E-wave Velocity Research Articles

Residential Proximity to Major Roadways Is Not Associated with Cardiac Function in African Americans: Results from the Jackson Heart Study.

Cardiovascular disease (CVD), including heart failure, is a major cause of morbidity and mortality, particularly among African Americans. Exposure to ambient air pollution, such as that produced by vehicular traffic, is believed to be associated with heart failure, possibly by impairing cardiac function. We evaluated the cross-sectional association between residential proximity to major roads, a marker of long-term exposure to traffic-related pollution, and echocardiographic indicators of left and pulmonary vascular function in African Americans enrolled in the Jackson Heart Study (JHS): left ventricular ejection fraction, E-wave velocity, isovolumic relaxation time, left atrial diameter index, and pulmonary artery systolic pressure. We examined these associations using multivariable linear or logistic regression, adjusting for potential confounders. Of 4866 participants at study enrollment, 106 lived <150 m, 159 lived 150–299 m, 1161 lived 300–999 m, and 3440 lived ≥1000 m from a major roadway. We did not observe any associations between residential distance to major roads and these markers of cardiac function. Results were similar with additional adjustment for diabetes and hypertension, when considering varying definitions of major roadways, or when limiting analyses to those free from cardiovascular disease at baseline. Overall, we observed little evidence that residential proximity to major roads was associated with cardiac function among African Americans.

Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients with Subclinical Hypothyroidism.

This study aimed to evaluate ventricular diastolic dysfunction, inter- and intraatrial conduction delay, and P-wave dispersion in pediatric patients with subclinical hypothyroidism. The study comprised a total of 30 pediatric patients with subclinical hypothyroidism (SH) (mean age 7.8 ± 3.2 years) and 30 healthy children (mean age 8.4 ± 3.6 years) as the control group. A SH diagnosis was made in the event of increased serum thyroid-stimulating hormone (TSH) and decreased serum free triiodothyronine (T3 ) and free thyroxine (T4 ) concentrations. Conventional Doppler imaging (TDI) showed low mitral early diastolic E-wave velocity and E/A ratio (P < 0.001) and significantly higher mitral late diastolic A-wave velocity (P = 0.001) in hypothyroidism patients. Moreover, patients with hypothyroidism had significantly lower left ventricular (LV) septal Em velocity and Em /Am ratios compared with the control group (P < 0.001), whereas Am velocity was higher in hypothyroidism patients (P = 0.018). LV lateral Em velocity and Em /Am ratio were significantly lower in patients with hypothyroidism compared with the control group (P < 0.001). With regard to atrial electromechanical conduction, atrial electromechanical delay (PA) lateral, PA septum, PA tricuspid, and each of interatrial and intraatrial conduction delay were significantly prolonged in hypothyroidism patients as compared with the control group (P < 0.001, P < 0.001, P = 0.023, P = 0.002, and P = 0.003, respectively). P-wave dispersion was significantly different in the pediatric patients with hypothyroidism (P < 0.001). This study demonstrated atrial electromechanical conduction delay, abnormal P-wave dispersion, and ventricle diastolic dysfunction in pediatric patients with hypothyroidism.

What Is the Effect of Metabolic Syndrome without Hypertension on Left Ventricular Hypertrophy?

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular events. There is a strong association between metabolic syndrome (MetS) and LVH in hypertensive patients. However, the relation between LVH and MetS in the absence of hypertension has not been studied. To study the impact of MetS on LV mass in patients without hypertension. Fifty MetS patients without hypertension and 50 healthy control subjects were enrolled. Twelve-lead electrocardiography, laboratory testing, and echocardiography were done with assessment of the left ventricular diastolic (LVEDD) and systolic dimensions (LVESD), fraction of shortening (FS), ejection fraction (EF), Doppler-derived mitral valve flow velocity waves (E-wave, A-wave, E/A ratio), left ventricular mass and mass index (LVMI). There was no significant difference between the two groups regarding LVEDD, LVESD, FS, EF, E-wave velocity, A-wave velocity, or E/A ratio. However, mean posterior wall thickness, IVST, LV mass, LVMI, and incidence of LVH were significantly higher in MetS patients. There was a significant positive correlation between LVMI and blood glucose level (r = 0.528, P < 0.00001), hemoglobin A1c (HbA1c) (r = 0.416, P < 0.0001), triglycerides level (r = 0.535, P < 0.00001), and obesity (r = 0.307, p = 0.0019). There was a significant negative correlation between LVMI and HDL-C level (r = -0.377, P < 0.0001). The same parameters were predictors for LVH in a logistic regression analysis. Even in the absence of hypertension, MetS patients had significantly higher LV wall thickness, LV mass and LVMI, and incidence of LVH than control subjects.

