead to an increase in their activity and the occurrence of pathological changes in the vascular wall. The purpose of this paper is to determine the role of MMP-2 and MMP-9 in vascular and ventricular remodelling in patients with heart failure with preserved ejection fraction. The patients were divided into three groups: 15 patients with heart failure with preserved ejection fraction (HFpEF), 72.73 ± 10.44 years old; 15 patients with arterial hypertension (AH), 63.73±7.06 years old; 10 healthy controls, 58.7± 5.87 years old. Arterial stiffness was assessed by pulse wave velocity (PWV). Diastolic dysfunction was assessed by the ratio of early diastolic mitral flow velocity and early diastolic myocardial velocity (E/Em ratio). Left ventricular mass was calculated by area-length method and indexed to body surface area (LVMI). MMP-2, MMP-9 and Brain Natriuretic Peptide (BNP) were measured by ELISA technique. MMP-2 was higher in patients with HFpEF and AH versus controls (13987±4464 ng/ml and 13040±5060 ng/ml vs 9260±4135 ng/ml, p = 0.047). MMP-9 was similar across the groups. BNP was higher in HFpEF versus AH and controls (775.33±443.59pg/ml vs 370.00±158.29 pg/ml and 345.00±94.39 pg/ml, p = 0.002). In HFpEF patients, PWV (12.04±2.46 m/s vs 10.06±1.94 m/s vs 7.22±1.19 m/s, p < 0.0001), LVMI (134.11±29.40g/m 2 vs 122.45±23.73 Elisa kits for MMP-2, MMP-9 and BNP were purchased with funds from project “Young researcher” No 4D/2011 of the Medical University of Sofia.

Relation Between RR Intervals and Early Diastolic Mitral Annular Velocities in Atrial Fibrillation

Background and ObjectivesIrregular RR intervals in atrial fibrillation (AF) make beat-to-beat changes in left ventricular (LV) systolic performance. Early diastolic mitral annular velocity (E') is one of the well-established parameters for evaluating LV diastolic function. The relation between RR intervals and E's is unknown. The aim of this study was to observe the influence of continuous changes in RR interval on the parameter for diastolic function in AF.Subjects and MethodsEchocardiography was performed in 117 patients with AF. E' was adjusted for the effect of pre-preceding RR interval (RR-2) using the logarithmic equation between RR-2 and E'. The logarithmic equation between adjusted E' and preceding RR interval (RR-1) was calculated.ResultsThe slope in the relation between RR-1 and E' varied from -2.5 to 2.6. The slope was lower (more likely negative) in patients with higher ratio of early diastolic mitral flow velocity (E) to E' (r=-0.21, p=0.023), ischemic heart disease (IHD, r=0.21, p=0.026), and higher systolic blood pressure (r=-0.19, p=0.046). When patients were divided into these 3 groups on the basis of slope, the lowest slope group (<-0.55, n=39) was associated with higher E'/E (p=0.004) and IHD (p=0.018) compared with the highest slope group (>0.57, n=39). The slope with regards to the relationship between RR-2 and E' also varied from -3.4 to 3.1.ConclusionChanges in RR intervals had variable effects on E's according to clinical variables in AF.

Effect of Food Intake on Commonly Used Pulsed Doppler and Tissue Doppler Measurements

This study evaluates the effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. A wide selection of pulsed Doppler and tissue Doppler variables were measured before a standardized meal as well as and 30 and 110 minutes afterwards. The following variables increased significantly (P < 0.05) 30 minutes after food intake: left ventricular stroke volume, left ventricular cardiac output, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, pulmonary vein peak velocities in systole (S) and in diastole (D), S/D, pulsed tissue Doppler peak systolic velocities, and late diastolic velocities. Deceleration time of E-wave decreased significantly (P < 0.05). The change in measured variables between fasting and 30 minutes after the food intake ranged from 7% to 28%. There were no significant (P > 0.05) changes in E/A, early diastolic tissue Doppler velocities (e'), and E/e'. Most, but not all variables returned to baseline values 110 minutes after food intake. This study shows that food intake affects several echocardiographic variables used to routinely assess diastolic function and hemodynamics. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible in such populations.

