Echocardiographic Parameters Of Diastolic Function Research Articles

The quantification and role of diffuse myocardial fibrosis in familial dilated cardiomyopathy - an equilibrium contrast cmr study

Objective To evaluate the role of diffuse myocardial fibrosis (DMF) in familial Dilated Cardiomyopathy (fDCM) using Equilibrium Contrast-CMR (EQ-CMR). Background Post mortem/biopsy studies have shown that DMF occurs in DCM, but its clinical significance remains largely unknown as its assessment requires invasive biopsy. EQ-CMR is a recently described technique that permits the non-invasive and accurate assessment of DMF by measuring the myocardial contrast volume of distribution (Vd(m)) at equilibrium contrast [1]. Methods Using international diagnostic guidelines we identified 28 patients with fDCM (mean age 42, 61% male, 89% NYHA class I, 11% NYHA class II). This cohort excluded the most severe cases of fDCM due to the high prevalence of permanent pacemakers or ICDs. The Vd(m) (a measure of DMF) was compared to that obtained in healthy volunteers (mean age 35, 63% male) and also to other indexed CMR parameters, including left atrial area and echocardiographic parameters of diastolic function (tissue doppler and strain imaging). Results fDCM patients had increased LV size (95mls/m2 vs 73mls/m2 , p=0.0001), worse ejection fraction (55% vs 69%, p<0.0001), increased indexed left atrial area (LAAi) (12.3cm2/m2 vs 9.5cm2/m2, p=0.0004) when compared to healthy volunteers. Significantly impaired diastolic function was detected in 14% of fDCM patients. No patients had worse than mild mitral regurgitation. The Vd(m) in patients was significantly greater than that of healthy volunteers (Fig 1) (0.282 vs 0.234, p=0.003). Vd(m) correlated with LAAi (fig 2) (r2= 0.44, p<0.0001) and EF (r2=0.12, p=0.034), but was independent of indexed LV diastolic volume, mass and echocardiographic derived parameters of diastolic function. On univariate analysis, LAAi was predicted by both Vd(m) (r2= 0.44) and E/Ea (r2= 0.31), which on multivariate analysis were independent with Vd(m) being the strongest predictor.

Correlation between N-Terminal Pro-Brain Natriuretic Peptide and Doppler Echocardiographic Parameters of Left Ventricular Filling Pressure in Atrial Fibrillation

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia with a population prevalence of about 1%. Natriuretic peptide level is elevated in patients with AF with diastolic dysfunction even with a normal left ventricular (LV) ejection fraction. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level and Doppler echocardiographic parameters for diastolic function have shown correlation with LV filling pressures. We aimed to evaluate the relationship between echocardiographic parameters and serum NT-proBNP in patients with AF with preserved LV ejection fraction.MethodsWe examined transthoracic echocardiography and NT-proBNP levels in the patients with AF and patients with sinus rhythm. Blood samples were taken for serum NT-proBNP measurements within 24 hours of echocardiographic examination. The group 1 was the patients with sinus rhythm (n = 30, mean age 68 ± 13 years) and the group 2 was the patients with AF (n = 33, mean age 70 ± 14 years).ResultsThe group 2 patients had significantly higher mitral E, E' (lateral annulus), E/E' (septal annulus), left atrial (LA) volume index, LA size, pulmonary vein diastolic velocity, and NT-proBNP level than those of group 1 patients (p < 0.05). The area under the receiver-operating characteristic curve showed a NT-proBNP had good diagnostic power for E/E' (septal annulus) > 15 in patients with AF at cutoff value of 433 pg/mL.ConclusionNT-proBNP level is well correlated with Doppler echocardiographic parameters of diastolic function in patients with AF and preserved LV ejection fraction. NT-proBNP level more than 433 pg/mL may suggest elevated LV filling pressure in patients with AF.

