Peak Systolic Mitral Annular Velocity Research Articles

Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism

Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was -20.88 ± 2.30 and -24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (-1.38 ± 0.19 vs -1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement.

Assessment of left ventricular long axis contraction in patients with ischemic mitral regurgitation after acute myocardial infarction

The development of ischemic mitral regurgitation (MR) after myocardial infarction (MI) may impose hemodynamic load during a period of active left ventricular remodeling and promote heart failure (HF). The aim of our study was to evaluate left ventricular (LV) long axis contraction assessed by both mitral annular plane systolic excursion (MAPSE) and peak systolic velocity in patients with ischemic MR after acute MI. Thirty eight patients with a first attack of acute MI were classified into two groups. Group I comprised 18 patients with MI and ischemic MR, and group II comprised 20 patients with MI without ischemic MR. Twenty subjects without acute MI were considered as the control group (group III). Measurement of MAPSE from M-mode tracing of the mitral annulus from apical 4- and 2-chamber, and Pulsed wave tissue Doppler imaging (TDI) of the 4 sides of the mitral annulus for assessment of peak systolic (Sa) and diastolic (Ea and Aa) velocities were done. Significant decrease of MAPSE in 4 sides in patients with acute MI with MR compared to MI without MR and control group ( P < 0.05). Peak systolic velocity (Sa) in septal, anterior, inferior sides of mitral annulus was significantly decreased in MI patients compared with control group ( P < 0.05); and not in lateral side ( P > 0.05). Significant correlation between MAPSE on anterior side of mitral annulus and LV EF ( P < 0.001) in patients with ischemic MR after acute MI. mitral annular displacement is a useful parameter for assessment of longitudinal LV function in patients with ischemic MR after MI.

Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study)

Little is known regarding the natural longitudinal changes in cardiac structure and function in CKD. We hypothesized that baseline CKD stage is associated with progressive worsening in cardiac structure and function. We conducted a prospective longitudinal study, recruiting 300 patients with stages 3-5 CKD from a major regional tertiary center and university teaching hospital in Hong Kong. Baseline CKD stages were studied in relation to natural longitudinal changes in echocardiographic and tissue Doppler imaging-derived parameters. Over 1 year, the prevalence of left ventricular (LV) hypertrophy increased from 40.3% to 48.9%, median left atrial volume index increased 4.8 (interquartile range [IQR], 2.1, 7.7) ml/m(2) (P<0.001), peak systolic mitral annular velocity decreased 0.5 (IQR, -1.5, 0.5) cm/s (P<0.001), early diastolic mitral annular velocity decreased 0.5 (IQR, -1.5, 0.5) cm/s (P<0.001), and eGFR declined 2.0 (IQR, -5.0, 0.0) ml/min per 1.73 m(2). CKD stages 4 and 5 were associated with more baseline abnormalities in cardiac structure and function and predicted greater longitudinal progression in LV mass index (odds ratio [OR], 3.02; 95% confidence interval [95% CI], 1.39 to 6.58), volume index (OR, 2.58; 95% CI, 1.18 to 5.62), and left atrial volume index (OR, 2.61; 95% CI, 1.20 to 5.69) and worse diastolic dysfunction grade (OR, 3.17; 95% CI, 1.16 to 8.69) compared with stage 3a in the fully adjusted analysis. In conclusion, more advanced CKD at baseline may be associated with larger longitudinal increases in LV mass and volume and greater deterioration in diastolic function.

Determinants of high sensitivity troponin T concentration in chronic stable patients with heart failure: Ischemic heart failure versus non-ischemic dilated cardiomyopathy

Cardiac troponin T is a marker of myocardial injury, especially when measured by means of the high-sensitivity assay (hs-cTnT). The echocardiographic and clinical predictors of hs-cTnT may be different in ischemic heart failure (IHF) and non-ischemic dilated cardiomyopathy (DCM). Sixty consecutive patients (19 female, 41 male; mean age 56.3 ± 13.9 years) with stable congestive heart failure (33 patient with IHF and 27 patients with DCM), with New York Heart Association functional class I-II symptoms, and left ventricular ejection fraction < 40% were included. In patients with IHF peak early mitral inflow velocity (E), E/peak early diastolic mitral annular tissue Doppler velocity (Em) lateral, peak systolic mitral annular tissue Doppler velocity (Sm) lateral and logBNP were univariate predictors of hs-cTnT above median. But only E/Em lateral was an independent predictor of hs-cTnT above median (p = 0.04, HR: 1.2,CI: 1-1.4). In patients with DCM; left atrial volume index, male sex, Sm lateral and global longitudinal strain (LV-GLS) were included in multivariate model and LV-GLS was detected to be an independent predictor for hs-cTnT above median (p < 0.05, HR: 0.7, CI: 0.4-1.0). While LV-GLS is an independent predictor of hs-cTnT concentrations in patients with DCM, E/Em lateral predicted hs-TnT concentrations in patients with IHF.

