Pulsed-wave Doppler Echocardiography Research Articles

AB0613 Clinical and Laboratory Differences between SSC Patients with and without Diastolic Dysfunction

BackgroundLeft ventricular diastolic dysfunction (LVDD) is the most common cardiac abnormality in systemic sclerosis (SSc). It is known that aging is a primary determinant of LVDD in SSc patients and...

The Effects of Pre-pregnancy Obesity on Fetal Cardiac Functions

Obesity is a substantial public health problem with a rapidly increasing prevalence in numerous industrialized nations. The objective of this study was to evaluate the effects of maternal pre-pregnancy obesity on fetal cardiac functions. We studied 55 fetuses of obese mothers and 44 fetuses of healthy mothers at 26-38 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, gestational age, estimated birth weight, serum lipids, and systolic-diastolic blood pressure. Fetal heart rate, diameters of the aortic and pulmonary valve annulus, aortic and pulmonary peak systolic velocities, ventricular systolic function, and cardiothoracic ratio were similar in the two groups. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the obese mothers. In the interventricular septum, left ventricle posterior wall, and right ventricle free wall, the E a and A a were higher, and E a/A a ratios were significantly lower in the study group than in the control group. The E/E a ratio was higher in the obese group than in the control group. The isovolumic relaxation time and the right and left ventricle myocardial performance indices were higher in the fetuses of the obese mothers than in the fetuses of the healthy mothers. We believe that maternal obesity has an important influence on fetal cardiac diastolic functions.

Echocardiographic assessment of coronary artery flow in normal canines and model dogs with myocardial infarction

This study was conducted to evaluate the usefulness of coronary arterial profiles from normal dogs (11 animals) and canines (six dogs) with experimental myocardial infarction (MI) induced by ligation of the left coronary artery (LCA). Blood velocity of the LCA and right coronary artery (RCA) were evaluated following transthoracic pulsed-wave Doppler echocardiography. The LCA was observed as an infundibular shape, located adjacent to the sinus of Valsalva. The RCA appeared as a tubular structure located 12 o'clock relative to the aorta. In normal dogs, the LCA and RCA mean peak diastolic velocities were 20.84 ± 3.24 and 19.47 ± 2.67 cm/sec, respectively. The LCA and RCA mean diastolic deceleration times were 0.91 ± 0.14 sec and 1.13 ± 0.20 sec, respectively. In dogs with MI, the LCA had significantly (p < 0.01) lower peak velocities (14.82 ± 1.61 cm/sec) than the RCA (31.61 ± 2.34 cm/sec). The RCA had a significantly (p < 0.01) rapid diastolic deceleration time (0.71 ± 0.06 sec) than that found in the LCA (1.02 ± 0.22 sec) of MI dogs. In conclusion, these profiles may serve as a differential factor for evaluating cardiomyopathy in dogs.

Investigation of endothelial dysfunction and arterial stiffness in children with type 1 diabetes mellitus and the association with diastolic dysfunction

The objective of this study is to investigate endothelial dysfunction (ED) and arterial stiffness (AS) and determine the association with diastolic dysfunction in children with type 1 diabetes mellitus (DM). A total of 42 patients without diabetic complications (mean age: 13.21 years) and 40 healthy (mean age: 13.07 years) children were included in this study. AS was assessed with ascending aorta M-mode measurements, diastolic dysfunction with pulsed wave (PW) Doppler and tissue Doppler echocardiography measurements and flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT) with high-resolution ultrasonography. Results of diabetic group and healthy children were compared. In diabetic group, aortic strain (8.40 ± 2.98, 20.12 ± 5.04; p < 0.001), aortic distensibility (7.36 ± 2.92, 16.59 ± 4.25; p < 0.001) and FMD% (7.70 ± 2.83, 11.33 ± 2.85; p < 0.001) were found decreased, and CIMT (0.52 ± 0.09 mm, 0.47 ± 0.08 mm; p < 0.05) was found increased. Additionally, left ventricular lateral segment and right ventricular free-wall isovolumic relaxation time (IVRT) and myocardial performance index (MPI) were found increased. Correlation analyses demonstrated a negative correlation between FMD and IVRT and MPI. ED and AS were found in type 1 DM patients without diabetic complications. Additionally, correlation was shown between increased AS and ED and right and left ventricular diastolic dysfunctions.

