Internal Dimension In Diastole Research Articles

Effects of aging on neuroendocrine activation in subjects and patients in the presence and absence of heart failure with left ventricular systolic dysfunction

The neuroendocrine profile and echocardiographic features of 40 patients (81 ± 1 years, mean ± standard error) with heart failure and impaired left ventricular systolic function were compared with those of an age-matched group of healthy subjects, 20 younger patients with heart failure (aged 58 ± 1 years), and 15 younger healthy subjects. Normal elderly subjects had a neuroendocrine profile similar to that of healthy younger subjects apart from elevated plasma norepinephrine (958 ± 84 vs 302 ± 118 pg/ml; p < 0.001) and atrial natriuretic peptide (40 ± 6 vs 28 ± 5 pg/ml; p < 0.05). Despite a similar severity of heart failure, elderly patients had smaller ventricular dimensions (left ventricular internal dimension in diastole 51 ± 2 vs 69 ± 3 mm; p < 0.0001) and greater impairment of ventricular compliance using Doppler indexes. Plasma norepinephrine was higher (1,191 ± 80vs620 ± 67 pg/ml; p < 0.01), and plasma atrial natriuretic peptide, plasma active renin, and angiotensin II were lower in the elderly than in the younger patients with heart failure. As functional capacity declines with age, elderly patients may have less severe cardiac dysfunction for any given level of functional impairment, and this may account for most of the differences in neuroendocrine activity with age. Age appears to be an important determinant of plasma norepinephrine and may be a confounding factor in interpreting the prognostic significance of this hormone.

Percutaneous transluminal coronary angioplasty failures in patients with multivessel disease: Is there an increased risk?: N. Wang, S.R. Gundry, G. Van Arsdell, A.J. Razzouk, A.C. Hill, M. Sjolander, K.A. Cavazos, J.M. Brewer, E.E. Vyhmeister, L.L. Bailey, F.L Grover, A. El Gamel, W. Dembitsky. Division of Cardiothoracic Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA. J Thorac

To evaluate vena contracta and other echocardiographic measures of myxomatous mitral valve disease (MMVD) severity in a multivariable analysis of survival in dogs.70 dogs diagnosed with MMVD from stored echocardiographic images that met study inclusion criteria.Left heart dimensions were measured as well as mitral regurgitant jet area/left atrial area (JAR), early mitral filling velocity (Evel), extent of mitral valve prolapse in right and left views (ProlR, ProlL), Prol indexed to aortic diameter (ProlR:Ao, ProlL:Ao), presence of a flail leaflet (FlailR, FlailL), and mitral regurgitation vena contracta diameter (VCR, VCL) indexed to aortic diameter (VCR:Ao, VCL:Ao). Follow-up from referring veterinarians was obtained by questionnaire or telephone to determine survival times. Inter- and intra-observer agreement was evaluated with Bland–Altman plots and weighted Kappa analysis. Survival was analyzed using Kaplan–Meier curves, logrank tests and Cox's proportional hazards.Logrank analysis showed VCL:Ao, VCR:Ao, FlailL, ProlR:Ao, ProlL:Ao, left ventricular internal dimension in diastole indexed to aortic diameter (LVIDD:Ao) >2.87, left atrium to aorta ratio (LA/Ao) >1.6, and Evel >1.4 m/s were predictors of cardiac mortality. In a multivariable analysis, the independent predictors of cardiac mortality were Evel >1.4 m/s [hazard ratio (HR) 5.0, 95% confidence interval (CI) 2.5–10.3], FlailL (HR 3.1, 95% CI 1.3–7.9), and ProlR:Ao (HR 2.8, 95% CI 1.3–6.3).Echocardiographic measures of mitral regurgitation severity and mitral valve pathology provide valuable prognostic information independent of chamber enlargement in dogs with MMVD.

Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity

To identify factors influencing left ventricular (LV) diastolic filling in patients with morbid obesity, we performed transthoracic and Doppler echocardiography on 50 subjects whose actual body weight was ≥twice their ideal body weight and on 50 normal lean control subjects. The transmitral Doppler E A ratio and E wave deceleration half-time were used to assess LV diastolic filling. Significant negative correlations were seen between the E A ratio and the LV internal dimension in diastole ( r = 0.819, p = 0.0001), systolic blood pressure ( r = 0.751, p = 0.0001), LV end-systolic wall stress ( r = 0.782, p = 0.0001), and LV mass/height index ( r = 0.901, p = 0.0001). Significant positive correlations were seen between the E wave deceleration half-time and the LV internal dimension in diastole ( r = 0.743, p = 0.0001), systolic blood pressure ( r = 0.789, p = 0.0001), LV end-systolic wall stress ( r = 0.828, p = 0.0001), and LV mass/height index ( r = 0.831, p = 0.0001). No correlation was seen between diastolic blood pressure and either index of LV diastolic filling. Thus increasing LV mass is associated with progressive impairment of LV diastolic filling in morbidly obese individuals. The aforementioned alterations in LV loading conditions may contribute to impairment of LV diastolic filling directly or by increasing LV mass.

