Doppler Parameters Of Diastolic Function Research Articles

The early effect of dapagliflozin on strain and tissue Doppler parameters of diastolic function in diabetic patients with heart failure with reduced ejection fraction.

IntroductionHeart failure (HF) with reduced ejection fraction (HFrEF) remains a challenging problem due to its high mortality rate. The PARADIGM HF trial and a new class of drugs – angiotensin receptor–neprilysin inhibitors (ARNIs) – managed to change the current perception of HF treatment by reducing cardiovascular mortality and morbidity as well as HF hospitalizations compared with enalapril and have emerged as an evidence-based therapy for HFrEF. Another novelty in HF therapy is dapagliflozin, a sodium-glucose transporter-2 inhibitor (SGLT2i) which decreased the rates of cardiac death and worsening of HF in the DAPA-HF trial, when added in other guideline recommended therapy. A recent study evaluated the potency of dapagliflozin in terms of mortality and deterioration of HF, in patients taking sacubitril/valsartan and in patients who were naive.Material and methodsA prospective cohort study of 30 symptomatic HF patients with EF < 35% (aged 65 ±10 years) was conducted. Diabetic (2TDM) patients of NYHA status II–III, previously treated with ARNI, β-blocker, and mineralocorticoid receptor antagonists (MRA) were included. Dapagliflozin was added to their therapy.ResultsEchocardiographic evaluation revealed improvement of both conventional tissue Doppler and diastolic strain parameters by dapagliflozin addition on HF therapy.ConclusionsDapagliflozin impact on diastolic function may explain the symptom amelioration and the improvement of quality of life. And more specifically, the ratio of early diastolic transmitral flow velocity to global strain rate at the early filling phase of diastole (E/SRE)may be considered a reliable index of HF therapy responders.

Role of Doppler Diastolic Parameters in Differentiating Physiological Left Ventricular Hypertrophy from Hypertrophic Cardiomyopathy

The association between athletic participation and alteration in diastolic function is not well established. The aims of this study were to determine the spectrum of Doppler parameters of left ventricular (LV) diastolic function in a large cohort of healthy athletes and to quantify the overlap between physiologic LV hypertrophy and hypertrophic cardiomyopathy (HCM). A retrospective analysis of indices of LV diastolic function was performed in 1,510 healthy athletes (mean age, 22±5years; range, 13-33years; 72% men). The results were compared with those from 58 young patients with HCM. Septal E' < 7cm/sec and lateral E' < 10cm/sec were found in five (0.3%) and eight (0.5%) athletes, respectively. Septal E' was >14.6cm/sec in 170 (11%) and lateral E' was >19.9cm/sec in 430 (28%) athletes. Athletes aged >25years showed lower E' velocities compared with younger athletes (mean septal E', 11.8±6.1 vs 12.9±5.9cm/sec [P<.001]; mean lateral E', 17.1±3.6 vs 19.3±4.1cm/sec [P<.001]). Athletes with high indexed LV end-diastolic diameters (>32mm/m2) exhibited lower septal E' compared with athletes with normal indexed LV end-diastolic diameters (mean septal E', 11.9±6 vs 12.7±6cm/sec; P=.002). Septal E' < 10cm/sec and lateral E' < 12cm/sec showed the best accuracy in differentiating between HCM and athlete's heart. Reduced septal and lateral E' are rarely observed in young elite athletes. Tissue Doppler velocities tend to decrease with increasing age and LV size, and values representative of supernormal diastolic function are found in less than one-third of young athletes. Cutoff thresholds for Doppler parameters of diastolic function should be corrected for multiple demographic and clinical variables to differentiate cardiac adaptation to exercise from HCM in young individuals.