The Effect of HFE Polymorphisms on Cardiac Iron Overload in Patients with Beta-Thalassemia Major

Objective: We aimed to investigate the effect of human hemochromatosis protein (HFE) polymorphisms on cardiac iron overload in patients with beta-thalassemia major. Methods: Our study included 33 patients diagnosed with beta-thalassemia major who were treated with regular transfusions and chelation therapy. M-mode, tissue Doppler, and pulsed wave Doppler echocardiography were performed on all patients. T2* magnetic resonance imaging (MRI) scans were also performed. The HFE polymorphisms (H63D, C282Y, S65C, Q283P, E168Q, E168X, W169X, P160delC, Q127H, H63H, V59M, and V53M) were studied using polymerase chain reaction. Results: The H63D polymorphism was detected in six patients with beta-thalassemia major. Five patients were heterozygous for the H63D polymorphism, while one was homozygous. There were no other polymorphisms. There was no relationship between the HFE polymorphisms and either the serum ferritin levels or the T2-weighted MRI values (P > .05). Moreover, conventional echo and tissue Doppler echo findings were not correlated with the HFE polymorphisms. Pulmonary vein atrial reversal flow velocity, which is a manifestation of diastolic dysfunction measured with pulse wave echo, was higher in the patients with HFE polymorphisms (P = .036). Conclusions: The HFE polymorphisms had no effect on cardiac iron overload. However, pulmonary vein atrial reversal flow velocity measurements can provide important information for detecting diastolic dysfunction during cardiac follow-up of patients with HFE polymorphisms. Studies with more patients are needed to provide more information regarding this matter.

GW24-e3081 Evaluation of right ventricular systolic function of patients with pulmonary hypertension by pulse wave tissue Doppler imaging

ObjectivesThe study purpose is to investigate the value of pulse wave tissue Doppler imaging (PW-TDI) in evaluating right ventricular systolic function of patients with pulmonary hypertension.Methods78 patients with pulmonary hypertension...

Assessment of Cardiac Functions in Fetuses of Gestational Diabetic Mothers

We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p=0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p<0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p<0.001). During the course of pregnancy, mitral E-wave (p<0.001), A-wave (p=0.007), tricuspid E-wave (p<0.001) and A-wave (p=0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E a-wave (p=0.02), A a-wave (p=0.04), and S a-wave (p<0.001) velocities of the right-ventricular (RV) free wall and the E a (p=0.02) and A a (p=0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E a/A a ratio of the RV posterior wall was greater in FGDM with advancing gestation (p<0.03). LV and RV E/E a ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p<0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.

Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease

Myocardial dysfunction is common in chronic kidney disease (CKD) and related to poor outcomes. New non-invasive methods to assess cardiac function have been introduced, but comparative studies evaluating their clinical usefulness in pediatric CKD are lacking. We studied left ventricular (LV) function in pediatric CKD and renal transplant patients, comparing conventional pulse-wave Doppler echocardiography (cPWD) with newer tissue Doppler imaging (TDI) and relating the results to known cardiovascular risk factors. The study included 34 children/adolescents with CKD stages 2-5, 44 renal transplant patients and 19 patients with a normal renal function. The mean age was 11.4 (range 0.8-18.8) years. Both patient groups had significantly lower LV diastolic function than those with a normal renal function. The most sensitive determinants were TDI E'/A' and cPWD E/TDI E' ratios. In a stepwise linear regression analysis, high blood pressure, young age and the presence of albuminuria all independently predicted LV diastolic function. Our study confirms the high prevalence of LV diastolic dysfunction in pediatric CKD patients and following renal transplantation, where TDI appears to be more sensitive than cPWD in assessing early myocardial dysfunction. Our results also underline the importance of preventive measures, such as rigorous blood pressure control, in pediatric CKD.

