Peak Atrial Systolic Velocity Research Articles

Diagnostic efficiency of ultrasound diagnosis of venous catheters and venous catheter blood flow spectrum

BackgroundVenous catheter abnormalities are related to chromosomal abnormalities, in order to detect whether the fetus has congenital diseases as soon as possible. ObjectiveTo explore the image characteristics and diagnostic efficiency of ultrasound diagnosis of venous catheter abnormalities and venous catheter blood flow spectrum abnormalities. Method60 pregnant women were divided into a venous catheter abnormality group (n = 12) and a normal group (n = 48). Both groups underwent ultrasound examination. Collect abnormal fetal umbilical vein catheter and venous catheter blood flow spectrum parameters from the abnormal venous catheter group. Calculate the diagnostic efficiency and prognosis of two groups of patients. ResultIn this experiment, there were differences in peak atrial systolic velocity among participants, and the peak atrial systolic velocity in the group with abnormal venous catheters was lower than that in the normal group (P < 0.05). The positive detection rate of the normal group was 4.17%, and the negative detection rate was 95.83%. The positive detection rate of venous catheter abnormalities group was 66.67%, and the negative detection rate was 33.33%. The prognostic differences among participants in this experiment showed SSI (P<0.05). The proportion of abnormal prognosis of venous catheter abnormalities is higher than that of the normal group. ConclusionUltrasound diagnosis of fetal venous catheter abnormalities has high clinical value, which is beneficial for determining whether the fetus has congenital diseases through abnormal venous catheter blood flow spectrum.

PLACENTAL HEMODYNAMIC ASSESSMENT IN WOMEN WITH SEVERE PREECLAMPSIA IN SECOND- AND THIRD-TRIMESTER PREGNANCY BY 3D POWER QUANTITATIVE DOPPLER ULTRASOUND

Objective: The present study analyzed the fetal–placental hemodynamic parameters in women with severe preeclampsia in second- and third-trimester pregnancy with a view to developing effective predictive indicators for preeclampsia and providing support for the prenatal clinical treatment of preeclampsia. Materials and Methods: From January 2015 to January 2019, 160 pregnant women diagnosed with severe preeclampsia at Xiangyang First People’s Hospital were recruited as the study group. The diagnostic criteria for preeclampsia were in accordance with the guidelines of the International Society for the Study of Hypertension in Pregnancy (ISSHP). A sample of 160 healthy pregnant women with normal blood pressure were selected as the control group. The GE Voluson E8 and E10 four-dimensional (4D) ultrasonic diagnostic instruments and the three-dimensional (3D) power Doppler in angio-quantitative mode were used to measure the hemodynamic parameters of the placenta, left uterine artery (LUA), right uterine artery (RUA), middle cerebral artery (MCA), umbilical artery (UA), and ductus venosus (DV) in the two groups. The above parameters were analyzed statistically using SPSS 22.0. Results: The systolic/diastolic velocity ratio (S/D), pulsatility index (PI), and resistance index (RI) of the MCA in the study group were lower than those of normal subjects of the same gestational age (P &lt; 0.05). These parameters in the UA were higher in the study group than those in normal subjects (P &lt; 0.05). The ratios between the peak ventricular systolic velocity and the peak atrial systolic velocity (S/A), pulsatility index for the vein (PIV), pre-load index (PLI), and peak velocity index for the vein (PVIV) in the DV were significantly different between the study and normal groups (P &lt; 0.05). The placental vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were lower in the study group than those in normal subjects of the same gestational age (P &lt; 0.05). There were good correlations between VI, VFI and RUA, PI, with correlation coefficients of −0.697 and −0.702, respectively. FI was the indicator that had the highest diagnostic efficacy for severe preeclampsia. The predictive sensitivity of the FI with a cut-off value of 34.92 was 96.3%, and the corresponding specificity was 86.9%. Conclusions: Placental FI had the highest predictive efficacy for severe preeclampsia and provides a reliable quantitative indicator and data support for preeclampsia management. 3D power quantitative Doppler ultrasound provides a novel avenue for the study of severe preeclampsia.