Assessment of left ventricular long axis contraction in patients with ischemic mitral regurgitation after acute myocardial infarction

IntroductionThe development of ischemic mitral regurgitation (IMR) after myocardial infarction (MI) may impose hemodynamic load during a period of active left ventricular remodeling and promote heart failure (HF). The aim of our study was to evaluate left ventricular (LV) long axis contraction assessed by both mitral annular plane systolic excursion (MAPSE) and peak systolic velocity (Sa) in patients with ischemic MR after acute MI. MethodsThirty-eight patients with a first attack of acute MI were classified into two groups. Group I comprised 18 patients with MI and ischemic MR, and group II comprised 20 patients with MI without IMR. Twenty age-matched subjects were considered as the control group (group III). Measurement of MAPSE from M-mode tracing of the mitral annulus in apical 4- and 2-chamber view, and pulsed wave tissue Doppler imaging (PW-TDI) of the 4 sides of the mitral annulus for assessment of the Sa velocity were done. ResultsA significant decrease of MAPSE was observed in 4 sides in patients with acute MI with IMR compared to MI without IMR and control group (P<0.05). Peak systolic velocity (Sa) in septal, anterior, and inferior sides of mitral annulus was significantly decreased in MI patients compared to control group (P<0.05). A significant correlation between MAPSE on anterior side of mitral annulus and LV ejection fraction (P<0.001) in patients with ischemic MR after acute MI was found. ConclusionMitral annular plane systolic excursion is a useful and superior parameter over peak Sa for assessment of longitudinal LV function in patients with ischemic MR after MI.

Influence of Comorbid Cardiovascular Risk Factors on Left Atrial-Left Ventricular Interaction in Asymptomatic Patients

Previous studies have examined the negative impacts of individual cardiovascular risk (CVR) factors on left atrial (LA)-left ventricular (LV) interaction, whereas the combined effects of these risk factors are insufficiently elucidated. We studied 176 asymptomatic patients with CVR factors and age-matched 50 healthy individuals by conventional and 2-dimensional speckle-tracking echocardiography. The patients were classified into 2 groups according to the number of CVR factors: one risk factor (single) group (n = 79) and 2 or more risk factors (comorbid) group (n = 97). The peak early diastolic transmitral flow velocity (E)/peak early diastolic mitral annular motion velocity (e')/peak systolic LA strain (S-LAs) was used as a surrogate for LA stiffness during ventricular systole. The E/e'/S-LAs was greatest in the comorbid group. The peak systolic LV circumferential and radial strains, peak early diastolic LV radial strain rate, and peak early diastolic LA strain and strain rate were lower in the comorbid group than in the single group. Multivariate regression analysis identified age, body mass index, systolic blood pressure, end-systolic LV diameter, peak systolic mitral annular motion velocity (s'), and peak systolic LV radial strain in the comorbid group, and peak atrial systolic transmitral fl ow velocity and s' in the single group, as independent predictors of E/e'/S-LAs. Subtle LA and LV dysfunction with individual CVR factors were more aggravated with the comorbid conditions in asymptomatic patients.

Differences of left ventricular systolic deformation in hypertensive patients with and without apical hypertrophic cardiomyopathy

