Clinical characteristics influence left and right ventricular diastolic function in healthy individuals

The aim of this study was to determine whether clinical characteristics have an influence on left (LV) and right ventricular (RV) diastolic function indices measured by echocardiography in healthy individuals. Five hundred and three volunteers (253 women and 250 men) aged 18-66 years (mean 36.9 +/- 11.9) who were normotensive and free of clinically apparent heart disease were included in the study. Mitral and tricuspid peak E wave and A wave velocities, E/A ratio, deceleration time (DT) of the E wave, and left ventricular isovolumetric relaxation time (IVRT) were evaluated as left and right ventricular diastolic function indices. In order to determine the effects of age, gender, body surface area (BSA), waist/hip ratio (WHR), and heart rate (HR) on left and right ventricular diastolic function indices Student's t test and correlation and linear regression analysis were used. IVRT and deceleration time of the mitral E wave (DTm) were significantly longer in men. Mitral and tricuspid A wave velocities, tricuspid E/A ratio, and deceleration time of the tricuspid E wave (DTt) were similar in both genders. Mitral and tricuspid E wave velocities and mitral E/A ratio were greater in women. Mitral E wave velocity and IVRT mostly correlated with WHR. Age was found to be the most important factor affecting mitral A wave velocity, DTm, E/A ratio, and right ventricular diastolic function indices. This study shows that age, heart rate, body surface area, and waist/hip ratio have important correlations with Doppler echocardiographic diastolic indices in normal individuals and should be considered in the evaluation of LV and RV diastolic function.     

Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients

Diastolic dysfunction is a recognized complication in heart transplant (HTx) recipients that limits exercise capacity and is a risk factor for mortality. We investigated the ability of echocardiography to detect elevated pulmonary capillary wedge pressure (mean PCWP>15 mmHg) in HTx recipients. This retrospective study comprised HTx recipients with echocardiography and right heart catheterization within 24 hours (n = 100, 113 investigations). Echocardiographic assessment was performed using mitral inflow (E/A ratio, deceleration time [DT], isovolumic relaxation time [IVRT]), tissue Doppler (E/E′ lateral) parameters, and the Doppler‐estimated pulmonary artery systolic pressure (Doppler PASP). The right atrial pressure (RAP) was estimated based on size and the effect of respiration or sniffing on the inferior vena cava diameter. Cutoff values were determined from a derivation group (n = 57, receiver operator characteristic curve analysis) and evaluated in a test group (n = 56). Elevated PCWP were found in 38%. The RAP and PCWP were both normal in 58 investigations and elevated in 39 investigations (concordance rate of 86.6%). The presence of signs of increased RAP by echocardiography or with three of five parameters (E/A, DT, IVRT, E/E′ lateral, and Doppler PASP) reaching the cutoff values ruled in elevated PCWP with positive likelihood ratios ranging from 15.3 to 9. With normal RAP by echocardiography or none of the other parameters reaching cutoff values elevated PCWP can be ruled out with negative likelihood ratios ranging from 0.07 to 0.19. In conclusion, elevated PCWP in HTx recipients can be assessed using echocardiography.     

Echocardiographic evaluation of left ventricular filling pressures validated against an implantable left ventricular pressure monitoring system

Background: Aim of this study was to assess the ability of different echocardiographic indices to evaluate left ventricular (LV) filling pressures in patients with reduced LV function. Methods: In 5 patients scheduled for aortocoronary bypass surgery, a telemetric intraventricular pressure sensor was implanted. Over 6 months, these patients underwent a total of 21 echocardiographic examinations with a simultaneous recording of left ventricular mean (LVMDP) and end‐diastolic pressure (LVEDP). The following echocardiographic parameters were extracted from the transmitral flow profile: early (E) and late (A) diastolic flow velocity, deceleration time of the E‐wave (DT) and the isovolumic relaxation time (IVRT). Early diastolic velocity of the mitral ring (E’) was recorded using pulsed‐wave tissue Doppler echocardiography. Results: All patients were in NYHA class III and mean ejection fraction was 30%. E correlated only moderately with LVMDP (r =–0.60, P = 0.003), but revealed the highest area under the receiver operating characteristic curve for the prediction of an elevated LVMDP > 12 mmHg (AUC = 0.94, sensitivity of 92% and specificity of 86%, cut‐off value 7.5 cm/s). E/A > 1 predicted LVEDP > 15 mmHg with a sensitivity of 87% and a specificity of 80%. E/E’ was not correlated with LVMDP or LVEDP. Conclusion: Although linear correlation between echocardiographic parameters and diastolic LV pressures reached statistical significance, the correlation coefficients were low. However, in these patients with severely reduced LV function due to ischemic heart disease conventional echocardiographic parameters of transmitral flow showed higher predictive values for elevated LV filling pressures than E/E’. (Echocardiography 2011;28:619‐625)     