0501 : Left atrial remodeling after percutaneous left atrial appendage closure

The importance of the left atrial appendage (LAA) on left atrial (LA) hemodynamics is unknown. We sought to evaluate the effect of LAA percutaneous closure (LAAPC) on left atrial remodeling in patients with paroxymal atrial fibrillation (AF) and permanent AF. All patients refered for LAAPC with Amplatzer Cardiac Plug (ACP) and Watchman device were enrolled. Cardiac computed tomography (CT) for LA volume measurement and transthoracic echocardiography (TTE) for diastolic function assessment were performed at baseline and 3 months after LAAPC. An average of 3 consecutives measurements were performed for TTE parameters in all patients. Sixty-three patients (mean age 73±9 years) were included. 38% (n=24) was in sinus rythm at baseline and 55% (n=35) in permanent AF. Patients in SR at baseline and permanent AF at 3 months were exclued (n=4, 7%). The mean CHA2DS2-VASc score was 4,3±1,3. The procedure was successful in all patients.There was no significant difference in the functionnal status (p=0,74) and BNP (155,6 ± 107 baseline vs 155±150,6 pg/ml at 3 months ; p=0,85). Left atrial volume excluding the LAA (14±55ml baseline vs 144±50 cm3 at 3 months; p=0,30) showed no significant change after 3 months in the overall population, neither in the SR (99,7 ± 19,1 baseline vs 103,8±21 cm3 at 3 months ; p=0,32) or the permanent AF groups (173,2±54 baseline vs 171,7±48,6 cm3 at 3 months ; p=0,59).MV peak E-wave (84,2 ± 22,7 ; 86,7±26 cm/s, p=0,62) and A-wave velocities (65,4±14,4 ; 68,5 ± 22,2 cm/s, p=0,66) did not differ between baseline and three months. E/E’ ratio was higher in the overall population and there was a trend to higher E/E’ ratio in the SR group. There's no evidence for early LA remodeling after LAAPC. LV pressure loading might be slighlty more elevated after LAA closure suggesting the potential reservoir role of the LAA. Further studies are warranted to confirm these prelimary results. The author hereby declares no conflict of interest

SIGNIFICANCE OF LEFT VENTRICULAR EARLY INFLOW-OUTFLOW INDEX FOR MITRAL REGURGITATION SEVERITY

There are some difficulties and limitations for the quantification of mitral regurgitation (MR) severity and integrated approaches using echocardiography are recommended. Recently, left ventricular early inflow-outflow index (LVEIO index), which is calculated by dividing the mitral E-wave velocity

Association of Increased Epicardial Adipose Tissue Thickness With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation.

The thickness of epicardial adipose tissue (EAT) was reported to be highly associated with the incidence and severity of atrial fibrillation (AF). This study was conducted to analyze the ability of EAT thickness in predicting adverse cardiovascular (CV) events in AF.In 190 persistent AF patients, we performed a comprehensive transthoracic echocardiographic examination with assessment of EAT thickness. The definition of CV events included CV mortality, hospitalization for heart failure, myocardial infarction, and stroke.There were 69 CV events including 19 CV deaths, 32 hospitalizations for heart failure, 3 myocardial infarctions, and 15 strokes during a mean follow-up of 29 (25th–75th percentile: 17–36) months. The multivariable analysis demonstrates that chronic heart failure, increased left ventricular (LV) mass index and the ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity, decreased body mass index, and increased EAT thickness (per 1-mm increase, odds ratio 1.224, 95% confidence interval [CI] 1.096–1.368, P < 0.001) were associated with adverse CV events. Additionally, the addition of EAT thickness to a model containing CHA2DS2-VASc score, left atrial volume index, and LV systolic and diastolic function significantly improved the values in predicting CV events (global χ2 increase 14.65, P < 0.001 and integrated discrimination improvement 0.10, 95% CI 0.04–0.16, P < 0.001).In AF, EAT thickness was useful in predicting adverse CV events. Additionally, EAT thickness could provide incremental value for CV outcome prediction over traditional clinical and echocardiographic parameters in AF.

