Doppler-derived Indices Of Diastolic Function Research Articles

Acute hemodialysis effects on doppler echocardiographic indices.

Conventional echocardiographic (ECHO) parameters of systolic and diastolic function of the left ventricular (LV) have been shown to be load dependent. However, the impact of pre-load reduction on tissue Doppler (TD) parameters of LV function is incompletely understood. To evaluate the effect of a single hemodialysis (HD) session on LV systolic and diastolic function using pulsed Doppler echocardiography and pulsed tissue Doppler imaging (TDI), we studied 81 chronic HD patients (40 males; mean age 52.4 ± 16.4 years) with these tools. ECHO parameters were obtained 30 min before and 30 min after HD. Fluid volume removed by HD was 1640 ± 730 cm³. HD led to reduction in LV end-diastolic volume (P <0.001), end-systolic volume (P <0.001), left atrium area (P <0.001), peak early (E-wave) trans-mitral flow velocity (P <0.001), the ratio of early to late Doppler velocities of diastolic mitral inflow (P <0.001) and aortic time velocity integral (P <0.001). No significant change in peak S velocity of pulmonary vein flow after HD was noted. Early and late diastolic (E') TDI velocities and the ratio of early to late TDI diastolic velocities (E'/A') on the lateral side of the mitral annulus decreased significantly after HD (P = 0.013; P = 0.007 and P = 0.008, respectively). Velocity of flow progression (Vp) during diastole was not affected by pre-load reduction. Pulmonary artery systolic pressure and the diameter of the inferior vena cava decreased significantly (P <0.001 and P <0.001, respectively) after HD. We conclude that most of the Doppler-derived indices of diastolic function are pre-load-dependent and velocity of flow progression was minimally affected by pre-load reduction in HD patients.

125: Haemodialysis: effects of acute decrease in preload on echocardiographic indices of systolic and diastolic function of the left ventricle in chronically uremic patients

Conventional echocardiographic (ECHO) parameters of left ventricular (LV) systolic and diastolic function have been shown to be load-dependent; however, the impact of preload reduction on tissue Doppler (TD) parameters of LV function is incompletely understood. The aim of this study was to evaluate the effect of a single hemodialysis (HD) session on left ventricular systolic and diastolic function using conventional pulsed-Doppler echocardiography and pulsed tissue Doppler imaging (TDI) in hemodialysis patients. Eighty-one chronically uremic patients (40 males; aged 52,43±16,35 years) on maintenance hemodialysis underwent conventional 2D and Doppler Echo together with measurement of longitudinal mitral annular motion velocities. Echocardiographic parameters were obtained 30 minutes before and 30 minutes after HD. Paired data were compared. Fluid volume removed by HD was 1640 ±730 cm3. Hemodialysis led to reduction in LV end-diastolic volume (p<0,001), end-systolic volume (p<0,001), left atrium area (p<0,001), peak early (E wave) transmitral flow velocity (p <0,001), the ratio of early to late Doppler velocities of diastolic mitral inflow (p <0,001) and aortic time velocity integral (p<0.001). No significant change in peak S velocity of pulmonary vein flow after HD. Early and late diastolic (Ea) TDI velocities and the ratio of early to late TDI diastolic velocities (Ea/Aa) on the lateral side of the mitral annulus decreased significantly after HD (p=0,013; p=0,007 and p=0,008; respectively). Velocity of flow progression (Vp) during diastole was not affected by preload reduction. Pulmonary artery systolic pressure and the diameter of the inferior vena cava decreased significantly (p <0,001and p <0,001; respectively) after HD. Most of Doppler-derived indices of diastolic function are preload-dependant. Velocity of flow progression was not or minimally affected by preload reduction in hemodialysis patients.