Measurement of Phase-Contrast MRI mitral flow and lateral wall motion for Assessment of Diastolic Function in a Normal Collective

In approx. 50% of cases, heart failure is caused by an isolated diastolic dysfunction (DD) in the presence of a preserved systolic function but with comparably devastating outcome. Among others, echocardiography (EC) categorized DD mainly according to early (E-wave) and late (A-wave) diastolic mitral blood flow (MBF) as well as tissue-doppler imaging (TDI) showing characteristic S`-E`-A` lateral wall velocity patterns. Cardiovascular magnetic resonance (CMR) has excellent capabilities to assess blood flow and myocardial tissue motion using phase contrast (PC-CMR) imaging but has not been used to quantify DD similar to the EC approach.

Mri assessment of diastolic dysfunction using the echocardiographic criteria of diastolic mitral blood flow, lateral wall motion velocity and pulmonary vein flow

In echocardiography (EC), classification of diastolic dysfunction (DD) is widely accepted and mainly assessed using three criteria (figure1): mitral blood flow (MBF, E-A-curve), lateral wall velocity (LWV, S-E`-A`-curve) and pulmonary vein flow (PVF, S-D-AR-curve). With these three characteristic flow and velocity patterns and their ratios E/A, E/E´ and S/D, regular diastolic function can be clearly distinguished from three degrees of DD (I-III°). Cardiovascular magnetic resonance (CMR) has excellent capabilities to assess blood flow and myocardial tissue motion using phase contrast (PC-CMR) imaging but has not been used to classify diastolic function similar to the EC approach.

Echocardiographic Estimation of Left Atrial Pressure in Beagle Dogs with Experimentally-Induced Mitral Valve Regurgitation

Non-invasive and immediate estimation of left atrial pressure (LAP) is very useful for the management of mitral regurgitation (MR), and many reports have assessed echocardiographic estimations of LAP to date. However, it has been unclear of which examination and evaluate article possess the best accuracy for the MR severity. The present research aims to establish the echocardiographic estimation equation of LAP that is well applicable for clinical MR dogs. After the chordae tendineae rupture was experimentally induced via left atriotomy in six healthy beagle dogs (three males and three females, two years old, weighing between 9.8 to 12.8 kg), a radio telemetry transmitter catheter was inserted, which allows the continuous recordings of LAP without the use of sedation. Approximately 5 weeks after the surgery, echocardiographic examination, indirect blood pressure measurement, measurement of plasma atrial natriuretic peptide (ANP) and LAP measurement by way of the radio telemetry system was performed simultaneously. Subsequently, simple linear regression equations between LAP and each variable were obtained, and the equations were evaluated whether to be applicable for clinical MR dogs. As a result, the ratio of early diastolic mitral flow to early diastolic lateral mitral annulus velocity (E/Ea) had the strongest correlation as maximum LAP=7.03*(E/Ea)-54.86 (r=0.74), and as mean LAP=4.94*(E/Ea)-40.37 (r=0.70) among the all variables. Therefore, these two equations associated with E/Ea should bring more precise and instant estimations of maximum and mean LAP in clinical MR dogs.

Right Ventricular Diastolic Function in Dialysis Patients Could Be Affected by Vascular Access

