Isovolumetric Contraction Time Research Articles

Evaluation of Right Ventricular Function in Patients With COPD

Pulmonary hypertension is an independent risk factor for death in patients with COPD. Current prognostic models of COPD do not include sufficient indicators of right ventricular (RV) function to enable accurate assessment of changes in RV function over time. The aim of the present study was to test the hypothesis that it would be useful to include noninvasive markers of RV function in the routine assessment and prognostic models of early stage COPD with or without pulmonary hypertension. We reviewed the clinical records of 49 male subjects who had COPD but no other conditions that might affect physical status or prognosis, who underwent cardiac ultrasonography. Various echocardiographic parameters of pulmonary circulation and RV function were compared with indices of physical status and prognosis. The Medical Research Council dyspnea score was higher in subjects with echocardiographic findings suggestive of pulmonary hypertension than those without (mean ± SD 3.17 ± 1.23 vs 2.26 ± 0.81, P = .02). RV ejection time, RV isovolumetric relaxation time, RV isovolumetric contraction time + RV isovolumetric relaxation time, and RV total ejection isovolume index differed significantly between subjects with echocardiographic findings suggestive of pulmonary hypertension and those without. The RV total ejection isovolume index was strongly correlated with the MRC score (P < .001), and was significantly correlated with the overall survival rate (hazard ratio 5.31, 95% CI 1.91-14.77) and hospital-free survival rate (hazard ratio 3.26, 95% CI 1.48-7.16). It may be valuable to add assessment of RV function to the routine evaluation of physical status in patients with COPD.

Evaluation of myocardial function using tissue Doppler imaging in children with moderate scorpion envenomation

Context. Scorpion envenomation is an important public health problem. It can cause life-threatening complications such as respiratory, neurological and cardiovascular compromise. Systemic envenoming signs and mortality rates are dramatically higher in children. Objective. The objective of this study was to evaluate myocardial function using pulsed tissue Doppler imaging in patients with moderate scorpion envenomation. Materials and methods. The study was conducted from July to October 2009 in the South-East Anatolia region of Turkey. The study population consisted of 30 children with moderate scorpion envenomation and 30 age- and sex-matched normal controls. Severe and mild envenomations were excluded. In addition to echocardiographic examination, pulsed tissue Doppler imaging was performed. Results. The average age was 7.6 ± 4.3 years in patients and 7.9 ± 3.2 years in controls (p value, 0.77). The mean heart rate was 114 ± 19 beats/min (range, 72–164) in patients and 95 ± 14 beats/min (range, 72–127) in controls (p < 0.01). Sinus tachycardia (> 120 beats/min in children) was detected in ten (33.3%) patients. Myocardial performance index (MPI) was obtained with tissue Doppler imaging. The ejection fraction, the fractional shortening, the MPI of the left ventricle, the MPI of the right ventricle, the left ventricular isovolumetric contraction time (ICT), the left ventricular isovolumetric relaxation time (IRT), the left ventricular ejection time, the right ventricular ICT, the right ventricular IRT and the right ventricular ejection were not statistically different between the patients and the controls (p > 0.05). Discussion. We did not detect any considerable myocardial involvement in the children presenting with moderate scorpion envenomation except for sinus tachycardia. If the patients are treated with antivenom within 4 h, patients with moderate scorpion envenomation may not develop cardiac dysfunction.