Postnatal Left Ventricular Diastolic Function After Fetal Aortic Valvuloplasty

Fetal aortic balloon valvuloplasty (FAV) has shown promise in altering in utero progression of aortic stenosis to hypoplastic left heart syndrome. In patients who achieve a biventricular circulation after FAV, left ventricular (LV) compliance may be impaired. Echocardiographic indexes of diastolic function were compared between patients with biventricular circulation after FAV, congenital aortic stenosis (AS), and age-matched controls. In the neonatal period, patients with FAV had similar LV, aortic, and mitral valve dimensions but more evidence of endocardial fibroelastosis than patients with AS. Patients with FAV underwent more postnatal cardiac interventions than patients with AS (p = 0.007). Mitral annular early diastolic tissue velocity (E') was lower in patients with FAV and those with AS and controls in the neonatal period and over follow-up (p <0.001). Septal E' was similar among all 3 groups in the neonatal period. In follow-up patients, with FAV had lower septal E' than patients with AS or controls (p <0.001). Early mitral inflow velocity/E' was higher in patients with FAV as neonates and at follow-up (p <0.001). Mitral inflow pulse-wave Doppler-derived indexes of diastolic function were similar between groups. In conclusion, echocardiographic evidence of LV diastolic dysfunction is common in patients with biventricular circulation after FAV and persists in short-term follow-up. LV diastolic dysfunction in this unique population may have important implications on long-term risk of left atrial and subsequent pulmonary hypertension.

Effets de la réduction de la précharge sur les paramètres échographiques de la fonction systolique et diastolique du ventricule gauche de l’enfant en insuffisance rénale terminale : étude comparative avant et après hémodialyse

Purpose Contrasting data exist about the hemodialysis induced changes of ventricular diastolic and systolic functions in adults. Few data in children with end-stage renal disease (ESRD) are reported. The aim of the present study was to evaluate the effect of a single hemodialysis (HD) session on left ventricular (LV) systolic and diastolic function using conventional pulsed-Doppler echocardiography and pulsed tissue Doppler imaging (TDI) in hemodialysis children. Methods Thirty-five children with chronic renal failure (15 males, aged 12.8 ± 3.8 years) on maintenance hemodialysis underwent conventional 2D and Doppler Echo together with measurement of longitudinal mitral annular motion velocities. Echocardiographic parameters were obtained 30 minutes before and 30 minutes after HD. Paired data were compared. Results Hemodialysis led to reduction in LV end-diastolic volume ( p = 0.001), end-systolic volume ( p = 0.05), left atrium area ( p < 0.0001), peak early (E wave) transmitral flow velocity ( p = 0.005), peak S velocity of pulmonary vein flow ( p = 0.002), aortic time velocity integral ( p < 0.0001) and aortic ejection time ( p < 0.0001). No significant change in Tei Index was observed after HD. Regarding TDI measures, velocities were not affected by preload reduction. Only the early diastolic velocities on the septal side of the mitral annulus decreased significantly ( p = 0.001) and the systolic velocities on the lateral side of the mitral annulus increased significantly ( p = 0.042) after hemodialysis. Conclusions Most of Doppler-derived indices of diastolic function are preload-dependant. TDI velocities and Tei Index were not or minimally affected by preload reduction in hemodialysis children.

Gender Differences in Diastolic Function Among Youth

Youth were studied to determine the influence of gender on diastolic function, which has been shown to express abnormalities early in the course of congestive heart failure. The study participants were 121 normotensive individuals (53 girls, 68 boys) ages 14 to 18 years. Demographics, hemodynamics, and Doppler-derived indices of diastolic function were collected. Dependent measures of diastolic function were the ratio of early (E) to late (A) peak filling velocities and the isovolumetric relaxation time (IVRT). The girls had a higher relative wall thickness (RWT) (36.58% +/- 4.59% vs 34.60% +/- 4.01%; p < 0.02), higher A (48.40 +/- 8.47 cm/s vs 42.36 +/- 10.43 cm/s; p < 0.001), a lower E/A ratio (1.96 +/- 0.40 vs 2.38 +/- 0.68; p < 0.01), and a shorter IVRT (51.80 +/- 11.14 ms vs 59.00 +/- 14.36 ms; p < 0.01) than the boys. The differences in deceleration time were not significant (181.30 +/- 81.33 ms vs 170.30 +/- 31.06 ms). Hierarchical stepwise regression analysis predicting E/A ratio found gender (male > female) to be the best predictor (R (2 )= 0.09) followed by heart rate (R (2) increase = 0.07; total R (2 )= 0.15; p < 0.01) and by RWT (R (2) increase = 0.05; total R (2 )= 0.21; p < 0.015). For IVRT prediction, gender (male > female) was the best predictor (R (2 )= 0.11), followed by total peripheral resistance (R (2) increase = 0.06; total R (2 )= 0.17; p < 0.017). The study data indicate that gender differences in diastolic function exist already in youth. Girls show a higher RWT, a lower E/A ratio, and a shorter IVRT. The implications of these differences for cardiovascular morbidity and mortality of the two genders require attention.

