Left Ventricular Diastolic Filling Research Articles

Modulation of Left Ventricular Diastolic Filling During Exercise in Persons with Cervical Motor Incomplete Spinal Cord Injury

PurposeThe impairment of systolic ventricular performance and the risk of cardiovascular diseases have been identified in individuals with different levels of spinal cord injury (SCI). Despite the high prevalence of cardiovascular disease among patients with SCI, limited progress has been made in understanding the pathophysiology of left ventricular (LV) hypokinesia. In particular, little is known about the underlying effects of a higher cervical spinal cord injury on ventricular filling and the cardiac loading impairment that could be precipitated. Therefore, the purpose of the study is to characterize LV diastolic function during exercise in adults with incomplete cervical (C5–C7) SCI.MethodsIn this cross‐sectional study, LV diastolic performance was examined using bioimpedance cardiography (ZCG). A convenience sample of 2 groups participated in the study: 8 males with incomplete cervical spinal cord injury (icSCI: age 39 ± 14 years; BMI 22.70 ± 2.46 kg.m−2) and lesions at levels ranging from C5–7, and 8 non‐injured male controls (CON: age 38 ± 13 years; BMI 24.48 ± 1.60 kg.m−2). The exercise protocol included a 3‐minute unloaded warm‐up and a stepwise increase in resistance of 5–10 Watts·min−1 until volitional exhaustion. The left ventricle diastolic indices including cardiac end‐diastolic volume (EDV), and early diastolic filling ratio (EDFR); thus, left ventricular ejection time (LVET) and stroke volume (SV) were compared between the group relative to % of peak oxygen consumption (VO2%). Analysis of covariance (ANCOVA) was used to determine the significant group differences in diastolic filling measures while controlling for the heart rate (HR) and cardiac inotropicity (dZ/dT2).ResultsPeak workload (CON 60 ± 5 Watts vs icSCI 29 ± 10 Watts, p = 0.001) and peak VO2 (CON 19.15 ± 3.38 ml/kg/min vs. icSCI 11.15 ± 4.03 ml/kg/min, p = 0.008) were significantly higher in CON than icSCI. The observed decline in EDV was evident during exercise in icSCI compared to CON (EDVpeak:131.4 ± 7.3 vs. 188.78 ± 9.4, p < 0.001). In icSCI, the EDFR was significantly lower than CON at peak VO2 (73.23 ± 14% vs. 118.5 ± 11 %, p = 0.006). LV filling during exercise was blunted at 50% of peak VO2. There was no significant difference in the LVET between the groups. Left ventricular stroke volume (SV), which is exactly equal to venous return per cardiac cycle, was significantly lower at peak exercise in icSCI vs. CON (77.1 ± 6.05 mL vs. 108.8 ± 7.10 mL, P < 0.000).ConclusionThe subjects with icSCI in this study had reduced LV preload and decreased LV filling compared to healthy subjects without SCI. Decreased diastolic filling dynamics occurred with observed declines in venous return and cardiac stroke volume. Overall, these findings support the premise that active venous muscle pump is an essential mechanism for increasing the preloading condition and rapid early diastolic filling during exercise. Illustration of left ventricular diastolic response to exercise for the icSCI and controls. *p‐value for comparison obtained form ANCOVA.imageIllustration of left ventricular diastolic response to exercise for the icSCI and controls. *p‐value for comparison obtained form ANCOVA.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Dynamic Piston Function of the Mitral Annulus to Assess Early Left Ventricular Diastolic Filling: A Proof of Concept Study