Chronic Pressure-Overload Hypertrophy Attenuates Vortex Formation Time in Patients With Severe Aortic Stenosis and Preserved Left Ventricular Systolic Function Undergoing Aortic Valve Replacement

Transmitral blood flow produces a vortex ring that enhances the hydraulic efficiency of early left ventricular (LV) filling. The effect of pressure-overload hypertrophy on the duration of LV vortex ring formation (vortex formation time [VFT]) is unknown. The current investigation tested the hypothesis that chronic LV pressure-overload hypertrophy produced by severe aortic stenosis (AS) reduces VFT in patients with preserved LV systolic function undergoing aortic valve replacement. Observational study. Veterans Affairs Medical Center. After the Institutional Review Board's approval, 8 patients (7 men and 1 woman; age, 62±5 y; and ejection fraction, 59%±5%) with AS (peak pressure gradient, 81±22 mmHg; aortic valve area, 0.78±0.25 cm(2)) scheduled for aortic valve replacement were compared with 8 patients (all men; age, 63±3 y; and ejection fraction, 60%±7%) without AS undergoing coronary artery bypass graft surgery. None. Under general anesthesia, peak early LV filling (E) and atrial systole (A) blood flow velocities and their corresponding velocity-time integrals were obtained using pulse-wave Doppler echocardiography to determine E/A and atrial filling fraction (β). Mitral valve diameter (D) was calculated as the average of minor and major axis lengths obtained in the midesophageal bicommissural and long-axis transesophageal echocardiography imaging planes, respectively. Posterior wall thickness (PWT) was measured at end-diastole using M-mode echocardiography. VFT was calculated as 4×(1-β)×SV/πD(3), where SV = stroke volume measured using thermodilution. Systemic and pulmonary hemodynamics, LV diastolic function, PWT, and VFT were determined during steady-state conditions 30 minutes before cardiopulmonary bypass. Early LV filling was attenuated in patients with AS (eg, E/A, 0.77±0.11 compared with 1.23±0.13; β, 0.43±0.09 compared with 0.35±0.02; p<0.05 for each). LV hypertrophy was observed (PWT, 1.4±0.1 cm compared with 1.1±0.2 cm; p<0.05) and VFT was lower (3.0±0.9 v 4.3±0.5; p<0.05) in patients with versus without AS. Linear regression analysis showed a significant correlation between VFT and PWT (VFT = -2.57 ×PWT + 6.81; r(2) = 0.345; p = 0.017). The results indicated that pressure-overload hypertrophy produced by AS reduced VFT in patients with normal LV systolic function undergoing aortic valve replacement.

Non-invasive assessment of cardiac function in a mouse model of renovascular hypertension

Hypertension continues to be a significant cause of morbidity and mortality, underscoring the need to better understand its early effects on the myocardium. The aim of this study is to determine the feasibility of in vivo longitudinal assessment of cardiac function, particularly diastolic function, in a mouse model of renovascular hypertension. Renovascular hypertension (RVH) was induced in 129S1/SvImJ male mice (n=9). To assess left ventricular (LV) systolic and diastolic function, M-mode echocardiography, pulsed-wave Doppler echocardiography and tissue Doppler imaging were performed at baseline, 2 and 4 weeks after the induction of renal artery stenosis. Myocardial tissue was collected to assess cellular morphology, fibrosis, extracellular matrix remodeling and inflammation ex vivo. RVH led to a significant increase in systolic blood pressure after 2 and 4 weeks (baseline: 99.26±1.09 mm Hg; 2 weeks: 140.90±7.64 mm Hg; 4 weeks: 147.52±5.91 mm Hg, P<0.05), resulting in a significant decrease in LV end-diastolic volume, associated with a significant elevation in ejection fraction and preserved cardiac output. Furthermore, the animals developed an abnormal diastolic function profile, with a shortening in the E velocity deceleration time as well as increases in the E/e' and the E/A ratio. The ex vivo analysis revealed a significant increase in myocyte size and deposition of extracellular matrix. Non-invasive high-resolution ultrasonography allowed assessment of the diastolic function profile in a small animal model of renovascular hypertension.

Early detection of cardiac involvement in systemic sclerosis assessed by tissue-Doppler echocardiography