Circulating Serum Matrix Metalloproteinase-3 and Metalloproteinase-9 Are Not Associated with Echocardiographic Parameters of Diastolic Function in Asymptomatic Type 2 Diabetic Patients

Serum concentrations of matrix metalloproteinase (MMP) 3 and MMP9 were evaluated in 82 asymptomatic type 2 diabetes mellitus patients without cardiovascular complications and in 41 non-diabetic control subjects. In the asymptomatic diabetic patients, the correlations of these concentrations with diabetes duration, selected biochemical parameters such as glycated haemoglobin (HbA(1c)), and echocardiographic parameters of diastolic function were also assessed. Pulsed and tissue Doppler echocardiography was performed in the two groups. Mean ± SD age was 61 ± 6 years for the asymptomatic diabetic patients and 61 ± 5 years for controls. Mean ± SD concentrations of MMP3 and MMP9 were significantly higher in the asymptomatic diabetic patients (67.5 ± 10.4 and 77.8 ± 28.8 μg/l, respectively) than in controls (47.2 ± 6.1 and 51.1 ± 13.7 μg/l, respectively). In the asymptomatic diabetic patients, MMP3 correlated only with albuminuria (r = 0.341) and MMP9 only with HbA(1c) (r = 0.262); neither MMP was correlated with echocardiographic parameters of diastolic function. Thus, in asymptomatic type 2 diabetic patients without cardiovascular complications, serum MMP3 and MMP9 were elevated, MMP9 was associated with HbA(1c) and MMP3 was associated with albuminuria, however, MMP3 and MMP9 were not associated with echocardiographic parameters of diastolic function.

Relation of Diastolic and Systolic Function, Exercise Capacity and Brain Natriuretic Peptide in Adults after Mustard Procedure for Transposition of the Great Arteries

Objectives: To evaluate the relation of echocardiographic parameters of diastolic function, exercise capacity (expressed as peakVO₂) and NT-proBNP in patients with transposition of the great arteries (TGA) and Mustard procedure. Methods: Diastolic function was determined by measuring tricuspid flow velocities (Ea/Aa ratio), isovolumic relaxation time (IVRT), and deceleration time (DT). E/Ea ratios were calculated. For assessment of systolic function, CMR was applied. Results: E/A (r = 0.07, p = 0.66), E/Ea medial (r = 0.03, p = 0.84), E/Ea lateral (r = –0.01, p = 0.92), IVRT (r = –0.13, p = 0.44), and DT (r = –0.05, p = 0.76) were not correlated with peakVO₂. NT-proBNP showed a significant correlation with IVRT (r = 0.44, p = 0.004) and Ea/Aa medial (r = –0.34, p = 0.025). No correlation was found between RV systolic function and peakVO₂ (r = 0.07, p = 0.63). Conclusions: Exercise capacity in patients with TGA and Mustard procedure is not related to echocardiographic parameters of diastolic function. NT-proBNP is associated with selected echocardiographic parameters of diastolic function.

The effect of atrial pacing on left ventricular diastolic function and BNP levels in patients with DDD pacemaker

We aimed to investigate the effect of atrial pacing on left ventricular diastolic function and brain natriuretic peptide (BNP) levels in patients with DDD pacemaker. Thirty patients with complete atrio-ventricular (AV) block and DDD pacemaker were included. All patients had normal left ventricular systolic function. Echocardiographic diastolic function parameters (transmitral and tissue Doppler velocities during early (E and E') and late (A and A') filling) and NT-pro-BNP levels were evaluated prospectively during atrial sensing and pacing periods. Echocardiographic data were compared with paired sample t test and NT-pro-BNP levels were compared with Wilcoxon test. Echocardiographic E/A, E'/A', E/E' ratios were calculated as 0.72+/-0.34, 0.61+/-0.21 and 8.76+/-2.58 during atrial sensing period. Same parameters were found as 0.71+/-0.23, 0.64+/-0.16 and 8.93+/-3.16 respectively during atrial pacing period. Echocardiographic left ventricular diastolic function parameters were not significantly different during atrial pacing and atrial sensing periods. Median plasma NT-pro-BNP levels were measured as 142 pg/ml (min-max 47-563 pg/ml) and 147 pg/ml (min-max 33-1035 pg/ml) during atrial sensing and pacing periods respectively. These levels were not significantly different (p=0.86). The result of this study has shown that, atrial pacing has not any additional detrimental effect on left ventricular diastolic function parameters in paced patients with normal left ventricular systolic function.

