Impact of a hemodialysis session on cardiac function in patients with chronic renal failure

AIM: To determine the impact of hemodialysis (HD) session on cardiac function in patients with chronic renal failure. MATERIAL AND METHODS: Thirty patients (17 male, 13 female, mean age 49 +/- 11 years) on bicarbonate HD were studied. M-mode echocardiography was performed and ejection fraction (EF) was estimated. Transmitral flow was assessed by Doppler echocardiography. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time (IVRT) and early deceleration time (DT) were estimated. All the estimations were made one hour before and immediately after HD by one investigator. Flow propagation velocity of early diastolic flow was assessed by color M-mode Doppler echocardiography. RESULTS: A significant decrease of the ejection fraction (delta EF) was observed only in patients with intradialytic hypotension. Hemodialysis resulted in a decrease of early flow velocity from 99.2 +/- 23.8 to 80.6 + 26.0 cm/s (p = 0.0000) and E/A ratio from 1.23 +/- 0.57 to 0.98 +/- 0.43 (p = 0.006). IVRT and DT showed no significant difference. There was a significant positive correlation between the amount of ultrafiltration and deltaE (r = 0.46; p = 0.01), there was no correlation between the amount of ultrafiltration and delta Vp (r = -0.01; p = 0.9). CONCLUSION: The results show that a hemodialysis session influences cardiac function in patients with chronic renal failure. Early diastolic filling considerably decreased in correlation with ultrafiltration. A significant decrease in an ejection fraction was detected only in patients with intradialytic hypotension. Ultrafiltration had no impact on flow propagation velocity of early diastolic flow of the left ventricle assessed by color M-mode Doppler echocardiography.     

Acute effects of hemodialysis on left ventricular function evaluated by tissue Doppler imaging.

Evidence exists that left ventricular function is impaired in chronic uremic patients. During hemodialysis (HD) treatment, myocardium undergoes electrolyte, hemodynamic and neuro-humoral stress; however, data about the acute changes on ventricular function are controversial. Aim of the present study was to evaluate the effect of a single hemodialysis session on left ventricular (LV) systolic and diastolic function using pulsed tissue Doppler imaging (TDI) sampled by echocardiography. The study group included 20 uremic patients (17 males, aged 51+/-13 yrs) on maintenance HD, free from clinically overt cardiac dysfunction who underwent echocardiography with pulsed TDI 30 min prior and 30 min after a HD session. TDI was performed by placing the sample volume in the center of the basal lateral segment and the basal interventricular septum in the apical four-chamber view. Myocardial systolic wave (S(m)) and early (E(m)) and atrial (A(m)) diastolic waves were measured. On standard sonography examination, no significant changes in LV systolic function parameters were observed after HD, but the indices for LV diastolic function deteriorated significantly (peak E, 75.4+/-11.2 vs. 58.8+/-12.5 cm/s, P<0.01; E/A ratio, 1.0+/-0.3 vs. 0.8+/-0.2, P<0.01). However, regarding TDI measures following HD, the patients exhibited a lower S(m) peak (septum: 7.6+/-1.1 vs. 5.9+/-0.8 cm/s; lateral wall: 7.7+/-1.7 vs. 6.8+/-1.2 cm/s, P<0.001), a lower E(m) peak (septum: 8.3+/-1.6 vs. 6.3+/-1.7 cm/s; lateral wall: 10.2+/-2.4 vs. 7.1+/-1.9 cm/s, P<0.001), and a reduced E(m)/A(m) ratio (septum: 1.0+/-0.4 vs. 0.7+/-0.2; lateral wall: 1.2+/-0.5 vs. 0.7+/-0.2, P<0.001, respectively), as compared to pre-HD parameters. Of interest, peak E(m), and E(m)/A(m) ratio of the lateral wall were negatively related to ultrafiltration rate (r = -0.60, P<0.05 and -0.69, P<0.01, respectively). Our data indicate that a single hemodialysis session is associated with acute deterioration of diastolic and systolic parameters of myocardial function, as assessed by TDI. These reversible changes could be considered as a cardiac stunning that seems to be related to the ultrafiltration rate and then to the interdialysis weight gain. These findings suggest that low ultrafiltration volume and/or limited interdialytic weight gain are cardioprotective measures in hemodialysis patients.     

