Age-dependent influence of heart rate on Doppler indexes of left ventricular filling

Abstract. Background and objective . The Doppler indexes of left ventricular filling are related to age and heart rate. The aim of this study was to assess whether the influences of heart rate and age interactions (that is, whether the effect of heart rate on the Doppler indexes) is modified by age. Subjects and methods . The effects of atropine-induced heart rate increases on the transmitral velocities were compared in 10 younger healthy subjects aged 26–38 years and 12 older healthy subjects aged 50–67 years. Results . With a comparable total rise in heart rate (on average 20 beats min^-1), the peak early diastolic velocity decreased likewise in both groups (from 66±9 to 57±9 cm s^-1 in the younger age group and from 58 ± 15 to 47±13 cm s^-1 in the older age group). The peak atrial velocity remained unaltered in the older group (53 ± 16 vs. 52 ± 14 cm s^-1) but rose from 33 ± 6 to 44 ± 12 cm s^-1 in the younger (P = 0.02). The early-to-atrial peak velocity ratio decreased from 1.2 ± 0.6 to 1.0 ± 0.4 cm s^-1 in the older subjects and from 2.0 ± 0.5 to 1.4 ± 0.5 cm s^-1 in the younger subjects (P = 0.01). Changes in the other Doppler indexes were similar in both groups. Conclusions . The effect of heart rate on certain Doppler indexes of left ventricular filling is age-dependent. The peak velocity ratio cannot be interpreted without adjusting for heart rate in younger subjects, whilst in older people heart rate variation is of less importance.     

Doppler evaluation of left ventricular filling: effect of verapamil on non-obstructive hypertrophic cardiomyopathy

Impaired left ventricular (LV) filling is known to be a major determinant of non-obstructive hypertrophic cardiomyopathy (HCM). Seventeen patients with non-obstructive HCM (mean age 71 years) were investigated by Doppler echocardiography, before and after oral treatment with verapamil (mean daily doses: 335 mg). Diagnosis was based on clinical and echocardiographic data. Mitral regurgitation was absent or mild. Heart rate, PQ interval and mitral regurgitation did not change after treatment. All calculated values of Doppler LV filling improved significantly: corrected relaxation time, ratio of atrial to early velocity, EF slope and pressure half-time (P less than 0.005) showed more significant differences than more sophisticated indices using time-velocity integrals of Doppler LV filling flow (P less than 0.005). Results appear to reflect an effect of verapamil on LV relaxation; a slight effect of a modified load was nevertheless not excluded. We conclude that all parameters of Doppler LV filling show marked improvement in this elderly group with non-obstructive HCM, after oral verapamil. Doppler echocardiography is an easy and useful clinical method to assess the effect of a drug on ventricular relaxation of non-obstructive HCM.     

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)     

Differences in echocardiographic assessment with standard Doppler and tissue Doppler imaging of left ventricular filling pressure in idiopathic and ischemic dilated cardiomyopathy

Background: In idiopathic and ischemic dilated cardiomyopathy (DCM) there are differences in left atrial and ventricular relaxation. We assessed the hypothesis of an influence of these dissimilarities in assessing left ventricular filling pressure (LVFP) in these two DCMs by standard Doppler and tissue Doppler imaging. In particular, we focused on early transmitral flow to early diastolic motion velocity of mitral annulus ratio (E/Ea), useful to estimate normal or elevated LVFP. However, when found in intermediate range (8–15), its role is unclear. Methods and Results: We evaluated 26 patients with ischemic and 21 patients with idiopathic DCM. To validate the echocardiographic estimation of LVFP, a sample (12 patients) underwent LVFP assessment by catheterization. In idiopathic DCM, E/Ea directly related to duration of retrograde pulmonary venous flow (ARd) (r = 0.66 P = 0001). In ischemic DCM E/Ea inversely related only to systolic to diastolic velocity ratio of pulmonary venous flow (S/D) (r =−0.56 P = 0002). After a mean follow up of 6 months, by a second echocardiogram we observed a direct relation between E/Ea and ARd percentage variation (r = 0.52 P = 0.02) in idiopathic DCM group, whereas in the ischemic DCM group there was an inverse relation between E/Ea and S/D percentage variation (r =−0.59 P = 0.02).Conclusions: In conclusion, ARd in idiopathic and S/D in ischemic DCM might be used as specific additional information to estimate LVFP when E/Ea falls within intermediate range.     