Left Ventricular Diastolic Function and Exercise Capacity in Patients with Chagas Cardiomyopathy

Parameters of diastolic function have been shown to correlate with exercise capacity (EC) in individuals with impaired left ventricular (LV) systolic function. However, the role of LV diastolic function in predicting EC in Chagas cardiomyopathy has not been reported. This study aimed to determine the relationship between LV diastolic parameters assessed by echocardiography and EC in patients with Chagas cardiomyopathy. We studied 40 patients (23 men; 49 + or - 8 years), with diagnosis of Chagas disease and dilated cardiomyopathy. Medical therapy was individually adjusted according to standardized guidelines. Methods of acquiring two-dimensional Doppler, tissue Doppler imaging (TDI), and their measurements were described. Exercise testing was performed by a Bruce protocol. Brain natriuretic peptide (BNP) levels were also determined. Most patients (63%) were in NYHA functional class I. Mean peak oxygen consumption estimated (peakVO(2)) was 31.7 + or - 10.2 mL/kg per minute, and mean left ventricular ejection fraction (LVEF) was 36.3 + or - 7.8%. Univariate analysis showed that various echocardiographic parameters of diastolic function were correlated with peakVO(2). There was no correlation between BNP levels or LVEF and EC. Multivariate analysis, after adjustment for age and gender, revealed that E/E' ratio and left atrial volume (LAV), emerged as independent predictors of EC, as demonstrated in the model: peakVO(2)= 60.825 + (0.439 x LAV) - (1.620 x E/E' ratio) - (0.483 x age) - (4.821 x female gender). The R(2) of this model was 0.52. Functional capacity assessed by peakVO(2) was related to increase LV filling pressures, independently on systolic function in patients with Chagas cardiomyopathy. (Echocardiography 2010;27:519-524).

Long-term effects of intracoronary bone marrow cell transfer on diastolic function in patients after acute myocardial infarction: 5-year results from the randomized-controlled BOOST trial--an echocardiographic study

We have recently observed that intracoronary autologous bone marrow cell (BMC)-transfer improves parameters of diastolic function in patients after acute myocardial infarction at 6 and 18 months. There is no clinical study addressing the long-term effect of BMC transfer on diastolic function. Therefore, we conducted a 5-year follow-up of the BOOST trial to evaluate a sustained benefit on echocardiographic parameters on diastolic function. After successful primary percutaneous coronary intervention (PCI) for acute ST-elevation MI, patients were randomized to a control (n = 28) or BMC transfer group (n = 28). Echocardiography was performed at 4.5 +/- 1.5 days after PCI, at 6, 18, and 60 months. Diastolic function was determined by measuring transmitral flow velocities (E/A ratio), diastolic myocardial velocities (E(a)/A(a) ratio), isovolumic relaxation time (IVRT), and deceleration time (DT). All analyses were performed in a blinded fashion. There was an overall treatment effect of BMC transfer on E/A (0.25 +/- 0.10; 95% CI 0.05-0.44; P = 0.01). E/A ratio was significantly lower at 6 (Control 0.90 +/- 0.07; BMC 1.23 +/- 0.14; P = 0.03) and 18 months (Control 0.87+/-0.04; BMC 1.13 +/- 0.09; P = 0.01) in the control group, whereas E/A ratio was not different at 60 months between both groups (Control 0.90 +/- 0.06; BMC 1.05 +/- 0.07; P = 0.12). We found no overall effect of BMC transfer on E(a)/A(a) ratio (0.21 +/- 0.14; 95% CI -0.03 to 0.46; P = 0.09), DT (-12 +/- 11 ms; 95% CI -21 to 28; P = 0.75), IVRT -6 +/- 7 ms; 95% CI -9 to 19; P = 0.43), and E/E(a) ratio (0.58 +/- 0.88; 95% CI -1.18 to 2.34; P = 0.51). Intracoronary autologous BMC transfer provides an overall treatment effect on echocardiographic parameters of diastolic function in patients after AMI. However, this effect is basically related to an early improvement of parameters of diastolic function without a sustained effect on long-term follow-up.