IntroductionEarly left ventricular (LV) filling has been described as an asymmetric toroidal vortex ring of blood entering the LV upon opening of the mitral valve. This phenomenon is in part responsible for cyclical changes in LV volumes during the cardiac cycle and also contributes to the apical and basal longitudinal displacements of the mitral annulus (MA). Although MA early diastolic (e’) velocities have been used to assess early LV filling characteristics, accurate distinction between normal aging and pathological diastolic dysfunction (DD) might be challenging at times.MethodsIn this pilot study, echocardiographic data from 60 consecutive patients were reviewed. The studied population was allocated into three groups based on the new American Society of Echocardiography guidelines for diastolic dysfunction classification. To better define LVDD, we based our interpretation of MA tissue Doppler imaging (TDI) signals on the well-described displacement pump mechanism of the MA plane functioning as a piston unit.ResultsPatients with normal diastolic function were younger (50 ± 14 years) than those with DD (group II: 69 ± 8 and group III: 63 ± 17 years) (p < 0.001) with a slight female predominance (57%). As expected, volumetric variables as well as mitral inflow and MA TDI measures were significantly different among the three studied groups (p < 0.001) with the exception of the left atrial volume index. Interestingly, careful interrogation of the MA TDI signal revealed a distinctive appearance of a recoil signal right after the MA e’ velocity only occurring in patients with normal LV diastolic function.ConclusionsIdentification of an early characteristic recoil signal occurring on the MA TDI right after the e’ velocity seems to be useful in the characterization of LVDD. Additional prospective studies are now needed to validate its utility as an additional criterion to be used in LVDD.

Association of Active and Passive Components of LV Diastolic Filling With Exercise Intolerance in Heart Failure With Preserved Ejection Fraction: Mechanistic Insights From Spironolactone Response

ObjectivesThis study sought to investigate the association of left ventricular (LV) untwisting rate (UT) and E/e’ ratio with the response of exercise capacity to spironolactone in heart failure with preserved ejection fraction (HFpEF). BackgroundIn most patients with HFpEF, LV filling abnormalities represent a central component in the development of dyspnea. LV diastolic filling is determined by the interplay of passive (LV stiffness and myocardial collagen content, reflected by E/e’ ratio) and active myocardial properties (UT, a precursor to isovolumic pressure decay and contributor to diastolic suction). MethodsIn 194 patients with HFpEF (64 ± 8 years), a complete echocardiogram (including assessment of myocardial deformation and rotational mechanics) was performed. Echocardiography following maximal exercise was undertaken to assess LV systolic and diastolic responses to stress. A subset of 105 patients with an exercise-induced increase in estimated LV filling pressure were randomly assigned to spironolactone 25 mg (n = 51) or placebo (n = 54) for 6 months. ResultsBaseline peak Vo2 was associated with UT (β = 0.19; p = 0.01) and E/e’ (β = −0.16; p = 0.03), independent of clinical data and exercise reserve in longitudinal deformation and ventricular-arterial coupling. An increase in peak Vo2 with treatment was independently associated with changes in UT (β = 0.28; p = 0.003) and exertional increase in E/e′ (β = −0.23; p = 0.01) from baseline to follow-up. A significant interaction with the use of spironolactone on peak Vo2 was found for E/e′ (p = 0.02) but not for UT (p = 0.62). ConclusionsBoth active and passive determinants of LV filling, as reflected by UT and E/e′, contribute to reduced exercise capacity in HFpEF. Improvement in functional capacity with a 6-month therapy with spironolactone is associated with improvements in both indices. However, the possible mediating effect of this medication is observed only on E/e′.

Aortic Regurgitation Following Transcatheter Aortic Valve Replacement: Impact of Preprocedural Left Ventricular Diastolic Filling Patterns on Late Clinical Outcomes. DOI: 10.1002/ccd.26298.

Aortic Regurgitation Following Transcatheter Aortic Valve Replacement: Impact of Preprocedural Left Ventricular Diastolic Filling Patterns on Late Clinical Outcomes. DOI: 10.1002/ccd.26298.

Left Ventricular Diastolic Filling Differences in Physically Active Aging Mice with Ankle Sprains

Left Ventricular Diastolic Filling Differences in Physically Active Aging Mice with Ankle Sprains

Evaluation of right and left ventricular diastolic filling.