0318 : Left ventricular diastolic dysfunction in asymptomatic type 1 diabetic children: two-dimensional echocardiography study

Diabetic cardiomyopathie (DCM) is a distinct new entity. Pathophysiological mechanisms are not well known. It's defined as the presence of abnormal myocardial performance or abnormal structure in the absence of epicardial coronary artery disease, hypertension and significant valvular disease. The relationship between type 1 diabetes (T1D) and cardiac function in children is not well established. Demonstration of an early diastolic and systolic dysfunction help us to diagnose children's DCM, and is important for the timely interventions. The objective of this study was to characterize diastolic function abnormalities using two-dimensional echocardiography in T1D children. Twenty four T1D children were compared to 20 healthy control matched for age, gender and body mass index and having normal echocardiography. A standard 12-lead electrocardiogram was recorded followed by measurement of blood pressure. Laboratory investigations included mean hemoglobin (HbA1c). Echocardiography with simultaneous ECG (standard lead II), including standard echocardiographic views and tissue Doppler imaging (TDI), was performed using Vivid 9, GE Ultrasound. Left ventricular end-diastolic diametre (LV-EDD), interventricular septal end-diastolic diametre (IVS-EDD) were measured. LV conventional Doppler parameters of diastolic function were obtained: peak early (E) and peak late (A) diastolic flow velocities, E-wave deceleration time and E/A ratio were measured on the basis of transmitral flow velocities. LVEF was assessed using the biplane Simpson's method in apical four and two chamber views. TDI was performed in four apical view. The following TDI variables were evaluated: peak systolic (S), peak early diastolic (E’) and peak late diastolic (A). The mean age was 11.13 years±0.54. The T1D children and control group were comparable with respect to age, gender and heart rate. Diabetic children were asymptomatic and had normal physical examination. The mean duration of diabetes was 7±0.54 years. The mean HbA1C was 8.79%±0.25. LVEDD was 41.8±0.84 mm and LVESD was 26.33±0.73 mm. The average of IVS was 5.5±0.19 mm. LVEF was preserved with an average of 67.88±1.18%. The left atrial area was 10.78±0.33 and the volume was 24.35±1.72 ml. For diastolic function, in the diabetic group, E wave was 1.07±0.03cm/s, A wave was 0.58±0.04cm/s and E/A ratio was 4.4±2.08. In the control group, the E wave was 1.04±0.01cm/s, the A wave was 0.59±0.14 and the E/A ratio of 1.78±0.046. There were no significant differences between the two groups. The TDE was however significantly shorter in the diabetic group 146.54±3.69 ms Vs 161.42 ms±2.38 for the control group, with p = 0.005. Similarly, E ’septal wave were significantly decreased in diabetic children compared to controls (0.16±0.006 Vs 0.20±0.007, p = 0.001). The E / E ’ ratio was significantly higher in the diabetic group compared to the control group (6.72±0.33 vs. 5.21±0.15, p = 0.0011). Subclinical left ventricular impairment has been well demonstrated. Our study showed that diastolic function is affected whereas the parameters of systolic function are still preserved. The author hereby declares no conflict of interest

Effects of subacute dietary salt intake and acute volume expansion on diastolic function in young normotensive individuals

Chronic excess salt intake may have blood pressure-independent adverse effects on the heart such as myocardial hypertrophy and fibrosis. Effects of subacute sodium loading with excess dietary salt on diastolic function in normotensive individuals have been conflicting and the mechanisms are poorly understood. Thirteen healthy normotensive subjects (age 24 ± 4 years) entered a 2-week crossover study with 1 week of a low-salt diet <10 mEq/day and 1 week of a high-salt diet >200 mEq/day. At the end of each study week, left ventricular dimensions, systolic, and diastolic function were assessed with echocardiography before and after 2 L of normal saline infusion. One week of high-salt and low-salt diets did not lead to differences in echocardiographic parameters of systolic or diastolic function, even after rapid volume expansion with saline infusion. The peak early diastolic strain rate (SR) increased after volume loading both after completion of low-salt (1.62 ± 0.23/s vs. 1.82 ± 0.14/s, P < 0.05) and high-salt diets (1.67 ± 0.16/s vs. 1.86 ± 0.22/s, P < 0.05). There was a positive correlation between the peak early diastolic SR and the cardiac index (r = 0.52, P = 0.017). In healthy normotensive individuals, subacute excess dietary sodium intake does not affect diastolic function. The peak early diastolic SR, similar to other mitral Doppler and tissue Doppler parameters of diastolic function, appears to be strongly dependent on pre-load.