Cardiologia CROATICA Background: To assess cardiac involvement in SSc patients and to explore the relationship between interleukin (IL)-6 levels and echocardiographic abnormalities, and NTproBNP levels in SSc patients and to correlate tested parameters with disease activity (EUSTAR) score. Methods: This case-control study included 31 SSc patients with preserved left ventricular ejection fraction (LVEF) and no concomitant disease, and 32 matched healthy controls. Serum IL-6 and NT-proBNP levels were measured and subjects were evaluated by conventional and pulsed-wave tissue Doppler echocardiography. Results: SSc patients had significantly lower values of LV systolic (7.7 vs 9.25 cm/s, P<0.001) and early diastolic (8.7 vs 10.3 cm/s, P=0.014) myocardial velocities and higher E/e’ ratio (9.04 vs 7.37, P=0.001), although there was no between-group difference according to LVEF (68 vs 65%, P=0.248) and E/A ratio (1 vs 1.11, P=0.312). 18 SSc patients had LV systolic dysfunction (septal s’ <7.5 cm/s) versus 5 control subjects (P=0.010). According to the ASE recommendations, 18 SSc patients and 9 controls had LV diastolic dysfunction (P=0.032). IL-6 level showed correlation with LV mean e’ (r=-0.57, P=0.001) and E/e’ ratio (r=0.55, P=0.001). Also, IL-6 level significantly correlated with the presence (r=0.46, P=0.010) and severity (r=0.54, P=0.002) of LVDD and NT-proBNP level (r=0.52, P=0.003) in the SSc group, whereas no correlation was observed in control group. EUSTAR score correlated with LV E/e’ (r=0.48, P=0.006), mean e’ (r=-0.67, P<0.001), mean s’ (r=-0.51, P=0.004), NT-proBNP (r=0.60, P<0.001) and IL-6 (r=0.79, P<0.001), and with LVSD presence (r=0.363, P=0.044), and LVDD presence (r=0.58, P=0.001) and severity (r=0.621, P<0.001). Correlation was also found between IL-6 level and EUSTAR-score (r=0.79, P<0.001) Conclusions: We showed that subclinical LV impairment is common in patients with SSc who have not already demonstrated cardiac involvement. Positive correlation between IL6 and EUSTAR score and their association with the echocardiographic abnormalities and NT-proBNP may open up new possibilities for the treatment of SSc cardiomyopathy.

Left Ventricular Function by Echocardiography, Tissue Doppler Imaging, and Carotid Intima-Media Thickness in Obese Adolescents With Nonalcoholic Fatty Liver Disease

The aims of this study were to evaluate left ventricular (LV) systolic and diastolic function in obese adolescents with nonalcoholic fatty liver disease (NAFLD) using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate the relations between LV function and carotid intima-media thickness (CIMT). LV remodeling, tissue Doppler-derived LV velocities, and cardiovascular risk profiles in obese adolescents with NAFLD were also studied. One hundred eighty obese adolescents and 68 healthy controls were enrolled in the study. LV end-diastolic and end-systolic and left atrial diameters and LV mass were higher in the 2 obese groups compared with controls. By pulsed-wave Doppler echocardiography and pulsed-wave tissue Doppler imaging, the NAFLD group had normal LV systolic function, impaired diastolic function, and altered global systolic and diastolic myocardial performance. In patients with NAFLD, LV mass was positively correlated with homeostasis model assessment of insulin resistance and serum alanine aminotransferase. CIMT was positively correlated with homeostasis model assessment of insulin resistance, alanine aminotransferase, and LV mass. By multiple stepwise regression analysis, alanine aminotransferase (β = 0.124, p = 0.026), homeostasis model assessment of insulin resistance (β = 0.243, p = 0.0001), LV mass (β = 0.874, p = 0.0001) were independent parameters associated with increased CIMT. In conclusion, insulin resistance has a significant independent impact on CIMT and LV remodeling in the absence of diabetes in patients with NAFLD. Pulsed-wave tissue Doppler imaging is suggested to detect LV dysfunction at an earlier stage in obese adolescents with NAFLD for careful monitoring of cardiovascular risk.

Assessment of Fetal Cardiac Function in Mild Preeclampsia

This study investigated cardiac function in 65 fetuses of mildly preeclamptic mothers and 55 fetuses of healthy mothers at 26-40 weeks of gestation. Fetuses with intrauterine growth restriction were excluded. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, and gestational age. Peak systolic aortic and pulmonary artery velocities were significantly lower in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. The two groups did not differ significantly in terms of shortening fraction or with regard to mitral or tricuspid annular plane systolic excursion. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the preeclamptic mothers. The Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in the preeclampsia group than in the control group. The E/Ea ratio was higher in the preeclampsia group than in the control group. The isovolumic relaxation time and the right and left myocardial performance indices were higher in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. An increased ductus venosus pulsatility index (PI) and a decreased middle cerebral artery (MCA) PI were found in the fetuses of the preeclamptic mothers. All the fetuses were asymptomatic. The results suggest that the increase in fetal cardiac afterload in mild preeclampsia may have caused early subclinical changes in fetal systolic and diastolic cardiac function. In addition, the decrease in MCA-PI may have been caused by redistribution of fetal cardiac output in favor of the left ventricle, secondary to increased placental vascular resistance.