Vortex ring behavior provides the epigenetic blueprint for the human heart.

The laws of fluid dynamics govern vortex ring formation and precede cardiac development by billions of years, suggesting that diastolic vortex ring formation is instrumental in defining the shape of the heart. Using novel and validated magnetic resonance imaging measurements, we show that the healthy left ventricle moves in tandem with the expanding vortex ring, indicating that cardiac form and function is epigenetically optimized to accommodate vortex ring formation for volume pumping. Healthy hearts demonstrate a strong coupling between vortex and cardiac volumes (R2 = 0.83), but this optimized phenotype is lost in heart failure, suggesting restoration of normal vortex ring dynamics as a new, and possibly important consideration for individualized heart failure treatment. Vortex ring volume was unrelated to early rapid filling (E-wave) velocity in patients and controls. Characteristics of vortex-wall interaction provide unique physiologic and mechanistic information about cardiac diastolic function that may be applied to guide the design and implantation of prosthetic valves, and have potential clinical utility as therapeutic targets for tailored medicine or measures of cardiac health.

Dynamic cycling in atrial size and flow during obstructive apnoea

ObjectiveObstructive sleep apnoea (OSA) is strongly associated with cardiovascular disease. However, acute cardiovascular effects of repetitive airway obstruction are poorly understood. While past research used a sustained Mueller manoeuver to...

Assessment of Left Atrial Ejection Force in Patients with different Grades of Left Ventricular Diastolic Dysfunction

Assessment of Left Atrial Ejection Force in Patients with different Grades of Left Ventricular Diastolic Dysfunction Objective: To assess left atrial ejection force (LAEF) in patients with different grades of left ventricular (LV) diastolic dysfunction compared to traditional Doppler and tissue Doppler measurements. Methods: 120 patients enrolled into four equal groups (n=30), each group represented a different grade of LV diastolic dysfunction and 30 subjects with normal diastolic function. We assessed echocardiographic measurements of dimensions and diastolic function, LA volume index (LAVI), and LAEF and age-corrected %LAEF. Results: In comparison to control subjects, the study group had more diabetic and hypertensive patients, increased all LV dimensions, estimated LVEDP (p<0.0001), LAVI (p<0.0001), LAEF and %LAEF (p<0.0001). On comparing different grades of diastolic dysfunction, patients with worse grades of diastolic dysfunction were older, more hypertensive and diabetic. They had larger LV dimensions, estimated LVEDP (p<0.0001), and LAVI (p<0.0001). LAEF and %LAEF showed an increase from grade I (8.84 ± 3.09 Kdynes, 188.93 ± 40.12%) to Ia (10.66 ± 3.10 Kdynes, 239.7 ± 72.45%) to II (11.82 ± 45.9 Kdynes, 256.57 ± 45.92%) then demonstrated a significant reduction in grade III to 2.77 ± 1.71 Kdynes, 57.88 ± 32.49% (p<0.0001) dropping below normal values seen in the control subjects (4.98 ± 1.72 Kdynes, 93.30 ± 9.31%) (p<0.0001). Linear regression analysis showed factors affecting %LAEF were: age, E-wave velocity, average e’ velocity, E/A ratio and E/e’ ratio. Conclusions: LAEF is generally increased in patients with LV diastolic dysfunction compared to those with normal diastolic function. Patients in grade III diastolic dysfunction show marked impairment of LAEF dropping below those with normal diastolic function.

Echocardiographic Assessment of Cardiac Changes during Normal Pregnancy among Nigerians

BACKGROUNDPregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women.MATERIALS AND METHODSEchocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of <0.05 was considered significant.RESULTSThe mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19–44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e′ velocity at the septal margin but a progressive increase in a′ velocity were also observed (P < 0.05).CONCLUSIONCardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