Tricuspid annular plane excursion (TAPSE) measurement in echocardiography is a measure of heart diastolic distensibility: a low TAPSE indicates reduced ventricular distensibility leading to diastolic dysfunction. It is a good prognostic index for cardiac mortality risk in congestive heart failure patients, adding significant prognostic information to the NYHA clinical classification. Our study was designed to evaluate the effect of a single hemodialysis (HD) session on diastolic function and TAPSE, focusing on the effects of vascular access typology. Twenty chronically uremic patients (age 51 ± 10 years, dialytic age 24 ± 8 months), without overt heart disease, underwent conventional two-dimensional and Doppler echocardiography immediately before starting and 15 min after ending a mid-week HD session. Ten patients had distal radiocephalic arterovenous fistula (AVF), and 10 had permanent central venous catheters (CVC). The amount of fluid removed by HD was 2,706 ± 1,047 g/session. HD led to a reduction in TAPSE, left ventricle end-diastole volume, left ventricle end-systole volume, right ventricle end-diastole diameter, peak early transmitral flow velocity, and the ratio of early to late Doppler velocities of diastolic mitral flow. AVF patients showed greater right ventricle diameters versus CVC patients, while TAPSE appeared higher in the latter. Only the AVF patient group showed TAPSE values <15 mm. Our data confirm the effects of terminal uremia on right ventricle function (chamber dilation, impaired diastolic function), showing that these abnormalities are more frequent in AVF patients as opposed to CVC patients. It is reasonable to explain these clinical features as the effect of preload increase operated by AVF.

THE IMPACT OF METABOLIC SYNDROME ON LEFT VENTRICULAR DIASTOLIC FUNCTION: DOES GENDER INFLUENCE?: PP.22.395

Objective: The metabolic syndrome (MS) represents a cluster of cardiovascular risk factors which act synergistically. The aim of this study was to estimate the influence of gender, if any, on the relationship between MS and left ventricular (LV) diastolic function. Method: The study included 175 subjects with MS (57% women) and 89 controls (60% women) adjusted by age. MS was defined by the presence of three or more of ATP-NCEP III criteria. All subjects underwent 24-hours ambulatory blood pressure monitoring, laboratory blood tests, and complete two-dimensional, pulse and tissue Doppler echocardiography. We determinated the ratio of early and late diastolic mitral flow velocities (E/A) and the ratio of early diastolic transmitral and septal area of the mitral annulus flow velocity (E/E□L). Results: Women without the MS had a 27% greater E/A compared with those in MS group (0.74 ± 0.22 vs. 1.02 ± 0.2, p < 0.001), whereas the difference was only 15% in men (0.88 ± 0.19 vs. 1.03 ± 0.21, p < 0.001). The E/E□L ratio was higher in women with MS for 45% (11.73 ± 3.64 vs. 6.4 ± 2.45, p < 0.001) and 26% in men (8.82 ± 2.78 vs. 6.5 ± 2.37, p < 0.001). A greater prevalence of LV diastolic dysfunction was found in women with the MS compared with men in MS group (43% vs. 21%, p = 0.008). Multiple logistic regression revealed that the MS was independently associated with a greater prevalence of LV diastolic dysfunction in women (fÀ = 0.38, p < 0.001) but not in men. Conclusions: MS has a different impact on LV diastolic function in men and women. The effect of MS is more pronounced in women.

Left ventricular diastolic function in hypertensive patients with different geometric patterns of left ventricle

