Transmitral Flow Propagation Velocity Research Articles

Glucose-insulin-potassium improves left ventricular performances after aortic valve replacement: a secondary analysis of a randomized controlled trial

BackgroundPatients with left ventricular (LV) hypertrophy may suffer ischemia-reperfusion injuries at the time of cardiac surgery with impairment in left ventricular function. Using transesophageal echocardiography (TEE), we evaluated the impact of glucose-insulin potassium (GIK) on LV performances in patients undergoing valve replacement for aortic stenosis.MethodsIn this secondary analysis of a double-blind randomized trial, moderate-to-high risk patients were assigned to receive GIK (20 IU insulin with 10 mEq KCL in 50 ml glucose 40%) or saline over 60 min upon anesthetic induction. The primary outcomes were the early changes in 2-and 3-dimensional left ventricular ejection fraction (2D and 3D-LVEF), peak global longitudinal strain (PGLS) and transmitral flow propagation velocity (Vp).ResultsAt the end of GIK infusion, LV-FAC and 2D- and 3D-LVEF were unchanged whereas Vp (mean difference [MD + 7.9%, 95% confidence interval [CI] 3.2 to 12.5%; P < 0.001) increased compared with baseline values. After Placebo infusion, there was a decrease in LV-FAC (MD -2.9%, 95%CI − 4.8 to − 1.0%), 2D-LVEF (MD -2.0%, 95%CI − 2.8 to − 1.3%, 3D-LVEF (MD -3.0%, 95%CI − 4.0 to − 2.0%) and Vp (MD − 4.5 cm/s, 95%CI − 5.6 to − 3.3 cm/s).After cardiopulmonary bypass, GIK pretreatment was associated with preserved 2D and 3D-LVEF (+ 0.4%, 95% 95%CI − 0.8 to 1.7% and + 0.4%, 95%CI − 1.3 to 2.0%), and PGLS (− 0.9, 95%CI − 1.6 to − 0.2) as well as higher Vp (+ 5.1 cm/s, 95%CI 2.9 to 7.3), compared with baseline. In contrast, in the Placebo group, 2D-LVEF (− 2.2%, 95%CI − 3.4 to − 1.0), 3D-LVEF (− 6.0%, 95%CI − 7.8 to − 4.2), and Vp (− 7.6 cm/s, 95%CI − 9.4 to − 5.9), all decreased after bypass.ConclusionsAdministration of GIK before aortic cross-clamping resulted in better preservation of systolic and diastolic ventricular function in patients with LV hypertrophy undergoing aortic valve replacement.Trial registrationClinicalTrials.gov: NCT00788242, registered on November 10, 2008.

Pretreatment with glucose-insulin-potassium improves ventricular performances after coronary artery bypass surgery: a randomized controlled trial.

Heart failure is the main cause of poor outcome following open heart surgery and experimental studies have demonstrated that glucose–insulin–potassium (GIK) infusion exerts cardioprotective effects by reducing myocardial ischemia–reperfusion injuries. This randomized controlled trial was designed to assess the effects of GIK on left ventricular function in moderate-to-high risk patients undergoing on-pump isolated coronary artery bypass surgery (CABGS), or combined with aortic valve replacement. The primary outcomes were the effects of GIK on two- and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF), and on transmitral flow propagation velocity (Vp), that occurred between the pre- and post-CPB periods. GIK administration was associated with favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp changes over the study periods. In GIK pretreated patients (N = 54), 2-D and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD] + 3.5%, 95% confidence interval [95% CI] − 0.2 to 7.1%, MD + 4.0%, 95% CI 0.6–7.4%, and MD + 22.2%, 95% CI 16.0–28.4%, respectively). In contrast, in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased after CPB (MD − 7.5% [− 11.6 to − 3.4%], MD − 12.0% [− 15.2 to − 8.8%] and MD − 21.3% [− 25.7 to − 16.9%], respectively). In conclusion, the administration of GIK resulted in better preservation of systolic and diastolic ventricular function in the early period following weaning from CPB.