Effect of Treadmill Exercise on Tricuspid Inflow and Tissue Doppler Velocity of Tricuspid Annulus in Healthy Persons

Effect of treadmill stress test on tricuspid flow and tissue Doppler imaging of tricuspid annulus were evaluated in 26 healthy persons. Exercise resulted in significant increase in A‐wave velocity and significant reduction in E‐wave deceleration time and E/A ratio. On tissue Doppler imaging Aa‐wave increased significantly with decrease in isovolumic relaxation time and Ea/Aa ratio.     

Doppler echocardiography in dilated and restrictive cardiomyopathies

Dilated cardiomyopathy is characterized by systolic dysfunction and cardiac enlargement of unknown origin. Various Doppler modalities are useful to detect and quantitate atrioventricular regurgitation, which is common and contributes to clinical symptoms. Pulsed Doppler assessment of mitral and tricuspid inflow velocities shows a spectrum of findings indicative of abnormal diastolic function and hemodynamic status. When mitral regurgitation is more than moderate and heart failure is severe, the ratio between early inflow E wave to atrial inflow A wave peak velocities is increased. Mitral deceleration time may be short. When mitral regurgitation is trivial and left atrial pressure is not increased, abnormal relaxation may be detected as a low E:A ratio. Mitral deceleration time and isovolumic relaxation time are prolonged. In restrictive cardiomyopathy, there is an abrupt limitation in early ventricular filling due to abnormal compliance of endocardial or endomyocardial origin. Mitral and tricuspid inflow velocities show normal to increased early peak velocity, rapid deceleration time, low peak atrial velocity, and an increased E:A ratio. Differentiation between restriction and constriction might be possible by the demonstration in pericardial constriction of inspiratory decreases in mitral early inflow peak velocities and in prolongation of isovolumic relaxation time, with reciprocal changes on tricuspid inflow velocity profiles. In constriction, these respiratory variations are caused by the ventricular limitation to accommodate changes in venous return due to the pericardial shell. Doppler abnormalities and two-dimensional echocardiographic assessment of ventricular and atrial size and ejection fraction provide the practicing physician with valuable diagnostic information.     

Effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements

Objective: This study evaluates the effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. Methods: Twenty‐three healthy subjects aged 25.6 ± 4.5 years were investigated. A wide selection of pulsed Doppler and tissue Doppler variables were measured before a standardized meal as well as and 30 and 110 minutes afterwards. Results: The following variables increased significantly (P < 0.05) 30 minutes after food intake: left ventricular stroke volume, left ventricular cardiac output, left ventricular outflow velocity–time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, pulmonary vein peak velocities in systole (S) and in diastole (D), S/D, pulsed tissue Doppler peak systolic velocities, and late diastolic velocities. Deceleration time of E‐wave decreased significantly (P < 0.05). The change in measured variables between fasting and 30 minutes after the food intake ranged from 7% to 28%. There were no significant (P > 0.05) changes in E/A, early diastolic tissue Doppler velocities (e’), and E/e’. Most, but not all variables returned to baseline values 110 minutes after food intake. Conclusions: This study shows that food intake affects several echocardiographic variables used to routinely assess diastolic function and hemodynamics. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible in such populations. (Echocardiography 2011;28:843‐847)     

ACE inhibitors unmask incoordinate diastolic wall motion in restrictive left ventricular disease.

