Peak Early Diastolic Transmitral Velocity Research Articles

Peak Early Diastolic Transmitral Velocity As A Surrogate Marker Of Short-Term Atrial Fibrillation Recurrence After Electrical Cardioversion.

The aim of this study was to assess if peak early diastolic transmitral velocity (E-wave) can be used as a surrogate marker of short-term atrial fibrillation (AF) recurrence. We prospectively studied 57 consecutive patients who underwent electrical cardioversion (ECV) for AF and successfully converted to sinus rhythm. N-terminal brain natriuretic peptide levels (BNP) before and after ECV was measured in all patients. The follow-up included physical examination and a 12-lead electrocardiogram 14 days and one month after the ECV. In 42.1% patients AF recurred during one-month follow-up period. Gender, presence of mitral regurgitation, treatment with angiotensin II receptor blocker and left atrium diameter independently influenced E-wave velocity before ECV. E-wave velocity fell immediately after successful ECV (94.0±27 cm/s vs 79.7±23 cm/s, P<0.0001). E-wave velocity before ECV>94 cm/s and E-wave velocity after ECV >80 cm/s were predictors of one-month AF recurrence [(Hazard Ratio) HR=3.62 with 95% CI=1.49-8.78 and HR=3.76 with 95% CI=1.40-10.10, respectively]. E-wave velocity before and E-wave velocity after ECV remained predictors of AF recurrence but only in non-hypertensive patients (HR=1.01 with 95% C.I=1.01-1.03 and HR=1.03 with 95% C.I=1.01-1.06, respectively). Similarly, BNP levels before and after ECV were associated with an increased the risk of AF recurrence (HR=1.14 with 95% C.I 1.01-1.28 and HR= 1.16 with 95% C.I 1.03- 1.31, respectively). The addition of BNP levels to E-wave velocity before ECV appeared to have incremental value on short-term AF recurrence but at a marginally statistical significance (LR chi2=3.28, p=0.07). E-wave velocity before and after ECV appears to be a marker of short-term recurrence of AF.

Optimal noninvasive assessment of initial left ventricular dysfunction in children with ectopic atrial tachycardia.

Tissue Doppler imaging (TDI) can identify cardiac dysfunction in adults. This study is aimed to improve early identification of initial left ventricular (LV) dysfunction secondary to ectopic atrial tachycardia (EAT) in children by TDI. A total of 70 children with EAT were included in the present study. Cardiac function was evaluated by conventional echocardiography, TDI, and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP). Doppler signals obtained from the mitral inflow and TDI of the mitral annulus were the average values of three consecutive heartbeats. Left ventricular ejection fraction (LVEF), peak early diastolic transmitral velocity (E), peak systolic mitral annulus velocity (S'), early diastolic mitral annular velocity (E'), the ratio E/E', and TDI-derived myocardial performance index (TDI-MPI) were compared between two groups of children with normal or elevated plasma NT-proBNP concentrations. Of the children, 18.6% demonstrated tachycardia-induced cardiomyopathy (TIC). Compared with LVEF, the TDI-MPI and E/E' showed better correlations with elevated plasma NT-proBNP. Addition of TDI-MPI and E/E' to LVEF provided increased information to detect elevated plasma NT-proBNP (91.67% sensitivity). TIC occurred in 18.6% of children with EAT. Initial LV dysfunction assessed by the TDI-MPI and E/E' is associated with elevated plasma NT-proBNP, even the LVEF is normal.

Hemodynamic Basis of Exercise Limitation in Patients With Heart Failure and Normal Ejection Fraction