Prognostic assessment of selected clinical and ultrasonographic indices in patients with non-critical lesions in coronary angiography.

Coronary heart disease is the leading cause of mortality, especially in industrialised countries. In the case of detection of significant lesions narrowing the vessel lumen, management is guided by recommendations of international cardiac societies, while in the case of non-critical lesions there are some doubts as to the further prognosis and identification of patients in whom accelerated progression of disease can be expected. The aim of this study was to evaluate the prognostic significance of selected clinical and ultrasonographic indices in patients with non-critical lesions in coronary angiography. In 100 symptomatic patients with non-critical stenosis in coronary arteries, cardiovascular events after one and three years of follow-up were assessed and analysed compared to a control group. During the follow-up period there were no deaths. In univariate analysis, factors associated with need for revascularisation in 4% of patients after one year and 7% at three years were: age (odds ratio [OR] 1.16, confidence interval [CI] 0.98-1.35; p = 0.04), fibrinogen concentration (OR 1.01, CI 1.00-1.02; p = 0.05), isovolumetric relaxation time [ms] (OR 1.07, CI 0.79-0.98; p = 0.04), and transmitral flow propagation velocity [cm/s] (OR 0.88, CI 1.01-1.12; p = 0.01). Nearly one third of patients with non-critical lesions despite optimal pharmacotherapy reported symptoms deteriorating quality of life. Factors predisposing to the occurrence of cardiovascular events in the 12 months of follow-up were: older age, higher plasma fibrinogen concentration, and impaired left ventricular filling pattern.

Effect of circadian rhythm of blood pressure on arterial wall stiffness and on left ventricular diastolic dysfunction

Background Arterial stiffness is a risk factor for cardiovascular morbidity and mortality. Variability of blood pressure has been reported to be related to worse cardiovascular outcome. The relationship between the arterial stiffness and the circadian rhythm of blood pressure (BP) has been controversial. The objective was to the examine impacts of BP variability on left ventricular diastolic function and arterial stiffness in the hypertensive patients. Methods Ambulatory BP monitoring, pulse wave velocity, and echocardiography were performed in 268 patients (153 males, 47 ± 11 years) with HTN and pre-HTN. BP was measured at the outpatient clinic and 24-h ABPM was performed. Using carotid femoral applanation tonometry, PWA was performed for evaluation of systemic arterial stiffness expressed as augmentation index. Echocardiograms were performed and an average of 3–6 cardiac cycles was done for all measurements including the left ventricular mass index (LVMI), relative wall thickness (RWT), trans mitral flow propagation velocity (Vp), TDI, and midwall shortening fraction (MWSF). Nocturnal dipping was defined as a reduction of diastolic BP (DBP) by >10% of systolic BP (SBP) when compared with the daytime values. Isolated systolic nondipping, is reduction of Results Among groups, the clinic SBP and DBP, daytime mean BP of 24-h ABPM, gender and body mass index were not statistically different. Augmentation pressure (AP), augmentation index (AI) showed statistically significant difference ( p = 0.008 and 0.021, respectively). Multivariate analysis showed that isolated diastolic non-dipping was correlated with arterial stiffness expressed as AI only in young group.

OP-035 CHANGE IN APELIN LEVEL IN RESPONSE TO TREATMENT AND RELATION WITH DIASTOLIC FUNCTION IN PATIENTS WITH NEWLY DIAGNOSED HYPERTENSION

