Wave Peak Velocity Research Articles

Can fetal left ventricular modified myocardial performance index predict adverse perinatal outcomes in intrahepatic cholestasis of pregnancy?

Objective: To investigate fetal left ventricular function using the left ventricular modified myocardial performance index (mod-MPI) and E wave/A wave peak velocity (E/A) ratio, and to explore the success of mod-MPI in the prediction of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP).Methods: Forty-one ICP cases were compared with 41 gestational age-matched healthy controls. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods [ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT)], which were employed in the calculation of mod-MPI [mod-MPI = (ICT + IRT)/ET]. The E/A ratio was calculated as well.Results: Fetal left ventricular mod-MPI values were significantly higher in the ICP group compared to controls (0.56 ± 0.09 versus 0.37 ± 0.04, p < 0.001), whereas the E/A ratio was lower (0.62 ± 0.11 versus 0.69 ± 0.10, p = 0.011). The optimal cutoff level for mod-MPI in prediction of adverse perinatal outcomes was >0.48 [sensitivity: 81.8%, specificity: 67.6%, area under the curve (AUC): 0.750, 95% CI: 0.613–0.887, p = 0.008].Conclusions: Fetuses of ICP cases have significant left ventricular dysfunction. Mod-MPI can be used in the prediction of adverse perinatal outcomes in ICP.

Utility of Tissue Doppler Imaging in the Echocardiographic Evaluation of Left and Right Ventricular Function in Dogs with Myxomatous Mitral Valve Disease with or without Pulmonary Hypertension

BackgroundIn human medicine, right ventricular (RV) functional parameters represent a tool for risk stratification in patients with congestive heart failure caused by left heart disease. Little is known about RV alterations in dogs with left‐sided cardiac disorders.ObjectivesTo assess RV and left ventricular (LV) function in dogs with myxomatous mitral valve disease (MMVD) with or without pulmonary hypertension (PH).AnimalsOne‐hundred and fourteen dogs: 28 healthy controls and 86 dogs with MMVD at different stages.MethodsProspective observational study. Animals were classified as healthy or having MMVD at different stages of severity and according to presence or absence of PH. Twenty‐eight morphological, echo‐Doppler, and tissue Doppler imaging (TDI) variables were measured and comparison among groups and correlations between LV and RV parameters were studied.ResultsNo differences were found among groups regarding RV echo‐Doppler and TDI variables. Sixteen significant correlations were found between RV TDI and left heart echocardiographic variables. Dogs with PH had significantly higher transmitral E wave peak velocity and higher E/eʹ ratio of septal (sMV) and lateral (pMV) mitral annulus. These 2 variables were found to predict presence of PH with a sensitivity of 84 and 72%, and a specificity of 71 and 80% at cut‐off values of 10 and 9.33 for sMV E/eʹ and pMV E/eʹ, respectively.Conclusions and clinical importanceNo association between variables of RV function and different MMVD stage and severity of PH could be detected. Some relationships were found between echocardiographic variables of right and left ventricular function.

Noninvasive assessment of pulmonary arterial capacitance by pulmonary annular motion velocity in children with ventricular septal defect.

BackgroundWe hypothesized that longitudinal pulmonary arterial deformation during the cardiac cycle reflects pulmonary arterial capacitance. To examine this hypothesis, we assessed whether tissue Doppler-derived pulmonary annular motion could serve as a novel way to evaluate pulmonary arterial capacitance in pediatric patients with ventricular septal defect (VSD).MethodsIn this prospective study, pulmonary annular velocity was measured in children (age, 6 months–5 years) with a preoperative VSD (VSD group, n = 35) and age-matched healthy children (Control group, n = 23). Pulmonary artery capacitance was calculated by two methods. Systolic pulmonary arterial capacitance (sPAC) was expressed as the stroke volume/pulmonary arterial pulse pressure. Diastolic pulmonary arterial capacitance (dPAC) was determined according to a two-element windkessel model of the pulmonary arterial diastolic pressure profile.ResultsPulmonary annular velocity waveforms comprised systolic bimodal (s1′ and s2′) and diastolic e’ and a’ waves in all participants. The peak velocities of s1′, s2′, and e’ were significantly lower in the VSD group than in the Control group. On multiple regression analysis, sPAC was an independent variable affecting the peak velocities of the s1′, s2′, and e’ waves (β = 0.41, 0.62, and 0.35, respectively). The dPAC affected the s1′ wave peak velocity (β = 0.34). The time durations of the s1′ and e’ waves were independently determined by the sPAC (β = 0.49 and 0.27).ConclusionPulmonary annular motion velocity evaluated using tissue Doppler is a promising method of assessing pulmonary arterial capacitance in children with VSD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12947-016-0081-4) contains supplementary material, which is available to authorized users.