Subclinical diastolic dysfunction in children with Wilson’s disease assessed by tissue Doppler echocardiography: a possible early predictor of cardiac involvement

Background The aim of this study was to evaluate the left ventricular systolic and diastolic functions and cardiac rhythm problems for the early detection of myocardial dysfunction in children with Wilson’s disease.Methods We compared patients who had Wilson’s disease (n = 22) with age- and sex-matched healthy control subjects (n = 21). The diagnosis of Wilson’s disease was based on clinical symptoms and laboratory tests (serum ceruloplasmin, urinary and hepatic copper concentrations). Standard echocardiographic examination, as well as pulsed-wave Doppler, tissue Doppler echocardiography examinations of all patients were performed. 24-hour ECG Holter monitoring was also performed in all subjects.Results All patients were asymptomatic on cardiological examination and had sinus rhythm on electrocardiography. Left ventricular ejection fraction, fractional shortening, wall thickness and left ventricular mass were similar in both groups. In comparison to healthy subjects, children with Wilson’s disease had signifi cantly lower mitral E velocity, mitral E/A ratio (P = 0.046, P= 0.021, respectively) and longer isovolumetric relaxation time values (P = 0.015) as estimated by pulsed wave Doppler echocardiography. Wilson patients had longer isovolumetric relaxation time (IVRT) values estimated by tissue Doppler echocardiography (P = 0.006) compared to the controls. On 24-hour ECG Holter monitoring, none of the Wilson patients showed life-threatening cardiac arrhythmia.Conclusion Our study showed results that might be consistent with subclinical diastolic dysfunction in cardiologically asymptomatic Wilson’s disease children which probably represents an early stage of cardiac involvement. Therefore it may be useful to monitor these signs in the follow-up of the patients.

Relationship between interleukin-6 and cardiac involvement in systemic sclerosis

To explore the relationship between IL-6 levels and echocardiographic abnormalities, and N-terminal probrain natriuretic peptide (NT-proBNP) levels in SSc patients and to correlate tested parameters with European Scleroderma Activity (EUSTAR) score. This case-control study included 31 SSc patients with preserved left ventricular ejection fraction (LVEF) and 32 matched healthy controls. Serum IL-6 and NT-proBNP levels were measured and subjects were evaluated by conventional and pulsed-wave tissue Doppler echocardiography. The level of IL-6 was significantly increased in patients with SSc (3.2 vs 2.2 pg/ml, P < 0.001). SSc patients had significantly lower values of LV systolic (7.7 vs 9.25 cm/s, P < 0.001) and early diastolic (8.7 vs 10.3 cm/s, P = 0.014) myocardial velocities and higher E/e' (9.04 vs 7.37, P = 0.001) ratio, although there was no between-group difference according to LVEF (68% vs 65%, P = 0.248). On evaluating the right ventricle there was no significant between-group difference in systolic tricuspid annular velocity (13 vs 13.9 cm/s, P = 0.105), but the peak early diastolic velocity was significantly lower (11.7 vs 13.6, P = 0.044) and E/e' was significantly higher (4.3 vs 3.38, P = 0.008) in SSc patients. IL-6 level showed correlation with LV mean e' (r = -0.57, P = 0.001), E/e' (r = 0.55, P = 0.001) and NT-proBNP (r = 0.52, P = 0.003). EUSTAR score correlated with LV E/e' (r = 0.48, P = 0.006), mean e' (r = -0.67, P < 0.001), mean s' (r = -0.51, P = 0.004), NT-proBNP (r = 0.60, P < 0.001) and IL-6 (r = 0.79, P < 0.001). IL-6 level is increased in patients with SSc and significantly correlates with LV diastolic dysfunction, NT-proBNP and EUSTAR score. These results support the role of IL-6 in the development of cardiac disease in SSc patients.

Normal pulsed wave doppler echocardiographic parameters of Turkmen horses of Iran.