The purpose of this study was to invasively investigate the hemodynamic response to exercise in patients with heart failure with normal ejection fraction (HFNEF) and to evaluate the ability of the peak early diastolic transmitral velocity to peak early diastolic annular velocity ratio (E/e') to reflect exercise hemodynamics. There is little information regarding the hemodynamic response to exercise in HFNEF. Patients with HFNEF (n = 14) and asymptomatic controls (n = 8) underwent right-side heart catheterization at rest and during supine cycle ergometer exercise and echocardiography with measurement of resting and peak exercise E/e'. Resting pulmonary capillary wedge pressure (PCWP) (10 +/- 4 mm Hg vs. 10 +/- 4 mm Hg; p = 0.94) was similar in HFNEF patients and controls, but stroke volume index (SVI) (p = 0.02) was lower, and systemic vascular resistance index (SVRI) (p = 0.01) was higher in patients. Patients stopped exercise at lower work rate (0.63 +/- 0.29 W/kg vs. 1.13 +/- 0.49 W/kg; p = 0.006). Although peak exercise PCWP was similar in both groups (23 +/- 6 mm Hg vs. 20 +/- 7 mm Hg; p = 0.31), the peak PCWP/work rate ratio was higher in patients compared with controls (46 +/- 31 mm Hg/W/kg vs. 20 +/- 9 mm Hg/W/kg; p = 0.03). Peak exercise SVI (p = 0.001) was lower and SVRI was higher (p = 0.01) in patients. Resting E/e' was modestly elevated in patients (13.2 +/- 4.1 vs. 9.5 +/- 3.4; p = 0.04). Peak exercise E/e' did not differ between the groups (11.1 +/- 3.4 vs. 9.4 +/- 3.4; p = 0.28). The HFNEF patients achieved a similar peak exercise PCWP to that of asymptomatic controls, at a much lower workload. This occurs at a lower SVI and in the setting of higher SVRI. The E/e' does not reflect the hemodynamic changes during exercise in HFNEF patients.

ESTIMATION OF LEFT VENTRICULAR FILLING PRESSURE USING TISSUE DOPPLER ECHOCARDIOGRAPHY IN PATIENTS WITH INTERMEDIATE E/EA

PURPOSE: Peak early diastolic transmitral velocity (using pulsed Doppler) / peak early mitral annular diastolic velocity (using pulsed tissue Doppler imaging –TDI) ratio (E/Ea) can be used to group patients according to filling pressures, but the intermediate group (E/Ea = 8 –15) requires additional information to correctly classify the left ventricular filling pressures(LVFP). Purpose: To assess the relationship between a new echocardiographic parameter, E/(Ea×Sa), where Sa is the peak systolic velocity in TDI of mitral annulus, and LVFP in patients with E/Ea between 8 and 15.

Tissue Doppler in critical illness: a retrospective cohort study

BackgroundThere is a paucity of published data on tissue Doppler imaging (TDI) in the critically ill. In a critically ill cohort, we studied the distribution of TDI and its correlation with other echocardiographic indices of preload. To aid hypothesis generation and sample size calculation, associations between echocardiographic variables, including the ratio of peak early diastolic transmitral velocity (E) to peak early diastolic mitral annular velocity (E'), and mortality were also explored.MethodsThis retrospective study was performed in a combined medical/surgical, tertiary referral intensive care unit. Over a 2-year period, 94 consecutive patients who underwent transthoracic echocardiography with E/E' measurement were studied.ResultsMean Acute Physiology and Chronic Health Evaluation III score was 72 ± 25. Echocardiography was performed 5 ± 6 days after intensive care unit admission. TDI variables exhibited a wide range (E' 4.7–18.2 cm/s and E/E' 3.3 to 27.2). E' below 9.6 cm/s was observed in 63 patients (rate of myocardial relaxation below lower 95% confidence limit of normal individuals). Fourteen patients had E/E' above 15 (evidence of raised left ventricular filling pressure). E/E' correlated with left atrial area (r = 0.27, P = 0.01) but not inferior vena cava diameter (r = 0.16, P = 0.21) or left ventricular end-diastolic volume (r = 0.16, P = 0.14). In this cohort, increased left ventricular end-systolic volume, but not E/E', appeared to be an independent predictor (odds ratio 2.1, P = 0.007) of 28-day mortality (31%; n = 29).ConclusionThere was a wide range of TDI values. TDI evidence of diastolic dysfunction was common. E/E' did not correlate strongly with other echocardiographic indices of preload. Further evaluation of echocardiographic variables, particularly left ventricular end-systolic volume, for risk stratification in the critically ill appears warranted.