Pulsed Doppler echocardiographic indices of left ventricular diastolic function in normal subjects.

To establish the normal limits for various pulsed Doppler echocardiographic indices of left ventricular diastolic function, 92 healthy volunteers aged from 5 to 75 years were prospectively studied. The influence of various variables including age, gender, body surface area, fractional shortening, and left ventricular mass on these parameters was also assessed. Mean (2SD) values for 15 direct and 11 derived parameters were analyzed from transmitral inflow velocity waveform. No statistically significant differences were observed between males and females for any of these parameters. On stepwise multivariate linear regression analysis, age was found to be an independent strong determinant (p less than 0.001) of peak velocity of early diastolic filling wave, area of atrial filling period, deceleration slope, normalized peak filling rate, and early filling fraction. There was a significant correlation between heart rate and time to peak early diastolic velocity, total diastolic time period, early diastolic period, atrial filling period, and atrial filling fraction. It was further observed that a significant correlation (p less than 0.001) persisted between both age and heart rate with area of early filling period, one-third filling area, one-half filling area, ratio of early to atrial peak velocity and area, atrial filling fraction, and one-third filling fraction. None of the parameters were found to correlate with fractional shortening or left ventricular mass. Thus an effort was made to establish normal limits for various Doppler-derived parameters in healthy volunteers for future comparison in diseased states.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of aging on Doppler echocardiographic filling parameters in normal subjects and in patients with coronary artery disease

This study was performed investigate and to investigate the influence of age on left ventricular diastolic filling parameters, as assessed by pulsed Doppler echocardiography. The study population consisted of 67 normal healthy subjects (Group I, age 15-66 years) and 117 patients (Group II, age 24-79 years), with angiographically proven coronary artery disease. Transmitral flow velocities were obtained by pulsed Doppler measurements at the level of the mitral annulus. Peak early and late diastolic filling velocities as well as integrated velocities during early and late filling phases were investigated for their relation to aging and a possible alteration with coronary artery disease. In normal subjects, a reduction of early filling velocities and a compensatory increase in late filling velocities were found with increasing age. In patients with coronary artery disease, however, there was no significant correlation of filling parameters with age. In addition, a comparison of filling parameters between age-matched normals and patients with coronary artery disease showed a further reduction of the contribution of early filling in patients with coronary artery disease. Thus, factors other than age may influence left ventricular diastolic filling behavior in patients with coronary artery disease. This can be demonstrated noninvasively using pulsed Doppler technique.     

Left ventricular diastolic filling in patients with left ventricular dysfunction

The pattern of abnormal left ventricular diastolic filling and its specificity in coronary disease patients with severe left ventricular dysfunction has received little attention. We evaluated the left ventricular diastolic filling curve derived from gated blood pool scans in 21 normals, 61 coronary disease patients with ejection fractions less than or equal to 30%, and 51 congestive cardiomyopathy patients with ejection fraction less than or equal to 30%. The peak filling rate (PFR), peak ejection rate (PER), PFR/PER and the % stroke volume filled at 1/3 of diastole (%SV-1/3 DT) and at the end of the rapid filling period (%SV-RFP) were determined for each group. The PFR and PER were reduced in both coronary disease and congestive cardiomyopathy groups. The PFR/PER was increased in the coronary disease group (1.19 +/- 0.28) and congestive cardiomyopathy group (1.21 +/- 0.32) as compared to normals (0.93 +/- 0.20, P less than 0.001). A greater %SV-1/3 DT and %SV-RFP were noted in both coronary disease and congestive cardiomyopathy groups. Coronary disease and congestive cardiomyopathy patients with a mean pulmonary capillary pressure (PCP) greater than or equal to 18 mm Hg had a greater PFR/PER, %SV-1/3 DT, and %SV-RFP than patients with a PCP less than 18 mm Hg. An abnormal and nonspecific pattern of left ventricular diastolic filling is present in both coronary disease and congestive cardiomyopathy patients and is characterized by an increased PFR/PER, a greater %SV-1/3 DT, and a greater %SV-RFP. This pattern may be related to elevated PCPs.     

The E/e filling index and right ventricular pressure in relation to applied international Doppler recommendations of left ventricular filling assessment.