Echocardiographic measurements of cardiac dimensions in normal ponies and horses.

Echocardiographic examinations were performed on 41 clinically normal small ponies, large ponies and horses. Using standardised two-dimensional (2-D) echocardiographic images to guide M-mode studies, the interventricular septal thickness, left ventricular internal dimension and left ventricular wall in systole and diastole, and aortic diameter in diastole were measured. Normal values for these echocardiographic dimensions were obtained across a wide range of bodyweights. Although there was a trend for echocardiographic dimensions to increase with bodyweight across the whole range of animals examined, little or no linear correlation was found between dimensions and bodyweight within the small pony, large pony and horse groups.

Identification of Cardiovascular Abnormalities in Children With Empyema Thoracis by Two-dimensional and Doppler Echocardiography

To our knowledge, echocardiographic assessment of children with empyema has not been reported previously in the literature. Two-dimensional and Doppler echocardiography were performed in 47 children with acute (n = 23) and chronic (n = 24) empyema and 34 control subjects. Echocardiography demonstrated pericardial effusion in 11 of 47 patients (23 percent). Those with acute empyema had significantly thicker pericardium (p < 0.009) than control subjects. Tricuspid regurgitation was present in 21 of 47 patients (45 percent). The mean right ventricular internal dimension in diastole was significantly larger in patients with acute (p < 0.00002) and chronic (p < 0.006) empyema than that of control subjects. The mean tricuspid pressure gradients indicated an elevated mean right ventricular systolic pressure with increased calculated mean pulmonary arterial systolic pressures of children with acute empyema (38.5 +/- 6.4 mm Hg) and chronic (39.8 +/- 5.6 mm Hg) empyema than the normal mean (20 +/- 4 mm Hg). Children with chronic empyema had significantly less mean left ventricular internal dimension in diastole (p < 0.005) and left ventricular internal dimension in systole (p < 0.02) than control subjects. Strikingly, their mean left ventricular mass was also significantly less (p < 0.05) than that of subjects with either acute empyema or control subjects. These results provide baseline data for follow-up of children with acute and chronic empyema.

Factors influencing left ventricular systolic function in nonhypertensive morbidly obese patients, and effect of weight loss induced by gastroplasty

Heart rate and blood pressure were measured, and echocardiography was performed in 39 patients whose actual body weight was greater than twice their ideal body weight to identify factors influencing left ventricular (LV) systolic function in morbidly obese patients and assess the effect of weight loss on LV systolic function. Patients were studied before and after weight loss induced by gastroplasty. The study cohort was 133 ± 8% overweight before weight loss and 39 ± 7% overweight at the nadir of weight loss. Before weight toss, LV fractional shortening varied inversely with LV internal dimension in diastole (an indirect index of preload), LV end-systolic wall stress and systolic blood pressure (indexes of afterload). The weight loss-induced change in LV fractional shortening varied directly with the pre-weight loss LV internal dimension in diastole, LV end-systolic wall stress and systolic blood pressure, and inversely with the pre-weight loss LV fractional shortening. The weight loss-induced change in LV fractional shortening varied inversely with the weight loss-induced changes in LV end-systolic stress and systolic blood pressure. In patients with reduced LV fractional shortening (n = 14), weight loss produced a significant increase in LV fractional shortening that was accompanied by a significant decrease in LV internal dimension in diastole, LV end-systolic stress and systolic blood pressure. The results suggest that LV loading conditions have an important role in determining LV systolic function in morbidly obese patients. Improvement in LV systolic function in these patients is closely related to weight loss-induced alterations in LV loading conditions.