Echocardiographic Predictors of Change in Left Ventricular Diastolic Pressure in Heart Failure Patients Receiving Nesiritide

To evaluate the usefulness of currently accepted echocardiographic parameters of diastolic function to assess the acute change in left ventricular end-diastolic pressure (LVEDP) following the administration of nesiritide in a heart failure population. In 25 heart failure patients (15 with systolic dysfunction, 10 with preserved ejection fraction [EF]), Doppler echocardiography, right and left heart catheterization, and invasive biventricular pressure hemodynamics were obtained at baseline and 30 minutes after nesiritide infusion. Twenty-four patients had sufficient echocardiographic images for analysis. The mean age was 60 +/- 11 years, 48% were male, 56% had coronary artery disease, and 64% had hypertension. Right ventricular systolic pressure (RVSP) had the highest correlation with LV filling pressure: pulmonary capillary wedge pressure (PCWP), pre-A wave LV, and LVEDP (r = 0.66, P = 0.0009; r = 0.63, P = 0.002; r = 0.72, P = 0.0002, respectively). Following nesiritide administration, the mean PCWP decreased from 17.1 +/- 7.8 mmHg at baseline to 9.6 +/- 6.2 mmHg (P < 0.001). Change in RVSP had the highest correlation with change in PCWP (r =-0.67, P = 0.10) and change in LVEDP (r =-0.71, P = 0.07). Echocardiographic parameters are frequently assessed in attempts to estimate left heart diastolic pressures. In heart failure patients, RVSP appears to be the best predictor of LVEDP, outperforming tissue Doppler E/E'. RVSP was found to be the best echocardiographic predictor of change in LV filling pressure with intravenous vasodilator therapy in heart failure patients. RVSP may provide a noninvasive means of assessing response to cardiac therapy.

Diastolic Dysfunction Is an Independent Risk Factor for Death in Patients With Sickle Cell Disease

The goal of this study was to characterize left ventricular diastolic function in the sickle cell disease (SCD) population and to relate echocardiographic measures of dysfunction with pulmonary hypertension and mortality. Pulmonary hypertension has been identified as a predictor of death in the adult SCD population. Although diastolic dysfunction is also observed in this population, its prevalence, association with high pulmonary artery systolic pressure, and attributable mortality remain unknown. Diastolic function assessment using tissue Doppler imaging was performed in a group of 141 SCD patients. Conventional echocardiographic parameters of diastolic function were performed in a total of 235 SCD patients. Diastolic dysfunction was present in 18% of patients. A combination of diastolic dysfunction and pulmonary hypertension was present in 11% of patients, and diastolic dysfunction accounted for only 10% to 20% of the variability in tricuspid regurgitation (TR) jet velocity. Diastolic dysfunction, as reflected by a low E/A ratio, was associated with mortality with a risk ratio of 3.5 (95% confidence interval 1.5 to 8.4, p < 0.001), even after adjustment for tricuspid regurgitation (TR) jet velocity. The presence of both diastolic dysfunction and pulmonary hypertension conferred a risk ratio for death of 12.0 (95% confidence interval 3.8 to 38.1, p < 0.001). Diastolic dysfunction and pulmonary hypertension each contribute independently to prospective mortality in patients with SCD. Patients with both risk factors have an extremely poor prognosis. These data support the implementation of echocardiographic screening of adult patients with SCD to identify high-risk individuals for further evaluation.

N-terminal proBNP levels in patients with Chagas disease: A marker of systolic and diastolic dysfunction of the left ventricle

NT-proBNP levels are known to be elevated in systolic and diastolic dysfunction. Doppler indices of diastolic dysfunction (DD) have been shown to have prognostic value in patients with Chagas' cardiomyopathy (CC). However, the additional value of NT-proBNP levels in further stratifying these patients according to DD has not been established. This study analyzed the correlation of N-terminal proBNP (NT-proBNP) levels with systolic and diastolic function in patients with CC. NT-proBNP levels were measured in 59 patients with dilated cardiomyopathy due to Chagas disease without other systemic illness that were studied by Doppler echocardiography, including left atrial volume (LAV) calculation and tissue Doppler evaluation of LV longitudinal function. Univariate analysis showed a strong correlation of NT-proBNP values with LVEF (r=-0.733, p<0.001) and a weak correlation with most Doppler echocardiographic parameters of diastolic function. On a multivariate analysis, LVEF and LAV volume emerged as correlating with elevated levels of the NT-proBNP. Patients with restrictive filling pattern (n=10), when compared to other patterns of DD, (n=49), showed a lower LVEF (25.4+/-6.4% vs. 39.8+/-9.4, p<0.001), a larger LAV (50.1+/-17.2 vs. 37.7+/-15.6 ml/m(2), p=0.004) and higher NT-proBNP levels (median+/-IQR: 3488+/-3056 vs. 492+/-700 pg/dl, p<0.001). A marked elevated concentration of NT-proBNP (> or =800 pg/ml) had a sensitivity of 90.0%, specificity of 70.5%, positive predictive value of 40.9% and negative predictive value of 96.9% for detecting a restrictive filling pattern. In patients with CC, NT-proBNP augmentation is a marker of LV dysfunction, with higher levels correlating with the more severe forms of both systolic and diastolic dysfunction.