OBJECTIVE: To assess the effect of ACE-inhibition on left ventricular filling and wall motion in patients with a clinical diagnosis of heart failure. DESIGN: Prospective examination of left ventricular systolic and diastolic function using M mode echocardiography and pulsed and continuous wave Doppler before and three weeks after starting an ACE inhibitor. SETTING: A tertiary referral centre for cardiac disease equipped with non-invasive facilities. SUBJECTS: 30 outpatients with a clinical diagnosis of heart failure in whom treatment with an ACE inhibitor was started; age 61 (SD 11) years; 27 male; 3 female; 21 healthy controls of similar age. RESULTS: Left ventricular cavity was dilated both at end systole and end diastole, and fractional shortening reduced. Although mean isovolumetric relaxation time (IVRT) and transmitral E (early) to A (late) filling velocity (E/A) ratio were not different from normal, a value of 1.0 on the normal frequency plot of the E/A ratio divided the patients bimodally into two groups: 20 patients (group A) with E/A ratio > 1.0 and 10 patients (group B) < 1.0. In group A patients, IVRT was short as was transmitral E wave deceleration time compared to normal (P < 0.001), fulfilling the criteria of restrictive left ventricular physiology. Left ventricular wall motion during IVRT was coordinate and left ventricular end diastolic pressure was raised on the apex-cardiogram (P < 0.001). In group B, E wave deceleration time was longer, relaxation incoordinate, and apexcardiogram normal. With an ACE inhibitor: in group A, left ventricular dimensions fell at end diastole (P < 0.05) and end systole (P < 0.01) but fractional shortening did not change; long axis total excursion (P < 0.01) and peak rate of shortening (P < 0.05) both increased; IVRT increased (P < 0.001) with the appearance of markedly incoordinate wall motion, minor axis lengthening, and long axis shortening (P < 0.001 for both); A wave amplitude also consistently increased (P < 0.001); finally, transmitral E wave velocity fell and A wave velocity increased. ACE inhibition did not alter any of the left ventricular minor and long axis or transmitral Doppler variables in patients in group B. CONCLUSIONS: Patients with a clinical diagnosis of heart failure differ in their presentation and response to ACE inhibition according to baseline haemodynamics. In restrictive left ventricular physiology, ACE inhibition reduces cavity size and prolongs IVRT, compatible with a fall in left atrial pressure. At the same time, ventricular relaxation becomes very delayed and incoordinate, greatly reducing early diastolic left ventricular filling velocity. Thus ACE inhibition unmasks major diastolic abnormalities in patients with restrictive left ventricular disease.     

Serial assessment of left ventricular diastolic function after Fontan procedure

OBJECTIVE—To assess longitudinal changes in systemic ventricular diastolic function late after the Fontan procedure.
DESIGN AND PATIENTS—Prospective study of 13 patients at 2.8 (2.0) years (early) and again at 11.4 (2.0) years (late) after the Fontan procedure by Doppler echocardiography with simultaneous ECG, phonocardiogram, and respirometer.
SETTING—Tertiary paediatric cardiac centre.
RESULTS—The isovolumic relaxation time (IVRT) was significantly longer, and E wave deceleration time, E and A wave velocities, and E:A velocity ratio were reduced compared to normal both early and late after the procedure. The mean (SD) z score of IVRT decreased significantly from +2.50 (1.00) to +1.24 (0.80) (p = 0.002), and the z score of the E wave deceleration time decreased from −1.69 (1.31) to −2.40 (1.47) (p = 0.03) during follow up. The A wave deceleration time also tended to decrease (early 80 (12) ms v late 73 (11) ms, p = 0.13) with increased follow up. There were no changes of the E and A wave velocities and E:A velocity ratio. The E wave velocity was inversely related to IVRT both early (r = −0.82, p = 0.001) and late (r = −0.59, p = 0.034) after the operation. The prevalence of diastolic flow during isovolumic relaxation decreased from 85% (11/13) to 38% (5/13) (p = 0.04), while that of mid diastolic flow increased from 23% (3/13) to 77% (10/13) (p = 0.02) between the two assessments.
CONCLUSIONS—Left ventricular diastolic function remains highly abnormal late after the Fontan procedure. The longitudinal changes demonstrated on follow up are compatible with reduction of left ventricular compliance in addition to persisting abnormalities of relaxation.


