Non-invasive assessment of left ventricular function in coronary artery disease by Doppler stress testing

Left ventricular (LV) function in 62 patients presenting with chest pain typical of angina was studied non-invasively at rest and at maximum-tolerated supine exercise using the continuous-wave Doppler technique of transcutaneous aorto-velography (TAV). The signals were analysed to derive peak velocity (Vp), systolic velocity integral [an index of stroke volume or stroke distance (Sd)], and minute distance (Md; index of cardiac output = Sd X heart rate). Comparison was made with results obtained from 66 normal volunteers. The percentage change in stroke distance with exercise (% delta Sd) was significantly related to the resting ejection fraction (EF) calculated from left ventriculography (r = 0.84), and was below 6% (lowest value observed in normal volunteers) in all of the 23 patients with coronary artery disease (CAD) whose EF was below 60%. No significant difference was observed in the % delta Sd between normal individuals and the 12 patients presenting with chest pain but who had normal coronary arteriograms. However, the % delta Vp, delta % Sd and % delta Md in the 50 patients with CAD were significantly lower than the normal individuals and the 12 patients with normal coronary arteriograms. Lower TAV measurements were observed with exercise, rather than at rest, with increasing number of coronary arteries with significant stenoses and the presence of history of myocardial infarction (linear trend p less than 0.003). These results suggest that Doppler recording of aortic blood velocity with exercise is a clinically useful non-invasive technique for studying LV performance in patients with CAD.(ABSTRACT TRUNCATED AT 250 WORDS)     

三维斑点追踪技术评价2型糖尿病患者左心室心肌收缩功能

目的应用三维斑点追踪超声心动图(3D-STE)评估2型糖尿病(T2DM)患者血糖在控制与非控制情况下,左心室各应变指标的差异及其与糖化血红蛋白(HbA1c)水平的相关性。方法收集60例T2DM患者(病例组),依据HbA1c水平分为A1亚组(HbA1c7%)和A2亚组(HbA1c≥7%),各30例,同时收集30名健康志愿者(对照组),其左心室射血分数(LVEF)均在正常范围(≥55%)。采集标准心尖四腔观左心室全容积图像,于Echopac PC工作站进行脱机分析,计算左心室整体纵向应变(LVGLS)、整体圆周应变(LVGCS)、整体径向应变(LVGRS)和整体面积应变(LVGAS)。比较病例组与对照组间各指标的差异,分析病例组应变值与HbA1c的相关性。结果与对照组比较,A1、A2亚组LVGLS均减低(P均0.05),A2亚组减低更为明显,A2亚组LVGCS、LVGAS和LVGRS亦明显减低(P均0.05),而A1亚组与对照组的差异均无统计学意义(P均0.05)。A2亚组中LVGLS(r=0.33,P0.01)、LVGAS(r=0.33,P0.01)、LVGCS(r=0.40,P0.01)、LVGRS(r=-0.54,P0.01)均与HbA1c具有相关性。结论 3D-STE能较准确地评价T2DM患者左心室心肌收缩功能的改变,其中LVGLS可以作为一项敏感指标。对于血糖控制不佳者,其HbA1c与心肌收缩功能损害具有相关性,可用于临床监控心肌损害。     

Assessment of left ventricular function by tissue Doppler echocardiography in pediatric chronic kidney disease

Abstract

Background: Cardiovascular (CV) disease remains the most common cause of mortality in chronic kidney disease (CKD). Methods: In this cross-sectional study, 43 pediatric patients with CKD were divided into two groups according to their estimated glomerular filtration rate (eGFR): groups 1 and 2 (eGR; 29–75 and 15–29?mL/min/1.73?m², respectively). M – mode, conventional pulsed wave Doppler (cPWD) echocardiography and tissue Doppler imaging (TDI) were performed in all patients and 16 healthy controls. Maximal early (E wave) and late (A wave) diastolic flow velocities were assessed by cPWD. Using TDI, the early (E′) and late (A′) diastolic filling velocities were recorded. Early and late diastoles were evaluated using E′ values and E/E′ ratios, respectively. Results: Left ventricular hypertrophy (LVH) was determined in 19/43 (44.2%) patients. The E/E′ ratio was significantly higher in group 2 than in group 1 and controls. E/E′ was found to be positively correlated with left ventricular mass (LVM) index, and negatively with hemoglobin (Hb) levels. Low Hb levels were only independent predictor of E/E′ (p?=?0.001, β: ?0.470, 95% CI: ?0.764; ?0.196). E′ ratio was significantly lower in both patient groups compared to the controls. Conclusions: LVH and diastolic dysfunction are already present in early stages of CKD. Treatment of risk factors, such as anemia, is important to improve the clinical outcome.     