Fetal Myocardial Performance (Tei) Index in Fetal Hemoglobin Bart's Disease

To assess the effectiveness of Tei index in differentiating fetal Hb Bart's disease in pregnancies at risk in the first half of pregnancy. Pregnancies meeting the inclusion criteria were consecutively recruited to the study. The inclusion criteria were as follows: 1) singleton pregnancies, 2) gestational age of 12 - 20 weeks, 3) at risk of Hb Bart's disease, 4) confirmed fetal diagnosis of Hb Bart's disease. Fetuses with frank hydrops fetalis or fetuses with chromosomal abnormalities or structural anomalies were excluded. Tei index was performed and immediately recorded before invasive prenatal diagnosis was performed. Of 152 fetuses, 50 were finally proven to be affected by Hb Bart disease, and the remainder was unaffected. Mean (± SD) Tei index were 0.48 ± 0.07 and 0.54 ± 0.08 in group of unaffected and affected fetuses, respectively. The mean difference was 0.05 which was statistically significant (p < 0.001). Likewise, mean (± SD) isovolumetric contraction time (ICT) in normal fetuses were also significantly different from that of affected fetuses. In the first half of pregnancy, Tei index in the fetuses with Hb Bart's disease was significantly higher than that in normal fetuses implying that Tei index may be a novel useful and non-invasive tool for early detection of fetal Hb Bart's disease among pregnancies at risk.

The effects of undifferentiated spondyloarthropathy on left ventricular systolic and diastolic function

Recent studies report that cardiovascular mortality is more common in patients with spondyloarthropathy (SpA) compared with the normal population. In this study, we aimed to determine left ventricular systolic and diastolic functions using tissue Doppler echocardiography (TDE) in addition to conventional methods in undifferentiated SpA (uSpA) patients. A total of 45 patients and 44 age and sex matched healthy controls participated in the present study. Left ventricular systolic and diastolic functions were assessed with two dimensional (2D) echocardiography, M-mode echocardiography, pulsed-wave (PW) echocardiography and tissue Doppler echocardiography. The peak systolic velocity (Sm), early diastolic myocardial peak velocity (Em), and late diastolic myocardial peak velocity (Am), myocardial isovolumetric contraction time (IVCTm), myocardial ejection time (ETm), myocardial isovolumetric relaxation time (IVRTm) and myocardial performance index (MPI) were measured at septal and lateral mitral annulus. Left ventricular diastolic inflow velocities showed that isovolumetric relaxation time (IVRT) and deceleration time (DT) were significantly longer in the uSpA group. Left ventricular lateral wall PW tissue Doppler echocardiography showed that Em was significantly lower in uSpA group. Septal PW tissue Doppler echocardiography showed that Em was lower and IVRT was longer in the uSpA group compared with healthy controls. In this study we determined that left ventricular systolic function is preserved in patients with uSpA. Although frequency of diastolic dysfunction was similar in both groups, deterioration of some diastolic parameters in the uSpA group might be considered for possible cardiac involvement in patients with uSpA.

Echocardiographic evaluation of ventricular function in young adults with bronchial asthma

BackgroundBronchial asthma (BA) is a common chronic inflammatory condition affecting the airways. Bronchial asthma not only affects the lung but also affects other organs including the heart. Right ventricular (RV) hypertrophy and dilation and left ventricular (LV) diastolic dysfunction were observed in severe BA. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been extensively studied before. PurposeThe aim of this study was to evaluate ventricular function in young adult patients with BA. Patients and methodsFifty patients with bronchial asthma and 30 control subjects (mean ages 28.3±7.0 and 26.8±6.2years, respectively) participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle (LV). LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, myocardial performance index (MPI) and transmitral flow propagation velocity (TFPV). RV function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. ResultsOur results revealed that there were statistically significant differences in the peak E velocity, peak E velocity/peak A velocity ratio and isovolumetric relaxation time between the two groups (p<0.05). Mean LV MPI in the bronchial asthma group (0.40±0.13) was also significantly higher than that of the controls (0.36±0.11, p<0.05). On the other hand, there were no significant differences in the mean value of peak A velocity, deceleration time and isovolumetric contraction time between bronchial asthma patients and controls. TFPV was significantly reduced in the bronchial asthma group when compared to controls (37.10±2.13 versus 43.40±3.11, respectively, p=0.001). We observed no significant difference in the echocardiographic indices of RV performance between the two groups. The mean RV MPI in the bronchial asthma group (0.29±0.11) was not significantly different from that of the controls (0.27±0.08). ConclusionFrom this study we concluded that LV diastolic function is impaired in patients with bronchial asthma despite no effect on RV diastolic function.