A conceptual fluid-dynamics framework for diastolic filling is developed. The convective deceleration load (CDL) is identified as an important determinant of ventricular inflow during the E wave (A wave) upstroke. Convective deceleration occurs as blood moves from the inflow anulus through larger-area cross-sections toward the expanding walls. Chamber dilatation underlies previously unrecognized alterations in intraventricular flow dynamics. The larger the chamber, the larger becomes the endocardial surface and the CDL. CDL magnitude affects strongly the attainable E wave (A wave) peak. This underlies the concept of diastolic ventriculoannular disproportion. Large vortices, whose strength decreases with chamber dilatation, ensue after the E wave peak and impound inflow kinetic energy, averting an inflow-impeding, convective Bernoulli pressure rise. This reduces the CDL by a variable extent depending on vortical intensity. Accordingly, the filling vortex facilitates filling to varying degrees, depending on chamber volume. The new framework provides stimulus for functional genomics research, aimed at new insights into ventricular remodeling.

Contributions of Blood Pressure, Body Mass Index and Left Ventricular Length to Aging-related Changes in Left Ventricular Early Diastolic Filling and Long Axis Motion

Objective: The transmitral E wave and the peak velocity of early diastolic mitral annular motion (e′) both decrease with age, but the cause of these aging effects is incompletely understood. We investigated the possible contributions of blood pressure (BP), body mass index (BMI) and left ventricular length (LVL) to the age-related reductions in E and e′. Methods: The study group comprised 80 healthy subjects between the ages of 20 and 52 years. Transmitral flow and mitral annular motion were recorded using pulsed-wave Doppler. LVL was measured as the maximum distance from the mitral annular plane to the apical endocardium at end-diastole in the apical four- and two-chamber images. Results: Age was positively correlated with mean BP (r = 0.33, p < 0.05) and BMI (r = 0.26, p < 0.05) and there was an inverse correlation of age with LVL (β = −0.33, p < 0.001) after adjustment for sex, height, weight and left ventricular end-diastolic diameter (LVEDD). Age was also inversely correlated with E (r = −0.37, p < 0.01), septal e′ (r = −0.52, p < 0.01) and lateral e′ (r = −0.55, p < 0.01). E was inversely correlated with mean BP (β = −0.35, p = 0.001) and LVEDD (β = −0.24, p = 0.026) but not related to BMI or LVL. Septal e′ was inversely correlated with diastolic BP (β = −0.34, p = 0.002) and BMI (β = −0.31 p = 0.009) and a positive correlation with LVL was borderline significant (β = 0.21, p = 0.058). Lateral e′ was inversely correlated with diastolic BP (β = −0.30, p = 0.007), positively correlated with LVL (β = 0.43, p < 0.001) and an inverse relationship with BMI was borderline significant (β = −0.22, p = 0.06). Conclusion: An aging-related increase in BP may contribute to the reductions in E and e′ which occur with aging, while an aging-related increase in BMI and decrease in LVL may contribute to the reduction in e′ which occurs with aging.

Effect of Elevated Left Ventricular Diastolic Filling Pressure on the Frequency of Left Atrial Appendage Thrombus in Patients With Nonvalvular Atrial Fibrillation

We investigated the relation between left ventricular diastolic dysfunction and left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF). We performed transesophageal echocardiography to examine LAA thrombus or spontaneous echo contrast (SEC) and to measure LAA emptying flow velocity in consecutive 376 patients with AF. We estimated diastolic filling pressure as the ratio of early transmitral flow velocity (E) to mitral annular velocity (e') on transthoracic echocardiogram. E/e' ratio in 28 patients (7.4%) with LAA thrombi was higher than that in patients without thrombus (18.3 ± 9.3 vs 11.4 ± 5.9, p <0.0001). The fourth quartile of E/e' (>13.6) consisted of 19 patients with thrombi and had a higher prevalence of thrombi than the others (p <0.0001). Multivariate regression analysis selected E/e' ≥13 as an independent predictor of LAA thrombus with an odds ratio of 3.50 (1.22 to 10.61) in addition to LA dimension and ejection fraction. Increased quartile of E/e' was negatively associated with LAA flow velocity and positively with rate of SEC. In conclusion, increased diastolic filling pressure is associated with a higher rate of LAA thrombus in AF, partly through blood stasis or impaired LAA function.