应用多普勒Tei-指数评价糖耐量异常及糖尿病患者的左室功能

目的 探讨超声多普勒Tei-指数评价糖耐量异常（IGT）及糖尿病（DM）患者左室功能的价值。方法 应用超声心动图对30例糖耐量正常者（NGT）、20例IGT及35例DM患者进行检查，分别比较：左室射血分数（EF）、二尖瓣血流频谱参数（VE、VA、VE/VA）、左室TEI-指数（TEI—index）。结果 ①DM组与NGT组相比：VA、Tei—index均明显升高（P〈0．01），VE／VA明显下降（P〈0．01），VE及EF下降（P〈0．05）；②IGT组与NGT组比较：VA、Tei—index升高（P〈0．05），VE/VA下降（P〈0．05），VE、EF改变无统计学意义；③DM组与IGT组比较：IGT组与NGT组比较：Tei—index升高（P〈0．05），VE/VA下降（P〈0．05），VA、VE、EF改变无统计学意义。结论 Tei—index是一种新的评价IGT和DM患者左室心功能的方法，敏感性和准确性高．可重复性好，对防治IGT和DM患者的心脏损害有重要指导意义。     

Normal left ventricular performance in children with X-linked hypophosphatemic rickets: a Doppler echocardiography study

To determine if chronic hypophosphatemia causes myocardial dysfunction, we explored one model for this metabolic derangement by prospectively investigating 11 patients (aged 5-18 years) with X-linked hypophosphatemic rickets (XLH) by M-mode, two-dimensional, and Doppler echocardiography. Inorganic phosphate and calcitriol (1,25-dihydroxyvitamin D3) treatment was withheld 72 h prior to study. None of the patients had cardiovascular symptoms. Fasting serum inorganic phosphate concentrations were subnormal in all: 2.6 +/- 0.5 mg/dl (SD). Serum total and ionized calcium, magnesium, sodium, potassium, and creatine kinase myocardial fraction (CK-MB) levels were unremarkable. Electrocardiograms revealed early repolarization abnormalities in 3 of the 11 patients: 1 had significant QT prolongation (corrected for heart rate), and 2 had T wave abnormalities. Exaggerated U waves occurred in 4 subjects. Resting echocardiograms were normal in 9 patients. In 1 subject there was mitral valve prolapse, and 1 patient possibly had an atrial septal defect (these findings were considered unrelated to hypophosphatemia). All M-mode measurements were normal. The two-dimensionally derived end-diastolic and end-systolic left ventricular volumes were 60.3 +/- 18.0 and 20.5 +/- 6.9 ml, respectively. Left ventricular ejection fraction was 66.1 +/- 4.7%, and the cardiac index by Doppler study was 4.1 +/- 0.8 liters/min per m2 (both values were within normal limits). Although the precise pathogenesis of XLH is unknown and our findings suggest that some electrocardiographic abnormalities may be common in this disorder, we found no evidence for left ventricular dysfunction in this human model of clinically significant long-standing hypophosphatemia.     

Myocardial blood volume reserve by intravenous contrast echocardiography predicts improvement in left ventricular function in patients with nonischemic dilated cardiomyopathy

Background

Impaired myocardial perfusion has been shown in nonischemic dilated cardiomyopathy (DCM). Intravenous myocardial contrast echocardiography (MCE) has been introduced to examine myocardial blood volume (MBV) noninvasively. This study was designed to evaluate if MBV reserve assessed by intravenous MCE with adenosine triphosphate (ATP) can predict efficacy of optimal medical therapy in patients with DCM.

Methods and results

Fifteen DCM patients and 8 control subjects underwent conventional echocardiography and intravenous MCE. We obtained the change in peak contrast integrated backscatter intensity (?PI) by ATP on the left ventricular (LV) anteroseptal myocardium. After 3 months of optimal medical therapy in DCM patients, we reperformed conventional echocardiography. A good responder to therapy was defined as a decrease in LVDd >5 mm to final LVDd <55 mm and increase in LVEF >20 % to final LVEF >45 %. In DCM patients, ?PI was lower compared to controls (p < 0.001). Good responders to therapy (n = 6) had higher ?PI than poor responders (n = 9) (p < 0.05).