Short-Time Impact of Laser Ablation of Placental Anastomoses on Myocardial Function in Monochorionic Twins with Twin-to-Twin Transfusion Syndrome.

Purpose To evaluate pre- and post-procedure myocardial function in monochorionic twins with TTTS who underwent laser ablation of placental anastomoses using pulsed wave tissue Doppler imaging (pw TDI). Materials and Methods 20 monochorionic twin gestations with TTTS were included and underwent laser ablation at our center between 2011 and 2014. Prior to and after the intervention, cardiac function was assessed by measuring the mitral annular plane systolic excursion (MAPSE), the tricuspid annular plane systolic excursion (TAPSE), Tei index, isovolumetric contraction time (ICT), ejection time (ET), isovolumetric relaxation time (IRT) for the left ventricle in pulsed wave Doppler (pw D) ultrasound as well as ICT, ET, IRT and Tei index in pw TDI for the left and right ventricle. E-, A-, E´- and A´-wave peak velocity and the systolic downward motion (S´) were measured for both ventricles and the E/A, E/E´ and E´/A´ ratios were calculated. In a mean of 1.3 (SD 0.6) days after laser ablation, this measurement protocol was repeated. Results Pre-intervention recipients had longer ICT, ET and IRT in pw D and pw TDI compared to donors not reaching statistical significance for most parameters. Statistically significant were prolonged ICT in pw D (p 0.01) and ET (p 0.01) in pw TDI in recipients. In donor fetuses preoperative myocardial function did not differ significantly from postoperative myocardial function except in increased left ventricular ejection time of the left ventricle in pw TDI (p 0.04) and an increased E´/A´ratio (p 0.01). After laser coagulation, myocardial function was slightly altered in recipients as ICT and IRT shortened and Tei indices decreased but only reaching statistical significance in shortened IRTs in pw TDI for both ventricles. Conclusion Laser ablation of placental anastomoses in TTTS might influence myocardial function in the postoperative period. Shortened IRT intervals may reflect an improvement of diastolic function in recipients.

Assessment of the left ventricular systolic function in cardiac syndrome X using speckle tracking echocardiography.

Objective:The aim of this study was to evaluate left ventricular (LV) systolic strain by speckle tracking echocardiography (STE) and real-time three-dimensional echocardiography (3-DE) for the early detection of myocardial dysfunction in patients with cardiac syndrome X (CSX).Methods:We compared 34 patients with CSX (18 females, mean age 47.9±10.0 years) with 41 healthy persons as a control group (23 females, mean age 50.6±9.9 years). Inclusion criteria for CSX were typical angina, a positive exercise ECG stress test, and angiographically documented normal coronary arteries. Exclusion criteria for both groups were hypertension, valvular heart disease, cardiomyopathies, inflammatory diseases, myocarditis, vasculitis, arthropathies, Tietze's syndrome, gastrointestinal diseases, aortic diseases, hormone replacement therapy, arrhythmias, liver diseases, and alcohol use. All subjects underwent two-dimensional STE and 3-DE to assess resting LV function. STE measures were taken from the basal septum, mid-septum, apical septum, apex, apicolateral, mid-lateral, basal lateral, anteroseptal, anterior, anterolateral, inferolateral, inferior, and inferoseptal walls. Student's t-test, Mann–Whitney U test, and chi-square test were used to statistically analyze data.Results:LV echo ejection fraction (EF) and systolic wave peak velocity were similar for both groups. Regional mean longitudinal strain (-17.7±2.5% vs. -19.8±1.8%; p<0.0001) was significantly lower in patients with CSX than in healthy control patients. However, regional mean circumferential strain values (-22.0±1.6% vs. -22.2±2.3%; p=0.78) did not differ significantly between the two groups.Conclusion:Significant impairment of LV longitudinal myocardial systolic function was detected with STE in patients with CSX, although normal 3-D EF and tissue Doppler imaging systolic parameters were observed. Arteriosclerosis of small coronary arteries and microvascular dysfunction may affect myocardial longitudinal strain.