BackgroundWe tested the hypothesis that the apical myocardial mechanics differ from those of other ventricular segments in hypertensive patients with and without apical hypertrophic cardiomyopathy (ApHCM).MethodsWe retrospectively studied hypertensive patients with and without ApHCM. Left ventricular longitudinal, circumferential, and radial strains were examined by two-dimensional speckle-tracking echocardiography at the basal, middle, and apical walls of the parasternal short-axis and apical 2-, 3- and 4-chamber views.ResultsFourteen consecutive patients with hypertension and ApHCM and 14 patients with hypertension without ApHCM were studied. Lower mitral annular peak systolic velocity and greater diastolic dysfunction were present in hypertensive patients with ApHCM than in hypertensive patients without ApHCM. Compared with hypertensive patients without ApHCM, hypertensive patients with ApHCM had significantly lower apical longitudinal (−13.9% vs −21.9%, p = 0.010) and radial strains (4.4% vs 11.5%, p = 0.017) without the base-to-apex gradient. The global longitudinal (−15.6% vs −18.8%, p = 0.027) and circumferential strains (−16.1% vs −19.2%, p = 0.019) were significantly lower in hypertensive patients with ApHCM than in hypertensive patients without ApHCM. Among systolic parameters, the global longitudinal strain was independently associated with hypertension with ApHCM (odds ratio, 1.457; 95% confidence interval, 1.002–2.119; p = 0.049).ConclusionsReduced apical longitudinal and radial strains without a base-to-apex gradient were present in hypertensive patients with ApHCM. The global longitudinal strain was independently associated with ApHCM in hypertensive patients.

Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: A two-dimensional speckle-tracking echocardiographic study

Hypertension and obesity each are well known to result in heart failure with preserved ejection fraction. Therefore, it is clinically important to clarify the mechanisms of further deterioration of left atrial (LA)-left ventricular (LV) interaction in asymptomatic patients with obesity in the presence of hypertension. Data on conventional and two-dimensional speckle-tracking echocardiography (2DSTE) were obtained from 134 asymptomatic hypertensive patients. The study sample was divided into two groups: non-obese (n = 80; body mass index [BMI] <25 kg/m2] and obese (n = 54; BMI ≥25 kg/m2). The end-diastolic LV diameter, ratio of early transmitral flow to mitral annular motion velocity (E/e’), peak systolic LV circumferential strain rate, and E/e’/peak systolic LA strain (S-LAs) were greater in the obese group. Among the significantly correlated variables with BMI and E/e’/S-LAs in univariate analyses, multivariate analyses revealed that BMI is independently associated with end-diastolic LV diameter and peak systolic LV radial strain in all hypertensive patients, and that age, systolic blood pressure, relative LV wall thickness, peak systolic mitral annular motion velocity (s’), peak systolic LV radial strain, and peak early diastolic LV longitudinal strain rate are identified as independent predictors related to E/e’/S-LAs in the obese patients, whereas only s’ contributes to the E/e’/S-LAs in the non-obese patients. Impaired LA-LV interaction was accelerated with obesity in the presence of hypertension. Assessment of the LA and LV function using 2DSTE provided additional information to the negative effects of cardiovascular risk factors on the LA and LV function in patients without clinical symptoms.

The increasing detection of asymptomatic left ventricular dysfunction in patients with type 2 diabetes mellitus without overt cardiac disease: Data from the SHORTWAVE study

AimsType 2 diabetes mellitus (DM) is associated with higher risk of heart failure. Over the last three decades several studies demonstrated the presence of asymptomatic systolic and/or diastolic left ventricular (LV) dysfunction (asymLVD) in patients with normal LV ejection fraction (LVEF). Purpose of our study was to assess the prevalence and factors associated with asymLVD in DM patients by echocardiographic indexes more sensitive than LVEF and transmitral flow detected by pulsed Doppler. Methods386 DM patients without overt cardiac disease were enrolled from January to October 2011. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S′) were considered as indexes of systolic function of circumferential and longitudinal myocardial fibers, respectively. Early diastolic velocity of transmitral flow was divided by early diastolic Tissue Doppler velocity of mitral annulus for identifying diastolic LVD. ResultsasymLVD was detected in 262 patients (68%). 106 (27%) had isolated systolic asymLVD, 61 (16%) isolated diastolic asymLVD; in 95 (25%) systolic and diastolic asymLVD coexisted. Patients with asymLVD were older, had lower glomerular filtration rate, higher levels of glycated hemoglobin, C reactive protein, LV mass, relative wall thickness and prevalence of valve calcifications. Older age (HR 1.1 [1.02–1.18], p=0.01), aortic valve calcifications (HR 6.3 [1.31–30.31], p=0.02), LV concentric geometry defined as relative wall thickness ≥0.43 (HR 15.44 [2.96–80.44], p=0.001) were independent predictors of asymLVD at multivariate analysis. ConclusionsUsing suitable echocardiographic indexes, asymLVD is detectable in two/third of DM patients without overt cardiac disease and is predicted by older age, cardiac valve calcifications and LV concentric remodeling.