Summary Turkmen horse is one of the oldest and purest breeds in the world, but there is no information on Doppler echocardiographic parameters in this horse. In the present study, pulsed-wave (PW) Doppler echocardiography was performed on 42 clinically normal 3- to 15-year-old racing Turkmen horses. No cardiac disease was detected with two-dimensional (2-D) real-time, M-mode, and colour flow mapping. Doppler echocardiographic parameters and indices of tricuspid, mitral, pulmonary and aortic flows were measured in this study. Tricuspid inflow velocities during rapid filling (E) and atrial contractions (A) were significantly higher than mitral inflow (P<0.05). The Doppler waveforms, obtained from the aortic outflow, showed a significantly longer pre-ejection period (PEP) and shorter ejection time (ET) than the pulmonary artery waveforms (P=0.001 and P=0.028, respectively). The time taken from the onset of the QRS complex to the onset of the A wave for tricuspid flow, pulmonary PEP, and pulmonary PEP/ET, had a significant positive correlation with age. These values can be used as standard and reference values for evaluation of cardiovascular disorders in Turkmen horse.

Echocardiographic evaluation of ventricular function in young adults with bronchial asthma

BackgroundBronchial asthma (BA) is a common chronic inflammatory condition affecting the airways. Bronchial asthma not only affects the lung but also affects other organs including the heart. Right ventricular (RV) hypertrophy and dilation and left ventricular (LV) diastolic dysfunction were observed in severe BA. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been extensively studied before. PurposeThe aim of this study was to evaluate ventricular function in young adult patients with BA. Patients and methodsFifty patients with bronchial asthma and 30 control subjects (mean ages 28.3±7.0 and 26.8±6.2years, respectively) participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle (LV). LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, myocardial performance index (MPI) and transmitral flow propagation velocity (TFPV). RV function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. ResultsOur results revealed that there were statistically significant differences in the peak E velocity, peak E velocity/peak A velocity ratio and isovolumetric relaxation time between the two groups (p<0.05). Mean LV MPI in the bronchial asthma group (0.40±0.13) was also significantly higher than that of the controls (0.36±0.11, p<0.05). On the other hand, there were no significant differences in the mean value of peak A velocity, deceleration time and isovolumetric contraction time between bronchial asthma patients and controls. TFPV was significantly reduced in the bronchial asthma group when compared to controls (37.10±2.13 versus 43.40±3.11, respectively, p=0.001). We observed no significant difference in the echocardiographic indices of RV performance between the two groups. The mean RV MPI in the bronchial asthma group (0.29±0.11) was not significantly different from that of the controls (0.27±0.08). ConclusionFrom this study we concluded that LV diastolic function is impaired in patients with bronchial asthma despite no effect on RV diastolic function.

Effect of exercise training on diastolic function in metabolic syndrome

It has been reported that metabolic syndrome (MetS) impairs left ventricular (LV) diastolic function. The objective of this study was to determine whether exercise training can improve LV diastolic function in individuals with MetS. Twenty-eight individuals with MetS (9 males, aged 60 ± 5 years) underwent a 1-year combined endurance and resistance exercise training program; maximal aerobic capacity (V̇O2max), blood pressure, blood markers, and LV diastolic function were measured at weeks 0, 12, 24, and 52 throughout the training. Pulsed wave Doppler echocardiography across the mitral valve was used to assess peak early flow velocity (E) and peak atrial flow velocity (A) to determine the E/A ratio. Individuals with MetS had a reversed E/A ratio, suggesting impaired LV relaxation, the first stage of LV diastolic dysfunction. Exercise training reduced systolic blood pressure (SBP) (129 ± 14 to 120 ± 12 mm Hg; p < 0.01) and increased V̇O2max (29.2 ± 6.3 to 33.4 ± 6.5 mL·kg(-1)·min(-1); p < 0.01) and high-density lipoprotein cholesterol (1.04 ± 0.21 to 1.12 ± 0.25 mmol·L(-1); p = 0.02), but did not improve LV diastolic function. Individuals with an E/A ratio <1 at the start of training had a tendency toward an increased E/A ratio (p = 0.12) accompanied by significant decreases in SBP and increases in V̇O2max with exercise training. Combined resistance and aerobic exercise training improved cardiometabolic health but did not improve the impaired LV diastolic function of individuals with MetS.

Multiple coronary artery-left ventricle microfistulae.