Objective The aim of this study was to evaluate diastolic function of left ventricle in hypertensive patients with different geometric patterns of left ventricle. Design and method The study included 88 hypertensive patients (mean age 52±8 years) and 45 healthy persons (mean age 51±7 years). The endsystolic and enddiastolic left ventricle dimensions, thickness of interventricular septum (IVS) and left ventricle posterior wall (PWT) were measured in all subjects by using two-dimensional echocardiography. The ratio of early and late diastolic transmitral flow velocities (E/A) was assessed by Doppler echocardiography and the ratio of early diastolic mitral flow velocity was achieved by pulsed-wave Doppler and tissue Doppler (E/Ea) in all subjects. Left ventricle mass index (LVMI) was calculated for all subjects. According to the value of relative wall thickness (RWT) and LVMI hypertensive patients were subdivided into four groups: normal (N) 30 (34%), concentric remodeling (CR) 28 (31.8%), concentric hypertrophy (CH) 20 (22.7%) and eccentric hypertrophy (EH) 10 (11.4%) patients. Results The E/A ratio gradually decreased in hypertensive patients from N to EH group (N, 1.1±0.13; CR, 1.01±0.14; CH, 0.88±0.15; EH, 0.85±0.14), and it was lower comparing it with control group (1.24±0.19), (p<0.01 for all). The E/Ea ratio was higher in all hypertensive groups (N, 9.43±1.72; CR, 10.09±2.86; CH, 14.85±3.76; EH, 11.66±3.03) compared with the controls (6.58±1.12), (p<0.01 for all). In CH group the E/Ea ratio was higher than in N, CR and EH groups (p<0.01, p<0.01, p=0.02, respectively). The E/Ea ratio in hypertensive group was correlated with LVMI (r=0.29, p<0.01), RWT (r=0.21, p=0.032) and IVS (r=0.31, p<0.01). Conclusion Left ventricular diastolic function is impaired in all hypertensive patients. The degree of geometric pattern diastolic cardiac function damage is the most obvious in concentric hypertrophy left ventricle geometric pattern. Objective The aim of this study was to evaluate diastolic function of left ventricle in hypertensive patients with different geometric patterns of left ventricle. Design and method The study included 88 hypertensive patients (mean age 52±8 years) and 45 healthy persons (mean age 51±7 years). The endsystolic and enddiastolic left ventricle dimensions, thickness of interventricular septum (IVS) and left ventricle posterior wall (PWT) were measured in all subjects by using two-dimensional echocardiography. The ratio of early and late diastolic transmitral flow velocities (E/A) was assessed by Doppler echocardiography and the ratio of early diastolic mitral flow velocity was achieved by pulsed-wave Doppler and tissue Doppler (E/Ea) in all subjects. Left ventricle mass index (LVMI) was calculated for all subjects. According to the value of relative wall thickness (RWT) and LVMI hypertensive patients were subdivided into four groups: normal (N) 30 (34%), concentric remodeling (CR) 28 (31.8%), concentric hypertrophy (CH) 20 (22.7%) and eccentric hypertrophy (EH) 10 (11.4%) patients. Results The E/A ratio gradually decreased in hypertensive patients from N to EH group (N, 1.1±0.13; CR, 1.01±0.14; CH, 0.88±0.15; EH, 0.85±0.14), and it was lower comparing it with control group (1.24±0.19), (p<0.01 for all). The E/Ea ratio was higher in all hypertensive groups (N, 9.43±1.72; CR, 10.09±2.86; CH, 14.85±3.76; EH, 11.66±3.03) compared with the controls (6.58±1.12), (p<0.01 for all). In CH group the E/Ea ratio was higher than in N, CR and EH groups (p<0.01, p<0.01, p=0.02, respectively). The E/Ea ratio in hypertensive group was correlated with LVMI (r=0.29, p<0.01), RWT (r=0.21, p=0.032) and IVS (r=0.31, p<0.01). Conclusion Left ventricular diastolic function is impaired in all hypertensive patients. The degree of geometric pattern diastolic cardiac function damage is the most obvious in concentric hypertrophy left ventricle geometric pattern.

Non-invasive assessment of left ventricular relaxation during atrial fibrillation using mitral flow propagation velocity

To elucidate the usefulness of the early diastolic mitral flow propagation velocity (V(p)) obtained from colour M-mode Doppler for non-invasively assessing left-ventricular (LV) relaxation during atrial fibrillation (AF). Ten healthy adult dogs were studied to correlate V(p) with the invasive minimum value of the first derivative of LV pressure decay (dP/dt(min)) and the time constant of isovolumic LV pressure decay (tau) at baseline, during rapid and slow AF, and during AF after inducing myocardial infarction. There were significant positive and negative curvilinear relationships between V(p) and dP/dt(min) and tau, respectively, during rapid AF. After slowing the ventricular rate, the average value of V(p) increased, while dP/dt(min) increased and tau decreased. After inducing myocardial infarction, the average value of V(p) decreased, while dP/dt(min) decreased and tau increased. The non-invasively obtained V(p) evaluates LV relaxation even during AF regardless of ventricular rhythm or the presence of pathological changes.