Objective: Apelin is a novel endogenous peptide which has different functions in cardiovascular system. In this study we aimed to investigate the change in apelin levels in patients with newly diagnosed hypertension after one month of drug therapy and identify the relation between apelin level and improvement in left ventricular diastolic function. Methods: This study included 45 patients (26 men, 19 women) who were diagnosed as stage 1 and 2 hypertension based on Eurepean Society of Cardiology guidelines. Patients who had coronary artery disease, diabetes mellitus, severe valvular disease, body mass index above 30 kg/ m, left ventricle ejection fraction below 45% and creatinine level above 1.6mg/dl were excluded. Patients were randomized to treatment groups of 80mg telmisartan and 10mg amlodipine. At baseline, blood samples for apelin level were obtained and transthoracic echocardiography was performed. In addition to routine echocardiographic measurements, lateral and septal annular e′ wave velocities were measured using tissue Doppler method and their mean were used in statistical analysis. Transmitral flow propagation velocity (Vp) was measured by M-mode echocardiography. After 1 month of treatment, plasma apelin level measurement and echocardiography were repeated. Results: There were 24 patients in the telmisartan and 21 patients in the amlodipine group. Mean age, gender, baseline blood pressure and apelin levels were similar between the groups (p > 0.05). There was a significant increase in apelin levels for all patients after one month of treatment (0.41±0.06 vs 0.46±0.07ng/dl, p = 0.003). When each group were evaluated separately, apelin was significantly increased in both telmisartan (0.39±0.06 vs 0.46±0.08ng/ dl, p = 0.04) and amlodipine groups (0.42±0.05 vs 0.46±0.06ng/dl, p = 0.02). Left atrial volume (38.8±6.9 vs 35.8±6.0ml, p < 0.001), isovolumetric relaxation time (98±15ms vs 90±12ms, p < 0.001) and E/e′ ratio (8.6±1.7 vs 7.0±1.4, p < 0.001) were decreased; Vp (43.4±8.2 vs 47.0±8.3 cm/s, p< 0.001) and mean e′ velocity (8.2±1.8 vs 9.8±1.9 cm/s, p < 0.001) were increased significantly. Similar results were obtained when telmisartan and amlodipine groups were analyzed separately. After treatment, apelin levels showed a significant reverse correlation with mitral deceleration time (r = −0.39, p = 0.02). Conclusion: Apelin levels were increased in newly diagnosed hypertensive patients after antihypertensive therapy. Apelin may be a useful marker for evaluating the efficacy of antihypertensive treatment. Further studies are needed to establish the relation between apelin levels and diastolic indices.

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.

Transient Pseudorestrictive Pattern of Transmitral Flow Velocity Curve in Patients with Paroxysmal Atrial Fibrillation

Early diastolic velocity of the mitral annulus and transmitral flow propagation velocity are reported as more reliable determinants of left ventricular diastolic function in patients with atrial fibrillation than are transmitral Doppler indices. This study aimed to test the hypothesis that transmitral flow curve shows pseudorestrictive pattern during rate-controlled atrial fibrillation. Thirteen paroxysmal atrial fibrillation patients were monitored for three phases: before atrial fibrillation, during atrial fibrillation, and after the recovery of atrial fibrillation to sinus rhythm. Standard two-dimensional, color flow, and tissue Doppler echocardiography were performed. We compared the indices of left ventricular diastolic function among the three phases. The early diastolic velocity of transmitral flow increased significantly during atrial fibrillation (before, 0.76 ± 0.19 m/sec; during, 0.86 ± 0.20 m/sec; after recovery to sinus rhythm, 0.73 ± 0.16 m/sec; P < 0.01). The deceleration time of early transmitral diastolic wave decreased during atrial fibrillation (182.5 ± 39.6 ms; 149.1 ± 38.7 ms; 184.0 ± 44.5 ms, respectively, P < 0.01). The early diastolic velocity of the mitral annulus increased during atrial fibrillation (5.37 ± 1.31 cm/sec; 7.29 ± 1.25 cm/sec; 5.37 ± 1.32 cm/sec; respectively, P < 0.01). The transmitral propagation velocity did not change significantly during atrial fibrillation. Although conventional Doppler indices showed abnormal relaxation pattern, left ventricular diastolic function was preserved during rate-controlled atrial fibrillation, as determined from early diastolic velocity of the mitral annulus and transmitral flow propagation velocity.

Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis

IntroductionLeft ventricular (LV) dysfunction frequently occurs after cardiac surgery, requiring inotropic treatment and/or mechanical circulatory support. In this study, we aimed to identify clinical, surgical and echocardiographic factors that are associated with LV dysfunction during weaning from cardiopulmonary bypass (CPB) in high-risk patients undergoing valve replacement for aortic stenosis.MethodsPerioperative data were prospectively collected in 108 surgical candidates with an expected operative mortality ≥9%. All anesthetic and surgical techniques were standardized. Reduced LV systolic function was defined by an ejection fraction <40%. Diastolic function of the LV was assessed using standard Doppler-derived parameters, tissue Doppler Imaging (TDI) and transmitral flow propagation velocity (Vp).ResultsDoppler-derived pulmonary flow indices and TDI could not be obtained in 14 patients. In the remaining 94 patients, poor systolic LV was documented in 14% (n = 12) and diastolic dysfunction in 84% of patients (n = 89), all of whom had Vp <50 cm/s. During weaning from CPB, 38 patients (40%) required inotropic and/or mechanical circulatory support. By multivariate regression analysis, we identified three independent predictors of LV systolic dysfunction: age (Odds ratio [OR] = 1.11; 95% confidence interval (CI), 1.01 to 1.22), aortic clamping time (OR = 1.04; 95% CI, 1.00 to 1.08) and Vp (OR = 0.65; 95% CI, 0.52 to 0.81). Among echocardiographic measurements, Vp was found to be superior in terms of prognostic value and reliability. The best cut-off value for Vp to predict LV dysfunction was 40 cm/s (sensitivity of 72% and specificity 94%). Patients who experienced LV dysfunction presented higher in-hospital mortality (18.4% vs. 3.6% in patients without LV dysfunction, P = 0.044) and an increased incidence of serious cardiac events (81.6 vs. 28.6%, P < 0.001).ConclusionsThis study provides the first evidence that, besides advanced age and prolonged myocardial ischemic time, LV diastolic dysfunction characterized by Vp ≤ 40 cm/sec identifies patients who will require cardiovascular support following valve replacement for aortic stenosis.

Perioperative diastolic dysfunction during vascular surgery and its association with postoperative outcome

To assess the association of perioperative cardiac dysfunction during elective vascular surgery with postoperative outcome. Patients with normal systolic function can have isolated diastolic dysfunction. Routine preoperative evaluation of left ventricular (LV) function does not include an assessment of diastolic function for risk stratification. We hypothesized that perioperative assessment of both diastolic and systolic function with transesophageal echo (TEE) may improve our ability to predict postoperative outcome. Perioperative TEE examinations were carried out on patients undergoing elective vascular surgery under general anesthesia. Abnormal systolic function was defined as LV ejection fraction (LVEF) <40%. Left ventricular diastolic function was assessed using transmitral flow propagation velocity (Vp); Vp <45 cm/sec was considered abnormal. We determined the association between LV function and the primary outcome of postoperative adverse outcome, defined as one or more adverse events: myocardial infarction (MI), congestive heart failure (CHF), significant arrhythmia, prolonged intubation, renal failure, and death. Three hundred thirteen patients undergoing vascular surgery were studied. We found that 8% (n = 24) of patients had isolated systolic dysfunction, 43% (n = 134) had isolated diastolic dysfunction, and 24% (n = 75) both systolic and diastolic dysfunction. The most common postoperative adverse outcome was CHF 20% (n = 62). By multivariate logistic regression, we found that patient age, Vp, type of surgery, female gender, and renal failure were predictive of postoperative adverse outcome. The presence of perioperative diastolic dysfunction as assessed with Vp is an independent predictor of postoperative CHF and prolonged length of stay after major vascular surgery. Patient age, gender, type of surgery, and renal failure were also predictors of outcome. Perioperative systolic function was not a predictor of postoperative outcome in our patients.