A 55-year-old woman with a 26-year history of systemic lupus erythematosus and scleroderma was referred to our hospital, due to shortness of breath. Six years previously, pulmonary hypertension caused by collagen disease was found. Her estimated pulmonary artery systolic pressure was 50 mmHg. She had been treated with an endothelin receptor antagonist (ERA). On examination, her blood pressure was 130/85 mmHg and pulse was regular at 88/min. Diastolic murmur (Levine II/VI) was heard at the right 2nd intercostal space. An electrocardiogram showed normal sinus rhythm. A chest computed tomography (CT) scan showed interstitial lung fibrosis. The diffusing capacity of the lungs for carbon monoxide was 48.6 %. Echocardiography showed normal left ventricle (LV) size and function. The LV wall thickness was normal, and noncompacted LV myocardium was not seen. Doppler echocardiography zooming in on the LV identified multiple diastolic flow signals perpendicular to the epicardium that drain into the LV (Fig. 1). Pulsed-wave Doppler echocardiography showed a diastolic flow with a peak velocity of 1.9 cm/s. Because no other findings including aortic regurgitation inducing the diastolic murmur were detected, the murmur was probably caused by the coronary artery fistulae. Left coronary angiography revealed a bizarre appearance of capillary blush draining into the LV (Fig. 2). Opacification of the LV through a network of microfistulae was seen. The microfistulae were predominantly arising from the diagonal branch. Similar communications arising from the circumflex and right coronary arteries were seen. Thallium 201 adenosine perfusion myocardial scintigraphy showed no perfusion defect. Ventilation/perfusion scintigraphy did not suggest pulmonary embolism. Her symptom was probably caused by pulmonary dysfunction. She required continuous follow-up and regular medications with ERA including prednisolone and azathioprine. Coronary artery fistulae have an incidence of 0.2 % in patients undergoing diagnostic cardiac catheterization [1– 4]. In more than 90 % of these patients, a single fistula drains into the right heart chambers or pulmonary artery. Multiple coronary artery–left ventricular fistulae arising from all 3 major coronary arteries and draining into the LV are extremely rare. These multiple communications, inducing left-to-left shunt, are presumed to result from the persistence of embryonic myocardial thebesian sinusoids [3]. In patients with multiple coronary artery–left ventricle microfistulae, auscultatory patterns are variable. Systolic, diastolic, or no murmur was reported in the literature. The coronary flow pattern on pulsed-wave Doppler echocardiograms was not clearly mentioned [2, 3, 5, 6]. Clinical presentation depends on the hemodynamic significance, though most of the patients are asymptomatic and are found incidentally [2–4]. However, some may present with congestive heart failure or myocardial ischemia caused by Y. Matsumura (&) Y. Ochi Y. Baba K. Tanioka K. Hayashi T. Kubo N. Yamasaki T. Furuno H. Kitaoka Y. Doi Department of Medicine and Geriatrics, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan e-mail: matsumur@kochi-u.ac.jp

Assessment of left ventricular function by tissue Doppler imaging in patients with ankylosing spondylitis

Ankylosing spondylitis (ASp)is a chronic, inflammatory and systemic disease affecting pericardium, myocardium and the conduction system of the heart. In this study, we aimed to analyse left ventricular systolic and diastolic functions using tissue Doppler imaging (TDI). 30 patients with ASp and 30 healthy volunteers having the similar demographic characteristics were included. Left ventricular systolic and diastolic functions were assessed by using two dimensional (2D) echocardiography, M-mode, pulsed-wave (PW) and tissue Doppler echocardiography. The peak systolic velocity (Sm), early diastolic myocardial peak velocity (m), late diastolic myocardial peak velocity (Am), isovolumic acceleration (IVA), myocardial precontraction time (PCTm), myocardial contraction time (CTm), myocardial relaxation time (RTm), and myocardial performance index (MPI) were measured at septal and lateral mitral annulus. In conventional echocardiography, end-diastolic interventricular septum and posterior wall diameters were higher in patients with ASp than the control group. The ratio of E/A was significantly lower and deceleration time was significantly prolonged in patients with ASp, but mitral E and A velocities, isovolumic relaxation time and MPI were similar in patient and control group (P>0.05). Left ventricular lateral and septal wall tissue Doppler echocardiography showed that Em, Em/Am ratio and CTm were significantly lower, IVRTm was longer and MPI was higher in patients with ASp. No significant differences were detected between the groups for IVA, Sm, Am, PCTm, PCTm/CTm ratio (P>0.05). We have demonstrated that in patients with ASp, diastolic functions were impaired but systolic functions were preserved by using TDI.