In Vivo Echocardiographic Detection of Enhanced Left Ventricular Function in Gene-Targeted Mice With Phospholamban Deficiency

We evaluated the ability of M-mode and Doppler echocardiography to assess left ventricular (LV) function reliably and repeatedly in mice and tested whether these techniques could detect physiological alterations in phospholamban (PLB)-deficient mice. Anesthetized wild-type mice (n = 7) and mice deficient in PLB (n = 8) were studied with two-dimensional guided M-mode and Doppler echocardiography using a 9-MHz imaging and 5- to 7.5-MHz Doppler transducer. Data were acquired in the baseline state and after intraperitoneal isoproterenol administration (2.0 micrograms/g IP). Interobserver and intraobserver variability and reproducibility were excellent. PLB-deficient mice were associated with significant (P < .05) increases in several physiological parameters (mean +/- SD) compared with wild-type control mice: normalized mean velocity of circumferential shortening (7.7 +/- 2.1 versus 5.5 +/- 1.0 circ/sec), peak aortic velocity (105 +/- 13 versus 75 +/- 9.2 cm/s), mean aortic acceleration (57 +/- 16 versus 31 +/- 4 m/s2), and peak early-diastolic transmitral velocity (80.0 +/- 7.2 versus 66.9 +/- 7.7 cm/s). LV dimensions, shortening fractions, heart rates, late diastolic transmitral (A) velocities, and early to late (E/A) diastolic velocity ratios were similar in both groups. Isoproterenol administration resulted in significant increases in Doppler indices of ventricular function in control but not PLB-deficient mice. These findings indicate that assessment of LV function can be performed noninvasively in mice under varying physiological conditions and that PLB regulates basal LV function in vivo.

Prevalence and predictors of audible physiological third heart sound in a population sample aged 36 to 37 years.

A physiological third heart sound (S3) is common in youth but allegedly very rare after the age of 40 years. The mechanism of its disappearance is not known. The aim of this work was to study the prevalence and predictors of physiological S3 in a population-based sample of persons approaching 40 years of age. A random sample of 120 persons born in 1954 was invited; 93 (42 men) entered the study. Their physical activity, alcohol and tobacco consumption, and salt intake were quantified by diary follow-up. The presence of an S3 was determined by auscultation and confirmed by phonocardiography. Left ventricular (LV) size, mass, and systolic function were assessed by M-mode echocardiography and LV filling by Doppler velocimetry of transmitral flow. An audible S3 was detected in 22 subjects, 1 of whom had heart disease. The prevalence of physiological S3 was 23.1%. Subjects with physiological S3 had a lower body mass index (22.3 +/- 2.8 versus 24.6 +/- 4.1 kg/m2 [mean +/- SD], P = .005), lower heart rate (63 +/- 7 versus 68 +/- 10 beats per minute, P = .015), higher peak early diastolic transmitral velocity (67 +/- 10 versus 58 +/- 8 cm/s, P = .002), and higher acceleration of early diastolic velocity (717 +/- 148 versus 622 +/- 122 cm/s2, P = .012) than those without S3. No differences were noted in the lifestyle characteristics, blood pressure, or LV mass and systolic function. Body mass index and peak early diastolic transmitral velocity were independent predictors of physiological S3 in logistic regression analysis. Nearly one fourth of persons approaching their forties still have an audible physiological S3. The presence of S3 is predicted by leanness and a high early diastolic LV inflow velocity; the disappearance of S3 is unlikely to be secondary to increasing blood pressure and relative LV hypertrophy, as is widely presented, but reflects a more primary age-related alteration of LV early diastolic function.

Transmitral velocities measured by pulsed Doppler in healthy volunteers: effects of acute changes in blood pressure and heart rate.

The effect of a two minute cold pressor test on transmitral velocities measured by pulsed Doppler was studied in 11 healthy volunteers. Blood pressure increased significantly during cold immersion but peak atrial and peak early diastolic transmitral velocities and their ratio (A:E) were unchanged. There was no correlation between changes in Doppler variables and changes in calculated mean arterial blood pressure during the test. Heart rate changes were variable and not related to changes in blood pressure. In individual people the change in pulse interval during cold immersion was significantly and inversely correlated with the change in the A:E ratio. The large acute increase in arterial pressure seen during the cold pressor test in normal volunteers had no consistent effect on the transmitral velocity profile although small changes in heart rate were associated with large changes in A:E ratio. The effect of small changes in heart rate may be of considerable importance in determining transmitral velocity profiles. Thus in clinical and experimental studies in which the heart rate is not controlled, Doppler data on transmitral flow should be interpreted with caution.