Echocardiographic evaluation of left ventricular end‐systolic elastance in the elderly

The aging heart is characterized by structural changes, which are implicated in the development of left ventricular diastolic dysfunction. However, important changes in systolic function may also occur. Left ventricular end-systolic elastance (E(es)) is a major determinant of cardiac systolic function and ventricular-arterial interaction. To evaluate left-ventricular E(es) in elderly subjects compared with adult control subjects. We studied dilated (DA, n=14) and hypertensive (HA, n=21) cardiomyopathy patients, and both adult control (A, n=25; age 55.6+/-6.6 years) and elderly (E, n=25; age 76.3+/-7.1 years) subjects without clinical-instrumental evidence of cardiovascular disease. M-mode, two-dimensional, and pulsed Doppler echocardiogram were performed. Doppler-derived indices of diastolic function were assessed and E(es) was calculated by a modified single-beat method. E(es) was reduced in dilated cardiomyopathy (1.32+/-0.10 mm Hg/ml) and increased in hypertensive cardiomyopathy (3.12+/-0.33 mm Hg/ml) patients compared to age-matched control subjects (1.96+/-0.26 mm Hg/ml; p<0.01 and p<0.05, respectively). More importantly, E(es) was higher in the elderly (2.52+/-0.70 mm Hg/ml) than in the adult control group (p<0.05) and was linearly correlated with age (r2=0.639; p<0.0001). Age-related increase in E(es), together with diastolic dysfunction, may lead to aging heart decompensation.

Automatic Border Detection for Assessment of Left Ventricular Diastolic Function Among Normal Neonates: Comparison with Doppler Echocardiography.

Doppler echocardiography is the standard noninvasive method to assess left ventricular (LV) diastolic function. Recently, automatic border detection (ABD), a method based on analysis of integrated ultrasonic backscatter, has been introduced permitting real-time, on-line assessment of LV diastolic function. A comparison of these methods in normal, full-term neonates has not been performed. Therefore, the objectives of this study were to evaluate the usefulness of ABD in the assessment of LV diastolic function among normal neonates, to compare parameters obtained with the ABD method with standard Doppler-derived indexes of diastolic function, and to assess the reproducibility of ABD measurements. We studied 17 consecutive normal neonates during natural sleep with both methods shortly after birth (mean 17.4 +/- 3.9 h) and approximately 2 weeks later (mean 14.8 +/- 2.2 days). An average of five consecutive cardiac cycles were performed. Similar to Doppler indexes, no significant change in any ABD parameter of diastolic function occurred between the early and later studies. A complete ABD study could be performed within 5 minutes. Mean interobserver variation for individual ABD measurements ranged from 0% to 11%. Compared with Doppler, rapid filling fraction was greater and atrial filling fraction was less with ABD. Regression analysis showed poor correlation of these parameters between methods, but their ratio by each method remained constant between studies. A similar poor correlation existed between peak E wave velocity by Doppler and peak rapid filling rate by ABD and between peak A wave velocity by Doppler and peak atrial filling rate by ABD. These differences may be explained by technical factors and different aspects of diastolic filling assessed by each method. This study indicated that ABD was a feasible and reproducible method compared with Doppler echocardiography for serial evaluation of LV diastolic function among neonates.

Left ventricle filling abnormalities prior to and following treatment of thyrotoxicosis -- is diastolic dysfunction implicated in thyrotoxic cardiomyopathy?