The impact of intrahepatic cholestasis of pregnancy on fetal cardiac and peripheral circulation.

The aim of this study was to evaluate changes in fetal cardiac and peripheral circulation in pregnancies complicated with intrahepatic cholestasis. The Doppler examination results of 22 pregnant subjects complicated with intrahepatic cholestasis of pregnancy (ICP) and 44 healthy controls were compared. The parameters of fetal cardiac circulation were pulmonary artery and aortic (Ao) peak systolic velocity (PSV), pulmonary vein (Pv), peak velocity index (PVI) and pulsatility index (PI), mitral valve (MV) and tricuspid valve (TV), early diastole (E)- and atrial contraction (A)-wave peak velocity ratio (E/A), and isthmus aortic peak systolic velocity (IAo PSV). The parameters of fetal peripheral circulation were middle cerebral artery (MCA) and umbilical artery (UA) PI, resistance index (RI), systolic/diastolic (S/D) ratio. Fetal obstetric Doppler monitoring was conducted weekly before 36 weeks and biweekly after that, and the results were compared with the normal reference values for gestational age. The Doppler parameters of fetal cardiac and peripheral circulation did not significantly differ between the two groups. S/D ratio readings in the ICP group were significantly above 2 SD before 35 weeks of gestation. Women with ICP had increased risks of preterm delivery, neonatal unit admission, and meconium-stained amniotic fluid compared with those in the controls. Fetuses of pregnant women with ICP showed no differences in the evaluation of cardiac and peripheral Doppler measurements compared with fetuses of healthy mothers. The Doppler investigation of the umbilical artery may be useful in monitoring of pregnancies complicated by early onset intrahepatic cholestasis.

Dissipative energy loss within the left ventricle detected by vector flow mapping in children: Normal values and effects of age and heart rate

BackgroundVector flow mapping (VFM) is a novel echocardiographic technology which enables visualization of the intraventricular flow velocity vector. Dissipative energy loss (EL) derived from the velocity vector field of intraventricular blood flow is considered to reflect the efficiency of blood flow, and could be an indicator of left ventricular function. We aimed to determine the reference values of the EL derived from VFM within the left ventricle. MethodsVFM analysis was performed using echocardiography in 64 healthy children. The velocity vector fields of the intra-left ventricular blood flow were obtained from the apical 5-chamber view, and the EL values during systole and diastole were calculated. The measurements were averaged over three cardiac cycles, and indexed to body surface area (BSA). ResultsThe mean subject age was 6.8±4.3 years. The mean EL was 4.10±2.35mW/m/m2 BSA during systole and 16.24±11.63mW/m/m2 BSA during diastole. On multivariate analysis, age and heart rate (HR) were independent predictors of systolic EL, whereas age, HR, and E wave peak velocity were independent predictors of diastolic EL. The regression equations used to predict the BSA-indexed systolic and diastolic EL were as follows: log10 (systolic EL)=−0.0332−0.00213×age (months)+0.00789×HR (beats/min) (adjusted R2, 0.833; p<0.0001); and log10 (diastolic EL)=0.277−0.00346×age (months)+0.00570×HR (beats/min)+0.00564×E wave peak velocity (cm/s) (adjusted R2, 0.867; p<0.0001). ConclusionsThe systolic and diastolic EL were positively correlated with HR and negatively correlated with age. Moreover, the diastolic EL was positively correlated with the E wave peak velocity. The present study provides reference values for the systolic and diastolic EL that can be used in future studies examining patients with heart disease.