21-day Balneotherapy Improves Cardiopulmonary Function and Physical Capacity of Pilots

[Purpose] The purpose of this study was to investigate the effects of balneotherapy on the cardiopulmonary function and physical capacity of pilots. [Subjects] Thirty-six healthy male pilots were recruited. [Methods] All subjects received entire-body immersion bath therapy in thermomineral water for 30 min a day for 21 days. Electrocardiograms, carotid pulse traces, and phonocardiograms were recorded using a cardiac function measuring device. Pulmonary function tests were performed using a Pony FX spirometer. The physical capacity of pilots was examined 1 day before and after balneotherapy. [Results] After 21 days of treatment, isovolumetric contraction time and the ratio of isovolumetric contraction time/left ventricular ejection time were reduced. Forced vital capacity, peak expiratory flow, the ratio of forced expiratory volume in 1 second/ forced expiratory volume and forced expiratory flow at 25–75% were elevated. The exercise numbers of pull-ups and sit-ups in 1 min were boosted. [Conclusion] The findings imply that balneotherapy for 21 days has a significant effect on the cardiopulmonary function and physical capacity of pilots.

Normal reference values of tissue Doppler imaging parameters for right ventricular function in young adults: a population based study.

Background:Tissue Doppler imaging is used routinely to quantify both left and right ventricular function. However, normal reference values of echocardiography parameters of the right ventricle in Iranian population are still unknown.Objectives:Accordingly, we conducted a study to determine the normal values of echocardiography parameters of right ventricular function in a healthy Iranian population.Patients and Methods:One hundred and eighty seven healthy volunteer subjects enrolled. Normal subjects were chosen by taking into account history, physical examination, ECG and echocardiography.Results:Reference ranges (5th and 95th percentile values) for tricuspid E velocity, A velocity, E/A ratio, deceleration time, annular Sa velocity, Ea velocity, and E/Ea ratio were derived for the whole individuals and for each of the three age groups (< 30, 30–39, 40-49). The deceleration time, E/ Ea ratio and acceleration time of the iso-volumetric contraction time (IVA) were greater in male than in female. All measured parameters were bigger but not statistically significant in the 40-49 year-old group in comparison with the < 30 year-old group. Comparison of data between different groups showed no significant differences between the majority of data when they have been adjusted to body surface area, age and sex.Conclusions:The reference ranges presented for the echocardiography parameters of right ventricular function, albeit not conducted in a sizable sample of normal cases, will help to standardize the assessment of RV functions, particularly by tissue Doppler imaging.

Left ventricular and aortic dysfunction in cystic fibrosis mice

Left ventricular (LV) abnormalities have been reported in cystic fibrosis (CF); however, it remains unclear if loss of cystic fibrosis transmembrane conductance regulator (CFTR) function causes heart defects independent of lung disease. Using gut-corrected F508del CFTR mutant mice (ΔF508), which do not develop human lung disease, we examined in vivo heart and aortic function via 2D transthoracic echocardiography and LV catheterization. ΔF508 mouse hearts showed LV concentric remodeling along with enhanced inotropy (increased +dP/dt, fractional shortening, decreased isovolumetric contraction time) and greater lusitropy (-dP/dt, Tau). Aortas displayed increased stiffness and altered diastolic flow. β-adrenergic stimulation revealed diminished cardiac reserve (attenuated +dP/dt,-dP/dt, LV pressure). In a mouse model of CF, CFTR mutation leads to LV remodeling with alteration of cardiac and aortic functions in the absence of lung disease. As CF patients live longer, more active lives, their risk for cardiovascular disease should be considered.