Evaluation of different methods of treatment of patients with stable stenocardia combined with arterial hypertension according to echocardiographic data

The authors evaluated the influence of three alternative methods of treatment of coronary artery disease (CAD) and stable exertional stenocardia accompanied by arterial hypertension on systolic and diastolic left ventricular (LV) function. The three methods were: conventional therapy with monocinque, chronotherapy with monocinque, and therapy with a combination of monocinque and melatonin. All the 65 patients aged 44 to 69 years underwent echoCG with Vivid 7 ultrasound scanner (USA) before and after the treatment. The study showed that chronotherapy with monocinque had the most favorable effect on LV diastolic function, which manifested by an increase in peak E from 0.47 +/- 0.02 to 0.53 +/- 0.02 m/s (p = 0.006) and peak E/peak A ratio from 0.77 +/- -0.05 to 0.93 +/- 0.05 (P = 0.002), as well as a decrease in peak A from 0.65 +/- 0.03 to 0.56 +/- 0.03 m/s (p = 0.05). Complex treatment with monocinque and melatonin improved systolic and diastolic LV function better than did conventional therapy. The favorable influence on myocardial contractility manifested by a reduction in end systolic LV size from 3.66 +/- 0.04 to 3.42 +/- 0.02 cm (p < 0.001), end diastolic LV volume from 126.7 +/- 1.3 to 118.4 +/- 1.1 ml (p < 0.001), and end systolic LV volume from 55.1 +/- 1.0 to 47.0 +/- 0.8 ml (p < 0.001), as well as an increase in ejection fraction from 56.5 +/- 0.9 to 60.3 +/- 0.8% (p = 0.003) and shortening fraction from 27.9 +/- 1.3 to 33.0 +/- 0.4% (p = 0.001). The normalizing effect on LV diastolic function manifested by an increase in peak E from 0.46 +/- 0.02 to 0.54 +/- 0.02 m/sec (p = 0.009) and peak E/peak A ratio from 0.68 +/- 0.05 to 0.82 +/- 0.05 (p = 0.002).     

Effect of cardiac resynchronization therapy on left ventricular diastolic filling pattern in responder and nonresponder patients

BACKGROUND: The aim of this study was to investigate the short- and long-term effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) diastolic filling pattern and the relation between the diastolic filling pattern and the response to CRT. METHODS: Twenty-three patients with systolic heart failure and complete left bundle-branch block underwent implantation of biventricular pacemaker devices. In order to follow the changes in diastolic function, mitral inflow, pulmonary venous flow, and LV flow propagation (Vp) velocities were measured with pulsed-wave and color M-mode Doppler echocardiography 1 week before and 1 and 6 months after pacemaker implantation. At the 6-month follow-up, patients were divided into two groups according to their response to CRT defined as a relative increase in LV ejection fraction (LVEF) > or =25% versus baseline. RESULTS: After biventricular pacemaker implantation, significant clinical improvement was observed in all patients. Compared to baseline, the ratio of early-to-late peak velocities (E/A) decreased significantly at the 6th month (E/A ratio: from 1.5 +/- 0.9 to 0.8 +/- 0.5 at the 6th month (P = 0.02)). Pulmonary systolic flow to diastolic flow ratio (PVs/PVd) increased with CRT after 6 months (PVs/PVd ratio: from 0.9 +/- 0.4 to 1.3 +/- 0.7 at the 6th month (P = 0.02)). E/Vp ratio decreased significantly at the 1st and 6th month (E/Vp ratio: from 2.7 +/- 0.8 to 2 +/- 0.8 at the 1st (P < 0.002) and to 1.9 +/- 0.7 at the 6th month (P < 0.02)). In responders (n: 17, 74%), E wave and PVra velocity decreased, E-wave deceleration time increased, and E/Vp ratio improved significantly, whereas in nonresponders, changes in LV diastolic parameters remained insignificant. However, diastolic filling pattern improved significantly at the 1st and 6th month of CRT in both responders and nonresponders. CONCLUSION: CRT enhances diastolic filling patterns in both responder and nonresponder patients. This may be related to improvement in symptoms even in nonresponders who have a relative increase in LVEF <25%.     

Tissue cardiovascular magnetic resonance demonstrates regional diastolic dysfunction in remote tissue early after inferior myocardial infarction.

PURPOSE: To investigate regional diastolic and systolic function using tissue cardiovascular magnetic resonance (CMR), early after transmural myocardial infarction of the inferior wall due to single proximal right coronary artery disease. MATERIALS AND METHODS: Velocity encoded CMR was used to measure early diastolic transmitral flow velocity (E), and regional, longitudinal, myocardial systolic (Sa) and early diastolic (Ea) velocities (tissue CMR) in 15 patients with a recent transmural inferior myocardial infarction and in 15 age and LV-mass index matched control subjects. An unpaired two-tailed t test was used to assess significance of continuous variables. RESULTS: Global systolic (ejection fraction 46 +/- 7% versus 57 +/- 4%, p = 0.000052) and global diastolic LV function (average Ea of infarcted or inferior, remote or anterior, adjacent or septal and lateral myocardium 6.8 +/- 1.7 cm/s versus 10.4 +/- 1.5 cm/s, p = 0.0000012) were impaired in patients as compared to controls. Regional systolic and diastolic LV velocities were impaired in infarcted and adjacent tissue in patients. However, in remote or anterior tissue, systolic velocities were preserved (Sa 6.6 +/- 2.0 cm/s versus 6.8 +/- 1.4 cm/s, p = 0.70), but diastolic velocities were impaired in patients as compared to controls (Ea 7.2 +/- 2.3 cm/s versus 10.2 +/- 2.5 cm/s, p = 0.0026). CONCLUSIONS: Regional diastolic velocities early after inferior myocardial infarction are impaired in the infarcted, adjacent and remote tissue, but regional systolic velocities are preserved in remote tissue.     