Evaluation of Short Term Effect of Atorvastatin on Myocardial Performance and Its Pleiotropic Effects on Ischemic Heart Failure

Background: statins are used routinely in patients with coronary artery disease for their lipid lowering effects. Some clinical studies have found that statins do not affect clinical outcomes in patients with chronic heart failure (CHF), while others have found that statins have many beneficial effects. The aim of this study was to evaluate the pleiotropic effects of atorvastatin on patients with chronic heart failure of ischemic etiology (IHF) using conventional echocardiography and tissue doppler imaging. Patient & Methods: Forty­eight patients with (CHF) were divided randomly into two equal groups; Atorvastatin group (received conventional therapy of HF plus atorvastatin 20 mg/d orally) and Original Research Article El-Sisi et al.; BJPR, 6(5): 343-357, 2015; Article no.BJPR.2015.076 344 Control group (received conventional therapy only) for 3 months. Patients were examined both before and after treatment for biochemical tests; serum tumor necrosis factor α (TNF­α), serum high sensetive c reactive protein (hs­CRP), oxidized low density lipoprotein (ox­ LDL), noradrenaline, adrenaline, renin, brain naturetic peptide (BNP­32), Troponin­I, total lipid profile and malondialdehyde. Conventional Echocardiography including left ventricle (LV) dimensions & wall thickness, ejection fraction (EF), E/A ratio, and tissue Doppler imaging (TDI) including Isovolumic contraction (IC), mitral annulus systolic velocity(S­peak), early (E) and late (A) diastolic peak velocities and Tei index were performed. Results: Atorvastatin group showed statistically significant decreased in TNF­ α, hs­CRP, ox­LDL, BNP­32 and noradrenaline compared to their baseline values before the study. Conventional echo failed to detect significant changes in each group except for significant increase in E/A ratio in atorvastatin group. DTI demonstrated that atorvastatin group showed significant improvement in systolic function [significant increase in S wave & isovolumic contraction (IC) peak velocities and better diastolic function [E peak velocity increased & E/E' ratio decreased significantly]. Tei index and heart rate improved significantly in atorvastatin group. Conclusion: Atorvastatin improved cardiac function, decreased inflammatory and oxidative stress parameters as well as modulated the neurohormonal imbalance in CHF patients.

Right ventricular function and symptomatology in patients with isolated mitral stenosis: A Doppler tissue imaging study

Abstract Objectives To compare RV function by DTI in symptomatic and asymptomatic patients with isolated mitral stenosis and with similar mitral valve area. Background Patients with MS of moderate or severe degree are not homogenous regarding symptomatology and some suffer more than others; the RV function is an important determinant of clinical symptoms. DTI is a technique that allows a quantitative assessment of myocardial function and by using this technique RV function can be assessed in MS patients of different degrees of symptomatology. Methods Fifty patients with isolated MS of moderate to severe degree were classified into two groups according to New York Heart Association (NYHA) class (asymptomatic group NYHA class I and symptomatic group NYHA class II–III). The RV function was evaluated by both conventional echo and Doppler tissue imaging. Pulsed wave DTI was placed at the lateral tricuspid annulus to measure the peak velocities of IVC (IVC max), S wave ( S max), E ′, A ′ waves and E ′/ A ′ ratio also the duration of IVC, IVR, time to peak of IVC, S wave duration were measured then isovolumic acceleration (IVA) and Tei index were calculated. Results Conventional echo could not detect significant changes between the two groups, while using DTI the symptomatic group was found to show a significantly lower E ′ wave peak velocity ( P = 0.005), E ′/ A ′ ratio ( P = 0.009), S wave peak velocity ( P = 0.033), IVC max ( P = 0.02) and IVA ( P = 0.001). Conclusion Patient with impaired RV function as detected by DTI are more symptomatic than other with better RV function and of similar MVA.