Impact of intracoronary bone marrow cell transfer on diastolic function in patients after acute myocardial infarction: results from the BOOST trial

We have recently shown in the randomized-controlled BOne marrOw transfer to enhance ST-elevation infarct regeneration (BOOST) trial that intracoronary autologous bone marrow cell (BMC) transfer improves left ventricular (LV) ejection fraction recovery in patients after acute myocardial infarction (AMI). However, the impact of BMC therapy on LV diastolic function in patients after AMI has remained uncertain. Using (tissue) Doppler echocardiography, we evaluated the effects of BMC transfer on LV diastolic function in patients enrolled in the BOOST trial. After successful primary percutaneous coronary intervention (PCI) for acute ST-elevation myocardial infarction (MI), patients were randomized to a control (n = 29) or BMC transfer group (n = 30). Diastolic function was determined 4.5+/-1.5 days after PCI, at 6 months, and at 18 months by measuring transmitral flow velocities (E/A ratio), diastolic myocardial velocities (Ea/Aa ratio), isovolumic relaxation time (IVRT), and deceleration time (DT). All analyses were performed in a blinded fashion. There was an overall effect of BMC transfer on E/A [0.33+/-0.12; 95% confidence interval (CI): 0.09-0.57; P = 0.008] and Ea/Aa ratios (0.29+/-0.14; 95% CI: 0.01-0.57; P = 0.04). In contrast, we found no effect of BMC transfer on DT (-5+/-14 ms; 95% CI: -33 to 22; P = 0.70), IVRT (-7+/-7 ms; 95% CI: -20 to 6; P = 0.29), and E/Ea ratio (0.35+/-0.14; 95% CI: -0.92 to 1.62; P = 0.57). Intracoronary autologous BMC transfer improves echocardiographic parameters of diastolic function in patients after AMI.

Elevated serum markers for collagen synthesis in patients with hypertrophic cardiomyopathy and diastolic dysfunction

The hypothesis of impaired collagenolysis in patients with hypertrophic cardiomyopathy (HCM) was tested by measuring serum markers of type-I collagen metabolism. These markers were correlated with echocardiographic parameters of diastolic function. HCM is a common disease in the adult population with a wide range of clinical manifestations. Left ventricular hypertrophy and increased intramyocardial collagen content are known to cause diastolic dysfunction in patients with HCM. In 26 patients with HCM and 38 control subjects (aged: 57+/-3 and 54+/-2 years, p=n.s.) serum levels of collagenolytic matrixmetalloproteinase-1 (MMP-1) and its inhibitor TIMP-1, the markers for collagen type-I synthesis (PICP) and degradation (ICTP) were determined by ELISA and RIA. Diastolic function were determined by Doppler echocardiography. Free TIMP-1 was elevated in HCM compared to controls (216,78+/-9,89 vs 183.77+/-7.57 ng/ml ; p=0.006) as well as PICP (165.92+/-10.26 vs 114.57+/-6.38 mug/l; p<0.001). Free MMP-1 was significantly lower in HCM (1.13+/-0.20 vs 2.33+/-0.34; p=0.01). ICTP did not differ. The MMP-1/TIMP-1 ratio was significantly lower in HCM (0.006+/-0.001 vs 0.012+/-0.001, p=0.003). PICP correlated positively with diastolic E/A ratio (r=0.389; p=0.05) and septal thickness (r=0.484; p=0.01). Serum marker of collagen synthesis (PICP) is increased in patients with HCM. Increased marker for inhibition of collagenolysis (TIMP-1) and a disturbed balance of collagen synthesis and degradation (ratio) with a predominance of inhibition of collagenolysis indicates collagen accumulation (fibrosis), which explains passive diastolic dysfunction in patients with HCM.