SAT0206 Role of Tissue Doppler Echocardiography in Detecting Preclinical Cardiac Involvement in Systemic Sclerosis Patients

BackgroundPrimary myocardial involvement is common in systemic sclerosis (SSc), but often underestimated. Clinically apparent myocardial involvement has significant therapeutic implications and is considered an important prognostic factor. Cardiac involvement may...

The validity of a global tissue Doppler index in estimating left ventricular end-diastolic pressure in patients with coronary artery disease

Background The left ventricular end diastolic pressure (LVEDP) is an important parameter in cardiac patients. There are few data on adding tissue Doppler derived mitral annular peak systolic velocity (S′) wave to the ratio of early mitral inflow to mitral annular velocity (E/E′) for the estimation of left ventricular end diastolic pressure (LVEDP) in patients with preserved LV ejection fraction. Objectives To assess the validity of E/(E′A ∼ S′) in estimating LVEDP in patients with CAD and intermediate E/E′. Methods Sixty-five subjects underwent echocardiography and TDI of the mitral annulus in less than 30 min of cardiac catheterization. Echocardiographic variables including E/E′ and E/(E′A ∼ S′) were compared to invasively measured LVEDP. Results Based on coronary angriography, 49 subjects showed significant CAD (group I) while 16 subjects showed no evidence of CAD (control group). The E/E′ and the E/(E′X S′) were significantly higher in CAD patients than in the control group ( P r = 0.785, P r = 0.274, P > 0.05). ROC analysis yielded an optimal E/(E′A ∼ S′) cutoff value of 1.43 for prediction of LVEDP >12 mmHg with a sensitivity of 90.9%, a specificity of 57.1%, a positive predictive value of 76.9% and a negative predictive value of 80.0% (AUC 0.88, 95% CI 0.71–1.00, P 12 mmHg with a sensitivity of 72.7%, a specificity of 28.6%, a positive predictive value of 61.5% and a negative predictive value of 40.0% (AUC 0.68, 95% CI 0.44–0.93, P > 0.05). Conclusions E/(E′A ∼ S′) correlates well with LVEDP and can be used as a simple andaccurate estimate ofLVEDP in coronary artery disease patients with intermediate E/E′.

The worrisome liaison between left ventricular systolic dysfunction and mitral annulus calcification in type 2 diabetes without coronary artery disease: Data from the SHORTWAVE study

Background and AimMitral annulus calcification (MAC) is a marker for coronary artery disease (CAD) and predicts poor outcome in the general population. No data are available on MAC in patients with type 2 diabetes. In these patients we assessed prevalence of MAC and the relation between MAC and left ventricular (LV) systolic function. Methods and ResultsAs many as 386 patients with type 2 diabetes without CAD were studied with Doppler echocardiography. LV systolic dysfunction was defined by analyzing 120 healthy subjects. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (peak S′) were considered as indexes of LV circumferential and longitudinal shortening and classified low if <89% and <8.5 cm/s, respectively (10th percentiles of controls). Patients who had MAC (107 = 28%) were older with longer duration of DM and were receiving more anti-hypertension medications than those who had not. At echocardiographic evaluation patients with MAC showed higher LV mass, larger left atrial volume (LAV), reduced sc-MS (88.4 ± 14.9 vs 92.6 ± 14.3%; p = 0.01) and peak S′ (8.9 ± 2.2 vs 10.0 ± 2.0 cm/s; p < 0.001) than patients without MAC. Multiple logistic regression demonstrated older age (OR 1.03 [IC 1.01–1.06], p = 0.009), larger LAV (OR 1.19 [IC 1.11–1.28], p < 0.001) and combined reduction in sc-MS and peak S′ (OR 3.00 [IC 1.57–5.72], p = 0.001) as independent factors associated with MAC. ConclusionsMAC is detectable in one fourth of patients with type 2 diabetes without CAD and is mostly related to LV systolic dysfunction expressed as combined impairment of LV circumferential and longitudinal fibers, independent of age and LAV.