Evaluation of left ventricular function in patients with chronic obstructive pulmonary disease with or without pulmonary hypertension

BackgroundChronic obstructive pulmonary disease (COPD) is a common entity in clinical practice. Development of right ventricular hypertrophy and eventual right side heart failure is also common in such patients. However, some disturbance in left ventricular (LV) function has been observed among such patients. ObjectivesThe aim of this study was to evaluate LV function in patients with chronic obstructive pulmonary disease (COPD) with or without pulmonary hypertension. Patients and methodsThirty-six patients with COPD without additional cardiac diseases and 12 age and sex-matched healthy subjects were enrolled into the study. All patients underwent spirometry, standard and tissue Doppler echocardiography. Results20 COPD patients (55.6%) had pulmonary hypertension. Left ventricular systolic function did not differ between patient and control groups. However the difference between both groups was significant regarding left ventricular diastolic function and left ventricular global function. Left ventricular diastolic function and global function differed significantly between different COPD grades. Patients with pulmonary hypertension had significantly higher heart rate, less E wave peak velocity (measured by DTI) (P⩽0.05), less E/A ratio (measured by DTI) (P⩽0.01) and E/A ratio (measured by flow) and higher myocardial performance index (P⩽0.05) than normal pulmonary pressure patients. ConclusionLeft ventricular diastolic function and LV global function are affected in COPD patients especially with progression of the disease. COPD patients with pulmonary hypertension are more liable to LV diastolic and global dysfunction than normal pulmonary pressure COPD patients. Doppler tissue echocardiography is a better tool in the assessment of left ventricular function.

Sexual dysfunction in pre-menopausal diabetic women: clinical, metabolic, psychological, cardiovascular, and neurophysiologic correlates

An increased prevalence of female sexual dysfunction (FSD) has been reported in women with diabetes mellitus (DM). Our aim was to evaluate correlates (psychological, cardiovascular, and neurophysiologic) of FSD in DM women without chronic diabetic complications. Female Sexual Function Index (FSFI), Beck Depression Inventory (BDI), Michigan Diabetic Neuropathy Index (DNI), and the symptoms of diabetic neuropathy (SDN) questionnaires, metabolic variables, endothelial vascular function (flow-mediated dilation, FMD), echocardiography, and electromyography were studied. 109 pre-menopausal women (18-50 years) [48 with DM (14 type 1 DM, 34 type 2 DM, duration 12.6 ± 1.91 years), and 61 healthy women] received the above questionnaires; physical activity, smoking habits, parity, BMI, waist circumference, HOMA-IR index, fibrinogen, cholesterol (total, HDL, LDL), triglycerides, HbA1c, high-sensitivity C-reactive protein, total testosterone, and estradiol were measured; echocardiography, assessment of intima-media thickness (IMT), FMD, ECG (heart rate and Qtc, indexes of sympathetic activity), and electromyography were performed. FSFI total score and score for arousal, lubrication, and orgasm domains were lower in DM women than in controls (P < 0.05); DM women had higher BDI, Doppler A wave peak velocity, DNI, and SDN score (P < 0.001 to P < 0.04). Doppler E wave peak velocity, peroneal, posterior tibial and sural nerves conduction velocity and amplitude were lower in diabetic women than in controls (P < 0.05 to P < 0.001). FSFI score was positively correlated with physical activity, Doppler E wave peak velocity, and peroneal nerve amplitude and negatively with BDI, parity, IMT, SDN, and HbA1c (P < 0.05 to P < 0.001). At stepwise regression, SDN score (negatively) and Doppler E wave peak velocity (positively) predicted FSFI score (r = 507, P < 0.001). In conclusion, cardiovascular and neurological impairments are associated with FSD in diabetic women. Follow-up studies are required to evaluate sexual dysfunction as a risk factor for future cardiovascular or neurological events.