Tissue Doppler Image-Derived Myocardial Performance(Tei Index) as a Simple Assessment of Global Cardiac Function in Adults

Background and Objectives：A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. Subjects and Methods：We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E’ ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction <50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a’) minus the duration of the systolic wave (b’) divided by b’, which is (a’-b’)/b’, is defined as the TDI-tei index. Results： The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. Conclusion：We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults. (Korean Circulation J 2005;35:315-321)

Doppler characterization of left ventricular diastolic function in beta-thalassaemia major. Evidence for an early stage of impaired relaxation.

Doppler echocardiographic studies of left ventricular diastolic function in patients with thalassaemia major have shown conflicting findings. This study was undertaken to compare Doppler echocardiographic parameters of diastolic function among a group of patients with thalassaemia major, a group with thalassaemia intermedia and a group of normal individuals. 50 patients with thalassaemia major, 38 patients with thalassaemia intermedia and 29 normal subjects were studied. All had normal systolic function. The thalassaemia intermedia patients had larger body surface area and left ventricular mass index than the thalassaemia major patients but less than the controls. The ratios between peak early and late mitral diastolic flow (E/A ratio) were comparable between the three groups. The haematocrit levels were comparable in the two study groups, but the ferritin levels were significantly higher in the thalassaemia major group (P<0.001). Using multiple regression analysis to correct for the influence of heart rate, age and body surface area, we found a prolonged isovolumic relaxation time (P<0.03) and a lower E wave (P<0.001) in the thalassaemia major group as compared to the thalassaemia intermedia group. The isovolumic relaxation time also differed significantly between the thalassaemia groups and the control (P<0.001), suggesting a state of impaired relaxation most notable in thalassaemia major that is probably due to iron overload. In patients with thalassaemia major and normal systolic function who have iron overload, the earliest sign of diastolic dysfunction is an impairment in left ventricular relaxation manifested as a prolonged isovolumic relaxation time.

The Role of Echocardlography In the FoIIow-Up of Orthotopic Heart Transplant Patients

Echocardiography is being used increasingly in the follow-up of patients after orthotopic heart transplantation. Doppler echocardiographic parameters of diastolic function [isovolumic relaxation time (IVRT), pressure half time (PHT), and early peak mitral inflow velocity (M1)] have been shown to be useful in detecting moderate to severe allograft rejection. Using each individual patient as his/her own control, accounting for the effects of recipient atrial contraction and time from transplant, a decrease in the IVRT or PHT Lx 15% is considered diagnostic of diastolic dysfunction and, hence, is an echocardiographic diagnosis of rejection. The sensitivity of these parameters to predict rejection approaches 80–90% with a specificity of 80–90%. Echocardiography is the procedure of choice in the diagnosis and follow-up of pericardial effusion and tricuspid regurgitation after transplantation. The presence of tricuspid regurgitation seems to be related to and a complication of the number of endomyocardial biopsies performed during the first year after transplantation. Dobutamine stress echocardiography is being used increasingly in the noninvasive diagnosis of transplant coronary artery disease. Using angiography as the “gold standard,” dobutamine stress echocardiography has a sensitivity of 80– 96% in the detection of transplant coronary artery disease. Echocardiographic measures of both systolic and diastolic function, and the development of regional wall motion abnormalities during dobutamine stress echocardiography, have all been shown to be useful predictors of mortality and the occurrence of cardiac events late after transplantation.