AIM: A ratio>15 between the early diastolic pulsed Doppler velocities of the mitral inflow (E) and the basal left ventricular (LV) tissue (e) has been demonstrated to predict an elevated LV filling pressure (FP). An elevated LVFP implies an elevated right ventricular pressure (RVp). In order to investigate the sensitivity of the E/e filling index, we compared E/e and RVp, in their ability to identify a Doppler-assumed elevation of LVFP. METHODS AND RESULTS: Application of pulsed Doppler international recommendations grouped 134 patients with acute coronary syndromes (ACS) and 50 age- and sex-matched controls, according to LV filling: normal; delayed relaxation; an isolated pathological mitral-pulmonary venous-A-wave-duration difference; pseudo normal; or a restrictive filling pattern. An E/e>15 and an RVp>30 mmHg showed the following (%) sensitivity (32/94), specificity (95/76), positive (68/59), and negative (80/97) predictive values of a Doppler-assumed elevation of LVFP, in terms of either a pseudo normal or a restrictive filling pattern. CONCLUSION: The low sensitivity of E/e to detect a Doppler-assumed elevation of LVFP could limit its clinical usefulness as a single variable, in ACS. The high sensitivity and negative predictive value of RVp support its use as an additional LV filling variable in these patients.     

Doppler echocardiographic evaluation of left ventricular function

Invasive measurements of maximum acceleration of aortic blood flow are sensitive indicators of left ventricular function. Doppler echocardiography provides noninvasive measurements of aortic blood flow acceleration. Our studies establish the accuracy of Doppler-derived indices of aortic blood flow velocity for evaluation of left ventricular function. Doppler-derived peak velocity and mean acceleration showed excellent correlation with invasively measured peak left ventricular dP/dt and maximum aortic blood flow (dQ/dt) under varying heart rate, preload, afterload, and inotropic states. Similar correlations were observed between Doppler-derived peak velocity and mean acceleration and invasively measured left ventricular dP/dt and dQ/dt under conditions of varying degrees of myocardial ischemia. Thus, Doppler echocardiography provides an accurate noninvasive method to evaluate left ventricular performance.     

Impaired left ventricular filling during ST-segment depression provoked by dipyridamole infusion in patients with syndrome X

The left ventricular filling and regional wall motion patterns were compared in 6 normal subjects, 20 patients with coronary artery disease, and 10 patients with syndrome X by means of Doppler and two-dimensional echocardiography during high-dose (0.9 mg/kg body weight in 10 min) dipyridamole infusion. During the procedure none of the normal subjects had chest pain or significant ST depression (greater than 0.1 mV) whereas 10 of 20 patients with coronary artery disease had ST depression, 3 with chest pain. Six patients with syndrome X had ST depression, 5 with chest pain. Regional wall motion abnormalities were identified in 6 patients with coronary artery disease who had ST depression but none were detected in normals or in patients with syndrome X. Compared with normals (-2.1 +/- 3.5%) there was a significant difference in percentage decrease in the peak early filling velocity in patients with coronary artery disease and ST depression (-10.3 +/- 6.2%; p less than 0.01) and in patients with syndrome X and ST depression (-9.4 +/- 6.9%; p less than 0.05). These findings indicate that, in the presence of dipyridamole-induced ST depression, patients with syndrome X have an abnormal left ventricular filling pattern similar to that observed in patients with coronary artery disease. This suggests that myocardial ischemia occurs in patients with syndrome X but the absence of regional wall motion abnormality suggests that it is diffuse.     

Effect of altered loading conditions during haemodialysis on left ventricular filling pattern

Changes in the circulating volume associated with haemodialysisresult in modification of left ventricular loading conditions.To determine the influence of haemodialysis on Doppler indicesof left ventricular filling, 12 patients (mean age 40.8 ±2.7(SEM) years) with renal insufficiency but without overt heartdisease were studied by Doppler-echocardiography immediatelybefore and after haemodialysis. Haemodialysis resulted in adecrease in body weight from 68.0±3.8 kg to 65.0 ±3.7kg (P< 0.01). Heart rate and blood pressure did not changesignificantly during haemodialysis. Left ventricular diastolicdimension (M-mode) decreased from 53.5±1.1 mm to 49.5±1.9mm (P < 0.05), whereas the shortening fraction did not change.Haemodialysis elicited marked changes in the early diastolicrapid filling wave (E wave) recorded by pulsed Doppler at thelevel of the mitral annulus. Peak velocity of the early rapidfilling phase (peak E) decreased significantly from 95.3 ±8.2 cm .s^–1 to 63.0 ±5.7cm .s^–1 (P< 0.001)and mid-diastolic deceleration of transmitral velocity decreasedfrom 437.3 ±54.2 cm . s^–2 to 239.7 ±54.4cm . s^–2 (P<0.01). The peak filling velocity duringatrial contraction (peak A) did not change (79.7 ±6.3cm .s^–1 vs 74.1±4.7 cm.s^–1;P=NS). The ratiopeak E/peak A decreasedfrom 1.19±0.06 to 0.85 ±0.04 (P < 0.01) during haemodialysis. The results providefurther evidence for the pronounced preload-dependence of Dopplerindices of left ventricular diastolic function.     