0290: Left atrial remodeling after percutaneous left atrial appendage closure

The importance of the left atrial appendage (LAA) on left atrial (LA) hemodynamics is unknown. We sought to evaluate the effect of LAA percutaneous closure (LAAPC) on left atrial remodeling in patients with paraxysmal atrial fibrillation (AF) and permanent AF. All patients refered for LAAPC with Amplatzer Cardiac Plug (ACP) and Watchman device were enrolled. Cardiac computed tomography (CT) for LA volume measurement and transthoracic echocardiography (TTE) for diastolic function assessment were performed at baseline and 3 months after LAAPC. An average of 3 consecutives measurements were performed for TEE parameters in all patients. Sixty-three patients (mean age 73±9 years) were included. 38% (n=24) in sinus rythm (SR) at baseline and 55% (n=35) in permanent AF. Patients in SR at baseline and permanent AF at 3 months were excluded (n=4,7%).The mean CHA2DS2-VASc score was 4,3±1,3. There was non significant difference in the functionnal status and BNP level (155,6±107 vs ±150,7pg/mL; p=0,85) between baseline and 3 months follow-up. Left atrial volume excluding the LAA (145 ±55cm 3 baseline vs 144±50cm 3 at 3 months; p=0,30) showed no significant change after 3 months in overall population, neither in the SR (99,7±19,1 vs 103,8±21cm 3 ; p=0,32) or the permanent AF groups (173,2±54 vs 171,7±48,6cm 3 ; p=0,59). MV peak E-wave (84,2±22,7 vs 86,7±26cm/s; p=0,62) and A-wave velocities (65,4±14,4; 68,5±22,2cm/s; p=0,66) dit not differ between baseline and follow-up but E/E’ ratio was increased in the overall population after LAAPC (7,9±2,1 vs 9,1±3,6cm/s; p=0,038) and there was trend to higher E/E’ ratio in the SR group (7,7±1,6 vs 9±3,3cm/s, p=0,46). There’s no evidence for early LA remodeling after LAAPC, but diastolic function might be negatively influenced by LAAPC suggesting the potential role of LAA in atrial function. Further studies are warranted to confirm the prelimary results.

Peak Early Diastolic Transmitral Velocity As A Surrogate Marker Of Short-Term Atrial Fibrillation Recurrence After Electrical Cardioversion.

The aim of this study was to assess if peak early diastolic transmitral velocity (E-wave) can be used as a surrogate marker of short-term atrial fibrillation (AF) recurrence. We prospectively studied 57 consecutive patients who underwent electrical cardioversion (ECV) for AF and successfully converted to sinus rhythm. N-terminal brain natriuretic peptide levels (BNP) before and after ECV was measured in all patients. The follow-up included physical examination and a 12-lead electrocardiogram 14 days and one month after the ECV. In 42.1% patients AF recurred during one-month follow-up period. Gender, presence of mitral regurgitation, treatment with angiotensin II receptor blocker and left atrium diameter independently influenced E-wave velocity before ECV. E-wave velocity fell immediately after successful ECV (94.0±27 cm/s vs 79.7±23 cm/s, P<0.0001). E-wave velocity before ECV>94 cm/s and E-wave velocity after ECV >80 cm/s were predictors of one-month AF recurrence [(Hazard Ratio) HR=3.62 with 95% CI=1.49-8.78 and HR=3.76 with 95% CI=1.40-10.10, respectively]. E-wave velocity before and E-wave velocity after ECV remained predictors of AF recurrence but only in non-hypertensive patients (HR=1.01 with 95% C.I=1.01-1.03 and HR=1.03 with 95% C.I=1.01-1.06, respectively). Similarly, BNP levels before and after ECV were associated with an increased the risk of AF recurrence (HR=1.14 with 95% C.I 1.01-1.28 and HR= 1.16 with 95% C.I 1.03- 1.31, respectively). The addition of BNP levels to E-wave velocity before ECV appeared to have incremental value on short-term AF recurrence but at a marginally statistical significance (LR chi2=3.28, p=0.07). E-wave velocity before and after ECV appears to be a marker of short-term recurrence of AF.

Effect of Mitral Annular Calcium on Left Ventricular Diastolic Parameters

Assessment of left ventricular (LV) diastolic function by Doppler flow imaging and tissue Doppler is an integral part of the echocardiographic examination. Mitral annular calcium (MAC) is frequently encountered on echocardiography. The aim of this study was to assess the impact of MAC, quantitatively measured by computed tomography scan, on echocardiographic LV diastolic parameters. We included 155 patients aged ≥65 years. Computed tomography reconstructions of the mitral annulus were created, and calcium identified and quantified by Agatston technique. Calcium locations were assigned using an overlaid template depicting the annular segments in relation to surrounding anatomic structures. Echocardiographic assessment of diastolic function was performed in standard fashion. Mean age was 77 years; 49% were men; and 43% were black. Patients with MAC had lower septal e' (p = 0.003), lateral e' (p = 0.04), and average e' (p = 0.01) compared with those without MAC. They also had a higher E-wave velocity (p = 0.01) and E/e' ratio (p <0.001). When evaluated by severity of MAC, and after adjustment for multiple clinical factors, there was a graded (inverse) relation between MAC severity and septal e' (p = 0.01), lateral e' (p = 0.01), and average e' (p = 0.01). In conclusion, LV diastolic parameters, as measured by Doppler echocardiography, are altered in the presence of MAC. This could be due to direct effects of MAC on annular function or might reflect truly reduced diastolic function. Interpretation of diastolic parameters in patients with MAC should be performed with caution.