Fetal evaluation of the modified‐myocardial performance index in pregnancies complicated by diabetes

To evaluate the fetal cardiac function by modified myocardial performance index (Mod-MPI) in pregnant diabetic patients. Modified myocardial performance index was measured in fetuses of patients with diabetes (DM) between 30 and 40 weeks of gestation. The isovolumetric contraction time, isovolumetric relaxation time and ejection time were measured. Mod-MPI was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Results were analyzed by using one-way analysis of variance (post hoc Bonferroni correction), Chi-square and Student's test. Modified myocardial performance index values of fetuses from DM mothers were significantly higher than controls (0.43 vs 0.37, P < 0.0001), and it was not different between gestational versus pregestational DM (0.42 vs 0.45, P = 0.18). Mod-MPI was also higher in the presence of polyhydramnios (0.49 vs 0.41, P < 0.0001), insulin use (0.46 vs 0.40, P < 0.05), and large for gestational age fetuses (0.49 vs 0.40, P < 0.0001). There were no significant differences in Mod-MPI between newborns with versus without neonatal complications such as hypoglycemia or polycythemia. In fetuses of DM mothers, evaluation of the Mod-MPI identifies those with worse maternal disease and large fetal size.

Normal Reference Ranges from 11 to 41 Weeks’ Gestation of Fetal Left Modified Myocardial Performance Index by Conventional Doppler with the Use of Stringent Criteria for Delimitation of the Time Periods

Objective: To establish normal reference intervals of the fetal left modified myocardial performance index (MPI) with the use of stringent criteria for delimitation of the time periods. Study Design: A cohort of consecutive singleton fetuses was created including at least 20 fetuses for each completed week of gestation between 11 and 41 weeks. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) were calculated using the clicks of the mitral and aortic valves as landmarks, and the MPI was calculated as follows: (ICT + IRT)/ET. Normal reference ranges for the MPI and its individual components were constructed by means of regression analysis of the mean and standard deviation against gestational age (GA). Results: A total of 730 fetuses were included. After a natural logarithmic transformation, a third degree cubic polynomial model (log_e mean MPI = 0.0477 × GA – 0.002565 × GA² + 0.000043 × GA³ –1.22, with GA measured in weeks) was selected to fit our data. There was a progressive increase in the mean MPI from 11 weeks (mean, 0.39; 95th centile, 0.51) to 41 weeks (mean, 0.55; 95th centile, 0.78) of gestation. While the mean ICT and IRT values increased with GA from 25 to 32 ms and from 39 to 51 ms, respectively, the ET showed an initial increase until 30 weeks and a progressive decrease thereafter. Conclusion: Normative references of left modified MPI from 11 to 41 weeks of gestation are provided, which could be useful in the assessment of cardiac function in fetuses.

Development of Australian Reference Ranges for the Left Fetal Modified Myocardial Performance Index and the Influence of Caliper Location on Time Interval Measurement

Objectives: To construct gestational age-adjusted reference ranges of the left fetal modified myocardial performance index (Mod-MPI) in the Australian population and assess the influence of valve click caliper position on constituent time intervals and the Mod-MPI. Methods: This is a prospective longitudinal study of 117 normal singleton fetuses undergoing 318 ultrasound scans at 4–6 weekly intervals between 18 and 38 weeks of gestation. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) were measured at 3 different caliper positions in each fetus: beginning of the original valve clicks (‘original’), beginning of the reflected valve clicks (‘reflected’), and peak of valve clicks (‘peak’). The Mod-MPI was calculated as (ICT + IRT)/ET. Results: The Mod-MPI increased throughout gestation with means ± SD of 0.42 ± 0.05 ‘reflected’ and ‘peak’ versus 0.49 ± 0.03 ‘original’ at 19 weeks, and means of 0.46 ± 0.05 ‘reflected and peak’ versus 0.51 ± 0.08 ‘original’ at 36 weeks. Throughout gestation, ICT remained fairly constant and IRT increased, while ET decreased with ‘original’ click and remained constant for ‘reflected’ and ‘peak’ clicks. A modest increase in Mod-MPI was seen with increasing fetal heart rate. Analysis of repeatability for the 3 methods showed the following ICCs: ‘original’, 0.797 (95% CI 0.762–0.829); ‘reflected’, 0.809 (95% CI 0.775–0.839), and ‘peak’, 0.799 (95% CI 0.764–0.831). Conclusions: Detailed exploration of the morphology of mitral and aortic valve closure and opening clicks shows how selection of different phases of these clicks may significantly influence the Mod-MPI. We recommend that the peak of the valve clicks be standardized between research groups.