Differentiation of left ventricular diastolic dysfunction, identification of pseudonormal/restrictive mitral inflow pattern and determination of left ventricular filling pressure by Tei index obtained from tissue Doppler echocardiography

BACKGROUND: Tei index obtained from tissue Doppler echocardiography (TDE-Tei index) has an inherent advantage of recording its systolic and diastolic components simultaneously on the same cardiac cycle. The aims of this study are to evaluate whether TDE-Tei index also exerts a correlation with left ventricular (LV) systolic and diastolic function and filling pressure and to see whether it can effectively identify the pseudonormal/restrictive mitral filling pattern. METHODS: Echocardiographic examination was performed in 243 consecutive patients. These patients were classified into three groups as normal, abnormal relaxation, and pseudonormal/restrictive groups according to the transmitral E/A-wave velocity (E/A), early diastolic velocity of lateral mitral annulus (Ea) and E/Ea. RESULTS: Standard Doppler indices of LV filling such as E, A, E/A, and E-wave deceleration time had a bimodal distribution, but Ea decreased and E/Ea and TDE-Tei index increased progressively with worsening of LV diastolic function. The sensitivity and specificity of TDE-Tei index>0.51 in the discrimination of pseudonormal/restrictive filling pattern were 85% and 96%, respectively. After stepwise multiple linear regression analysis, TDE-Tei index had a significant negative correlation with Ea (beta=-0.296, P<0.001) and ejection fraction (beta=-0.293, P<0.001) and positive correlation with E/Ea (beta=0.235, P=0.001). CONCLUSIONS: TDE-Tei index increased with worsening of LV diastolic function and can effectively identify the pseudonormal/restrictive mitral inflow pattern. It also correlated with the echocardiographic parameters of LV systolic and diastolic function and filling pressure. It suggests that TDE-Tei index is a simple and feasible marker in assessing global LV function.     

Echo-Doppler evaluation of the effects of heart rate increments on left atrial pump function in normal human subjects

It is commonly believed that the atrial contribution to left ventricular filling increases during heart rate increments. However, the relative contribution of the pump function (atrial systole) and of the passive role (diastasis and reservoir) of the atrium to end-diastolic left ventricular filling is not well known. In order to investigate this problem, we performed a two-dimensional echo-Doppler study during right atrial pacing. Transmitral flow velocity curves were obtained by means of pulsed Doppler. Pacing was performed (1) at the lowest heart rate at which it was possible to obtain a stable capture of the atria, (2) at the heart rate at which the early and late Doppler filling waves almost completely overlapped. In both stages pacing was interrupted for a few seconds to obtain some post-pacing beats. Doppler tracing recorded at rest, during pacing and in the immediate post-pacing beats were analysed to obtain well-known parameters of atrial contribution; atrial peak flow velocity, early to atrial peak flow velocity ratio, and time-velocity integral of the atrial wave. Furthermore, in order to distinguish end-diastolic passive flow from the active contribution of atrial systole to filling, we superimposed the envelope of the last Doppler curve obtained during atrial pacing over the envelope of the first post-pacing curve. In this way the area of the atrial wave of the paced beat was divided by the mid-diastolic part of the post-pacing one into two areas, the integrals of which correspond to the active and passive atrial contribution respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pattern of left ventricular filling in hypertrophic cardiomyopathy: Assessment by Doppler echocardiography and radionuclide angiography