E/e' Ratio in Patients With Unexplained Dyspnea: Lack of Accuracy in Estimating Left Ventricular Filling Pressure.

Elevated left ventricular filling pressure is a cardinal feature of heart failure with preserved ejection fraction. Mitral E/e' ratio has been proposed as a noninvasive measure of left ventricular filling pressure. We studied the accuracy of E/e' to estimate and track changes of left ventricular filling pressure in patients with unexplained dyspnea. We performed supine and upright transthoracic echocardiography in 118 patients with unexplained dyspnea who underwent right heart catheterization. Supine E/e' ratio modestly but significantly correlated with supine pulmonary arterial wedge pressure (PAWP; r=0.36; P<0.001) and demonstrated poor agreement with PAWP values (Bland-Altman limits of agreement of -8.3 to 8.3 mm Hg; range, 6.5-21.2 mm Hg). Similarly, E/e' ratio cut off of 13 performed poorly in identifying patients with elevated left ventricular filling pressure (sensitivity 6%, specificity 90%). The receiver-operating characteristic area of E/e' was 0.65 (95% confidencce interval, 0.50-0.79). With change from the supine to upright position, PAWP decreased (-5±4 mm Hg; P<0.001) as did both E wave (-17±15 cm/s; P<0.001) and e' (-2.7±2.7 cm/s; P<0.001) velocities, whereas E/e' remained stable (+0.2±2.6; P=0.57). Positional change in PAWP correlated modestly with change in E-wave (r=0.37; P<0.001) velocity. There was no appreciable relationship between change in PAWP and change in average E/e' (r=-0.04; P=0.77) and in half the patients the change in PAWP and E/e' were directionally opposite. In patients with unexplained dyspnea, E/e' ratio neither accurately estimates PAWP nor identifies patients with elevated PAWP consistent with heart failure with preserved ejection fraction. Positional changes in E/e' ratio do not reflect changes in PAWP.

The Utility of Systolic and Diastolic Echocardiographic Parameters for Predicting Coronary Artery Disease Burden as Defined by the SYNTAX Score.

Early identification of high-grade ischemia based on echocardiographic diastolic abnormalities may be clinically useful in the acute coronary syndrome (ACS) setting. This could provide the clinician with an awareness of the burden of coronary artery disease (CAD) before angiography is performed to allow for early intervention of suspected ischemic lesions. The objective of the study was to assess whether 2D transthoracic echocardiography (TTE)-derived tissue Doppler imaging parameters can predict the severity of CAD in comparison with the cardiac catheterization-derived SYNTAX score. A retrospective study of 74 stable angina or patients with ACS was performed in 2012 at a single tertiary care center. In all study subjects, TTE and angiography were performed within 6 months of each other without revascularization in the interim. The study population included a total of 74 patients (mean age 67 ± 12 years) with 77% presenting with an ACS. The median SYNTAX score was 24.0 (6.0-35.0). The E-wave velocity was higher, and deceleration time (DT) was lower in the high SYNTAX group in comparison with the low/intermediate SYNTAX group (P = 0.045 and P = 0.001, respectively). Septal mitral annular S' was lower in the high SYNTAX group (P = 0.02). After multivariate analysis, E/A ratio (OR 0.03, 95% 0.00-0.36, P = 0.0067), DT (OR 0.93, 95% CI 0.89-0.97, P = 0.0001) and septal annular S'-wave velocity (OR 0.34, 95% CI 0.16-0.71, P = 0.0038) remained strong predictors of a high SYNTAX score. Early identification of systolic and diastolic dysfunction based on echocardiographic parameters may be of important clinical significance for predicting CAD burden prior to invasive angiography.

Left ventricular early inflow-outflow index: a novel echocardiographic indicator of mitral regurgitation severity.