E0444 The value of tissue doppler-derived e/e’ in predicting heart failure in patients admitted for unstable angina and non ST elevation myocardial infarction

BackgroundIn patients with acute myocardial infarction (AMI), diastolic function provides important prognostic information that is incremental to systolic function. Unlike other Doppler parameters of diastolic function, early mitral annulus velocity,...

The Impact of Early Diastolic Myocardial Relaxation on the other Parameters of Diastolic Function and Association of Tissue Doppler Parameters of Diastolic Function with Diabetes Compensation and Duration in Type 2 Diabetic Patients

This study assessed the impact of tissue Doppler derived myocardial early diastolic relaxation velocity (E(m)) on the other parameters of diastolic function (preload dependent transmitral early diastolic velocity [E], tissue Doppler derived myocardial late diastolic velocity [A(m)], preload dependent transmitral late diastolic velocity [A]) and evaluated the correlation of these parameters with selected clinical variables in type 2 diabetic patients. Using tissue Doppler echocardiography, 82 type 2 diabetic patients were evaluated, divided into two equal groups of E(m) < 7.5 cm/s or > or = 7.5 cm/s. Patients with E(m) < 7.5 cm/s had significantly lower E/A and E(m)/A(m), and higher E/E(m) values. Multilinear regression showed a negative correlation between E(m) and glycated haemoglobin (Hb(A1c)) and duration of diabetes, a negative correlation of E(m)/A(m) with age, duration of diabetes and Hb(A1c), and a positive correlation of E/E(m) with age, duration of diabetes and use of diuretics. The E/A ratio only correlated negatively with age. It is concluded that E(m) is a reliable parameter of diastolic function, and that the tissue Doppler parameters of diastolic function are associated with diabetes compensation and diabetes duration.

Does Left Atrial Size Predict Mortality in Asymptomatic Patients with Severe Aortic Stenosis?

We assessed the hypothesis that diastolic function represented by left atrial size determines the rate of development of symptoms and the risk of all-cause mortality in asymptomatic patients with severe aortic stenosis (AS). From a database of 622 asymptomatic patients with isolated severe AS (velocity by Doppler >or= 4 m/sec) followed for 5.4 +/- 4 years, we reviewed the echocardiograms and evaluated Doppler echocardiographic indices of diastolic function. Prediction of symptom development and mortality by left atrial diameter with and without adjusting for clinical and echocardiographic parameters was performed using Cox proportional-hazards regression analysis. The age was 71 +/- 11 years and 317 (62%) patients were males. The aortic valve mean gradient was 46 +/- 11 mmHg, and the Doppler-derived aortic valve area was 0.9 +/- 0.2 cm(2). During follow-up, symptoms developed in 233 (45%), valve surgery was performed in 290 (57%) and 138 (27%) died. Left atrial enlargement was significantly correlated with symptom development (P < 0.05) but the association diminished after adjusting for aortic valve area and peak velocity (P = 0.2). However, atrial diameter predicted death independent of age and gender (P = 0.007), comorbid conditions (P = 0.03), and AS severity and Doppler parameters of diastolic function (P = 0.002). Diastolic function, represented as left atrial diameter, is related to mortality in asymptomatic patients with severe AS.

