Lateral Side Of Mitral Annulus Research Articles

The Effect of Exercise Training on Diastolic and Systolic Function After Acute Myocardial Infarction: A Randomized Study.

After acute myocardial infarction (AMI), diastolic dysfunction is frequent and an important determinant of adverse outcome. However, few interventions have proven to be effective in improving diastolic function. We aimed to determine the effect of exercise training on diastolic and systolic function after AMI.One month after AMI, 188 patients were prospectively randomized (1:1) to an 8-week supervised program of endurance and resistance exercise training (n = 86; 55.9 ± 10.8 years) versus standard of care (n = 89; 55.4 ± 10.3 years). All patients were submitted to detailed echocardiography and cardiopulmonary exercise test, at baseline and immediately after the study. Diastolic function was evaluated by the determination of tissue-Doppler derived early diastolic velocities (E′ velocity at the septal and lateral sides of mitral annulus) and by the E/E′ (ratio between the E wave velocity from mitral inflow and the E’ velocity) as recommended in the consensus document for diastolic function assessment.At the end of the study, there was no significant change in E′ septal velocity or E/E′ septal ratio in the exercise group. We observed a small, although nonsignificant, improvement in E′ lateral (mean change 0.1 ± 2.0 cm/s; P = 0.40) and E/E′ lateral ratio (mean change of −0.3 ± 2.5; P = 0.24), while patients in the control group had a nonsignificant reduction in E′ lateral (mean change −0.4 ± 1.9 cm/s; P = 0.09) and an increase in E/E′ lateral ratio (mean change + 0.3 ± 3.3; P = 0.34). No relevant changes occurred in other diastolic parameters. The exercise-training program also did not improve systolic function (either tissue Doppler systolic velocities or ejection fraction).Exercise capacity improved only in the exercise-training group, with an increase of 1.6 mL/kg/min in pVO2 (P = 0.001) and of 1.9 mL/kg/min in VO2 at anaerobic threshold (P < 0.001).After AMI, an 8-week endurance plus resistance exercise-training program did not significantly improve diastolic or systolic function, although it was associated with an improvement in exercise capacity parameters.

Acute effects of cigarette smoking on the cardiac diastolic functions

BackgroundSmoking is an independent risk factor for coronary heart diseases and it increases all causes of cardiovascular morbidity and mortality. Aim of the workTo assess the acute effect of cigarette smoking on ventricular diastolic functions (LV and RV) in healthy, young, and slim smokers. MethodsThirty volunteers who had recently commenced smoking (less than one year) and who smoked 1–2 cigarettes per day, underwent ECG, 2D and M-mode echocardiography, standard Doppler echocardiography, pulsed TDI (tissue Doppler imaging) on septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were measured. The investigator asked them to hold smoking for at least two days after which echocardiographic examination was conducted before smoking one cigarette and the second examination conducted immediately after smoking one cigarette containing at least 0.4mg of nicotine. ResultsDoppler findings over the mitral valve showed the E wave was significantly reduced from 82.7±10.4 to 74.6±10.4 after smoking; the A wave increased; the E/A ratio was reduced from 1.5±0.3 to 1.2±0.2; the E′ septal significantly decreased (15.3±2.4 vs. 11.2±1.1) after smoking, and the E/E′ ratio increased from 5.5±1.1 to 6.7±1.1. Doppler findings over the tricuspid valve showed the E wave was reduced from 60.6±9.7 to 52.7±9.6; the A wave increased from 42.2±6.5 to 50.1±6.6; and the E/A ratio decreased (1.45±0.25 vs. 1.06±0.19). The E′ significantly decreased from 14.1±1.8 to 10.9±2.4, while the A′ increased (10.2±2.4 vs. 12.7±3.6) after smoking; and the IVRT of the RV was significantly prolonged from 62.9±7.5 to 68.7±7.9 after smoking. The Vp was markedly reduced from 67.8±8 to 55.2±3.5 after smoking. These findings reflected on the LV filling pressure (LVFvp) which increased from 9.8±1.4 to 10.5±1.3 after smoking. All changes were statistically significant at P<0.001. ConclusionsOur study reveals that cigarette smoking can result in significant acute alteration in the diastolic functions of both ventricles.