BackgroundNo gold standard currently exists for quantification of mitral regurgitation (MR) severity. Classification by echocardiography is based on integrative criteria using color and spectral Doppler and anatomic measurements. We hypothesized that a simple Doppler left ventricular early inflow–outflow index (LVEIO), based on flow velocity into the left ventricle (LV) in diastole and ejected from the LV in systole, would add incrementally to current diagnostic criteria. LVEIO was calculated by dividing the mitral E-wave velocity by the LV outflow velocity time integral.Methods and ResultsTransthoracic echocardiography reports from Montefiore Medical Center and its referring clinics from July 1, 2011, to December 31, 2011 (n=11 235) were reviewed. The MR severity reported by a cardiologist certified by the National Board of Echocardiography was used as a reference standard. Studies reporting moderate or severe MR (n=550) were reanalyzed to measure effective regurgitant orifice area by the proximal isovelocity surface area method, vena contracta width, MR jet area, and left-sided chamber volumes. LVEIO was 9.3±3.9, 7.0±3.2, and 4.2±1.7 among those with severe, moderate, and insignificant MR, respectively (ANOVA P<0.001). By receiver operating characteristic analysis, area under the curve for LVEIO was 0.92 for severe MR. Those with LVEIO ≥8 were likely to have severe MR (likelihood ratio 26.5), whereas those with LVEIO ≤4 were unlikely to have severe MR (likelihood ratio 0.11). LVEIO performed better in those with normal LV ejection fraction (≥50%) compared with those with reduced LV ejection fraction (<50%) (area under the curve 0.92 versus 0.80, P<0.001). By multivariate logistic regression analysis, LVEIO was independently associated with severe MR when compared with vena contracta width, MR jet area, and effective regurgitant orifice area measured by the proximal isovelocity surface area method.ConclusionLVEIO is a simple-to-use echocardiographic parameter that accurately identifies severe MR, particularly in patients with normal LV ejection fraction.

Maternal cardiac evaluation during uncomplicated twin pregnancy with emphasis on the diastolic function

The objective of the study was to evaluate the longitudinal changes in maternal systolic and diastolic function in a series of women carrying an uncomplicated twin pregnancy. A series of women carrying a twin pregnancy underwent standard M-mode, 2-dimensional color Doppler, and tissue Doppler transthoracic echocardiography during the first (11-13 weeks), the second (20-23 weeks), the third (28-32 weeks) trimesters, and the postpartum (6 months after delivery). From January 2012 to September 2013, 30 women with an uncomplicated twin pregnancy were included in this prospective study. All the pregnancies were diamniotic including 24 dichorionic and 6 monochorionic sets. Overall, 60 live births were observed with a mean gestational age at delivery of 37 ± 1 weeks and a mean birthweight of 2532 ± 313 g. During pregnancy a significant worsening of left ventricle systolic function expressed by ejection fraction, fractional shortening and S1 longitudinal contractility decrease was observed. These findings also persisted at postpartum assessment. Regarding diastolic function, our data showed a significant progressive reduction of pulsed Doppler E-wave velocity and an increase of A-wave from the first to the third trimester. Similar changes were documented for tissue Doppler E1 and A1 peak velocities assessed at the level of the mitral and tricuspid annulus. After delivery diastolic findings returned to values comparable with those obtained in the first trimester. In uncomplicated twin gestations, significant changes in maternal systolic and diastolic function occur from the first to the third trimester. Moreover, although diastolic parameters normalize after pregnancy, a relative systolic dysfunction seems to persist after delivery.

Aortic arch anatomy is a strong correlate of arterial wave reflections in systolic heart failure