Aims The left ventricle in hypertrophic cardiomyopathy is anatomicallyand functionally non-uniform. This study was undertaken to verifywhether a heterogeneity in the pattern of diastolic fillingcan be detected along the left ventricular inflow tract in hypertrophiccardiomyopathy. Methods and results Early (E) and late (A) diastolic velocitieswere recorded by Doppler echocardiography at mitral and at mid-ventricularlevel in 16 normal volunteers and 30 patients with hypertrophiccardiomyopathy. Patients with hypertrophic cardiomyopathy alsounderwent radionuclide angiography to assess left ventricularfunction. E wave decreased significantly in normal volunteers(80±15 to 60±14cm.s^–1;P<0·001),but it increased in hypertrophic cardiomyopathy (76±22to 87±28cm.s^–1;P=0·04), whereas the A wavedecreased similarly in both. By multivariate analysis, systolicasynchrony and the ejection fraction of left ventricular lateralwall were directly related to the pattern of early filling progression(r=0·656; F=9·467;P<0·002). Moreover,systolic asynchrony showed a univariate direct correlation withchanges in E velocity (r=0·42;P=0·02). Conclusion Many patients with hypertrophic cardio-myopathy havean acceleration of filling within the left ventricular inflowtract; this phenomenon is directly related to systolic asynchronyand ejection fraction of the left ventricular lateral wall,suggesting increased suction.     

Doppler echocardiographic assessment of left ventricular filling dynamics in patients with coronary heart disease and normal systolic function

The purpose of this study was to assess altered left ventriculardiastolic filling by noninvasive means in patients with coronaryartery disease and normal systolic pump function. Mitral inflowvelocity was measured by pulsed Doppler, and left ventricularvolumes were obtained from cross-sectional echocardiographyat rest and during upright bicycle exercise. Peak and integratedearly and late diastolic filling velocities were calculatedfrom Doppler-derived time-velocity curves. Studies were performedin normal subjects (group I, n = 8) and in patients with angiographicallyproven coronary artery disease (Group II, n = 18). The ejectionfraction was not significantly different in group II as comparedto group I (group 1, 60 ± 7%; group II, 55 ± 11%).During exercise, ejection fraction increased significantly ingroup I by 7·6%, but did not increase in group II. Inall cases, diastolic filling showed a biphasic pattern. At rest,the major part of diastolic filling occurred during early diastole:the ratio of early filling velocity integral (E) to the latefilling velocity integral (L) was significantly greater in groupI than in group II (group I, 1·74 ± 37; groupII, 1·19 ±·3, P<0·001). Duringexercise, early diastolic filling was unchanged in normal subjectsbut decreased in patients, with a significant decrease in E/Lindex of 34% (P < 0·001). Thus, pulsed Doppler echocardiography provides a useful methodfor assessing noninvasively exercise-induced changes in leftventricular diastolic filling dynamics in patients with coronaryartery disease.     

Doppler assessment of right ventricular filling dynamics during volume loading in ischemic heart disease.

To assess the effects of volume loading on right ventricular (RV) filling dynamics, the RV inflow pattern was recorded using pulsed Doppler echocardiography (PDE) during dextran infusion in 7 normal subjects (Group I) and 24 patients with ischemic heart disease. The patients with ischemic heart disease were divided into three groups according to the left ventricular (LV) and RV ejection fractions (EF). Group II consisted of 11 patients whose LVEF and RVEF exceeded 50%. Group III consisted of 7 patients whose LVEF was lower than 50% and RVEF was higher than 50%. Group IV was comprised of 6 patients whose LVEF and RVEF were lower than 50%. Peak flow velocity of the RV rapid filling wave in early diastole [R(T)] and that of the atrial contraction wave [A(T)] were measured, and the ratio of A(T) to R(T) [A(T)/R(T)] in each cardiac cycle was calculated. In some of the subjects, simultaneous right-sided cardiac catheterization was performed with a Swan-Ganz thermodilution catheter. The LV and RV function during volume loading were calculated according to the following formulae: delta Stroke volume index (SVI)/delta pulmonary artery wedge pressure (PAWP) and delta SVI/delta right atrial pressure (RAP), respectively. After dextran infusion, R(T) increased significantly in Groups I, II, and III, but not in Group IV. The A(T) and A(T)/R(T) ratio remained unchanged in all groups. The percent change of the R(T) correlated well with delta SVI/delta RAP (r = 0.56, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

The third heart sound

A unitary concept is proposed to explain the genesis of the third heart sound and associated "rapid filling wave" of the apexcardiogram in physiological and pathological states including constrictive pericarditis. This theory not only clarifies the hitherto unexplained phenomenon such as presence of S3 in significant mitral stenosis, but also places in proper perspective the hemodynamic significance of S3 in physiological and various pathological states.     