Conclusions

The present study demonstrates that the response to the medical therapy in DCM is predicted by the assessment of dilator reserve in MBV. Intravenous MCE with ATP may provide useful information to evaluate MBV reserve.

     

Intraoperative assessment of the mitral valve: transesophageal Doppler echocardiography vs. left ventricular filling of the flaccid heart.

Several methods can be used for the intraoperative assessment of residual mitral regurgitation (MR) following reconstruction of the mitral valve. The aim of this study was to compare the reliability of two of these methods: left ventricular filling of the arrested heart with saline (LVF) and intraoperative transesophageal Doppler echocardiography (TEE). Reliability was assessed by comparing LVF and TEE to postoperative left ventricular angiography (LVA) in 27 patients. LVF, TEE and LVA grading of MR was 0-4. Correlations, as measured by the Kappa statistic, were as follows: LVF-LVA: K = 0.33 (95% confidence interval (CI): 0.06-0.59), TEE-LVA: K = 0.48 (95% CI: 0.20-0.77), LVF-TEE: K = 0.43 (95% CI: 0.20-0.67). Considering LVF and TEE as predictors of LVA gradings above 2, sensitivities were 0.4 and 0.6, respectively. Specificities were 1.0 for each method. In conclusion, we found TEE in the beating heart not to be significantly more reliable in the prediction of residual MR than LVF in the flaccid heart.     

Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64)

BACKGROUND: The progression of nephropathy from diagnosis of type 2 diabetes has not been well described from a single population. This study sought to describe the development and progression through the stages of microalbuminuria, macroalbuminuria, persistently elevated plasma creatinine or renal replacement therapy (RRT), and death. METHODS: Using observed and modeled data from 5097 subjects in the UK Prospective Diabetes Study, we measured the annual probability of transition from stage to stage (incidence), prevalence, cumulative incidence, ten-year survival, median duration per stage, and risk of death from all-causes or cardiovascular disease. RESULTS: From diagnosis of diabetes, progression to microalbuminuria occurred at 2.0% per year, from microalbuminuria to macroalbuminuria at 2.8% per year, and from macroalbuminuria to elevated plasma creatinine (>or=175 micromol/L) or renal replacement therapy at 2.3% per year. Ten years following diagnosis of diabetes, the prevalence of microalbuminuria was 24.9%, of macroalbuminuria was 5.3%, and of elevated plasma creatinine or RRT was 0.8%. Patients with elevated plasma creatinine or RRT had an annual death rate of 19.2% (95% confidence interval, CI, 14.0 to 24.4%). There was a trend for increasing risk of cardiovascular death with increasing nephropathy (P < 0.0001), with an annual rate of 0.7% for subjects in the stage of no nephropathy, 2.0% for those with microalbuminuria, 3.5% for those with macroalbuminuria, and 12.1% with elevated plasma creatinine or RRT. Individuals with macroalbuminuria were more likely to die in any year than to develop renal failure. CONCLUSIONS: The proportion of patients with type 2 diabetes who develop microalbuminuria is substantial with one quarter affected by 10 years from diagnosis. Relatively fewer patients develop macroalbuminuria, but in those who do, the death rate exceeds the rate of progression to worse nephropathy.     

Microalbuminuria and the risk for early progressive renal function decline in type 1 diabetes

This study aimed to establish the time of initiation and the determinants of renal function decline in type 1 diabetes. Until now, such decline has been assumed to be a late-occurring event associated with proteinuria. A total of 267 patients with normoalbuminuria and 301 patients with microalbuminuria were followed for 8 to 12 yr. Linear trends (slopes) in GFR were estimated by serial measurement of serum cystatin C. Cases of early renal function decline were defined by loss in cystatin C GFR that exceeded -3.3%/yr, a threshold that corresponds to the 2.5th percentile of the distribution of GFR slopes in an independent nondiabetic normotensive population. Cases of early renal function decline occurred in 9% (mean slope -4.4; range -5.9 to -3.3%/yr) of the normoalbuminuria group and 31% (mean slope -7.1; range -23.8 to -3.3%/yr) of the microalbuminuria group (P < 0.001). Risk for early renal function decline depended on whether microalbuminuria regressed, remained stable, or progressed, rising from 16 to 32 and 68%, respectively (P < 0.001). In multivariate analysis, risk for decline was higher after age 35 yr or when glycosylated hemoglobin exceeded 9% but did not vary with diabetes duration, smoking, BP, or angiotensin-converting enzyme inhibitor treatment. Contrary to the existing paradigm of diabetic nephropathy, progressive renal function decline in type 1 diabetes is an early event that occurs in a large proportion of patients with microalbuminuria. Together with testing for microalbuminuria, clinical protocols using cystatin C to diagnose early renal function decline and track response to therapeutic interventions should be developed.     