The Value of the Echo-Doppler in Cardiomyoplasty Procedures

Echo-Doppler determinations were performed in patients submitted to cardiomyoplasty procedure using the latissimus dorsi muscle graft (LDMG). In four patients who had 1 year of follow-up or more the left ventricular internal dimension in diastole (LVIDd), left ventricular internal dimension in systole (LVIDs), septal-E point separation (E-septum), distance of the mitral valve (E-E'), maximal aortic cuspid separation (MACS) and left atrium dimension (LA) were determined by two-dimensional echocardiogram. With a pulsed Doppler in the aortic root the following parameters were obtained: aortic peak flow (AoPF), velocity time integral (VTI), and ejection period (EP). With the stimulator on, the determinations were done using a ventricle muscle (VM) delay of 25, 75, and 250 msec. No significant differences were observed by Echo determinations between the stimulator off and on. With the supporting contraction of the LDMG the best hemodynamic performance was obtained when the VM delay ranged between 75 and 250 msec. Values with the stimulator off and on were as follows: AoPF: 90.8 +/- 8 cm/sec and 104.5 +/- 9 cm/sec; VTI: 14.8 +/- 2 cm and 19.2 +/- 2 cm; EP: 230 +/- 10 msec and 245 +/- 20 msec. A decrease in the systolic pressure of the pulmonary artery and a decreased functional regurgitation of the mitral and tricuspid valve were observed in the follow-up determinations. All patients showed restricted mitral flows that remained unchanged during the follow-up. In this group of patients the echo-Doppler showed an improvement of the systolic function of the left ventricle when it is supported by the LDMG.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of age on left ventricular filling in children of hypertensive parents.

Doppler transmitral flow velocity A/E ratio is a useful noninvasive estimate of left ventricular (LV) filling. However, the A/E ratio increases with age. To evaluate the effect of age on LV filling in children, Doppler transmitral flow velocity A/E ratios and echocardiographic measurements were obtained in 51 normal children (mean age 12 +/- 4 years) of hypertensive parents (study children), sex- and age-matched against 28 normal children (mean age 12 +/- 4 years) from normotensive parents (control children). There was a significant correlation between age and LV systolic and diastolic internal dimensions (r = 0.74 and 0.83, respectively, P less than .0001, in study children, and r = 0.70 and 0.79, respectively, P less than .0001, in control children), total wall thickness (r = 0.72, P less than .0001, in study children, and 0.61, P less than .001, in control children), and with LV mass index (r = 0.56, P less than .0001 and r = 0.45, P less than .02, respectively). In contrast, there was no correlation between age and transmitral flow velocity A/E ratio in either group (r = 0.12 and 0.07, respectively). In conclusion, age does not have an effect on LV filling in normal children from either normotensive or hypertensive parents. Therefore, age correction of A/E ration, which is necessary in adults, is not required in children. Because of a strong correlation between age and LV mass as well as LV mass index, age should be taken into account when defining criteria for LV hypertrophy in children.

Effect of Increasing Intraabdominal Pressure and Volume on Left Ventricular Function in Continuous Ambulatory Peritoneal Dialysis (CAPD)

To determine the effect of increasing intraabdominal pressure on left ventricular (LV) systolic function in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), we studied 15 patients who had been on CAPD for at least 2 months. The study protocol included measurement of echocardiographic LV internal dimensions in diastole and systole, LV wall thickness and mass, LV ejection time, the mean velocity of circumferential fiber shortening (mean Vcf), heart rate, BP, and intraabdominal pressure. Measurements were obtained at baseline (OL) and following intraperitoneal infusion of 1-L increments of dialysate solution (up to 4 L) in both the recumbent and standing positions. Significant differences in LV systolic function resulting from intraperitoneal infusion of dialysate were confined to the subgroup with increased LV wall thickness (n = 8). In this subgroup, mean Vcf decreased progressively from 0.99 +/- 0.18 circumferences/second at baseline to 0.88 +/- 0.16 circumferences/second at 1 L (P = NS), to 0.86 +/- 0.16 circumferences/second at 2 L (P = NS), to 0.66 +/- 0.18 circumferences/second at 3 L (P less than 0.005), and to 0.60 +/- 0.14 circumferences/second at 4 L (P less than 0.005) in recumbent position. Measurements obtained in the standing position paralleled those observed during recumbency. These changes were accompanied by a significant decrease in the mean LV internal dimension in diastole and a significant increase in intraabdominal pressure, but no significant change in the mean LV internal dimensions in systole, mean heart rate, or mean systolic or diastolic BP.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity

To determine cardiac chamber size, wall thickness and left ventricular (LV) systolic function in morbidly obese patients, M-mode and cross-sectional echocardiography was performed in 62 patients whose body weight was ≥ twice their ideal weight but who were free from underlying organic heart disease and systemic hypertension. The initial clinical protocol consisted of a medical history, physical examination, electrocardiogram at rest, chest x-ray and echocardiogram. Thereafter, each patient underwent gastric restriction. Thirty-four patients returned for follow-up echocardiography 4.3 ± 0.3 months after substantial weight loss was achieved. For the whole group (n = 62) and LV internal dimension in diastole was enlarged in 24 (39%), the right ventricular internal dimension was enlarged in 20 (32%), the left atrial dimension was enlarged in 25 (40%) and the ventricular septal and LV posterior wall thickness was increased in 35 (56%). In the 34 patients who returned for follow-up, mean body weight decreased significantly, from 135 ± 8 to 79 ± 6 kg (73 ± 4% of the amount over ideal body weight). In the subgroup with low preoperative LV fractional shortening (n = 13), mean LV fractional shortening increased from 22 ± 2% to 31 ± 2% (p < 0.01). This was accompanied by a significant decrease in the mean LV internal dimension in diastole and mean blood pressure. The results indicate that cardiac chamber enlargement, LV hypertrophy and LV systolic dysfunction occur frequently in morbidly obese patients and that LV systolic dysfunction in such persons may improve following substantial weight loss.

Value of Systolic Time Intervals in the Diagnosis of Large Patent Ductus Arteriosus in Fluid-Restricted and Mechanically Ventilated Preterm Infants

M-mode echocardiographic features suggesting a patent ductus arteriosus are based on two groups of indirect criteria: dilation of the left cardiac cavities and changes of systolic time intervals. The reliability of the first group of criteria has been questioned in fluid-limited, mechanically ventilated preterm infants. The sensitivity of the systolic time intervals in the same circumstances is investigated. Twenty-three patients with a large patent ductus arteriosus were selected. Review of their echocardiograms shows that the sensitivity of the various criteria (expressed as percentage of positivity) was as follows: inversion of the ratio of left ventricular preejection period to right ventricular preejection period, 91.3%; left ventricular preejection period to left ventricular ejection time over right ventricular preejection period to right ventricular ejection time less than 1,83%; left atrium dilation, 74%; shortening of left ventricular preejection period, 70%; dilation of left ventricular internal dimensions in diastole, 65%; increase in left atrium/aorta, 52%; and decrease of left ventricular preejection period to left ventricular ejection time, 48%. Three criteria involving time intervals (left ventricular preejection period to right ventricular preejection period, left ventricular preejection period, and left ventricular preejection period to left ventricular ejection time) had 100% specificity. The lowest specificity was found with criteria involving the left atrium (left atrial to aortic root ratio 75% and left atrium 63%). It is concluded that study of systolic time intervals is a reliable means of detecting preterm infants with hemodynamically significant left-to-right shunt through a patent ductus arteriosus even if the infants are mechanically ventilated and fluid restricted.

M-mode echocardiography in the developing human fetus.

The M-mode echocardiogram can be obtained in the developing human fetus from around the 16th week of gestation until term. Errors in interpretation of the M-mode echocardiogram can be avoided by concurrent two dimensional fetal cardiac examination. The pattern of motion of the mitral, tricuspid, aortic, and pulmonary valves and ventricular wall motion can be studied. Motion of the foramen ovale flap, which is characteristic in fetal life, can also be observed. Using the M-mode tracing, measurement data for six variables were made and growth charts constructed. The variables recorded were septal and left ventricular wall thickness, right and left ventricular internal dimension in diastole, aortic root dimension, and left atrial internal dimension. The measurements were made in normal pregnancies where the fetal heart was structurally normal. Confidence limits for each measurement were derived for gestational ages between 16 and 39 weeks.

Handgrip exercise in normal young women: a noninvasive cardiovascular assessment.

Blood pressure, heart rate, and echocardiographic parameters of left ventricular size and shortening were measured both under baseline conditions and during handgrip exercise (50% maximum handgrip effort held to fatigue) in 20 normal women (20 through 29 years of age). As a group, there was a significant increase in heart rate (72 +/- 10 vs 83 +/- 12; P less than .001), systolic blood pressure (111 +/- 8 vs 133 +/- 14 mm Hg; P less than .001), diastolic blood pressure (67 +/- 8 vs 89 +/- 12 mm Hg; P less than .001), and calculated cardiac output (4.3 +/- 1.5 vs 5.2 +/- 1.7 liters/minute; P less than .005). There was no significant change in left ventricular internal dimension in diastole or systole, shortening fraction, or calculated stroke volume. The average group response of an increase in cardiac output secondary to an increase in heart rate is similar to that of male subjects in their second decade. Individual variability in responses was of specific interest since only three of the 20 women demonstrated a totally characteristic response to handgrip exercise. Handgrip exercise in young women may not provide a uniformly characteristic response from which to predict hemodynamic changes in a given individual and may lead to clinical misinterpretation if appropriate caution is not used.