102名健康中年人运动试验前后舒张功能的正常变异

目的：观察健康中年人运动试验前后舒张功能的变化。方法：使用多普勒彩色超声心动图仪分别测量102名健康中年人静息时、运动试验后15min及60min的E峰最大流速（EPFV）、A峰最大流速（APFV）、EPFV／APFV（EK／A）比值、E峰减速时间（Edt)。结果：健康中年人运动试验后15min及60min EPFV、E／A比值、Edt与静息时相比均明显下降。APFV运动试验前后无差异。运动试验后15min E/A比值比静息时降低0．5以内。结论：健康中年人运动试验后舒张功能存在生理性下降，运动后15min的E／A比值较静息时明显降低，但应＜0．5。     

Coronary artery bypass grafting in patients with severe left ventricular dysfunction: predictive significance of left ventricular diastolic filling pattern.

AIMS: The aim of our study was to evaluate the influence of left ventricular (LV) diastolic filling impairment on postoperative results in patients (pts) with low LV ejection fraction (EF) (<35%) undergoing coronary artery bypass grafting (CABG). METHODS: The study covered 56 patients (mean age 58.9 +/- 17.1 years). Two dimensional Doppler echocardiographic investigations were performed pre- and 10-14 days post-CABG. Patients were divided into three groups according to the LV diastolic filling. RESULTS: Early postoperative mortality rate (including perioperative period and 2 weeks after surgery) was highest in the restriction group (33%) vs. pseudonormalization (12.5%) vs. impaired relaxation (13.6%). Postoperative cardiovascular complications rate was highest also in the restriction group, 55.5%, and did not differ between pseudonormalization (25%) and impaired relaxation group (27.2%). Logistic regression analysis showed that restrictive LV filling pattern, early diastolic filling deceleration time and LV end-diastolic diameter independently influence perioperative mortality. In the early postoperative period mean LV wall motion score (WMS) did not improve in 8/19 (42%), 6/14 (43%) and 8/12 (67%) patients, respectively, in the impaired relaxation, pseudonormalization and restriction group. CONCLUSIONS:In patients with severe LV dysfunction undergoing CABG, impaired relaxation and pseudonormal pattern of LV diastolic filling correlated with postoperative improvement in LV regional contraction, while restrictive pattern correlated with high early postoperative mortality, morbidity and minimal improvement in LV systolic function. Restrictive LV filling pattern, early diastolic filling deceleration time and LV end-diastolic diameter were found to be independent predictors of perioperative mortality.     

Significance of echocardiographic atrioventricular plane displacement for the evaluation of left ventricular filling and end-diastolic pressure in patients with coronary artery disease

The aim of this study is to assess the left ventricular filling and estimate the end-diastolic pressure of the left ventricle in patients with coronary artery disease (CAD) by echocardiographic measurement of the atrioventricular plane displacement (AVPD). In 101 patients (mean age 59 ±12 years) with CAD, a complete transthoracic echocardiographic study was performed, just prior to cardiac catheterization. The AVPD was recorded by Mmode echocardiography, from apical four and two chamber views. The recordings were obtained at four sites, corresponding to the septal, lateral, anterior and inferior walls of the left ventricle. The mean AVPD resulting from atrial systole (At), the mean total (T) diastolic AVPD, the ratio At/T(%) and the ratio of mitral annulus excursion during early and late diastole [(T-At)/At] were calculated. Firty-two age-matched healthy subjects served as control group. Both At and At/T were significantly greater in patients with CAD than in the controls (6.06 ±0.94 vs 5.53 ±0.55 mm, p<0.01 and 43.4 ±5.9% vs 33.49 ±4.45%, p<0.001 respectively). The ratio [(T-At)/At] correlated with the E/A ratio of transmitral flow, both in healthy subjects (r=0.850, p<0.001) and in patients with CAD (r = 0.722, p<0.001). Correlation also existed both in patients with segmental wall motion abnormality (SWMA) (r = 0.691, p<0.001) and in patients with SWMA (r=0.818, p<0.001). In patients with CAD, At/T further correlated with the left ventricular end-diastolic pressure (r=0.517, p<0.001). In patients with SWMA and in patients without, a correlation was also found (r=0.516, p<0.001 and r=0.566, p<0.001 respectively). In conclusion, AVPD measured by echocardiography can be used as a simple noninvasive parameter to evaluate left ventricular filling in patients with CAD and for the gross estimation of end-diastolic pressure of left ventricle.