Evaluation of left ventricular diastolic function: state of the art after 35 years with Doppler assessment

Left ventricular (LV) diastolic function can be evaluated by echocardiographic indices of LV relaxation/restoring forces, diastolic compliance, and filling pressure. By using a combination of indices, diastolic function can be graded and LV filling pressure estimated with high feasibility and good accuracy. Evaluation of diastolic function is of particular importance in patients with unexplained exertional dyspnea or other symptoms or signs of heart failure which cannot be attributed to impaired LV systolic function and to assess filling pressure in patients with heart failure and reduced LV ejection fraction. Furthermore, grading of diastolic dysfunction can be used for risk assessment in asymptomatic subjects and in patients with heart disease.     

Echocardiographic assessment of left ventricular function in left ventricular volume load and the immediate changes after operation

Cardiac function and changes following surgery was studied with computerized M-mode echocardiography in 12 patients with volume load of the left ventricle. Half of them had congenital lesions, the other half aortic regurgitation. Left ventricular (LV) shortening fraction and LV ejection time were significantly reduced postoperatively and came close to normal mean values. Also cardiac output and LV diameters normalized or at least started its normalization. The computerized values for rates of decrease and increase of left ventricular diameter were reduced postoperatively (p less than 0.01 and p less than 0.05 respectively) compared to elevated preoperative values. The study shows that relief of volume load on the left ventricle immediately leads to normalization of left ventricular function, especially if the myocardium was intact preoperatively.     

组织多普勒等容收缩期参数评价2型糖尿病患者右心室功能

目的应用脉冲组织多普勒参数评价无临床症状2型糖尿病患者的右心室功能。方法应用超声心动图脉冲组织多普勒技术检测血压正常的糖尿病患者（DM组,n=24）、合并高血压的糖尿病患者（DMHT组,n=22）及30名正常人（NC组）的右心室功能,得出常规二维超声测值及组织多普勒参数值,包括等容收缩期加速度（IVA）、等容收缩期峰值流速（IVV）、收缩期峰值流速（Sa）、舒张早期峰值流速（Ea）、舒张晚期峰值流速（Aa）、Ea/Aa、E/Ea及Tei指数,并进行统计学分析。结果 3组间常规二维超声测值差异无统计学意义。DMHT组和DM组的右心室脉冲组织多普勒参数中,Ea、Aa、Ea/Aa、E/Ea、IVA及Tei指数与NC组相比差异有统计学意义;其中DMHT组与DM组比较E/Ea及Tei指数差异有统计学意义,而IVA值差异无统计学意义。Sa及IVV在各组间比较差异均无统计学意义。IVA与Ea/Aa呈正相关（r=0.31,P〈0.01）,与E/Ea呈负相关（r=-0.44,P〈0.05）,与Tei指数呈负相关（r=-0.56,P〈0.05）。结论脉冲组织多普勒等容收缩期参数可早期无创评价糖尿病患者右心室收缩和舒张功能。     

Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study.

BACKGROUND: We evaluated to what extent the presence of risk factors and their interactions increased the likelihood of microalbuminuria (MAU) among individuals with type 2 diabetes. METHODS: Fifty-five Italian diabetes outpatient clinics enrolled a sample of patients with type 2 diabetes, without urinary infections and overt diabetic nephropathy. A morning spot urine sample was collected to centrally determine the urinary albumin/creatinine ratio (ACR). A tree-based regression technique (RECPAM) and multivariate analyses were performed to investigate interaction between correlates of MAU. RESULTS: Of the 1841 patients recruited, 228 (12.4%) were excluded due to the presence of urinary infections and 56 (3.5%) for the presence of macroalbuminuria. Overall, the prevalence of MAU (ACR = 30-299 mg/g) was of 19.1%. The RECPAM algorithm led to the identification of seven classes showing a marked difference in the likelihood of MAU. Non-smoker patients with HbA1c <7% and waist circumference 98 cm and HbA1c >8% showed the highest likelihood of MAU (odds ratio = 13.7; 95% confidence intervals 6.8-27.6). In the other classes identified, the risk of MAU ranged between 3 and 5. Age, systolic blood pressure, HDL cholesterol levels and diabetes treatment represented additional, global correlates of MAU. CONCLUSIONS: The likelihood of MAU is strongly related to the interaction between diabetes severity, smoking habits and several components of the metabolic syndrome. In particular, abdominal obesity, elevated blood pressure levels and low HDL cholesterol levels substantially increase the risk of MAU. It is of primary importance to monitor MAU in high-risk individuals and aggressively intervene on modifiable risk factors.     