A Depression in Left Ventricular Diastolic Filling following Prolonged Strenuous Exercise is Associated with Changes in Left Atrial Mechanics

Standard marathon running can result in a depression of left ventricular (LV) diastolic function during early recovery. Left atrial (LA) mechanics are integral in maintaining an early diastolic pressure gradient as well as being responsive to changes in LV diastolic function, and therefore the detailed assessment of LA mechanics may provide further insight. The aim of this study was to determine the impact of prolonged strenuous exercise on mechanics of the left atrium and the association with changes in LV diastolic function. Myocardial speckle-tracking echocardiograms of the left atrium and left ventricle were obtained prior to, immediately after, and 6 hours after the completion of a marathon (42.2 km) in 17 healthy adult men. Speckle tracking was used to determine peak atrial deformation, early diastolic deformation rate, and contractile function, including atrial activation time. LA volumes throughout the cardiac cycle were also assessed to provide reservoir, conduit, and booster pump volumes. Diastolic assessment of the left ventricle included peak early diastolic strain rate, late diastolic strain rate, and standard indices. Temporal assessment of LV "twist" and "untwist" was also evaluated. All 17 subjects completed the marathon (mean finishing time, 209 +/- 19 minutes; range, 173-241 minutes). Although contractile function was significantly increased, there was a reduction in early diastolic deformation rate that was correlated with reduced atrial deformation. Atrial activation time was significantly increased after the race. All LV indices of diastolic function were reduced in early diastole, whereas late diastolic function was increased after the race. LV torsion was significantly reduced at end-systole and significantly elevated in the isovolumic period and early diastole, after the race. All indices returned toward baseline at 6 hours after exercise. This study demonstrates transient changes in LV diastolic relaxation following prolonged exercise that appear to have a direct impact on subsequent LA deformation. The impact of reduced LA preload on these findings and the delay in LA activation time requires further exploration.

Left Ventricular Diastolic Filling Pressures During Dobutamine Stress Echocardiography: Relationship to Symptoms and Ischemia

Limited information exists regarding the relationship of left ventricular diastolic filling parameters measured by Doppler echocardiography during dobutamine stress echocardiography (DSE) and stress-induced symptoms or myocardial ischemia. To determine if there is an association between Doppler parameters of left ventricular filling and symptoms and ischemic wall motion abnormalities during DSE, the authors prospectively studied 219 patients (mean age, 66+/-11 years; 55% men) referred for clinically indicated DSE. Pulsed-wave Doppler measurements of mitral inflow and medial annular tissue velocities at baseline, 20 microg/kg/min, peak stress, and recovery were made. Patients were classified as having stress-induced ischemia (n=70) or no ischemia (n=149) on the basis of the development of new or worsening wall motion abnormalities. Patients who developed ischemia had lower baseline and peak stress diastolic annular tissue velocities (e') (5.7+/-1.9 vs 6.4+/-1.9 cm/s at baseline, P=0.02; 5.2+/-1.6 vs 7.4+/-2.4 cm/s at peak stress, P<.0001). At peak stress, the E/e' ratio was higher (13.1+/-6.3 vs 10.2+/-4.2, P=.003); these differences persisted into recovery. The increase in E/e' from 20 microg/kg/min to peak stress was greater (0.9+/ 2.1 vs -0.8+/-3.1, P=.0009) in patients who developed symptoms during DSE and in patients who presented with dyspnea (0.3+/-2.6 vs -1.0+/-3.2, P=.02). The change in e' velocity from baseline to peak stress, the change in E/e' from baseline to recovery, known coronary artery disease, and the development of symptoms during DSE were independently associated with ischemia. The development of symptoms and myocardial ischemia during DSE are both associated with an increase in E/e'. The prognostic implications of elevated E/e' during DSE have yet to be elucidated.