The Effect of Smoking on Myocardial Performance Index in Middle‐Aged Males after First Acute Myocardial Infarction

Cigarette smoking is associated with increased rates of coronary artery disease and acute myocardial infarction (MI). Paradoxically, smokers had lower mortality after MI. The purpose of this study was to evaluate the effect of chronic smoking on myocardial performance index (MPI) in middle-aged men after an acute MI. A total of 429 patients (325 smokers vs. 104 nonsmokers) presenting with acute ST elevation MI were enrolled in this study. Thrombolysis in myocardial infarction (TIMI) flow of the infarct related artery was measured before and after the primary percutaneous coronary intervention (PCI), and Gensini score was also calculated. Conventional echocardiography and tissue Doppler echocardiography (TDI) were performed within 48-72 hours after onset of chest pain. Peak early (Em) and late (Am) diastolic velocities, peak systolic (Sm) mitral annular velocities and time intervals were recorded with TDI. The MPI, ratio of Em/Am, and E/Em were calculated. Baseline demographic and angiographic characteristics such as Gensini score, pre and, post PCI TIMI flow were similar in 2 groups. In contrast, LV MPI was preserved among smokers (0.59 ± 0.15 vs. 0.66 ± 0.14, P = 0.01), and Em/Am values were also higher in smokers (0.84 ± 0.28 vs. 0.75 ± 0.31, P = 0.01). Independent predictors of impaired MPI (≥0.60) were determined as nonsmoking status (odds ratio 2.940, 95% CI 0.98-5.83, P = 0.05), left anterior descending artery stenosis (odds ratio 3.196, 95% CI 1.73-5.91 P = 0.001), and, age (odds ratio 1.12, 95% CI 1.03-1.22, P = 0.01). Despite similar demographic and angiographic characteristics, smoker males had a paradoxically better MPI after acute MI.

The effect of exercise training on left ventricular relaxation and diastolic suction at rest and during orthostatic stress after bed rest

A marked reduction in upright stroke volume (SV) contributes substantially to orthostatic intolerance after exposure to spaceflight or bed rest. It is unclear whether slowed left ventricular (LV) relaxation and diastolic suction contribute to the reduction in SV or whether these changes are influenced by exercise training while in bed. Twenty-seven healthy adults completed 5 weeks of -6 deg head-down bed rest (HDBR). During HDBR, nine subjects were sedentary (NOEX), while 18 performed near-daily rowing ergometry (EX). Left ventricular mass, SV, LV end-diastolic volume (LVEDV), pulmonary capillary wedge pressure and Doppler ultrasound indices of LV function were collected pre- and post-HDBR during supine rest (twice) and during reduced LV loading (lower body negative pressure; LBNP) and increased LV loading (saline infusion). Post-HDBR, LV mass increased in the EX group, but decreased in the NOEX group. The reduction in SV and LVEDV during supine rest and LBNP were greater with NOEX in comparison to EX after HDBR. Peak early mitral annular velocity, isovolumic relaxation time, early propagation velocity, a non-invasive index of early diastolic filling and ventricular diastolic suction, and peak global longitudinal early strain rate were slowed during supine rest after HDBR with NOEX; however, these variables were either unaltered or the reduction was less prominent with EX. Doppler ultrasound measures of early diastolic filling, ventricular relaxation and diastolic suction were not significantly affected during LV unloading by LBNP after HDBR in either group. All Doppler indices were restored to pre-HDBR levels in both groups during saline infusion to normalize LV filling pressure after HDBR. It is concluded that Doppler indices of dynamic LV filling were reduced in both groups after HDBR; however, these effects were more pronounced in the NOEX group. Irrespective of group, post-HDBR Doppler parameters were restored when LV filling pressure was increased to pre-HDBR levels during saline infusion. Therefore, the reduction in upright SV after HDBR is more influenced by changes in LV loading conditions, namely left atrial pressure in the setting of LV remodelling, rather than ventricular relaxation and diastolic suction.

Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study

The present study aims to study the relationship between tissue Doppler echocardiography (TDE) indices of right ventricle and exercise capacity in patients after total correction for tetralogy of Fallot (ToF). This cross-sectional observational study included 20 patients, after undergoing total correction procedure for ToF diagnosed with mild/moderate pulmonary regurgitation and 30 age-matched healthy children. In the postoperative period, patients were invited to hospital for evaluation of the ventricular functions by 2D, M-mode, Doppler (DE) echocardiography and TDE and exercise testing to evaluate the effort capacity. Statistical analysis was performed using Mann-Whitney U and Chi-square tests, and Pearson correlation analysis. Compared with the controls; the mitral annular peak systolic flow velocity (Sm) value was significantly lower, while isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT) and myocardial performance index (MPI) values obtained at the tricuspid and mitral (MV) valves were significantly higher (p<0.05 for all) in patients after ToF repair. There was a negative correlation between the exercise period and the total correction age (r=-0.20, p=0.015) and the same negative correlation existed between the exercise period and METS (r=-0.25, p=0.010). MV IVCT with DE and TDE was found to be correlated with METS (r=-0.45, p=0.04). Left ventricular MPI was found to be correlated with maximum heart rate (r=-0.20, p=0.03). By DE, tricuspid valve deceleration time and Sm peak flow velocity with TDE were significantly correlated with METS (r=-0.30, p=0.04; r=-025, p=0.005, respectively). MPI calculated with TDE was correlated with maximum heart rate (r=-0.15, <0.01). Even if patients, undergone total correction surgery for ToF were asymptomatic or had minimal clinical symptoms, MPI index assessed by pulse wave TDE and exercise testing may allow early diagnosis of right ventricle dysfunction.

135 Chronic DPP-4 inhibition by sitagliptin enhances both global and regional myocardial function during dobutamine stress in patients with type 2 diabetes mellitus and coronary artery disease

BackgroundGlucagon-like peptide-1 (GLP-1) is an incretin hormone secreted by the gut in response to the oral ingestion of nutrients. Through augmentation of myocardial glucose uptake and subsequent reduction in fatty...

Analysis of Circumferential and Longitudinal Left Ventricular Systolic Function in Patients With Non-Ischemic Chronic Heart Failure and Preserved Ejection Fraction (from the CARRY-IN-HFpEF Study)

Heart failure with preserved left ventricular ejection fraction (HFpEF) is implicitly attributed to diastolic dysfunction, often recognized in elderly patients with hypertension, diabetes, and renal dysfunction. In these patients, left ventricular circumferential and longitudinal shortening is often impaired despite normal ejection fraction. The aim of this prospective study was to analyze circumferential and longitudinal shortening and their relations in patients with nonischemic HFpEF. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S') were measured in 60 patients (mean age 73 ± 13 years) with chronic nonischemic HFpEF in stable New York Heart Association functional class II or III and compared to the values in 120 healthy controls and 120 patients with hypertension without HFpEF. Sc-MS was classified as low if <89% and S' as low if <8.5 cm/s (the 10th-percentile values of healthy controls). Isolated low sc-MS was detected in 46% of patients with HFpEF, 27% of patients with hypertension, and 2% of controls; isolated low S' was detected in 11% of patients with HFpEF, 7% of patients with hypertension, and 5% of controls; and combined low sc-MS and low S' was detected in 26% of patients with HFpEF, 9% of patients with hypertension, and 5% of controls (HFpEF vs others, all p values <0.001). Thus, any alteration of systolic function was found in 83% of patients with HFpEF. The relation between sc-MS and S' was nonlinear (cubic). Changes in S' within normal values corresponded to negligible variations in sc-MS, whereas the progressive decrease below 8.5 cm/s was associated with substantial decrease in sc-MS. In conclusion, circumferential and/or longitudinal systolic dysfunction is present in most patients with HFpEF. Circumferential shortening normalized by wall stress identifies more patients with concealed left ventricular systolic dysfunction than longitudinal shortening.

Prognostic Value of Pulsed Tissue Doppler Imaging for the Assessment of Left Ventricular Systolic Function in Patients with Nonischemic Dilated Cardiomyopathy

There is still some debate regarding the prognostic significance of left ventricular longitudinal systolic dysfunction as assessed by tissue Doppler (TD) imaging in patients with chronic heart failure (HF), since previous studies have included patients with postischemic wall motion abnormalities. Thus, this study was designed to ascertain whether TD-derived longitudinal systolic dysfunction may influence the outcome of patients with nonischemic chronic HF. In 200 consecutive patients with chronic HF secondary to dilated cardiomyopathy and no history of ischemic heart disease, peak systolic mitral annular velocity (S(m) ) was measured by pulsed TD at the septal and lateral annular sites. The end points were cardiac death or hospitalization for worsening HF. Mean follow-up duration was 30 months. In a time independent analysis, averaged S(m) calculated as the average of septal and lateral S(m) , resulted to be a significant predictor of outcome in the study population (area under receiver-operator characteristic curve: cardiovascular death, 0.69, P < 0.0001; cardiovascular events, 0.64, P = 0.0005). In a time-dependent analysis, average S(m) was associated with both cardiovascular death (hazard ratio 0.832, P = 0.0019) and cardiovascular events (hazard ratio 0.904, P = 0.039), independently of other clinical risk factors and echocardiographic parameters of systolic function. Septal S(m) but not lateral S(m) was independently associated with the outcome measures. In conclusion, the assessment of systolic mitral annular velocity by pulsed TD is a useful indicator for prognostic stratification of patients with nonischemic dilated cardiomyopathy and chronic HF.