The Impact of Preload Alteration on the Myocardial Performance Index through Implementing Positive End Expiratory Pressure

Load independent methods should be used for the assessment of ventricular function. Debate still exists regarding whether tissue Doppler imaging (TDI) indices are influenced by preload. Here, we evaluated the effect of positive end expiratory pressure (PEEP) related preload reduction on both conventional pulsed Doppler (PD) and TDI myocardial performance index (MPI). Thirty-eight mechanically ventilated patients of 3 months to 12 years old (mean ± SD age of 30 ± 11 months) without overt heart disease were enrolled. Doppler mitral inflow velocities, isovolumetric contraction and relaxation times and aortic ejection time in addition to TDI peak systolic, early and late diastolic velocities from the basal segment of left ventricular lateral wall were determined for each patient before and after applying high PEEP (10 cmH(2) O).PD-MPI was load dependent (0.61 ± 0.22 vs. 0.78 ± 0.25, P = 0.002). However, TDI-MPI did not significantly change after the use of high PEEP declining the left ventricular volume loading (0.78 ± 0.21 vs. 0.84 ± 0.22, P = 0.23). Hence, regarding various interfering pathophysiologic factors particularly preload reduction, it seems that TDI-MPI would be a more reliable index for the assessment of ventricular function.

PP018 Cardiac reflex responses measured by impedance cardiography are different between low and high cardiac output pre-eclampsia

Pre-eclampsia (PE) has been categorised into subtypes depending on low or high cardiac output (CO) states. Are cardiac reflex responses (CRR) different between these two subtypes? Impedance cardiography (ICG) measurements of cardiac cycle time intervals (CCTI) before and after orthostatic challenge are evaluated in the clinical phase of PE with low and high CO (LPE and HPE, respectively). Examinations were performed in 25 LPE (CO⩽7l/min) and 16 HPE (CO⩾9l/min). A third generation ICG device using a four electrode arrangement (NICCOMO, Medis, Germany) was used to measure CCTI in supine position and after moving to upright position. The pre-ejection period (PEP) is the time-interval between ventricular depolarisation and start of aortic flow. The left ventricular ejection time (LVET) is the time-interval between opening and closing of the aortic valve. Systolic time ratio (STR) is PEP/LVET. Diastolic time (DT) is the heart period duration - (PEP+LVET). Time intervals were expressed as a percentage of the heart period duration, i.e. PEPi, LVETi and DTi. Orthostatic-induced changes from supine to upright position (cardiac reflex response or CRR) were evaluated using One-sample Wilcoxon Signed Rank Tests. All CRRs were compared between LPE and HPE using Mann-Whitney U tests. Data are presented as medians (interquartile ranges). Maternal age was comparable between LPE and HPE [29 (26-34) vs 28 (26-33) years; p=0.55]. This was also true for gestational age [34 (30-38) vs 36 (31-39) weeks; p=0.50], and pre-gestational BMI [24 (22-30) vs 25 (24-32); p=0.21]. Birth weight percentiles were lower in LPE compared to HPE [18 (5-31) vs 44 (18-83); p<0.01]. CRRs within each group are shown in Table 1. CRRs of PEP, PEPi and DT were different between LPE and HPE [p⩽0.04], whereas changes in LVET, LVETi, DTi and STR were not [p⩾0.09]. Reflex-induced changes of diastolic blood pressure and heart rate (HR) were not significantly different between LPE and HPE [p⩾0.41]. Orthostasis does not change PEP in HPE, but induces a significant increase of PEP in LPE. PEP is dependent on HR, preload, afterload and sympathetic activity. There is no difference in the reflex-induced response of HR, DBP (∼afterload), and STR (∼sympathetic activity) between the two groups. This suggests that the orthostatic-induced change in the isovolumetric contraction time in LPE is preload-induced. Our observations suggest that hemodynamic background mechanisms behind LPE and HPE are different, and support the view that these subtypes are two different clinical entities.