P-95 Pre-Ejection Flow Wave: A New Marker of Increased Left Ventricular Diastolic Filling Pressure

P-95 Pre-Ejection Flow Wave: A New Marker of Increased Left Ventricular Diastolic Filling Pressure

Impact of Septal Myectomy on Left Atrial Volume and Left Ventricular Diastolic Filling Patterns: An Echocardiographic Study of Young Patients with Obstructive Hypertrophic Cardiomyopathy

Septal myectomy in young patients with obstructive hypertrophic cardiomyopathy (HCM) can be performed with low mortality, and leads to excellent improvement in symptoms. Left atrial (LA) enlargement has been associated with exercise intolerance, severity of mitral regurgitation (MR), and left ventricular (LV) outflow tract (LVOT) obstruction in adults with HCM. Young patients (1-22 years of age) who had a septal myectomy for obstructive HCM between 2002 and 2005 were identified. Retrospective analyses of premyectomy and postmyectomy echocardiograms were performed. In this cohort of 32 patients (25 male), the average maximal LV wall thickness was 25 +/- 9 mm and LVOT maximal instantaneous gradient was 106 +/- 44 mm Hg. MR was present in all patients with a mean grade of 3 +/- 1. All patients had successful myectomy and there were no early deaths. After myectomy, LVOT maximal instantaneous gradient decreased to 17 +/- 13 mm Hg (P < .0001). Mean LA volume (LAV) index decreased from 52.1 +/- 2.2 to 33.2 +/- 11.9 mL/m(2) (P < .0001). Mean MR grade decreased to 2 +/- 1. Early mitral medial annular tissue Doppler velocity (E') increased from 6.2 +/- 1.9 to 13 +/- 2.6 cm/s (P < .043). A postmyectomy decrease in LAV index correlated with decrease in LVOT obstruction (P = .001) and change in degree of MR (P = .04). Septal myectomy not only reduces LVOT maximal instantaneous gradient and MR in young patients, but also results in decreased LAV index, and E/A and E/E' ratios. These hemodynamic improvements may contribute to the observed survival benefit and increased exercise tolerance observed after myectomy. This is the first series to demonstrate that LAV correlates closely with hemodynamic status in children with obstructive HCM and may be a significant predictor of clinical outcome in these patients.

Effects of Surgical Septal Myectomy on Left Ventricular Wall Thickness and Diastolic Filling

This study was conducted to examine the late effects of surgical myectomy on left ventricular (LV) structure and diastolic function in patients with obstructive hypertrophic cardiomyopathy. Patients with hypertrophic cardiomyopathy who had complete echocardiographic studies before and > or =6 months after myectomy were included in this retrospective analysis of cavity dimension, septal and LV posterior wall thicknesses, and Doppler flow variables. Compared with preoperative measurement, mean septal thickness (23.6 vs 19.5 mm, p <0.001) and LV posterior wall thickness (14.2 vs 12.4 mm, p <0.001) were smaller after myectomy. Likewise, mitral inflow Doppler velocity curves indicated improvement in LV filling, with decreased mitral E velocity (0.95 to 0.87 m/s, p = 0.008). In conclusion, the long-term benefits of this operation may be mediated in part by favorable LV remodeling and changes in LV diastolic filling.

Left Ventricular Diastolic Filling Pattern at Doppler Echocardiography and Apoptotic Rate in Fatal Acute Myocardial Infarction