Keywords: diastolic function; Fontan procedure     

Reference Values of Tissue Doppler Imaging and Pulsed Doppler Echocardiography for Analysis of Left Ventricular Diastolic Function in Healthy Adults

To determine reference values for tissue Doppler imaging (TDI) and pulsed Doppler echocardiography for left ventricular diastolic function analysis in a healthy Brazilian adult population. Observations were based on a randomly selected healthy population from the city of Vitória, Espírito Santo, Brazil. Healthy volunteers (n = 275, 61.7% women) without prior histories of cardiovascular disease underwent transthoracic echocardiography. We analyzed 175 individuals by TDI and evaluated mitral annulus E′‐ and A′‐waves from the septum (S) and lateral wall (L) to calculate E′/A′ ratios. Using pulsed Doppler echocardiography, we further analyzed the mitral E‐ and A‐waves, E/A ratios, isovolumetric relaxation times (IRTs), and deceleration times (DTs) of 275 individuals. Pulsed Doppler mitral inflow mean values for men were as follows: E‐wave: 71 ± 16 cm/sec, A‐wave: 68 ± 15 cm/sec, IRT: 74.8 ± 9.2 ms, DT: 206 ± 32.3 ms, E/A ratio: 1.1 ± 0.3. Pulsed Doppler mitral inflow mean values for women were as follows: E‐wave: 76 ± 17, A‐wave: 69 ± 14 cm/sec, IRT: 71.2 ± 10.5 ms, DT: 197 ± 33.3 ms, E/A ratio: 1.1 ± 0.3. IRT and DT values were higher in men than in women (P = 0.04 and P = 0.007, respectively). TDI values in men were as follows: E′S: 11± 3 cm/sec, A′S: 13 ± 2 cm/sec, E′S/A′S: 0.89 ± 0.2, E′L: 14 ± 3 cm/sec, A′L: 14 ± 2 cm/sec, E′L/A′L: 1.1± 0.4. E‐wave/ E′S ratio: 6.9 ± 2.2; E‐wave / E′L ratio: 4.9 ± 1.7. In this study, we determined pulsed Doppler and TDI derived parameters for left ventricular diastolic function in a large sample of healthy Brazilian adults. (Echocardiography 2010;27:777‐782)     

Doppler-derived mitral and pulmonary venous flow variables are predictors of pulmonary hypertension in dilated cardiomyopathy

This study assessed whether Doppler-derived mitral and pulmonary venous flow parameters were predictors of pulmonary artery hypertension in patients with left ventricular dysfunction. Doppler echocardiographic examinations were performed in patients (n = 100) with dilated cardiomyopathy in sinus rhythm either symptomatic or asymptomatic before and after optimized therapy with ACE inhibitors, diuretics, and vasodilators. In case of weak or poor Doppler signals, measurable tricuspid regurgitation and pulmonary venous flow tracings were obtained after intravenous administration of 2.5 grams of Levovist at 400 mg/ml. At baseline, left ventricular ejection fraction was 30% +/- 7% and pulmonary artery systolic pressure was 48 +/- 14 mmHg. At the follow-up study carried out after 6 +/- 2 months, reversibility of pulmonary artery hypertension was apparent only in those patients exhibiting favorable changes of mitral flow curve from the restrictive or pseudonormal to impaired relaxation pattern (53 +/- 7 mmHg vs 38 +/- 8 mmHg; P < 0.0001). Numerous variables correlated significantly with pulmonary artery systolic pressure at baseline, while the correlations were generally weaker at the follow-up study. The closest correlations were found with E wave deceleration rate (r = 0.73) at baseline and with the systolic fraction of pulmonary venous flow forward peak velocities (r = -0.67) at follow-up. The stepwise regression model showed that the E wave deceleration rate and the degree of mitral regurgitation were the strongest independent predictors of pulmonary hypertension at baseline, while the ratio between pulmonary venous flow reverse and mitral wave velocities at atrial systole and ejection fraction added minor contributions, leading to a cumulative r value of 0.81. The systolic fraction was the strongest at the follow-up study, with minor contributions provided by the E wave deceleration rate and the left atrial dimension index, leading to a cumulative r value of 0.71.     