OS095. Impedance cardiography: A straightforward and reliable tool to evaluate differences of cardiac reflex response between normal pregnancy and pre-eclampsia

Reflex responses of cardiac cycle time intervals (CCTI) can be measured by echocardiography, and are reported to differ between uneventful pregnancy (UP) and pre-eclampsia (PE). It is unknown whether impedance cardiography (ICG) is a useful method to measure CCTI during pregnancy. ICG measurements of CCTI before and after orthostatic challenge are evaluated in UP and in the clinical phase of PE. Examinations were performed twice in 16 UP (30-36 weeks), and once in 30 early PE (EPE, <34 weeks) and in 32 late PE (LPE, ⩾34 weeks). A 3rd generation ICG device using a 4 electrode arrangement (NICCOMO, Medis, Germany) was used to measure CCTI in supine position and after moving to upright position. The pre-ejection period (PEP) is the time-interval between ventricular depolarisation and start of aortic flow. The left ventricular ejection time (LVET) is the time-interval between opening and closing of the aortic valve. Diastolic time (DT) is heart period duration - (PEP+LVET). Orthostatic-induced changes from supine to upright position (cardiac reflex response or CRR) were evaluated using One-sample Wilcoxon Signed Rank Tests. All CRRs in EPE and LPE were compared to UP using Mann-Whitney U tests. Data are represented as medians (interquartile ranges). Maternal age was comparable between all groups [29 (26-32) years; p⩾0.47]. Gestational age was comparable between both early [31 (28-32) vs 31 (27-33) weeks] and late [37 (36-39) vs 38 (36-39) weeks] third trimester UP and PE [p⩾0.38]. Pre-gestational BMI was higher in EPE compared to UP [26 (24-32) vs 23 (21-24); p<0.01]. This was not true for LPE [25 (23-28); p=0.06]. Birth weight percentiles were lower in both EPE and LPE compared to UP [UP: 44 (38-78), EPE: 18 (5-28), LPE: 31 (18-59); p<0.05], and also lower in EPE compared to LPE [p=0.03]. CRRs within each group are shown in Table 1. The CRRs of PEP were significantly different between UP and both EPE and LPE [p⩽0.01], due to orthostatic-induced increase in PE but not in UP . Our study confirms that orthostasis does not change PEP in UP but induces a significant increase of PEP in PE. The increased reflex-induced duration of isovolumetric contraction time can be explained by a decreased left ventricular performance in the clinical phase of PE as compared to UP. ICG turns out to be a straightforward and useful method to evaluate these hemodynamic features.

Reproducibility of constituent time intervals of right and left fetal modified myocardial performance indices on pulsed Doppler echocardiography: a short report

To assess reproducibility of constituent time intervals measured by pulsed Doppler echocardiography for calculation of the right and left fetal myocardial performance indices (MPIs). This was a prospective study of 30 normal singleton pregnancies (19-36 weeks). In each, five different time intervals were measured from the Doppler waveform and four repeated measures were taken for each time interval. Three were from the left heart: isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT) and ejection time (ET); two were from the right heart: 'a-interval' and 'b-interval'. The left and right modified MPIs (Mod-MPIs) generated by these constituent time intervals were also evaluated. Two operators evaluated the reproducibility of all measures. There was generally good intra- and interobserver reproducibility for all time intervals and resultant Mod-MPIs: ICT, range, 19-43 ms with intraclass correlation coefficient (ICC), 0.91 (95% CI, 0.85-0.95); ET, range, 160-184.8 ms with ICC, 0.90 (95% CI, 0.84-0.95); IRT, range, 35.8-48.5 ms with ICC, 0.67 (95% CI, 0.52-0.81); a-interval, range 208-265 ms with ICC, 0.89 (95% CI, 0.82-0.94); b-interval, range, 163.1-188.3 ms with ICC, 0.82 (95% CI, 0.71-0.90); left Mod-MPI, range, 0.33-0.48 with ICC, 0.84 (95% CI, 0.74-0.91); right Mod-MPI, range, 0.21-0.49 with ICC, 0.82 (95% CI, 0.71-0.90). The 95% limits of agreement showed no statistically significant difference in measurements between the two examiners for all time intervals. This is the first study to evaluate the reproducibility of the component time intervals of both right and left fetal Mod-MPIs in the second and third trimesters and supports the reproducibility of fetal functional cardiac assessment. The IRT is the main source of variation for the left Mod-MPI so should be the focus of further investigation. Even using two separate pulsed-wave Doppler gates and therefore separate cardiac cycles, the right Mod-MPI is reproducible.