hypertension free of overt cardiovascular complications. In 171 untreated, grade 1-2, hypertensive patients (age 49 13 yr.; 92 males) we measured anthropometric variables, plasma biochemistries, glomerular filtration rate (GFR), PA and active renin, and assessed by conventional and tissue Doppler (TDI) echocardiography the morphology of the LV and variables of LV diastolic function (E/A, e-wave velocity, e/ a and E/ e ratio). LV diastolic dysfunction with a pattern of abnormal relaxation was detected by TDI echocardiography in 101 patients (59%) who were older, more frequently males and diabetics, and had higher body mass index (BMI), systolic blood pressure (SBP), and LV mass index, and lower PA levels (134 77 pg/ml) than patients with preserved LV diastolic function (168 94 pg/ml, P1⁄40.014). Variables of diastolic function measured both at conventional and TDI echocardiography were significantly related to increasing age, BMI, duration of hypertension, and LV mass index and to decreasing GFR (Table). TDI e-wave velocity was also directly related to SBP and PA levels and its relationship with age (b1⁄4-0.436, P<0.001), LV mass index (b1⁄4-0.167, P1⁄40.036), and PA levels (b1⁄40.144, P1⁄40.027) resulted independent of other confounders in a multiple regression model. Multivariate logistic regression indicated that diastolic dysfunction as detected at TDI was independently predicted by older age (b1⁄40.289, P1⁄40.001), higher BMI (b1⁄40.193, P1⁄40.017) and SBP (b1⁄40.149, P1⁄40.043), and lower PA levels (b1⁄4-0.153, P1⁄40.034). In conclusion, LV diastolic dysfunction is associated with lower plasma aldosterone levels in patients with uncomplicated hypertension suggesting that this hormone does not contribute to LV stiffening.

Effect of Cardiac Resynchronization Therapy on Left Ventricular Diastolic Function

Aims: Cardiac Resynchronization Therapy (CRT) improves systolic performance in Heart Failure (HF). However, the effects of CRT on Left Ventricular (LV) diastolic function were variable and not fully understood. The aim of this study was to determine the effects of cardiac resynchronization therapy on LV diastolic filling pattern and the relation between the diastolic filling pattern and the response to CRT. Methods and Results: Twenty nine patients (mean age, 66 ± 8 years; 26 men; mean LV ejection fraction 25±7%) with severe HF were included. Measurements included LV volumes and Ejection Fraction (EF), pulsed-wave Doppler (PWD)-derived transmitral filling indices (E- and A-wave velocities, E/A ratio, Ewave deceleration time). Clinical responders were defined as survived patients with an improvement by one or more NYHA functional class, echocardiographic response to CRT was defined as a decline in LV end-systolic volume >15% during follow-up. In clinical responder group, both diastolic and systolic LV volumes decreased significantly (p=0.02 and p<0.001 respectively) and LVEF increased significantly (p=0.001) in 26 of 29 patients (89%) and were accompanied by reduction in mitral E-wave velocity and E/A ratio (both p<0.001), and increased A-wave velocity and Ewave deceleration time (p=0.03 and p<0.001). In echocardiographic responders, reverse remodelling (52%) was coupled to the improvement in LV diastolic function but diastolic filling pattern improved also in 42% in patients without reverse remodelling. Conclusion: Left ventricular diastolic indices after CRT improved in the clinical responder group, but there was no significant change in these indices among non-responders. CRT enhances diastolic filling patterns in both echocardiographic responder and nonresponder patients. This may be related to improvement in symptoms even in echocardiographic nonresponders who were clinical responders.

Radius of proximal isovelocity surface area in the assessment of rheumatic mitral stenosis: Connecting flow to anatomy and hemodynamics

BackgroundEchocardiographic assessment of left atrial pressure (LAP) in mitral stenosis (MS) is controversial. We sought to examine the role of the radius of the proximal isovelocity surface area (PISA-r) in the assessment of the hemodynamic status of MS after fixing the aliasing velocity (Val). Methods and resultsWe studied 42 candidates of balloon mitral valvuloplasty (BMV), for whom pre-BMV echocardiography was done and LAP invasively measured before dilatation. PISA-r was calculated after fixing aliasing velocity to 33cm/s. In addition, the ratio IVRT/Te’–E was also measured, where IVRT was isovolumic relaxation time, and Te’–E was the time difference between the onset of mitral flow E-wave and mitral annular early diastolic velocity. IVRT/Te’–E and PISA-r showed a strong correlation with LAP (r=−0.715 and −0.637, all p<0.001) and with right-sided pressures. In addition, PISA-r correlated with mitral valve area by planimetry method (MVA) and with left ventricular outflow tract stroke volume (r=0.66 and 0.71, all p<0.001). Receiver operator characteristic curve (ROC-curve) showed that PISA-r was not inferior to IVRT/Te’–E in differentiating LAP ⩾25 from <25mmHg. ConclusionProvided that Val is set to a constant of 33cm/s, PISA-r can assess the hemodynamic status of MS, and seems a simple alternative to the tedious IVRT/Te’–E for estimation of LAP.