CHARACTERISTIC FEATURES OF PROGRESSIVE CARDIOVASCULAR DISEASE IN TYPE 2 DIABETIC PATIENTS WITHOUT HYPERTENSION-10 YEARS FOLLOW-UP: PP.17.119

Aim: Incidence of cardiovascular disease (CVD) in diabetes is related to not only glucose levels, but also multiple risk factors. Hypertension is a common comorbidity in patients with diabetes, and greatly increases the risk of CVD. To know characteristic features of progressive CVD in diabetes, we investigate relationship between incidence of CVD and risk factors and left ventricular (LV) function at baseline and progression of hypertension in type 2 diabetic patients without hypertension with 10-year follow-up. Subjects and Methods: In 1998 and 1999, 97 type 2 diabetic patients without hypertension who did not have both overt cardiac disease and macro-albuminuria were enrolled. Eighty-four patients (male 54, age 56 (8) years (mean (SD)), BMI 23.0 (2.7) kg/m2) were completed 10-year follow-up. Clinical characteristics and echocardiography was performed at baseline. LV internal diameter was measured by M-mode echocardiography, and fractional shortening (FS) and LV mass were also calculated. LV systolic function was assessed by FS, and LV diastolic function was assessed by the ratio between the peak diastolic velocity and the peak atrial systolic velocity (E/A) and isovolumic relaxation time (IVRT) with Doppler examination. Hypertension was defined that patients with 140 and/or 85 mmHg and more, or use of antihypertensive medications. The primary outcome was a composite of nonfatal myocardial infarction (MI), nonfatal stroke, or death from cardiovascular causes. Results: During 10-year follow-up, 14 patients (17%) had CVD events (8 patients had nonfatal MI, 4 angina pectoris, 1 heart failure, and 1nonfatal stroke.)(CVD group), and 4 patients died of cancer and leukemia, and 66 patients did not have any cardiovascular diseases (N group). CVD group had older age (60 (6) vs 55 (6) years, p < 0.05), elevated systolic blood pressure (130 (10) vs 121 (11) mmHg, p < 0.01), higher LDL cholesterol level (141 (20) vs 123 (36) mg/dl, p < 0.05), and higher presence of retinopathy (64 vs 35 %, p < 0.05) at baseline than N group. During 10 years, 54% of CVD group had newly diagnosed hypertension as compared to 23% in N group, but there were not significant differences between CVD and progression of hypertension. For LV function, CVD group had decreased LV diastolic function as compared to N group (IVRT 78.5 (16.3) vs 70.6 (10.7) ms, p < 0.05). In logistic regression analysis, independent risk factors for CVD were presence of retinopathy (3.059 (1.309–7.153); OR (95% CI), p <0.005), extended IVRT (1.050 (0.999–1.109), p = 0.05), systolic blood pressure at baseline (1.062 (0.998–1.113), p = 0.059). Conclusions: During 10-year follow-up, 17% of type 2 diabetic patients without hypertension had CVD. It suggests that LV diastolic dysfunction is a subclinical important factor for incidence of CVD, and to preserve lower blood pressure level may also be important to prevent CVD in type 2 diabetic patients.

Cardio-Ankle Vascular Index Is Superior to Brachial-Ankle Pulse Wave Velocity as an Index of Arterial Stiffness

Both cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV) are noninvasive methods to estimate arterial stiffness. The purpose of this study is to determine whether CAVI or baPWV is superior as an index of arterial stiffness. One hundred and thirty patients with chest pain syndrome who underwent coronary angiography (CAG) were included in this study. We obtained intima-media-thickness (IMT) and the stiffness parameter beta of the carotid artery by carotid ultrasounds (CU). The peak early diastolic velocity (E), deceleration time of E (EDCT), peak atrial systolic velocity (A) of transmitral flow and left ventricular mass index (LVMI) were obtained by echocardiography. CAVI, baPWV, total cholesterol (T-C), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were measured before CAG. There was a significant correlation between CAVI and baPWV (r = 0.64, p < 0.01). Both CAVI and baPWV were significantly correlated with age, IMT and beta (age: r = 0.64, p < 0.01 for CAVI, and r = 0.48, p < 0.01 for baPWV; IMT: r = 0.40, p < 0.01, and r = 0.31, p < 0.01; beta: r = 0.36, p < 0.01 and r = 0.25, p < 0.01). However, only CAVI was correlated with the parameters of left ventricular diastolic indices from echocardiography (E/A: r = 0.44, p < 0.01; EDCT: r = 0.36, p < 0.01). Additionally, LDL-C and T-C/HDL-C were also associated with only CAVI (LDL-C: r = 0.26, p < 0.02; T-C/HDL-C: r = 0.30, p < 0.01), not baPWV. Finally, only CAVI was significantly higher in the group with angina pectoris than in the normal group (9.708 +/- 1.423 vs. 9.102 +/- 1.412; p = 0.0178). All parameters associated with atherosclerosis suggested that CAVI was superior to baPWV as a parameter of arterial stiffness.