Effects of surgical stress and volatile anesthetics on left ventricular global and regional function in patients with coronary artery disease. Evaluation by computer-assisted two-dimensional quantitative transesophageal echocardiography.

We investigated the effects of halothane, enflurane, and isoflurane on central hemodynamics and left ventricular global and regional function when used to control intraoperative hypertension in 39 patients with coronary artery disease. Left ventricular short-axis, midpapillary images were obtained by transesophageal echocardiography. Using a centerline algorithm, we analyzed left ventricular images for global area ejection fraction (GAEF) and segmental area ejection fraction (SAEF). The SAEF/GAEF ratio was calculated for each of eight segments. Measurements were performed after induction of anesthesia but before skin incision; 1 min after sternotomy; and during administration of the inhaled anesthetic. The increase in arterial blood pressure during sternotomy was due to an increase in vascular resistance accompanied by increases in heart rate and filling pressures while GAEF decreased. No changes in the SAEF/GAEF ratio appeared during sternotomy. The inhaled anesthetics restored arterial blood pressure by a similar decrease in vascular resistance. Isoflurane caused an increase in cardiac index that was not seen with halothane or enflurane (halothane vs isoflurane, P < 0.05). The GAEF was decreased by halothane but unaffected by isoflurane and enflurane (halothane vs enflurane; P < 0.05). Isoflurane induced a decrease in the SAEF/GAEF ratios of two segments corresponding to the inferolateral wall of the left ventricle that was, in one of these segments, significantly more pronounced compared with both halothane and enflurane. Halothane or enflurane did not cause any change in regional wall motion. We conclude that isoflurane is more likely to cause regional wall motion changes than halothane or enflurane in patients with coronary artery disease.     

二维斑点追踪成像评价萝卜硫素对2型糖尿病大鼠左心室功能的影响

目的观察二维斑点追踪成像(2D-STI)技术用于评价萝卜硫素(SFN)对2型糖尿病(T2DM)大鼠左心室功能影响的价值。方法将30只T2DM SD大鼠模型随机均分为T2DM组、T2DM+低SFN组、T2DM+高SFN组;另以10只健康大鼠为对照组(NC组)。对T2DM+低SFN组、T2DM+高SFN组每天左下腹皮下注射0.5、1.0 mg/kg体质量SFN,T2DM组和NC组注射等量生理盐水;3个月后检测各组大鼠常规超声心动图参数,包括左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、左心室射血分数(LVEF)及左心室短轴缩短率(FS),以2D-STI技术测得左心室短轴二尖瓣水平圆周应变。之后处死大鼠,取心肌组织,以天狼猩红染色观察心肌纤维化,免疫组织化学染色观察结缔组织生长因子(CTGF)表达。结果各组大鼠间体质量、随机血糖、LVDd、LVDs、LVEF、FS及局部圆周应变差异均有统计学意义(P均0.05)。T2DM组、T2DM+低SFN组、T2DM+高SFN组大鼠体质量、LVEF、FS及局部圆周应变均低于NC组(P均0.05),而随机血糖、LVDd、LVDs均高于NC组(P均0.05);T2DM+低SFN组、T2DM+高SFN组体质量、LVEF、FS、局部圆周应变高于T2DM组(P均0.05),而随机血糖、LVDd、LVDs低于T2DM组(P均0.05)。与NC组比较,其他3组大鼠心肌组织胶原沉积及CTGF阳性表达均增加,T2DM+低SFN组、T2DM+高SFN组均低于T2DM组(P均0.05),而T2DM+低SFN组与T2DM+高SFN组上述指标差异均无统计学意义(P均0.05)。结论 SFN可提高T2DM大鼠左心室局部圆周应变,减轻心肌纤维化,改善左心室心肌运动功能;2D-STI技术可用于评价SFN对T2DM大鼠左心室功能的影响。     

A genome-wide search for type 2 diabetes susceptibility genes in West Africans: the Africa America Diabetes Mellitus (AADM) Study