Measurement of the fetal isovolumetric contraction time in the fetus with a left ventricular aneurysm

We present a case of an antenatally diagnosed congenital aneurysm of the left ventricle in which fetal cardiac contractility was evaluated by measuring the fetal isovolumetric contraction time (ICT). The workup of the fetus at 26 weeks' gestation led to the identification of a left ventricle aneurysm. Initially, the value of ICT of the left ventricle indicated adequate cardiac function. However, the fetal ICT was gradually prolonged, suspecting deteriorated cardiac contractility. Following an uncomplicated term delivery, a postnatal echocardiogram showed normal cardiac function. It is considered that because of the hypokinesis of the wall of the left ventricular aneurysm, the ICT did not fully predict cardiac function in this setting.

Effect of Blood Donation Mediated Volume Reduction on Right Ventricular Function Parameters in Healthy Subjects

We aimed to investigate the effect of controlled and limited volume change by the blood donation model to the right ventricular (RV) function via different echocardiographic parameters in healthy adults. Study population was composed of 71 healthy subjects who were volunteers for blood donation and evaluated before and after 450 mL blood donation. Pulsed-wave Doppler of the RV inflow and tissue Doppler of tricuspid lateral annulus, and tricuspid annular plane systolic excursion (TAPSE) were assessed. E velocity of inflow decreased significantly (67.6 ± 15.9 vs 60.9 ± 12.2, P = 0.006). S' and A' velocities did not change (15.3 ± 3.2 vs 15.2 ± 2.5 cm/s, P = NS; 14.1 ± 3.3 vs 13.4 ± 3.1 cm/s, P = NS, respectively) but E' showed significant decrease (13.7 ± 2.9 vs 12.2 ± 3.2 cm/s, P = 0.011). E'/A' ratio and E/E' ratio were found to be unchanged (1.0 ± 0.3 vs 1.0 ± 0.4, P = NS; 5.1 ± 2 vs 5.3 ± 2, P = NS, respectively). Myocardial performance index (MPI) was found to be increased but ejection time obtained from the tricuspid annulus did not change (0.50 ± 0.13 vs 0.54 ± 0.11, P = 0.040; 243 ± 37 vs 240 ± 27, P = NS, respectively). Isovolumetric relaxation and contraction times showed difference close to the significance limit (56 ± 19 vs 64 ± 23 ms, P = 0.055; 61 ± 16 vs 67 ± 16 ms, P = 0.062, respectively). TAPSE decreased significantly (2.62 ± 0.29 vs 2.41 ± 0.27 mm, P = 0.005). E' velocity and TAPSE were sensitive to a volume reduction as little as 450 mL in healthy subjects. MPI index of the tricuspid annulus is less sensitive than E' and TAPSE but need much care under changing volume state. However S' and A' velocity and E'/A' ratio were found to be resistant to the effects of volume depletion.