Assessment of Left Ventricular Function Using Pulsed Tissue Doppler Imaging in Healthy Dogs and Dogs with Spontaneous Mitral Regurgitation

Pulsed tissue Doppler imaging (pulsed TDI) has been demonstrated to be useful for the estimation of left ventricular (LV) systolic and diastolic functions in various human cardiac diseases. The objectives of this study were to investigate the relationship between pulsed TDI and LV function by using cardiac catheterization in healthy dogs and to evaluate the clinical usefulness of pulsed TDI in dogs with spontaneous mitral regurgitation (MR). The peak early diastolic velocity (E'), peak atrial systolic velocity (A'), and peak systolic velocity (S') were detectable in the velocity profiles of the mitral annulus in all the dogs. In the healthy dogs, S' and E' were correlated with LV peak +dP/dt and -dP/dt, respectively. E' was lower in dogs with MR than in dogs without cardiac diseases. E/E' in the MR dogs with decompensated heart failure was significantly increased in comparison with those with compensated heart failure. The sensitivity and specificity of the E/E' cutoff value of 13.0 for identifying decompensated heart failure were 80% and 83%, respectively. In addition, E/E' was significantly correlated with the ratio of left atrial to aortic diameter. These findings suggest that canine pulsed TDI can be applied clinically for estimation of cardiac function and detection of cardiac decompensation and left atrial volume overload in dogs with MR.

Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus

To determine the prevalence of left ventricular diastolic dysfunction in asymptomatic, normotensive patients with type 2 diabetes mellitus, we studied 61 consecutive normotensive patients with type 2 diabetes using conventional Doppler echocardiography at rest (deceleration time, isovolumic relaxation time, early diastolic velocity [E]/peak atrial systolic velocity [A] ratio), and during the Valsalva maneuver. In addition, mitral annular velocity and velocity of flow propagation were assessed in all patients using tissue Doppler imaging (TDI) and color M-mode echocardiography. A standard resting echocardiogram excluded significant valvular disease and stress echocardiography excluded significant coronary artery disease in those with diastolic dysfunction. Diastolic dysfunction was found in 43 of 57 patients (75%) when all of the above echocardiographic techniques were used. TDI detected diastolic dysfunction more often (63%) than any other echocardiographic approach. Thus, the prevalence of left ventricular diastolic dysfunction in asymptomatic, normotensive patients with type 2 diabetes without significant coronary artery disease is much higher than previously suspected. TDI markedly improved the echocardiographic detection of diastolic dysfunction in asymptomatic patients with type 2 diabetes.