Diagnosis of constrictive pericarditis by pulsed Doppler echocardiography of the hepatic vein

The diagnostic value of hepatic venous flow patterns was evaluated for constrictive pericarditis by pulsed Doppler. A characteristic flow pattern was assumed to be associated with the well-known atrial pressure curve. Thirteen patients with constrictive pericarditis were compared to 13 control subjects and to 25 patients with right ventricular pressure overload including 13 patients with tricuspid regurgitation. The characteristic finding in constrictive pericarditis was a W-wave pattern of flow velocities in the dilated hepatic veins, with abrupt reversal of flow late in systole and diastole before the A wave (100% specificity, 68% sensitivity). This depends, however, on the absence of tricuspid regurgitation (for its systolic component) or fast sinus rhythm (for its diastolic component). Additional diagnostic markers were systolic deceleration time of forward flow (40 to 130 ms) and systolic integral of flow velocities (4.3 to -4.0 cm) (sensitivity and specificity greater than or equal to 92%). In the presence of tricuspid regurgitation, diastolic deceleration time less than 150 ms and diastolic integral of flow velocities less than 6 cm were useful diagnostic signs. If combined, these criteria had 100% sensitivity and specificity for the diagnosis. Thus, pulsed Doppler assessment of flow velocities in the hepatic vein facilitates the diagnosis of constrictive pericarditis in clinical routine, using an auxiliary site with unlimited diagnostic access to the characteristic flow velocity pattern, which reflects right atrial pressure curve and filling abnormalities.     

The origin and clinical significance of the signal opposite to the mitral E-wave: a simple and novel indicator of left ventricular filling pressure

Objectives: We noted a low‐velocity signal opposite to the early diastolic transmitral flow (E) by pulsed Doppler echocardiography. The purpose of this study was to examine the origin and significance of this signal. Background: The background of the signal remains uncertain. Methods: We studied 59 adult patients (34 men and 25 women; mean age, 58.9 [20.2] years) without mitral valve heart disease. Mitral E‐wave velocity and the signal (EW) opposite the E‐wave were measured by pulsed Doppler echocardiography. Early diastolic mitral valve ring motion velocity (Ea) was measured by pulsed tissue Doppler echocardiography. Pulmonary capillary wedge pressure (PCWP) was measured by a Swan‐Ganz catheter in 34 of the 59 patients. Results: A blue signal was observed during early diastole from the mitral valve ring to the mitral orifice areas by color tissue Doppler echocardiography. The velocity profile method revealed the same direction and time between peak Ea and EW. Peak EW positively correlated with Ea (r = 0.67, P < 0.01). There were significant positive correlations between mean PCWP and E/Ea (r = 0.61, P < 0.01) and E/EW (r = 0.59, P < 0.01). E/EW was significantly greater in patients with PCWP > 12 mmHg than in patients with PCWP ≤ 12 mmHg (5.6 [1.3] cm/s vs. 4.3 [0.9] cm/s, P < 0.01). Conclusions: EW may be related to mitral valve ring motion, and the E/EW ratio may be a noninvasive simple parameter for assessing left ventricular filling pressure. (Echocardiography 2011;28:606‐611)     

Color M-mode flow propagation velocity and conventional doppler indices in the assessment of diastolic left ventricular function during isometric exercise

BACKGROUND AND OBJECTIVE: Color M-mode flow propagation velocity (Vp) was shown to be a preload-independent measure of diastolic function. To study the effects of an increase in afterload induced by isometric handgrip exercise on diastolic function assessment in patients with cardiomyopathy, we measured Vp and conventional Doppler indices at baseline and at 30% of predetermined maximum handgrip strength. METHODS: Twenty-four patients with systolic dysfunction were divided into two groups: Group I comprising 12 patients with E/A < 1 (early filling velocity/atrial contraction velocity) and Group II comprising 12 patients with E/A > 1. All the patients underwent measurement of Vp, E velocity, its deceleration time (DT), A velocity, isovolumic relaxation time (IVRT), and pulmonary atrial flow reversal velocity (PFR) at baseline and at 30% of predetermined maximum handgrip strength. Twelve healthy controls underwent these same measurements. RESULTS: When comparing baseline to peak echocardiographic data, no significant changes were noted in Vp in any of the groups while a shift of pulsed Doppler indices of Group I toward a pattern closer to that of Group II was noted and a decrease in E velocity and E/A ratio with an increase in IVRT occurred in healthy controls. CONCLUSIONS: Color M-mode flow propagation velocity seems to be an afterload-independent measure of diastolic function in patients with moderate to severe cardiomyopathy while pulsed Doppler indices are more sensitive to loading conditions induced by isometric exercise.     