Echocardiographic evaluation of acute administration of oxyfedrine in patients with coronary artery disease.

In order to assess the effects of oxyfedrine in ischaemic heart disease, echocardiographic evaluation of left ventricular function was performed 2,5,10,15 and 20 minutes after the intravenous administration of 12 mg oxyfedrine in 15 patients with coronary artery disease without angiographic abnormalities of left ventricular wall motion. The following parameters were measured: heart rate, mean arterial blood pressure, internal dimension in diastole (LVIDd) and in systole (LVIDs) of the left ventricule and the percentage shortening of the LVID (%LVID). There was a significant increase in %LVID (peak 10 minutes after drug administration; p less than 0.001) indicating improved left ventricular function, associated with slight changes in pre-load (LVIDd) and in heart rate, and no variation in mean blood pressure. No abnormalities of contraction were observed after the administration of oxyfedrine. These results suggest that oxyfedrine exerts a direct positive inotropic effect of the myocardium in patients with significant coronary artery stenoses.

Severity of mitral regurgitation assessed by echocardiography. Reliability and limitations.

To assess whether echocardiography may represent a useful mean to evaluate the degree mitral regurgitation (DR), left ventricular diastolic internal dimension (LVIDd), left atrial dimension (LAD), and velocity of circumferential fiber shortening (Vcf) were compared to DR assessed by left ventriculography in 48 patients with primary (n = 21) and cardiomyopathic (n = 27) valvular incompetence. In patients with good left ventricular contractility, i.e. with Vcf values above 1.02, a significant positive linear correlation was found between LVIDd and DR (LVIDd = 5.38 + 0.45DR; r = 0.72; p less than 0.001). In contrast, in patients with depressed left ventricular function, i.e. with Vcf values below 1.02, LVIDd did not correlate to DR. In either group LAD and Vcf did not correlate to DR. Thus, echocardiography may provide useful semiquantitative information concerning DR only in patients with preserved left ventricular performance.

Echocardiographic Observations Regarding Pericardial Effusions Associated with Cardiac Disease

Cardiac disease associated with congestive heart failure was found to be the most common cause (22 of 76) of pericardial effusion in patients referred for echocardiography. Parameters of left heart function were markedly abnormal in these patients with congestive heart failure and pericardial effusion, but were not significantly different from a group of patients with congestive heart failure without pericardial effusion. Clinical findings consistent with cardiac decompensation also failed to discern between these two groups. Nonetheless, patients with congestive heart failure with pericardial effusion had significantly larger right ventricular internal dimensions than those without effusion. Patients with pericardial effusion related to congestive heart failure (P < .01), heart disease without congestive heart failure (P < 0.001) and those patients post recent myocardial infarction (P < 0.05) had significantly larger right ventricular internal dimensions in diastole than normal subjects. Patients with pericardial effusions related to recent open heart surgery, idiopathic pericarditis or of miscellaneous causes had normal right ventricular internal dimensions. It is likely that right ventricular dilation indicates abnormal volume/pressure relationships of the right heart and that this abnormality, through alterations in venous and lymphatic drainage, underlies the accumulation of pericardial effusion in these patients with heart disease with or without congestive heart failure.

Echocardiographic measurements in normal subjects: Evaluation of an adult population without clinically apparent heart disease

In order to determine normal echocardiographic values for older subjects, we studied 136 adults (78 men and 58 women, 20 to 97 years of age) without evidence of cardiovascular disease. When patients were subdivided into six age groups, progressive changes were found in mean normal values for various parameters. Specifically, when the oldest group (over 70 years) was compared with the youngest group (21-30 years), significant (p less than 0.01) increases in aortic root (22 percent) and left atrial (16 percent) dimensions, in ventricular septal (20 percent) and left ventricular free-wall (18 percent) thicknesses, and in estimated left ventricular mass (15 percent) were noted. In addition, a significant (p less than 0.01) decrease in mean mitral E-F slope (43 percent) and slight decreases in mean left ventricular systolic and diastolic internal dimensions (5 and 6 percent, respectively; p less than 0.05) were noted. Left ventricular ejection fraction and percentage fractional shortening were found to be independent of age. These data have been used to derive regression equations that are related to both age and body surface area. The regression equations can be used to calculate mean normal values and 95 percent prediction intervals for echocardiographic measurements in adults.