P-271 The Predictive Value of Transmitral Flow Propagation Velocity on Left Atrial Appendage Functions

P-271 The Predictive Value of Transmitral Flow Propagation Velocity on Left Atrial Appendage Functions

Myocardial Performance Index Is a Predictor of Outcome After Abdominal Aortic Aneurysm Repair

Perioperative measurement of the myocardial performance index (MPI) with transesophageal echocardiography in patients undergoing elective abdominal aortic aneurysm repair and its association with outcome. A prospective observational study. A tertiary care university hospital. Patients undergoing elective abdominal aortic aneurysm repair. Perioperative transesophageal echocardiography. Fifty-one consecutive patients undergoing elective abdominal aortic aneurysm repair were enrolled in the study. The MPI was calculated by using pulse-wave Doppler from the midesophageal window and the deep transgastric position of the probe. In addition, diastolic function was measured as the slope of the transmitral flow propagation velocity, and ejection fraction was calculated as a measure of ventricular systolic function. Comparisons between subjects with uncomplicated versus adverse outcomes were made by using a Mann-Whitney U test. Comparison of the incidence of adverse outcome among subjects with normal and elevated MPIs was made by using a Fisher exact test. Statistical significance was set at p < 0.05. It was possible to calculate MPI in all patients with transesophageal echocardiography perioperatively. Patients with adverse postoperative outcomes had an elevated MPI as compared with those without any adverse outcome (0.50 v 0.30, p < 0.001). Also, an MPI of > or = 0.36 was associated with a statistically significant higher incidence of complications (congestive heart failure/prolonged intubation) (p < 0.001). The MPI is an easily obtained echocardiographic measure of global ventricular performance, which can be measured perioperatively and may be useful as a prospective risk stratification index for patients undergoing elective abdominal aortic aneurysm surgery.

Abstract 2288: Does Perioperative Diastolic Dysfunction Affect Postoperative Outcome ?

Objective: To assess the presence of perioperative diastolic dysfunction (DD) in patients undergoing vascular surgery with transesophageal echo (TEE) and its association with postoperative morbidity and mortality. Methods: We conducted TEE examinations on 282 patients undergoing high-risk vascular surgery under general anesthesia (GA). All TEE examinations were conducted after induction of GA and endotracheal intubation. We used transmitral flow propagation velocity (Vp); a validated echocardiographic index of left ventricular filling and DD, for assessment of perioperative DD. A Vp value of &lt; 0.45m/sec is considered diagnostic of DD. We used Fisher’s Exact Test and Pearson’s Chi-Square to compare the incidence of postoperative complications i.e. congestive heart failure (CHF), myocardial infarction (MI), arrhythmias, prolonged intubation and death in patients with and without DD. Statistical significance was set at a p-value of ≤ 0.05. Results: There were 176 males and 102 females. The mean age in males was 68.6 and 72 years in females. We were able to assess Vp in all these patients. A total of 184 (66%) patients had Vp &lt; 0.45 m/sec. Of these patients with DD, 60 patients (32.6%) had at least one adverse outcome. Ejection fraction (EF) was comparable between the patients with and without adverse outcomes. A Vp value of &lt;0.45m/sec was associated with a statistically significant increase in the incidence of postoperative CHF and arrhythmias and a trend towards higher incidence of postoperative prolonged intubation but not that of MI or death (Table 1 ). Conclusion: Vp is an easily obtained index of left ventricular filling. Almost 2/3 rd (66%) of the patients presenting for vascular surgery were diagnosed to have DD by an abnormal Vp. Presence of perioperative DD is associated with a higher incidence of postoperative complications (CHF, Arrhythmias, Prolonged Intubation). Table 1 Vp: Transmitral Flow Propagation Velocity

Transmitral Flow Propagation Velocity and Assessment of Diastolic Function During Abdominal Aortic Aneurysm Repair