Effect of Heart Rate on Tissue Doppler Measures of Diastolic Function

Our aim was to study the independent effect of heart rate (HR) on parameters of diastolic function, particularly mitral annular velocities measured by tissue Doppler imaging (TDI), an effect which is not well understood. Sixteen patients with dual chamber pacemakers attending for routine pacemaker review underwent detailed echocardiographic assessment during atrial pacing with intact atrioventricular conduction at baseline and accelerated HRs. Mitral inflow and annular tissue Doppler velocities and systolic strain parameters were compared. Parameters of systolic function were unaffected by increased HR. When these parameters were compared at baseline (mean 67 bpm) and accelerated HR (mean 80 bpm), the following was observed: a significant decrease in early mitral inflow (E) wave (70.5 +/- 5.5 cm/s vs 63.5 +/- 4.9 cm/s, P < 0.02) and early mitral annular (E') velocities (7.0 +/- 0.5 cm/s vs 6.3 +/- 0.6 cm/s, P < 0.003) and a significant increase in mitral inflow A wave (70.3 +/- 4.5 cm/s vs 77.3 +/- 4.4 cm/s, P < 0.05) and late mitral annular (A') velocities (9.3 +/- 0.6 cm/s vs 10.8 +/- 0.5, P < 0.00004). Changes in HR have previously unrecognized significant effects on tissue Doppler parameters of diastolic function. Further study is required to determine if tissue Doppler derived annular velocities should be corrected for HR.

Changes in systolic and diastolic function during multivessel off-pump coronary bypass grafting.

To measure the changes in systolic and diastolic left ventricular function that occur during off-pump coronary artery bypass grafting (OPCAB) as a consequence of positioning the heart and interrupting coronary flow. 2-D Transoesophageal echocardiography was used to derive systolic wall motion indices and pulsed Doppler parameters of diastolic function including the E/A ratio, PVS/PVD ratio, and deceleration time. A continuous cardiac output thermodilution pulmonary artery catheter was used to provide hemodynamic measures of left ventricular function. Data was obtained prior to, during and following coronary grafting. Thirty-four consecutive anastomoses were evaluated, including eight circumflex (LCX), 17 left anterior descending artery (LAD) and nine right coronary artery (RCA) anastamoses. Significant changes in diastolic and systolic cardiac function were identified in those patients who underwent LCX grafting. Specifically during LCX grafting, both wall motion score index (2.4+/-1.4 vs 1.5+/-0.63 and 1.9+/-0.91) and the E/A ratio were significantly increased (3.5+/-1.4 vs 1.1+/-0.33 and 1.2+/-0.44) when compared to RCA and LAD grafting, respectively. The PVS/PVD ratio was significantly decreased during left circumflex grafting (0.7+/-0.45 vs 1.1+/-0.19 and 1.0+/-0.58) when compared to RCA and LAD grafting, respectively. All functional parameters returned to baseline by the end of surgery. Multivessel OPCAB can be achieved with mild impairment of left ventricular function that returns to baseline by the end of the procedure. Impairment of diastolic function is most marked during circumflex grafting as demonstrated by a restrictive filling pattern. Measures of diastolic function may be helpful in developing better strategies for exposure of the circumflex graft site.

Cardiac abnormalities and cytosine-thymineguanine trinucleotide repeats in myotonic dystrophy

This study investigated the correlation between cardiac abnormalities and cytosine-thymine-guanine (CTG) trinucleotide repeat expansion in patients with myotonic dystrophy (MD). We studied 18 patients with the adult form of classical MD and 18 age-matched control subjects. In patients with MD, left ventricular systolic function at rest was not different from that in normal subjects. On the other hand, of Doppler parameters of diastolic function, mitral inflow peak early velocity and atrial velocity were significantly lower, and deceleration time and isovolumic relaxation time were significantly longer in patients with MD compared with normal controls. No significant correlation was observed between these diastolic parameters and CTG repeat expansion in the patients, although the parameters showed a positive correlation with age and neurologic symptom duration. Electrocardiographic conduction abnormalities were detected in 42% of patients. These patients showed a significantly longer symptom duration, although the size of CTG repeats was not different between the patients with and without conduction abnormalities. This study demonstrated that, in patients with MD, significant alterations in ventricular diastolic function (myocardial myotonia) occur in addition to conduction abnormalities. The size of CTG expansion is not a predictor of these cardiac involvements. (Am Heart J 1997;134:292-7.)