Peak Systolic Mitral Annulus Velocity Reflects the Status of Ventricular-Arterial Coupling—Theoretical and Experimental Analyses

Peak systolic mitral annular velocity (S(m)) measured by tissue Doppler echocardiography has been recognized as an independent predictor of mortality in patients with heart failure and in the general population. However, the mechanical determinants of S(m) remain poorly defined. A theoretical model of S(m) was derived, which indicates that S(m) is affected positively by left ventricular (LV) contractility and preload and inversely by LV afterload and ejection time (EJT). In 16 anesthetized dogs, S(m), LV volume, and LV pressure were measured using sonomicrometry and catheter-tip micromanometry. LV contractility, preload, and afterload were indexed by the end-systolic pressure/volume ratio (E(es)'), end-diastolic volume (V(ed)), and effective arterial elastance (E(a)), respectively. LV contractility, loading conditions, and heart rate were varied over wide ranges, and a total of 76 data sets were obtained for S(m) (1.2-9.1 cm/sec), E(es)' (1.5-17.6 mm Hg/mL), V(ed) (11-99 mL), E(a) (3.6-58.4 mm Hg/mL), EJT (100-246 msec), heart rate (66-192 beats/min), and the ventricular-arterial coupling ratio (E(es)'/E(a); 0.2-3.0). The theoretical model accurately predicted S(m) (R(2)= 0.79, P < .0001). By univariate analysis, S(m) was correlated significantly with E(es)' (R(2)= 0.64, P < .0001) and with the reciprocal of E(a) (R(2)= 0.49, P < .01). V(ed) and EJT did not affect S(m). E(es)'/E(a) was correlated strongly with S(m) (R(2)= 0.73, P < .0001). E(es)' and the reciprocal of E(a) were not correlated with each other. LV contractility and afterload independently determine S(m). The effects of LV preload and EJT on S(m) might be small, even though they are theoretically associated with S(m). S(m) strongly reflects the status of ventricular-arterial coupling.

Recovery of Long‐Axis Left Ventricular Function after Aortic Valve Replacement in Patients with Severe Aortic Stenosis

Patients with aortic stenosis (AS) should undergo aortic valve replacement (AVR) before irreversible LV dysfunction has developed. Assessment of long-axis left ventricular (LV) function may assist in proper timing of AVR. To assess serial changes in long-axis LV function before and after AVR in patients with severe AS and preserved LV ejection fraction. The study comprised 27 consecutive patients (mean age 64.9 ± 11.7 years, 15 males) with symptomatic severe AS, scheduled for AVR. Seventeen subjects without known cardiac disease, matched for age, gender, LV ejection fraction and cardiovascular risk factors, served as a control group. Long-axis LV function assessment was done with tissue Doppler imaging at 3 weeks, 6 months, and 12 months after AVR. Mean aortic valve area in the AS group was 0.70 ± 0.24 cm². Pre-AVR peak systolic mitral annular velocities were significantly lower compared to controls (6.7 ± 1.5 vs. 8.9 ± 2.0 cm/s, P < 0.05). Post-AVR peak systolic mitral annular velocities improved to 9.1 ± 2.9 at 3 weeks, 8.6 ± 2.7 at 6 months, and 8.1 ± 1.7 cm/s at 12 months (P < 0.05). Improvements were seen over the whole range of pre-AVR peak systolic mitral annular velocities. Patients with improved Sm after AVR (defined as ≥ 10% compared to baseline values) did not differ in baseline characteristics as compared to those who did not improve. In patients with severe AS and preserved LV ejection fraction, abnormal systolic mitral annular velocities improve after AVR, independent of the pre-AVR value.