Despite cardiac failure being a well recognised complication of thyrotoxicosis, systolic function has generally been reported as maintained or enhanced. In this study, left ventricular diastolic function was assessed in 16 thyrotoxic patients and 18 age-matched controls by pulsed-Doppler echocardiography. Patients were re-studied after 3 and 12 months of treatment. Prior to treatment all standard Doppler-derived indices of diastolic function were significantly different to control (isovolumic relaxation time (IVRT) 63 +/- 18.9 vs 84.0 +/- 14.8 ms, peak early filling velocity (Emax) 79.2 +/- 15.2 vs 61.9 +/- 10.7 cm.s-1, peak atrial filling velocity (Amax) 68.2 +/- 17.9 vs 42.2 +/- 9.4 cm.s-1, deceleration of early filling (E/F slope) 6.1 +/- 1.8 vs 3.7 +/- 1.1 m.s-1, thyrotoxic vs control). However, these filling abnormalities appear likely to reflect the tachycardia and reduced systemic vascular resistance (SVR) found in the patients (heart rate 102 +/- 15 vs 76 +/- 9, SVR 874 +/- 207 vs 1293 +/- 362 dynes.s-1 x cm-5, both P < 0.001). After 3 months of treatment haemodynamics were similar in the two groups but filling remained abnormal in patients with a pattern suggesting increased transmitral pressure gradients (Emax 73.1 +/- 15.1 cm.s-1, Amax 55.8 +/- 19.2 cm.s-1, E/F slope 4.9 +/- 2.0 m.s-1, all P < 0.05 compared to controls).(ABSTRACT TRUNCATED AT 250 WORDS)

Left Ventricular Diastolic Filling in Elderly Hypertensive Patients

To evaluate the effects of mild to moderate hypertension and of LVH on diastolic filling and other Doppler indices in the elderly. Survey with a control group. Seventy-one hypertensives (34 men, 37 women) referred for echocardiograms and 32 age- and sex-matched normotensive volunteers. Thirty-six of the hypertensives had LVH; 34 did not. Echocardiographic laboratory. M-mode, two-dimensional, and pulsed Doppler echocardiograms. A wide variety of Doppler-derived indices of diastolic function were assessed. All Doppler derived indices of left ventricular diastolic filling (peak E, peak A, their ratio, EF slope, time-velocity integrals, atrial filling fraction, and isovolumic relaxation time) were similar among the three groups. Elderly mild to moderate hypertensives with or without LVH have LV diastolic filling that is normal for age. The identification of pathological diastolic dysfunction requires comparison to age-matched controls, since aging, a major factor influencing diastolic filling, can mask the effect of hypertension.

Echocardiographic diagnosis of cardiac allograft rejection

Current echocardiographic methods are promising for detection of rejection either as an increase in LV mass or a decrease in LV compliance. Both increased mass and decreased compliance during rejection may be mediated by the common mechanism of edema. Edema will appear specifically as increased wall volume in quantitative echocardiograms and, through decreased LV compliance, will be reflected in doppler-derived indices of diastolic filling. Initial difficulties with quantitative echocardiography related to image quality have largely been resolved. These have been replaced by concern for factors independent of rejection that affect LV mass, including hypertrophy due to hypertension or denervation-induced catecholamine hypersensitivity, and secondary effects of the immunosuppressive agents. An additional difficulty with quantitative echocardiography is that convenience for the patient is offset by the labor-intensive nature of planimetry-based analysis that has not yet been supplanted by fully automated methods. Diastolic function abnormalities within the early months following transplantation are indicators of acute rejection. However, their value in the long-term management of transplantation recipients may be diminished by effects of myocardial fibrosis, hypertension-induced hypertrophy, and accelerated coronary atherosclerosis. Analysis of echocardiographically derived indices of diastolic function is also a labor-intensive process that may not be economically feasible in the clinical setting. Echocardiography does have unique advantages for characterizing the functional changes accompanying late-onset chronic rejection. At the present time, echocardiographic techniques cannot replace endomyocardial biopsy; however, echocardiography can be a useful adjunct in the monitoring of patients for acute rejection. Clinical experience has demonstrated that both increased LV mass and abnormalities of doppler-derived indices of diastolic function can herald the onset of acute rejection in some patients that may be missed by standard techniques of immunological surveillance. Experience is insufficient to define whether different sensitivities of echo measurements and endomyocardial biopsy are statistical anomalies or reflect specific differences in the physiology of rejection. Similarly, it is unclear whether poor clinical results frequently seen in such instances reflect a fundamental property of the rejection episode or relatively late detection and treatment. A combined echocardiographic approach that includes measurement of LV mass, ultrasound tissue characterization, and evaluation of diastolic function would lead to further understanding of the interrelationship between the anatomical and physiological changes in the transplanted heart. The applications of echocardiography to the study of the cardiac allograft are multiple, and can be expected to increase as technology continues to improve.