Assessment of Normal Mitral Annulus Velocity by Doppler Tissue Imaging

Background and Objectives:The objective of this study was to establish the reference values of mitral annulus velocity using Doppler tissue imaging, which has been previously thought of as a new parameter of left ventricular diastolic function. Many parameters, including the mitral inflow, that have been used in the evaluation of left ventricular diastolic function are affected by several conditions, sometimes limiting the information they can provide about left ventricular diastolic function. The knowledge of mitral annulus velocity by Doppler tissue imaging will provide new guidelines for the evaluation of diastolic function. However, reference values in normal systems and changes according to age have not been fully evaluated. Methods:We examined 246 patients lacking symptoms related to the either cardiac systolic or diastolic dysfunction, as well as 80 healthy volunteers, according to an age. Early (E) and late (A) transmitral flow velocity and the ratio of early to late peak velocity (E/A) were obtained by pulsed Doppler echocardiography. Early diastolic velocity of mitral annulus (E’) and peak atrial systolic velocity of mitral annulus(A’) were obtained from the medial (or septal) corner of the mitral annulus and subsequently from the lateral corner by Doppler tissue imaging. We obtained E’, A’ and the ratio of E’ to A’(E’/A’) and E/E’ according to age. Results:E’ from the medial corner was the highest in subjects in their twenties and declined gradually and A’ from the medial corner was the lowest in the same age group and gradually increased. The E’/A’ ratio from the medial corner was the highest in subjects in their twenties, declined gradually and reversed in subjects in their forties. E’, A’ and E’/A’ from the lateral corner were similar to the medial corner however the E’/A’ was reversed in subjects in their fifties. The E/E’ from the medial and lateral corner was the lowest in subjects in their twenties and gradually increased with age. In our comparison between the transmitral flow velocity and mitral annulus velocity, there was a good relationship between E/A and E’/A’ (p=0.01). Conclusion:We measured the reference values of mitral annulus velocity by Doppler tissue imaging and E/E、 according to an age. (Korean Circulation J 2001;31(7):662-669)

Prevalence of left ventricular hypertrophy in Type I diabetic patients with diabetic nephropathy.

The increased mortality of patients with diabetic nephropathy is mainly due to cardiovascular disease and end stage renal failure. Left ventricular hypertrophy is an independent risk factor for myocardial ischaemia and sudden death. The aim of our cross-sectional study was to evaluate left ventricular structure and function in Type I (insulin-dependent) diabetic patients with diabetic nephropathy. M-mode and Doppler echocardiography were done on 105 Type I diabetic patients with diabetic nephropathy [61 men, age (means +/- SD) 44+/-9 years, and albuminuria [median(range)] 567(10-8188) mg/24 h, serum creatinine 109 (53-558) micromol/l], and 140 Type I diabetic patients with persistent normoalbuminuria [79 men, 47+/-10 years, urinary albumin excretion rate 8 (0-30) mg/24 h, and serum creatinine 81 (55-121) micromol/l]. Patients with and without nephropathy were comparable with respect to sex, body mass index, and duration of diabetes. Arterial blood pressure was slightly higher in patients with nephropathy: 140/79 +/- 17/9 mm Hg vs 134/78 +/- 15/8 mm Hg, p < 0.01, and the majority of proteinuric patients received antihypertensive drugs, 84 vs 17 %, respectively, p < 0.001. Left ventricular mass index was increased in the nephropathic group (means +/- SD) 100.6+/-23.9 g/m2 compared with the normoalbuminuric group 91.4+/-21.9 g/m2, p = 0.002. Left ventricular hypertrophy was found more often in patients with nephropathy 23 (14-31)% compared with patients with normoalbuminuria 9 (5-14)%, p < 0.005. Diastolic function, assessed by the ratio between the peak diastolic velocity and the peak atrial systolic velocity (E/A ratio) and isovolumic relaxation time, was reduced in patients with vs without nephropathy: 1.17+/-0.29 vs 1.34+/-0.32, and 81.7+/-16.5 vs 74.6+/-14.5, p < 0.001 and p = 0.002, respectively. Systolic function was about the same and normal in both groups. Our study suggests that an increase in left ventricular mass index and a decrease in diastolic function occurs early in the course of diabetic nephropathy.

Left ventricular diastolic properties of hypertensive patients measured by pulsed tissue doppler imaging