The impact of two different doses of chelating therapy (deferasirox) on echocardiographic tissue Doppler indices in patients with thalassemia major

Background: Chelating therapy in transfusion‐dependent patients with β‐thalassemia major (β‐TM) is mandatory to reduce the toxic effect of iron on the myocardium. Aim: To evaluate the impact of low and high dose of oral chelating therapy (deferasirox) on pulsed and tissue echocardiographic indices in patients with β‐TM. Methods: This interventional study conducted on patients with transfusion‐dependent β‐TM (n = 38) on deferasirox 20 mg/kg/d medication, group (DFX‐20) for at least 6 months, followed by administration of a higher dose of deferasirox, 40 mg/kg/d, group (DFX‐40) for another 6 months. Pulsed and tissue Doppler echocardiography carried out at the beginning and at the end of treatment interval (6 months) for both groups, with monthly blood analysis of serum ferritin, alanine transaminase, hemoglobin, and creatinine. An age‐matched control group of 38 patients was evaluated for echo Doppler blood analysis. Results: Patients of group DXF‐40 compared with group DFX‐20, the tissue Doppler echocardiogram showed lower E/Em ratio (16.01 ± 2.85 vs. 19.68 ± 2.81, P < 0.05), higher systolic wave velocity (Sm) (5.87 ± 1.40 vs. 4.80 ± 1.20, P < 0.05), and higher early diastolic wave (Em) velocity (4.25 ± 1.70 vs. 3.50 ± 1.80, P < 0.05), respectively. Patients in group DFX‐20, compared with control group, had M‐Mode echo with thicker left ventricle (LV) septal wall (P < 0.001) and posterior wall (P < 0.01), higher left ventricle end diastolic diameter index (P < 0.05). The pulsed Doppler echocardiogram showed a higher LV transmitral E wave velocity (P < 0.05), higher E/A ratio (P < 0.01), and the duration of deceleration time was significantly shorter (P < 0.01). There were no significant changes observed in the left ventricle ejection fraction percentage (LVEF%) or fractional shortening between both treatment groups. Serum ferritin was significantly lower in DFX‐40 group compared with DFX‐20 β‐TM group (338). There was a significant positive correlation between the serum ferritin and the E/Em ratio (r = 0.31, P < 0.001). The tricuspid valve velocity was significantly higher in β‐TM patients compared with the control group (P < 0.05). Conclusion: The increment of oral deferasirox as chelating therapy in β‐TM patients to 40 mg/kg/d over 6 months duration showed a significant increments of systolic and diastolic tissue Doppler velocities with a significant reduction of E/Em ratio in comparison with 20 mg/kg/d. There were no changes of LVEF. A longer duration of follow‐up may be justified in such group of patients.     

Acute effects of low doses of ethanol on left and right ventricular function in young healthy subjects

Background: Moderate‐to‐high blood concentrations of ethanol acutely impair conventional echocardiographic measures of left ventricular (LV) performance, but the effects of low concentrations are unclear. This study explored the acute effects of low blood concentrations of ethanol on sensitive and load‐independent indices of LV and right ventricular (RV) function. Methods: This is a crossover experimental study conducted in 64 young healthy volunteers. Participants were asked to drink a light dose of Italian red wine equivalent to 0.5 mg/kg of ethanol, and an equal volume of fruit juice in separate experiments. The following measurements were taken at baseline and 60 minutes after the challenges: tissue Doppler mitral annulus systolic velocity (S’) and excursion (MAPSE), early diastolic velocity (E’), its ratio to late diastolic velocity (E’/A’), and the ratio of mitral‐to‐myocardial early diastolic velocities (E/E’); and tricuspid annulus systolic velocity (tricuspid S’) and amplitude (TAPSE), early diastolic velocity (tricuspid E’), and its ratio to late diastolic velocity (tricuspid E’/A’). Results: Blood ethanol concentration after wine intake was 0.48 ± 0.06 g/l. Compared with the control challenge, ethanol yielded a decrease in all measures of LV function (S’, ?9.7%; E’, ?11.2%; E’/A’, ?13.4%; MAPSE, ?8.8%; p < 0.05 for all). Among indices of RV function, increases in tricuspid E’/A’ ratio and TAPSE were observed (+24.5% and +9.0%, respectively; p < 0.05 for both). Conclusions: Low blood concentrations of ethanol acutely impair LV function and increase some indices of RV function in young healthy individuals.     