Heart failure is a complex syndrome characterized by impaired emptying and/or impaired filling of the heart chambers. The use of parameters of diastolic function has provided novel tools for risk stratification and management of patients with heart failure. This study evaluated the potential correlation between apoptosis at time of death and left ventricular (LV) diastolic function after acute myocardial infarction. We selected, at routine postmortem examination, 14 subjects who died 10 to 62 days after an acute myocardial infarction and had an available echocardiographic report from the most recent hospital admission. The apoptotic rate was calculated at the region bordering the infarct, using co-localization of in situ end-labeling for deoxyribonucleic acid fragmentation and immunohistochemistry for caspase-3. Transthoracic echocardiographic studies were retrospectively reevaluated and pulse-wave Doppler spectra of mitral inflow were analyzed. LV diastolic function was assessed by measuring the ratio of E peak velocity to A peak velocity and E-wave deceleration time; a ratio of E peak velocity to A peak velocity >or=2 and deceleration time <115 ms were considered a restrictive filling pattern. A restrictive pattern was found in 4 cases (29%). All subjects with a restrictive pattern were symptomatic for New York Heart Association class IV heart failure (100% vs 20%, p = 0.015) and had larger transverse heart diameters at pathology (p = 0.014). The apoptotic rate in the peri-infarct region was significantly higher in patients with a restrictive versus nonrestrictive diastolic pattern (13%, 10 to 14, vs 3%, 1 to 6, p = 0.014). At multivariable analysis that included the restrictive pattern, class IV heart failure, and cardiac diameters, the restrictive pattern remained an independent predictor of increased apoptosis (p = 0.030). In conclusion, patients with severe postinfarction LV diastolic dysfunction had significantly higher rates of cardiomyocyte loss by apoptosis, which may partly explain their unfavorable outcome.

Effects of Prolonged Strenuous Exercise on Left Ventricular Diastolic Filling in Male and Female Triathletes

Effects of Prolonged Strenuous Exercise on Left Ventricular Diastolic Filling in Male and Female Triathletes

Predictive Value of C-Reactive Protein and Left Ventricular Diastolic Filling Pattern after a Non-ST Elevation Myocardial Infarction

Recent studies have shown that the odds ratio for high-sensitivity C-reactive protein (CRP) in predicting a coronary events in healthy subjects is 1.4, a value substantially less than previously reported. It is unclear whether this extends to acute coronary syndrome patients or if CRP would predict long-term events in this population. We evaluated the predictive value of CRP in patients with non-ST segment elevation myocardial infarction (NSTEMI) as their first manifestation of coronary artery disease and compared it with that of left ventricle diastolic function. Serum CRP concentration measurement and left ventricle diastolic function evaluation were performed in 51 consecutive patients with NSTEMI 48 hours, 3 months, and 6 months after infarction. Patients were followed for 1 year and events comprising the endpoints of death, new myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting were reported. Thirty of 51 patients developed the endpoints. Mean CRP concentration in patients who developed any endpoint and those who did not was similar at 48 hours, 3 months, and 6 months. A strong correlation between the presence of impaired relaxation 6 months after the infarction and development of the combined endpoints was noted (P < 0.001). CRP has limited value in predicting future cardiovascular events in subjects with NSTEMI. Other biomarkers or a combination of other biomarkers may be needed to identify patients at high risk. Evaluation of diastolic left ventricular function not during the acute phase but 6 months later could predict adverse outcome in our series.

Effect of Aerobic Exercise on Left Ventricular Diastolic Filling and Arterial Compliance in Older Hypertensives

Effect of Aerobic Exercise on Left Ventricular Diastolic Filling and Arterial Compliance in Older Hypertensives

Effect of Aerobic Exercise on Left Ventricular Diastolic Filling and Arterial Compliance in Older Hypertensives