Examination of left ventricular (LV) diastolic dysfunction in hypertensive patients has been based on parameters obtained from the transmitral flow velocity during pulsed Doppler echocardiography. However, these parameters are affected by loading conditions. We evaluated LV diastolic function along the longitudinal and transverse axes by pulsed tissue Doppler imaging (TDI) in 50 hypertensive (HT) patients and 36 age-matched healthy volunteers (N). Transmitral flow velocity was recorded by pulsed Doppler echocardiography. LV posterior wall motion velocity along the longitudinal and transverse axes also was recorded by pulsed TDI. In both groups, peak early diastolic velocity of the LV posterior wall (Ew) along the transverse axis (N: 15.8+/-5.2 cm/s, HT: 12.2+/-4.4 cm/s) was higher than that along the longitudinal axis (N: 12.7+/-3.1 cm/s, HT: 9.5+/-3.3 cm/s). Peak atrial systolic velocity of the LV posterior wall (Aw) along the longitudinal axis (N: 9.1+/-1.8 cm/s, HT: 9.7 +/-2.6 cm/s) significantly exceeded that along the transverse axis (N: 8.0+/-2.2 cm/s, HT: 8.4+/-2.4 cm/s) in both groups. The Ews were lower and the Aws were higher along both axes in the patient group than in the control group. The time intervals from the aortic component of the second heart sound to the peak of the early diastolic wave (IIA-Ews) along both the transverse (N: 142+/-18 ms, HT: 154+/-19 ms) and longitudinal (N: 151 16 ms, HT: 162+/-20 ms) axes were longer in the patient group. In 29 patients, Ews along both axes correlated negatively (transverse: r = -0.80, P < .0001; longitudinal: r = -0.71, P < .0001) and IIA-Ews correlated positively (transverse: r = 0.81, P < .0001; longitudinal: r = 0.74, P < .001) with the time constant of the LV pressure decay during isovolumic diastole. The Aws along both axes in the 24 patients without pseudonormalization in transmitral flow velocity correlated positively (transverse: r = 0.60, P < .001; longitudinal: r = 0.74, P < .0001) with the LV end-diastolic pressure. In conclusion, LV relaxation and filling along the longitudinal and transverse axes were impaired in many patients with hypertension. Pulsed TDI was useful for evaluating LV diastolic dynamics in this disease.

Differences in Transmitral Flow Velocity Pattern during Increase in Preload in Patients with Abnormal Left Ventricular Relaxation

Changes in transmitral flow (TMF) and pulmonary venous flow (PVF) velocities during increases in preload were compared in patients with a higher peak atrial systolic velocity than peak early diastolic velocity (A/E > 1) for the TMF velocity to determine differences in hemodynamic response. Fifteen patients with dilated hearts, 22 with hypertrophied hearts and 15 control patients were studied. TMF and PVF velocities were recorded by transesophageal pulsed Doppler echocardiography before and during application of lower body positive pressure. The value for peak early diastolic velocity increased, while the isovolumic relaxation time decreased with increases in preload in all groups. The value for peak atrial systolic velocity decreased in the dilated-heart group, but increased in the hypertrophied-heart and control groups. The peak second systolic and early diastolic PVF velocities increased in the dilated- and hypertrophied-heart groups, but did not change in the control group. The peak atrial systolic PVF velocity and the difference in duration of the atrial systolic PVF and TMF velocities increased in the dilated- and hypertrophied-heart groups, and its changing rate was highest in the group with dilated hearts. These results suggest that both peak early diastolic and atrial systolic TMF velocities increase during increases in preload through the Frank-Starling mechanism in hypertrophied hearts. Furthermore, the left ventricular functional reserve was lower in the dilated-heart group. Thus, TMF and PVF velocities respond differently during increases in preload, depending on the underlying heart disease.

Left Atrial Contribution to Left Ventricular Filling in Patients with Mitral Stenosis: Combined Analysis of Transmitral and Pulmonary Venous Flow Velocities.

We recorded transmitral and pulmonary venous flow velocities using transthoracic continuous-wave and transesophageal pulsed Doppler echocardiography, respectively, in 36 patients with mitral stenosis who were in sinus rhythm to investigate the left atrial contribution to left ventricular filling in mitral stenosis. The mitral valve area was determined by transthoracic two-dimensional short-axis echocardiography. Patients were classified as having mild stenosis (>/=1.5 cm(2), n = 17) or moderate stenosis (<1.5 cm(2), n = 19). The mean pulmonary capillary wedge pressure and left atrial maximal diameter were significantly larger, and left atrial volume change during atrial contraction was significantly smaller in the moderate group than in the mild group. The percent left atrial contribution to left ventricular filling, estimated from the transmitral flow velocity, the peak atrial systolic velocity, and the percent ratio of left atrial systolic regurgitation to left atrial filling, estimated from the pulmonary venous flow velocity, were significantly lower in the moderate group than in the mild group. The percent left atrial contribution to left ventricular filling, the peak atrial systolic velocity, and the percent ratio of left atrial systolic regurgitation to left atrial filling were positively correlated with the mitral valve area and negatively correlated with the mean pulmonary capillary wedge pressure. These results suggest that the left atrial contribution to left ventricular filling in patients with mitral stenosis in sinus rhythm decreases as the severity of valve stenosis increases, and that analysis of the atrial systolic waves of the transmitral and pulmonary venous flow velocities provides important information for evaluation of left atrial systolic performance in patients with mitral stenosis.