Ocean wave modes in the South Atlantic by a short-scale simulation

ABSTRACTThe shortage of observational ocean wave data in the South Atlantic (SA) Ocean has resulted in numerical modelling becoming the most used tool for the investigation of wave climate in this oceanic region. In this article, the global model WAve Model (WAM) is used to simulate ocean waves in the SA from June 2006 to July 2007 with high time resolution. The four leading modes of the significant wave height, swell, wave peak period and surface wind velocity based on the empirical orthogonal functions (EOF) and singular value decomposition (SVD) methods are computed and analysed. The results show a number of specific characteristics present in the short-scale regime which emphasise and, in some cases, reduce some of the aspects of the global wave climate. The interaction between atmosphere and ocean has been found in several fields and modes that were examined. A relationship between tracks of extratropical cyclones are observed.

Echocardiographic assessment of left atrial volume index in elderly patients with left ventricle anterior myocardial infarction

Introduction:Enlarged left atrium predicts outcomes in patients with heart failure, atrial fibrillation and stroke. Left atrial volume especially when corrected for body size, is a more accurate representation of true LA size.Aims and Objectives:To study left atrial volume index in elderly patients with left ventricle anterior infarction and correlate LAVi with left ventricle ejection fraction and transmitral Doppler flow.Materials and Methods:Control group consisted of 25 healthy elderly subjects Study group consisted of age and sex matched patients with LV anterior infarction with history of characteristic ischaemic chest pain. Patients with valve lesions, large shunts and rythum disturbances were excluded. On transthoracic echocardiography biplane method of disks was used to calculate LA volume. LAVi was calculated by dividing LA volume by body surface area of subjects.Observation and Results:LAVi was significantly raised in elderly patients who suffered from AMI (P<0.005). We also found significant negative correlation of LAVi with LVEF, E wave peak velocity and deacceleration time.Conclusion:Patients with advanced left venticular systolic and diastolic dysfunction had a significantly larger LAVi than healthy subjects. LAVi is useful for risk stratification and for guiding therapy in such patients.

Coronary artery perfusion and myocardial performance after patent ductus arteriosus ligation

To study coronary artery (CA) perfusion and myocardial performance after patent ductus arteriosus (PDA) ligation. The postoperative course in premature infants undergoing surgical ligation of PDA is often complicated by cardiorespiratory instability secondary to impaired left ventricular performance. Serial echocardiography was performed before and after (1, 8, and 24 hours) PDA ligation to assess systolic (left ventricular output [LVO]) and diastolic (isovolumic relaxation time, E and A wave peak velocity) myocardial performance, and CA diastolic flow (CA velocity time integral and flow). The ratio of CA flow to LVO was calculated as a surrogate of coronary flow. A total of 20 infants (gestational age at birth, 26.3 ± 0.7 weeks) requiring PDA ligation at a median of 28.5 days (range, 9-40) after birth and weight of 780 g (range, 570-2840) were studied. A postoperative increase in the CA flow/LVO ratio was demonstrated. An early decrease in E and A wave peak velocity (P < .05) and increase in isovolumic relaxation time (P < .05) were demonstrated at 1 hour, before any clinical deterioration. A low baseline CA velocity time integral was associated with a low E/A ratio (r = 0.63, P = .01) at 1 hour and lower systolic blood pressure at 8 hours (r = 0.5, P = .05). The postoperative need for inotropes (n = 8) was associated with a low baseline CA velocity time integral at 1 hour (r = 0.52, P < .05), low LVO at 1 and 8 hours (P < .05), and increased oxygen requirement at 24 hours (P < .05). PDA ligation is followed by altered CA perfusion. Perioperative evaluation of the CA perfusion can help identify neonates at risk of impaired myocardial performance, systolic hypotension, and the need for inotropes.

Two-Dimensional and Doppler echocardiographic findings in healthy non-sedated red-eared slider terrapins (Trachemys scripta elegans)

Echocardiographic evaluation was performed in six healthy young adult non-sedated terrapins (Trachemys scripta elegans). The best imaging quality was obtained through the right cervical window. Base-apex inflow and outflow views were recorded, ventricular size, ventricular wall thickness and ventricular outflow tract were measured, and fractional shortening was calculated. Pulsed-wave Doppler interrogation enabled the diastolic biphasic atrio-ventricular flow and the systolic ventricular outflow patterns to be recorded. The following Doppler-derived functional parameters were calculated: early diastolic (E) and late diastolic (A) wave peak velocities, E/A ratio, ventricular outflow systolic peak and mean velocities and gradients, Velocity-Time Integral, acceleration and deceleration times, and Ejection Time. For each parameter the mean, standard deviation and 95% confidence interval were calculated. Echocardiography resulted as a useful and easy-to-perform diagnostic tool in this poorly known species that presents difficulties during evaluation.