0583 Left ventricular diastolic dysfunction (LVDD) and impaired arterial compliance (IAC) may be subtle, early indices of vascular dysfunction with aging, sedentary lifestyle and hypertension. LVDD and IAC may impair exercise performance in those at risk who engage in therapeutic exercise training; while exercise testing may “unmask” LVDD and IAC among those starting such training programs and be used as a marker of risk improvement in addition to blood pressure lowering. PURPOSE: To evaluate the effect of aerobic exercise on LVDD and IAC in older hypertensive patients prior to starting and following an 8 week exercise training program. METHODS: Eight subjects participated in the study. Measures of LVDD (early filling flow velocity (E), late filling flow velocity (A), E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT)) and IAC (compliance (C) and distensibility (D) in carotid and brachial arteries) were assessed using VingMed-5 cardiac imaging system at rest before and following an 8 week exercise training program. RESULTS: LVDD indices (E, A, E/A, IVRT and DT) remained unaltered throughout the study (0.68 ± .13 vs 0.68 ± .15m/s, 0.82 ± .19 vs 0.89 ± .16m/s, 0.81 ± .24 vs 0.76 ± .05, 92.6 ± 1.0 vs 86.9 ± 7.6msec and 288.9 ± 59.6 vs 279.7 ± 75.1msec, respectively). None of IAC indices (C and D) in carotid artery changed during the exercise program (0.70 ± .12 vs 0.77 ± .08 cm2/mmHgx10−3, 0.18 ± .02 vs 0.24 ± .03 1/mmHgx10−2, respectively); however, IAC indices (C and D) in brachial artery changed significantly following the exercise program (0.20 ± .02 vs 0.29 ± .05 cm2/mmHgx10−3, 0.18 ± .02 vs 0.22 ± .02 1/mmHgx10−2, p<.05, respectively). CONCLUSION: These data suggest that in older hypertensives 8 week exercise training significantly improves the peripheral (brachial artery) artery compliance whereas no improvement in more “central” (left ventricle and carotid artery) artery compliance. Supported by A.M Anderson Award, Lawson Health Research Institute.

Effects of Altered Volume Loading on Left Ventricular Hemodynamics and Diastolic Filling During Hemodialysis

Background. Changes in the circulating volume associated with hemodialysis (HD) resulted in alternations of left ventricular (LV) filling. However, previous studies offered conflicting findings. This study thus evaluated the impact of HD on LV diastolic filling indices and hemodynamics. Materials and Methods. Forty patients with end‐stage renal disease were studied by Doppler echocardiography immediately before and after HD. The cardiac size, volume and mass were determined by M‐mode and two‐dimensional echocardiography. LV diastolic filling parameters and hemodynamics were assessed from mitral inflow using Doppler echocardiography. Results. Left atrial and LV dimension, LV volume, and LV mass decreased significantly after HD (p < 0.001). Cardiac output declined from 5.74 ± 1.37 to 4.98 ± 1.27 L/min (p < 0.001), whereas, the ejection fraction remained unchanged. HD elicited marked changes in the early diastolic E (95.1 ± 20.5 to 70.3 ± 18.2 cm/s, p < 0.001) and late atrial filling A velocities (104.3 ± 20.9 to 88.9 ± 16.9 cm/s, p < 0.001). In addition, correction of the deceleration time of E and isovolumic relaxation time prolonged significantly (p = 0.011 and p < 0.001, respectively). Conclusions. Findings in this study indicate that HD altering the loading condition significantly influenced the LV diastolic function and hemodynamics. Moreover, Doppler echocardiography provides an effective means of assessing the effects on LV diastolic filling and hemodynamics during HD.

Acute Effects of Diltiazem on Regional Left Ventricular Diastolic Filling Dynamics in Patients With Hypertrophic Cardiomyopathy as Assessed by Color Kinesis

The effect of calcium antagonists on regional left ventricular (LV) filling dynamics in patients with hypertrophic cardiomyopathy (HCM) is not well known, so the present study evaluated the results of echocardiography with color kinesis (CK) analysis during diltiazem infusion. Nineteen patients (16 men, 3 women; mean age 55+/-15 years) underwent echocardiography with CK analysis during intravenous diltiazem (10 mg/2 min). Using the quantitative CK software the LV short-axis image was divided into 6 segments and the percent endocardial expansion at the early, mid- and late-diastolic filling time was averaged for all segments, with the standard deviation of the mean used as an index of diastolic asynchrony (asynchrony index). The regional mean filling time was also measured for the corresponding segments. As global diastolic parameters, the global filling time, peak filling rate, and the time-to-peak filling were calculated. After the administration of diltiazem, the asynchrony index was decreased for all three diastolic filling times. Diltiazem shortened the mean filling time overall, especially in the posterior and lateral wall segments. These findings were associated with significant improvement in the CK-derived global diastolic parameters. Diltiazam has a favorable effect on LV diastolic asynchrony, which may account for the acute changes in global LV relaxation.