A Novel Noninvasive Method to Assess Left Ventricular −dP/dt Using Diastolic Blood Pressure and Isovolumic Relaxation Time

Background: Left ventricular Doppler‐derived ?dP/dt determined from the continuous‐wave Doppler spectrum of the mitral regurgitation (MR) jet has been shown to be a valuable marker of diastolic function, but requires the presence of MR for its assessment. We sought to determine if a novel method of determining ?dP/dt using the diastolic blood pressure and isovolumic relaxation time (DBP‐IVRT method) correlates with Doppler‐derived ?dP/dt using the MR method (Doppler‐MR method). Methods: Thirty‐three patients with less than severe MR were enrolled. ?dP/dt was determined using the Doppler‐MR method from the continuous‐wave Doppler spectrum of the MR jet (32 mmHg/time from 3 to 1 m/sec). ?dP/dt was also determined using the DBP‐IVRT method using the following equation: ?dP/dt = (DBP ? LVEDP)/IVRT, where left ventricular end‐diastolic pressure (LVEDP) was estimated based on tissue Doppler and mitral inflow patterns. Results: Twenty‐five patients had adequate Doppler waveforms for analysis. The average amount of MR was mild‐to‐moderate severity. The mean ?dP/dt was 680 ± 201 mmHg by the Doppler‐MR method and 681 ± 237 mmHg by the DBP‐IVRT method. There was a significant correlation between the 2 methods of determining ?dP/dt (Pearson r = 0.574, P = 0.003). The Bland–Altman plot revealed almost no bias between the 2 methods; the difference in ?dP/dt between the 2 techniques was noted to be greater for patients with higher ?dP/dt, however. Conclusion: Diastolic blood pressure and isovolumic relaxation time may be used to noninvasively assess diastolic function in patients who do not have MR, especially in those with reduced diastolic function.     

Effect of blood donation mediated volume reduction on right ventricular function parameters in healthy subjects

Purpose: We aimed to investigate the effect of controlled and limited volume change by the blood donation model to the right ventricular (RV) function via different echocardiographic parameters in healthy adults. Methods: Study population was composed of 71 healthy subjects who were volunteers for blood donation and evaluated before and after 450 mL blood donation. Pulsed‐wave Doppler of the RV inflow and tissue Doppler of tricuspid lateral annulus, and tricuspid annular plane systolic excursion (TAPSE) were assessed. Results: E velocity of inflow decreased significantly (67.6 ± 15.9 vs 60.9 ± 12.2, P = 0.006). S’ and A’ velocities did not change (15.3 ± 3.2 vs 15.2 ± 2.5 cm/s, P = NS; 14.1 ± 3.3 vs 13.4 ± 3.1 cm/s, P = NS, respectively) but E’ showed significant decrease (13.7 ± 2.9 vs 12.2 ± 3.2 cm/s, P = 0.011). E’/A’ ratio and E/E’ ratio were found to be unchanged (1.0 ± 0.3 vs 1.0 ± 0.4, P = NS; 5.1 ± 2 vs 5.3 ± 2, P = NS, respectively). Myocardial performance index (MPI) was found to be increased but ejection time obtained from the tricuspid annulus did not change (0.50 ± 0.13 vs 0.54 ± 0.11, P = 0.040; 243 ± 37 vs 240 ± 27, P = NS, respectively). Isovolumetric relaxation and contraction times showed difference close to the significance limit (56 ± 19 vs 64 ± 23 ms, P = 0.055; 61 ± 16 vs 67 ± 16 ms, P = 0.062, respectively). TAPSE decreased significantly (2.62 ± 0.29 vs 2.41 ± 0.27 mm, P = 0.005). Conclusion: E’ velocity and TAPSE were sensitive to a volume reduction as little as 450 mL in healthy subjects. MPI index of the tricuspid annulus is less sensitive than E’ and TAPSE but need much care under changing volume state. However S’ and A’ velocity and E’/A’ ratio were found to be resistant to the effects of volume depletion. (Echocardiography 2012;29:451‐454)     