The mitral late diastolic flow acceleration slope after the restoration of sinus rhythm in acute atrial fibrillation: relationship to atrial function and change over time

This study was prospectively designed to evaluate the relationship between the mitral A wave acceleration slope (AWA-slope) and the left atrial ejection fraction (LA-EF) after the restoration of sinus rhythm in patients with atrial fibrillation (AF), and also to evaluate the change in the AWA-slope between the sequent second day and first month. Twenty-nine patients (16 female, mean age 56 ± 13 years) with unknown cause of AF (except for age) converted to sinus rhythm within the first 48 hours were included into the study. A transthoracic echocardiography was performed in all patients on the second day and the first month after restoration of the sinus rhythm. The paired Student's t test was used in comparisons of the continuous variables. The simple and multiple correlations of the LA-EF were evaluated by the simple and multiple linear regression analyses, respectively. Left atrial ejection fraction (42 ± 17 vs 51 ± 19%, p=0.03) and AWA-slope (950 ± 337 vs 1087 ± 351 cm/sec2, p=0.021) obtained after the first month were greater than on the second day. A significant correlation between LA-EF and AWA-slope was observed both on the second day (r=0.76, p=0.001) and at the end of the first month (r=0.71, p=0.001). In addition, there were the correlations between LA-EF and mitral A wave peak velocity (r=0.42, p=0.025) or mitral E/A ratio (r=-0.39, p=0.040) at the end of the first month. On multiple linear regression analysis, only AWA-slope was found to be related to LA-EF (y=9.35+0.04 (AWA-slope), the overall R2=0.51, beta =0.71; 95% CI 0.02-0.05; p=0.001). Mitral A wave acceleration slope is a simple, reliable and non-invasive method that can be used to evaluate left atrial contractile function. It can also be used in monitoring of atrial stunning period in patients with sinus rhythm converted from AF.

Association between troponin T and impaired left ventricular relaxation in patients with acute decompensated heart failure with preserved systolic function

To examine relationships between cardiac troponin T (cTnT) and parameters of left ventricular (LV) structure and function in patients with acute destabilized heart failure (HF) with preserved LV ejection fraction. In 44 patients with acute heart failure (HF) with preserved left ventricular (LV) ejection fraction, parameters of LV structure and function were assessed via comprehensive two-dimensional Doppler echocardiography. There was no correlation between cTnT and LV wall thickness, left atrial volume index, or transmitral E wave velocity or deceleration time. There were associations between cTnT and LV end-diastolic dimension (r = -0.34, P = 0.02) and LV mass index (r = 0.32; P = .04). A lower tissue Doppler Ea wave peak velocity was associated with higher cTnT concentrations (r = -0.90, P < 0.001). In multivariate analyses, only LV end-diastolic dimension (t = 2.2; P = 0.04), LV mass index (t = 2.3; P = .03), and tissue Doppler Ea wave peak velocity (t = -4.7; P < .001) emerged as significant predictors of cTnT. In patients with HF with preserved LV ejection fraction, cTnT is strongly associated with the extent of LV relaxation abnormalities and LV mass.