Prevalence of Sleep-Disordered Breathing in Diastolic Heart Failure

Sleep-disordered breathing (SDB) is common in congestive heart failure. While isolated diastolic heart failure (DHF) accounts for up to a third of all cases of congestive heart failure, the prevalence of SDB in DHF is unknown. We aim to determine the prevalence and characteristics of SDB in a group of patients with symptomatic DHF. Twenty subjects with symptomatic DHF (New York Heart Association class II or III) and isolated diastolic dysfunction on echocardiography were assessed with lung function tests, modified sleep and health questionnaire, and overnight polysomnography. Significant SDB was defined as an apnea/hypopnea index (AHI) > 10. Thirteen female and seven male subjects (mean age, 65+/-6.0 years; mean body mass index (BMI), 28+/-3.2) were evaluated, of whom 17 (85%) had a diagnosis of hypertension. Overall sleep quality was poor, with fragmentation and frequent arousals associated with respiratory events. Fifty-five percent of the patients had significant SDB, mainly obstructive apneas. BMI and the prevalence of hypertension were similar in patients with and without SDB. The deceleration time, an index of diastolic dysfunction, was more prolonged in the group with SDB (236+/-40 ms vs 282+/-31 ms; p<0.05). As a group, a lower minimum percentage arterial oxygen saturation during sleep, but not the AHI was associated with more severe degree of diastolic dysfunction on echocardiogram, including a lower ratio between the early peak transmittal flow velocity and the late peak atrial systolic velocity (rho=0.57; p<0.05) and a prolonged isovolumic relaxation time (rho=-0.54; p<0.05). SDB is common in patients with DHF. Patients with DHF and SDB may be associated with worse diastolic dysfunction than those without SDB, although a causal relationship remains to be established.

Relationship between the angiotensin converting enzyme gene polymorphism and the effects of enalapril on left ventricular hypertrophy and impaired diastolic filling in essential hypertension: M-mode and pulsed Doppler echocardiographic studies.

To investigate the relationship between the angiotensin converting enzyme (ACE) gene polymorphism and the effects of the ACE inhibitor enalapril on left ventricular hypertrophy and impaired diastolic filling. Enalapril (5-10 mg/day) was administered for 12 months to 60 previously untreated patients with essential hypertension. M-mode and pulsed Doppler echocardiography were performed before and after treatment, and changes in various parameters after treatment with enalapril were examined. ACE gene polymorphism was examined by the polymerase chain reaction method and the patients were classified as having the 190 bp deletion homozygous (DD) genotype, the 490 bp insertion homozygous (II) genotype or the 490 bp insertion 190 bp deletion heterozygous (ID) genotype. The DD genotype was observed in 10 patients (17%), the ID genotype in 24 patients (40%) and the II genotype in 26 patients (43%). Plasma ACE activity before treatment with enalapril was significantly higher in seven patients with DD genotype than it was in 18 patients with ID genotype and in 14 patients with II genotype. In all of the 60 patients, the left ventricular mass index, the peak atrial systolic velocity:early diastolic velocity ratio and the deceleration time from the peak of the early diastolic wave to the baseline in transmitral flow velocity were decreased significantly after treatment with enalapril. The changes in left ventricular mass index and atrial systolic velocity:early diastolic velocity ratio after enalapril administration were significantly greater in the DD genotype group than they were in the other two genotype groups. Enalapril-induced regression of left ventricular hypertrophy and improvement in left ventricular impaired diastolic filling were significantly greater in the DD genotype group than they were in the ID and II genotype groups, suggesting that the circulating and tissue renin-angiotensin systems, particularly the former system, are most active in hypertensive patients with the DD genotype.