Diastolic function of the left ventricle in aortic valve stenosis. Doppler echocardiography]

Doppler echocardiographic parameters of LV diastolic function (isovolumic relaxation time, E wave velocity, ratio of E/A wave velocities, mitral valve pressure half time) were compared to catheter data in 35 patients (average age 67 years) with pure or dominant aortic stenosis (mean gradient: 65 +/- 30 mmHg). The isovolumic relaxation time was prolonged in most patients (m = 103 +/- 23 ms) and seemed uninfluenced by any haemodynamic parameter. There was a positive correlation between pressure half time and ejection fraction (r = 0.41, p = 0.02) and a negative correlation with pulmonary capillary pressure (r = -0.61, p < 0.01). The E and E/A ratio were negatively correlated with the ejection fraction (r = -0.41 and -0.52) and positively correlated with pulmonary capillary pressure (r = 0.46 and 0.62). The Doppler parameters were independant of the patients' age, severity of stenosis and degree of left ventricular hypertrophy. Patients with normal pulmonary capillary pressure (< 15 mmHg, N = 19) had abnormal diastolic filling with low E wave velocities (71 +/- 28 cm/s) and E/A ratios (0.9 +/- 0.6) and prolonged half pressure times (96 +/- 37 ms). Conversely, patients with high pulmonary capillary pressures (> 15 mmHg, N = 16) had normal or high E wave velocities (107 +/- 31 cm/s) and E/A ratios (1.5 +/- 0.6) and normal or shortened isovolumic relaxation times (62 +/- 22 ms).(ABSTRACT TRUNCATED AT 250 WORDS)     

Can the left ventricular early diastolic tissue-to-blood time interval be used to identify a normal pulmonary capillary wedge pressure?

The pulsed Doppler early diastolic left ventricular (LV) tissue (e)-blood (E) onset temporal relationship (e-E) is suggested to predict pulmonary capillary wedge pressure (PCWP), through the formulas: tau = 32 + 0.7(e-E) and PCWP = LV end-systolic pressure x e(-IVRT/tau). Small changes/errors in E could influence the quotient IVRT/tau by oppositely affecting IVRT and e-E. At rest in 50 healthy individuals we noted: e-E: 2 +/- 14 ms; IVRT: 89 +/- 17 ms; calculated tau: 33 +/- 10 ms; and PCWP: 9 +/- 9 mmHg (> 12 mmHg in 28%). Non-pharmacological preload alterations in 14 individuals rendered an intraindividual 'PCWP'-fluctuation of up to 40 mmHg. This application may therefore not be clinically robust.     

Right ventricular function in patients with acute anterior myocardial infarction: tissue Doppler echocardiographic approach

OBJECTIVE: Our purpose was to investigate the right ventricular (RV) performance of patients with a first acute anterior myocardial infarction (AAMI) by using pulsed wave Doppler tissue (PWDT) samplings of tricuspid annulus and RV free wall. METHODS AND RESULTS: The study group included 31 patients with AAMI and 20 age-matched controls. Conventional indexes of RV functions were the magnitude of tricuspid annular plane systolic excursion (TAPSE), and the transpulmonary and transtricuspid Doppler parameters. PWDT velocities were obtained by placing the sample volume at the lateral tricuspid annulus and the mid-segment of RV free wall; the peak systolic (S), early (E) and late (A) diastolic PWDT velocities and time intervals from ECG-Q wave to their peaks were analysed. Standard indexes were comparable except TAPSE that was significantly lower in AAMI-patients (p < 0.001). S velocities were similar; A of both regions (p = 0.018 and 0.012) and E of RV free wall (p = 0.011) were significantly increased in AAMI-group. Q-Sa intervals in both regions (p = 0.007 and 0.015) and Q-Ea of tricuspid annulus (p = 0.045) were significantly shorter in patients with AAMI. TAPSE and E of RV free wall had significant negative correlations with left ventricular systolic volume index and right atrial filling fraction (AFF), respectively (r = -0.46, p = 0.01 for both). A of tricuspid annulus had a positive correlation with left AFF (r = 0.42, p = 0.02). CONCLUSION: PWDT imaging of tricuspid annulus and RV free wall is capable to sensitively detect the adaptive mechanisms and unfavourable diastolic properties of RV dynamics in patients with AAMI.