Serum Levels of the Interleukin-1 Receptor Family Member ST2, Cardiac Structure and Function, and Long-Term Mortality in Patients With Acute Dyspnea

ST2, a biomarker of cardiomyocyte stretch, powerfully predicts poor outcomes in patients with acute dyspnea, but nothing is known about associations between soluble ST2 (sST2) and cardiac structure and function, or whether sST2 retains prognostic meaning in the context of such measures. One hundred thirty-four dyspneic patients with and without decompensated heart failure had echocardiography during index admission and vital status was ascertained at 4 years. Echocardiographic and clinical correlates of sST2 as well as independent predictors of death at 4 years were identified. sST2 correlated with left ventricular end-systolic dimensions/volumes and left ventricular ejection fraction. sST2 was inversely associated with right ventricular fractional area change (rho=-0.18; P=0.046), higher right ventricular systolic pressure (rho=0.26; P=0.005), and right ventricular hypokinesis (P<0.001) and was correlated with tissue Doppler Ea wave peak velocity, but not to other indices of diastolic function. In multivariate regression, independent predictors of sST2 included right ventricular systolic pressure (t=2.29; P=0.002), left ventricular ejection fraction (t=-2.15; P=0.05) and dimensions (end systolic, t=2.57; end diastolic, t=2.98; both P<0.05), amino-terminal pro-B-type natriuretic peptide (t=3.31; P=0.009), heart rate (t=2.59; P=0.01), and presence of jugular venous distension (t=2.00; P=0.05). In a Cox proportional hazards model that included echocardiographic results and other biomarkers, sST2 independently predicted death at 4 years (hazard ratio=2.70; P=0.003). Among dyspneic patients with and without acute heart failure, sST2 concentrations are associated with prevalent cardiac abnormalities on echocardiography, a more decompensated hemodynamic profile and are associated with long-term mortality, independent of echocardiographic, clinical, or other biochemical markers of risk.

Acute effects of positive end-expiratory pressure on left ventricle diastolic function in healthy subjects

We evaluated the acute effect of the application of positive end-expiratory pressure (PEEP) on LV diastolic function in 10 healthy subjects. We assessed load dependent diastolic function by Doppler examination of transmitral flow and load independent diastolic function by color M-mode propagation velocity of early flow into the LV cavity (Vp). During the application of PEEP in comparison to the baseline, we found a significant reduction of the E wave peak velocity [79 (64-83) vs. 65 (57-72) cm/s; p = 0.028] and a significant reduction in Vp [84 (73-97) vs. 53 (48-66); p = 0.012]. Moreover, we found a significant reduction in left atrial area [15 (13-18) vs. 12 (10-14) cm(2); p = 0.018] and right atrial area [12 (11-15) vs. 11 (9-12) cm(2); p = 0.015]. No difference was found in global LV systolic function. The application of PEEP acutely modifies the diastolic flow pattern across the mitral valve, and reduces atrial dimensions.

Tissue Doppler imaging in the assessment of right ventricular function in congenital heart disease. Echo-MRI correlation

The noninvasive evaluation of right ventricular function is difficult, especially in postoperative complex congenital heart disease due to the special right ventricular geometry. The right ventricular dysfunction is a key factor in morbidity and mortality and in the determination of the necessity of reoperation. To report the author's experiences of 133 TDI investigations. Pts age: 14 days-20 yrs, mean 12,4 yrs. To assess right ventricular function TDI investigations were performed for "systemic right ventricular" function in transposition of great arteries after Senning operation (Group I.21 TDI in 17 pts) and after reconstruction of Tetralogy of Fallot (Group II, 21 pts). RV tricuspid anulus systolic velocity (Sy) and early diastolic velocity (E') were measured from Doppler inflow the E wave peak velocity, and the E/E' ratio was calculated. The deviation of these TDI velocities from normal values were analyzed and the correlation with RV ejection fraction was measured by MRI. In Group I we found significant differences from normal population Sy 9.3 +/- 3.7 cm/s vs. 14.2 +/- 2.3, E' 12.8 +/- 4.7 cm/s vs. 16.7 +/- 2.8 cm/s, E/E' 7.2 +/- 4.6 vs. 3.7 +/- 1.4. Sy TDI velocity and E/E' ratio showed good correlation with RV EF measured by MRI ( p > 0.001). In Group II Sy velocity was decreased: 11.3 +/- 4.3 cm/s and showed also good correlation with MRI EF ( p > 0.001). TDI for RV function analysis is recommended in congenital heart disease and also proposed in addition to other methods. Due to experience with MRI, reliable data can be collected for the postoperative pts, to decide the correct time of redo operation.