In the perioperative arena, pronounced changes in cardiac loading conditions can make assessment of diastolic parameters difficult. A number of Doppler techniques have been introduced to assess perioperative diastolic function. To compare transmitral flow propagation velocity (Vp) with other pulse-wave Doppler echocardiographic assessments of diastolic function in patients undergoing elective abdominal aortic aneurysm (AAA) resection. A prospective observational study. Forty-five consecutive patients undergoing elective AAA repair under general anesthesia. Transesophageal echocardiographic examination was performed before, during, and after removal of the aortic cross-clamp (AXC). Diastolic function was categorized on the basis of the ratio of transmitral pulse-wave Doppler (PWD) into early (E) and late (A) waves and their ratio (E/A), deceleration time, and use of pulmonary venous inflow patterns to identify pseudonormal pattern. Subjects were then assessed by using the Canadian Consensus Guidelines (CCG) and on the basis of transmitral flow Vp. The correlation among methods for diagnosis of diastolic dysfunction and pseudonormal pattern was examined. Diastolic function over each of the 3 periods to assess changes during AXC was examined. Data analysis was completed in 35 patients. The authors found excellent correlation between E/A ratio and Vp for diagnosis of diastolic dysfunction (24/25 cases) and a pseudonormal pattern (18/20 cases). The CCG methodology identified fewer cases of diastolic dysfunction than Vp (p = 0.003). The evaluation using CCG methodology could not be categorized in 15% of cases. The incidence of diastolic dysfunction increased during placement of AXC with both Vp and CCG (p < 0.05) but not by E/A ratio, and returned to baseline after removal of the AXC. Good correlation was found among all 3 methods (p < 0.05 and r > 0.5 for all). Vp assessment identified the majority (93%) of cases of diastolic dysfunction identified by traditional methods. Furthermore, the incidence of diastolic dysfunction increased with application of the AXC but returned to baseline after removal.

Long-Term Effects of Atrial Synchronous Ventricular Pacing on Systolic and Diastolic Ventricular Function in Patients with Normal Left Ventricular Ejection Fraction

Background: Atrial synchronous right ventricular pacing (VP) may compromise ventricular function in patients undergoing pacemaker implantation for atrioventricular block. We assessed the usefulness of tissue Doppler imaging (TDI) and color M-mode echocardiography in evaluating patients with VP, and examined the long-term effects of VP on ventricular function by echocardiographic indices and B-type natriuretic peptide (BNP) measurements. Methods: We studied 60 clinically stable elderly dual-chamber pacemaker recipients (mean age: 74 ± 9 years) who had normal left ventricular (LV) systolic function and on the long term the same cardiac rhythm, either intrinsic normal ventricular activation (IA) (n = 20), or VP (n = 40). Results: Paced patients, compared to patients with IA, had decreased stroke volume (p < 0.05) and a more depressed relaxation pattern, as indicated by decreased peak early mitral velocity (E)/peak atrial contraction velocity ratio and tissue Doppler imaging (TDI)-early transmitral diastolic velocity (Ea) measures (p < 0.05). Both groups presented similar BNP levels and LV filling pressures, as assessed by E/Ea and E/early diastolic transmitral flow propagation velocity. In VP patients, age (β = 0.31), Ea (β = –0.28) and E/Ea (β = 0.32) emerged as independent predictors of BNP levels. Conclusions: VP is associated with reduced LV systolic function and signs of impaired relaxation. Elevated BNP levels in elderly VP patients with normal ejection fraction may be predicted by TDI signs of LV diastolic dysfunction.

Doppler echocardiographic evaluation of ventricular function in patients with rheumatoid arthritis.

Cardiac involvement in rheumatoid arthritis (RA) has been reported previously. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been reported before. Thus, the aim of this study was to evaluate ventricular function by measurement of myocardial performance index (MPI) and transmitral flow propagation velocity (TFPV). Thirty-two patients with long-standing RA and 32 control subjects (mean ages 52 +/- 11 and 50 +/- 10 years, 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, MPI and TFPV. Right ventricular (RV) function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. Systolic function was normal in all subjects. Among the echocardiographic indices of LV diastolic function the peak E velocity, E velocity/A velocity ratio, isovolumetric relaxation time, MPI and TFPV in the RA group were significantly different from those of the controls ( P < 0.05). However, we did not observe a significant difference in RV echocardiographic indices between the two groups. Our results show that there is LV diastolic dysfunction in patients with long-standing RA. The lack of a history of cardiotoxic antirheumatic drug use among our patients suggests that this abnormality is due to RA itself.

408 Left ventricular systolic function is the main determinant of early transmitral flow propagation velocity

408 Left ventricular systolic function is the main determinant of early transmitral flow propagation velocity