The incidence of type 2 diabetes is growing rapidly, not only in developed countries but also worldwide. We chose to study type 2 diabetes in West Africa, where diabetes is less common than in the U.S., reasoning that in an environment where calories are less abundant, incident cases of type 2 diabetes might carry a proportionately greater genetic component. Through the Africa America Diabetes Mellitus (AADM) study, we carried out a genome-wide linkage analysis of type 2 diabetes in a cohort of 343 affected sibling pairs (691 individuals) enrolled from five West African centers in two countries (Ghana: Accra and Kumasi; Nigeria: Enugu, Ibadan, and Lagos). A total of 390 polymorphic markers were genotyped, and multipoint linkage analysis was conducted using the GENEHUNTER-PLUS and ASM programs. Suggestive evidence of linkage was observed in four regions on three chromosomes (12, 19, and 20). The two largest logarithm of odds scores of 2.63 and 1.92 for chromosomes 20q13.3 and 12q24, respectively, are particularly interesting because these regions have been reported to harbor diabetes susceptibility genes in several other populations and ethnic groups. Given the history of forced migration of West African populations during the slave trade, these results should have considerable relevance to the study of type 2 diabetes in African Americans.     

Dobutamine stress echocardiography predicts myocardial improvement in patients supported by left ventricular assist devices (LVADs): hemodynamic and histologic evidence of improvement before LVAD explantation.

BACKGROUND: Cardiac function may improve in patients with end-stage heart failure who receive long-term support (>30 days) with left ventricular assist devices (LVADs). Dobutamine stress echocardiography (DSE) has been used to quantitate myocardial recovery in patients with heart failure supported with LVADs. By recording the hemodynamic response with the use of DSE, we evaluated and applied the resulting data to patients receiving LVAD support. METHODS AND RESULTS: The study population included 16 patients who underwent LVAD implantation, regained functional capacity on full LVAD support, and tolerated decreased mechanical support with no worsening of dyspnea or fatigue. All 16 patients underwent dobutamine stress with increasing doses of dobutamine (from 5 to 40 mcg/kg/min). Hemodynamics and 2-dimensional (2-D) echocardiography was performed at each dose level. In addition, paired myocardial samples were obtained and analyzed histologically to determine myocyte size and collagen content. Dobutamine stress separated the study population into 2 groups: those who had favorable responses to dobutamine (9/16) and those who had unfavorable responses (i.e., experienced hemodynamic deterioration; 7/16). Favorable dobutamine responses were characterized by improved cardiac index, improved force-frequency relationship in the left ventricle (dP/dt), improved left ventricular ejection fraction, and decreased left ventricular end-diastolic dimension. All 9 favorable responders underwent LVAD explantation, and 6 survived for more than 12 months. In all patients studied, LVAD support resulted in decreased myocyte size (n = 14, 33.9 +/- 0.9 microm before vs 16.6 +/- 0.8 microm after support, p = 0.0001; normal, 5-15 microm) but resulted in no consistent changes in collagen content. CONCLUSIONS: Dobutamine stress echocardiography with hemodynamic assessment may be a useful tool in assessing physiologic improvement in myocardial function of patients with end-stage heart failure who receive LVAD support. It may help predict which patients can tolerate LVAD removal. Prospective analysis of cardiac function is now warranted to better define myocardial recovery in patients supported with LVADs.     

Differences in left ventricular filling patterns in heart and heart-lung transplant recipients as assessed by Doppler echocardiography of transmitral flow.

The conventional surgical technique of orthotopic heart transplantation involves reconstruction of atria from donor and recipient components. The mechanical function of the atria is thus likely to be altered either by this anatomic disruption or by the autonomic denervation, which also occurs as a result of transplantation. We investigated 18 subjects with Doppler echocardiography of transmitral flow, to assess the contributions of passive and active filling of the left ventricle in six normal subjects, six heart transplant recipients, and six heart-lung transplant recipients. The ratio of passive transmitral flow to active flow was significantly higher in isolated heart transplant recipients than in normal subjects (p < 0.001), suggesting a reduced active, late diastolic component to left ventricular filling. This was not due to denervation, because the ratio in heart-lung recipients was lower than that in normal subjects (p < 0.01). These data suggest that anatomic rather than neural dysfunction is responsible for a major change in transmitral flow characteristics after isolated heart transplantation; whether the resulting change in pattern of left ventricular filling is clinically important deserves further investigation.