Impaired relationship between Doppler echocardiographic parameters of diastolic function and left ventricular filling pressure during acute ischemia

The relationship between left ventricular filling pressure and Doppler echocardiographic parameters of diastolic mitral flow (MF) was evaluated in patients with ischemic heart disease during acute ischemia induced by percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending artery. Thirty-two patients were examined by simultaneous recordings of the Doppler MF signal and the mean pulmonary capillary wedge pressure (PCm) as an approximation of left ventricular filling pressure. At rest PCm was correlated with the early/late velocity integral ratio (Ei/Ai: r = 0.62: p < 0.0001 n = 32). In 25 of 32 patients the recordings during PTCA could be evaluated. At the end of the inflation (duration: 69 ± 24 seconds) PCm increased from 11.2 ± 5.5 to 17.2 ± 7.2 mm Hg ( p < 0.001), and total MF integral as an index of systolic ventricular function decreased by 14.9 ± 12.8% ( p < 0.001). Inasmuch as both early and late velocity integrals were reduced during PTCA, the Ei/Ai ratio did not change significantly (1.41 ± 0.51 to 1.34 ± 0.60; NS). In a subgroup of inflations without ECG signs of ischemia, Ei was decreased without a concomitant decrease in Ai, thus leading to a decrease in the Ei/Ai ratio (1.36 ± 0.43 to 1.17 ± 0.31; p < 0.05). Summarizing the events during PTCA, a steady increase in PCm was observed, whereas the Ei/Ai ratio was slightly decreased. Thus the observation at rest that an elevated PCm was associated with an elevated Ei/Ai was no longer valid during PTCA (Ei/Ai : r = 0.28; NS). A significant correlation was found between parameters of Doppler MF and PCm in patients with ischemic heart disease at rest. During PTCA this relationship was attenuated. Therefore noninvasive assessment of left ventricular filling pressures during acute ischemia by Doppler echocardiography does not seem feasible.

Early detection of doxorubicin cardiotoxicity: Interest of Doppler echocardiographic analysis of left ventricular filling dynamics

Doxorubicin (Adriamycin) is an effective anticancer agent but its therapeutic value is limited by its myocardial cardiotoxicity. To improve early detection of doxorubicin cardiotoxicity, studies were performed in patients with long-term doxorubicin treatment using pulsed Doppler echocardiography to assess the changes in left ventricular (LV) diastolic filling dynamics. M-mode echocardiographic systolic parameters and Doppler transmitral flow velocities were analyzed in two groups of patients. In group A (45 patients, mean age 45 ± 13 years), the results were compared with those of a control group of 35 normal subjects matched for age. In group B (19 patients, mean age 44 ± 12 years), the pretreatment results were prospectively compared with those obtained during treatment protocol. The patients received a cumulative dosage of 253 ± 125 mg/m 2 of doxorubicin for group A and 240 ± 135 mg/m 2 for group B. After doxorubicin treatment, in the two groups there were no significant changes in LV dimensions, shortening fraction, and mean velocity of circumferential fiber shortening (VCF). In contrast, Doppler echocardiographic parameters of diastolic function were significantly modified after doxorubicin in the two groups:isovolumic relaxation period was prolonged by 32% in group A ( p < 0.001) and by 22% in group B ( p < 0.005). The early peak flow velocity was reduced by 18% in group A ( p < 0.002) and by 13% in group B ( p < 0.04), and the ratio early peak flow velocity/atrial peak flow velocity also decreased significantly, by 23% in group A ( p < 0.001) and by 20% in group B ( p < 0.01). The deceleration rate of the early peak flow velocity decreased from 458 ± 162 to 352 ± 193 cm/sec 2 in group A ( p < 0.005) and from 426 ± 168 to 339 ± 176 cm/sec 2 in group B ( p < 0.007); this parameter was reduced in 84% of group B patients. These changes were not correlated with doxorubicin dosage. In conclusion, in patients with long-term doxorubicin treatment, LV diastolic function abnormalities precede resting systolic dysfunction.

Influence of sublingual nitroglycerin on diastolic transmitral flow velocities in normal subjects

Pulsed Doppler echocardiographic sampling of transmitral diastolic flow velocities provides a noninvasive method for the serial evaluation of left ventricular diastolic function. 1 A reduction in the peak early filling (E) velocity and an increase in the peak late filling (A) velocity suggests reduced compliance of the left ventricle. 1 Similar changes in the velocity-time profile occur after the administration of nitroglycerin, 2 since diastolic function may be affected by changes in loading conditions 3 independent of intrinsic myocardial relaxation abnormalities. 4 Our purpose was to identify, in normal subjects, Doppler echocardiographic parameters of diastolic function that are not affected by preload reduction with sublingual nitroglycerin.