Respiratory changes in the E/A wave pattern can be an early sign of diastolic dysfunction: An echocardiographic long-term follow-up study

SummaryBackgroundThe left ventricular filling pattern may show changes during respiration, which are generally used in the diagnosis of diastolic dysfunction. The clinical importance of the respiratory E/A wave pattern change has been investigated in a limited number of studies. The aim of the present study was to assess the diastolic function of hypertensive patients with respiratory changes in mitral flow over a long-term follow-up period.Material/MethodsOur study included 107 newly diagnosed and untreated hypertensive patients (49 males; mean age, 46±10 years) with respiratory changes during transthoracic echocardiography (TTE). In addition, the patient group was classified into 2 groups according to the change in E/A pattern by the Valsalva maneuver. After a mean follow-up period of 44±7 month, 90% of the hypertensive patients and the entire control group were re-examined.ResultsRelaxation abnormalities developed in 84% of the patients (58/80) in the Valsalva-positive group after the follow-up period. The frequency of relaxation abnormalities was 60% in the Valsalva-negative group and 3.1% in the control group (p<0.001). Based on multivariate regression analysis, the echocardiographic predictors of the development of relaxation impairment were mitral E velocity, A velocity, deceleration time, isovolumetric contraction time, E/E′ ratio, and the presence of respiratory change. The most important parameter for the development of an abnormal relaxation pattern was the presence of respiratory change after adjustment according to the changes with the Valsalva maneuver.ConclusionsRespiratory change in mitral flow can be evaluated as an early sign of diastolic dysfunction in patients with hypertension.

Left Atrial Volume Index as Indicator of Left Ventricular Diastolic Dysfunction: Comparation between Left Atrial Volume Index and Tissue Myocardial Performance Index

BackgroundTo point out a possible correlation between left atrial volume index (LAVI) and left ventricular (LV) diastolic time interval to better define LV diastolic dysfunction, this study was performed.MethodsIn 62 hypertensive-hypertrophic patients without LV systolic dysfunction, LV volumes, myocardial mass index, ejection fraction% (EF%) and LAVI were measured by two-dimensional echocardiography. Instead, tissue Doppler echocardiography (TDE) was used to measure myocardial performance index (MPI) and its systo-diastolic time intervals, such as: iso-volumetric contraction time (IVCT); iso-volumetric relaxation time (IVRT); ejection time. LAVI, TDE-MPI and time intervals where also measured in 15 healthy controls, to obtain the reference values.ResultsResults shown a significant increase of LV volumes in hypertensives in comparison to the control group (p < 0.05). LV mass index also augmented (p < 0.001). Instead, EF% not significantly changed in hypertrophic patients in comparison with healthy controls. LAVI raised in hypertensives wih left ventricular hypertrophy, whereas IVCT resulted within the normal limits. On the contrary, IVRT significantly raised. Accordingly, MPI resulted higher in controls.ConclusionLAVI, MPI and its time intervals appear as reliable tools to non-invasively individualize LV diastolic dysfunction in systemic hypertension, in absence of mitral valve disease.

Monitoring the Variation in Myocardial Function With the Doppler-Derived Myocardial Performance Index During Aortic Cross-Clamping

To investigate the effects of acute elevation in afterload on global (systolic and diastolic) myocardial function by performing serial intraoperative transesophageal echocardiograms during and after cross-clamp application on patients undergoing elective abdominal aortic aneurysm (AAA) surgery. A prospective observational study. A tertiary care university hospital. Patients undergoing elective AAA repair under general anesthesia (GA). The use of perioperative transesophageal echocardiography to calculate a tissue Doppler-derived myocardial performance index (MPI) during different stages of the surgery. Twenty consecutive patients scheduled for suprarenal AAA repair under GA were included in the study. Perioperative transesophageal echocardiography was performed after the induction of GA. MPI was calculated with Doppler tissue imaging as the sum of isovolumetric contraction and relaxation times divided by the ejection time before cross-clamping of the aorta and then 2, 10, and 20 minutes after cross-clamp application. A final MPI was measured after unclamping of the aorta. As compared with baseline, cross-clamp application initially worsened MPI within 2 minutes and then MPI improved to baseline after 10 minutes of cross-clamp application. The MPI improved significantly after unclamping of the aorta. The authors observed a temporal variation in global myocardial function after the application of a cross-clamp in the suprarenal position. There was transient deterioration of global myocardial function (the prolongation of MPI) 2 minutes after cross-clamp application, which improved within 10 minutes. Myocardial function returned to baseline after unclamping the aorta.