A Case of WPW Syndrome Exhibiting a Retrograde Accessory Pathway with Decremental Conduction Property after Ablation of an Anterograde Conduction over the Same Accessory Pathway

A surface electrocardiogram of a sixty-year old woman showed typical delta waves of type-A at a sinus rhythm, and a narrow QRS duration during tachycardia at a rate of 150. Electrophysiologic studies were performed. Right ventricular apical pacing showed a ventriculoatrial (VA) conduction with the shortest interval of 37 msec recorded at coronary sinus of lateral side of mitral annulus. This VA conduction had no decremental property, and the retrograde atrial activation sequence was the same as that during atrioventricular tachycardia. Via a transaortic approach, an anterograde accessory pathway located at the left lateral side of mitral annulus was ablated at a sinus rhythm, when delta waves on electrocardiogram disappeared. However, a narrow QRS tachycardia with longer VA conduction interval but with the same atrial activation sequence as clinical tachycardia was induced. Right ventricular pacing at a sinus rhythm showed the same atrial activation sequence as seen in the tachycardia. This VA conduction interval was elongated by 50 msec compared with that recorded before anterograde accessory pathway ablation. The VA conduction was blocked with a 10-mg infusion of adenosine and furthermore, showed decremental property by ventricular extra stimuli. Finally, this retrograde conduction pathway was ablated at a similar lateral side of the mitral annulus.

139 Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles

Aims Conventional echocardiographic parameters of LV and RV systolic and diastolic function have been shown to be load-dependent. The impact of preload reduction on tissue Doppler parameters of LV and RV function is incompletely understood. The aim of this study was to examine the effect of acute preload reduction by haemodialysis on conventional and TDI indices of systolic and diastolic function of the LV and RV. Methods and results 17 uremic patients (age 31+10 years), without overt heart disease underwent conventional 2D and Doppler ECHO together with measurement of longitudinal mitral and tricuspid annular motion velocities. Haemodialysis led to reduction in LV end-diastolic volume (P,0.0001), end-systolic volume (P, 0.001), peak early (E wave) transmitral flow velocity (P 1/4 0.0001), and the ratio of early to late Doppler velocities of diastolic mitral inflow (P 1/4 0.021).For the LV, early diastolic (E0) TDI velocities and the ratio of early to late TDI diastolic velocities (E0/A0) only on the septal side of the mitral annulus decreased significantly after HD (P 1/4 0.0001and P 1/4 0.009, respectively). In a subgroup of 7 patients who sustained significantly larger fluid volume loses following HD, E0 and the ratio of E0/A0 at the lateral side of mitral annulus also decreased suggesting a greater resistance of the lateral annulus to preload changes. Systolic velocities decreased after HD on both sides of mitral annulus (septal P 1/4 0.006; lateral, P 1/4 0.011). For the RV, systolic tricuspid annular velocities decreased (P 1/4 0.002) together with early diastolic velocities after HD (P 1/4 0.0001). Both systolic and early diastolic tricuspid annular velocities correlated directly with fluid removal (P,0.01). Conclusion This study shows that both systolic and diastolic TDI velocities of the LV and RV are preload dependent.The lateral mitral annulus is more resistant to preload changes than either the septal mitral annulus or the lateral tricuspid annulus.

Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles

Conventional echocardiographic (ECHO) parameters of left ventricular (LV) and right ventricular (RV) systolic and diastolic function have been shown to be load-dependent; however, the impact of preload reduction on tissue Doppler (TD) parameters of LV and RV function is incompletely understood. The aim of this study was to examine the effect of acute preload reduction by haemodialysis (HD) on conventional (ECHO) and TD imaging (TDI) indices of systolic and diastolic function of the left and right ventricles. Seventeen chronically uremic patients (age 31 +/- 10 years), without overt heart disease underwent conventional 2D and Doppler ECHO together with measurement of longitudinal mitral and tricuspid annular motion velocities. Fluid volume removed by HD was 2706 +/- 1047 cm(3). Haemodialysis led to reduction in LV end-diastolic volume (P < 0.0001), end-systolic volume (P < 0.001), peak early (E wave) transmitral flow velocity (P = 0.0001), and the ratio of early to late Doppler velocities of diastolic mitral inflow (P = 0.021). For the LV, early diastolic (E0) TDI velocities and the ratio of early to late TDI diastolic velocities (E0/A0) only on the septal side of the mitral annulus decreased significantly after HD (P = 0.0001 and P = 0.009, respectively). In a subgroup of seven patients who sustained significantly larger fluid volume loses following HD, E0 and the ratio of E0/A0 at the lateral side of mitral annulus also decreased suggesting a greater resistance of the lateral annulus to preload changes. Systolic velocities decreased after HD on both sides of mitral annulus (septal 6.90 +/- 1.10 vs. 5.97 +/- 1.48 cm/s, P = 0.006; lateral 8.68 +/- 2.67 vs. 6.94 +/- 1.52 cm/s, P = 0.011). For the RV, systolic tricuspid annular velocities decreased (13.45 +/- 1.47 vs.11.73 +/- 1.90 cm/s, P = 0.002) together with early diastolic velocities after HD (13.95 +/- 2.90 vs.10.62 +/- 2.45 cm/s, P = 0.0001). Both systolic and early diastolic tricuspid annular velocities correlated directly with fluid removal (P < 0.01). This study shows that both systolic and diastolic TDI velocities of the LV and RV are preload-dependent. However, the lateral mitral annulus is more resistant to preload changes than either the septal mitral annulus or the lateral tricuspid annulus.

Alterations in Left Ventricular Structure and Diastolic Function in Professional Football Players: Assessment by Tissue Doppler Imaging and Left Ventricular Flow Propagation Velocity

Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler imaging (TDI) and ventricular early flow propagation velocity (Vp) are new tolls in the evaluation of myocardial function. We sought to compare TDI and Vp findings in professional football players and age-adjusted sedentary controls to assess the effect of regular athletic training on myocardial function. Twenty-four professional football players and age-, sex-, and weight-adjusted 20 control subjects underwent standard Doppler echocardiography pulsed TDI, performed parasternal four-chamber views by placing sample volume septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were obtained by measuring the slope delineated by first aliasing velocity from the mitral tips toward the apex by using apical four-chamber color M-mode Doppler images. Age, body surface area, blood pressure, and heart rate were comparable between two groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter, and decreased transmitral diastolic late velocity. In athletes TDI analysis showed significantly increased mitral annulus septal DTI peak early diastolic (e) velocity (0.22 +/- 0.04 vs 0.19 +/- 0.04, P < 0.05), lateral DTI peak e velocity (0.19 +/- 0.03 vs 0.16 +/- 0.02, P < 0.05) and lateral DTI e/a peak velocity ratio (1.96 +/- 0.41 and 1.66 +/- 0.23, P < 0.05). The ratio of transmitral peak early diastolic velocity (E) to e in both lateral (4.72 +/- 1.20 vs 5.95 +/- 1.38, P = 0.007) and septal (3.90 +/- 0.80 vs 5.25 +/- 1.50, P = 0.002) side of mitral annulus were significantly lower in athletes. In Vp evaluation, we found higher Vp values (60.52 +/- 6.95 in athletes and 56.56 +/- 4.24 in controls, P = 0.03) in football players. Professional football playing is associated with morphologic alteration in left ventricle and left atrium and improvement in left ventricle diastolic function that can be detected by TDI and Vp. These techniques may be new tools to define and quantitate the degree of LV diastolic adaptations to endurance exercise.

Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index

Myocardial performance index (MPI) is usually measured with pulsed wave Doppler (PWD). Our aim was to assess the degree of agreement between PWD and a method based on tissue Doppler imaging (TDI). Seventy-five patients with prior myocardial infarction and 20 healthy subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI at septal and lateral sides of mitral annulus. MPI and TDI-MPI at septal side showed the best intraclass correlation coefficient (ICC=0.54; p<0.0005). Ninety-five percent interval of agreement ranged from -0.27 to 0.22. These differences were attributed to discrepancies in isovolumic contraction and relaxation times. In the healthy group the results were similar (ICC=0.44), although the 95% interval of agreement was lower (from -0.13 to 0.12). The agreement between PWD and TDI in the measurement of MPI is only moderate. This should be taken into account in the interpretation of studies in which TDI is used for this measurement.