Differences in left ventricular diastolic dysfunction between eccentric and concentric left ventricular hypertrophy in hypertensive patients with preserved systolic function

Left ventricular (LV) hypertrophy (LVH) may be eccentric or concentric (2 × LV posterior wall thickness relative to LV end-diastolic dimension ≤ 0.42 or > 0.42, respectively). The LV diastolic function between age-matched hypertensive patients with eccentric and concentric LVH was compared in the present study. Echocardiography was used to measure LV mass index (LV mass/body surface area; LVMI) as an index of LVH. LV diastolic function was assessed by measurements of peak early transmitral flow velocity (E)/peak late transmitral flow velocity (A) (the E/A ratio), peak early diastolic mitral annular velocity (e') and the E/e' ratio. Although LVMI, E/A and e' did not differ between the two groups, E/e' was significantly higher (worse) in patients with concentric LVH (13.4 ± 5.4) than in those with eccentric LVH (11.1 ± 3.6). Among hypertensive patients with LVH, those with concentric LVH may, therefore, have more severe LV diastolic dysfunction than those with eccentric LVH even if their LVMIs, which reflect the degree of LVH, are similar.     

Assessment of diastolic function by tissue Doppler echocardiography: comparison with standard transmitral and pulmonary venous flow.

The objective of this study was to determine the utility of Doppler tissue echocardiography in the evaluation of diastolic filling and in discriminating between normal subjects and those with various stages of diastolic dysfunction. We measured myocardial velocities in 51 patients with various stages of diastolic dysfunction and in 27 normal volunteers. The discriminating power of each of the standard Doppler indexes of left ventricular filling, pulmonary venous flow, and myocardial velocities was determined with the use of Spearman rank correlation and analysis of variance F statistics. Early diastolic myocardial velocity (E(m)) was higher in normal subjects (16.0 +/- 3.8 cm/s) than in patients with either delayed relaxation (n = 15, 7.5 +/- 2.2 cm/s), pseudonormal filling (n = 26, 7.6 +/- 2.3 cm/s), or restrictive filling (n = 10, 7.4 +/- 2.4 cm/s, P <.0001). E(m ) was the best single discriminator between control subjects and patients with diastolic dysfunction (P =.7, F = 64.5). Myocardial velocities assessed by Doppler tissue echocardiography are useful in differentiating patients with normal from those with abnormal diastolic function. Myocardial velocity remains reduced even in those stages of diastolic dysfunction characterized by increased preload compensation.     

彩色血流传播速度对二尖瓣置换术后左心室舒张功能的定量评估

目的 探讨彩色M型多普勒(CMM)评价二尖瓣置换术(MVR)后患者左室舒张功能的临床价值.方法 52例接受MVR术后3个月以上患者为病例组,另选取年龄、性别相匹配的30例正常人为对照组.测量左房室腔大小、机械瓣口流速、射血分数(EF)等常规超声心动图指标;应用CMM测量舒张期左室内彩色血流传播速度(Vp),计算二尖瓣位机械瓣口血流速度(E)与Vp比值(E/Vp);应用组织多普勒测量二尖瓣环舒张期峰值速度(Em),计算均值Em'和E/Em'.结果 ①MVR组Vp、Em较对照组明显减低,E/Vp、E/Em'较对照组明显增高,差异有统计学意义(P<0.001).E/Vp与E/Em'相关性良好,r=0.86,P <0.01;②Vp受左窜收缩功能和心律的影响,当EF≤50%或者心房颤动时,Vp减低更明显(P<0.01),而E/Vp受EF及心房颤动的影响较小(P>0.05);③绘制ROC曲线,以E/Vp≥2.00为最佳截断值,预测E/Em'≥15的敏感性为92.31%,特异性为83.65%,曲线下面积0.954.结论 CMM可用于评价MVR术后左室舒张功能;E/Vp与E/Em具有良好的一致性,可作为评价MVR术后左室舒张功能的有效指标.     

The mitral L wave: a marker of pseudonormal filling and predictor of heart failure in patients with left ventricular hypertrophy.

OBJECTIVES: We sought to examine the relationship of the mitral L wave with echocardiographic indexes of diastolic function and heart failure (HF) events in patients with left ventricular (LV) hypertrophy (LVH). BACKGROUND: The L wave, representing middiastolic transmitral flow, is of unknown clinical and prognostic significance in patients with LVH. Methods Consecutive echocardiograms performed during a 6-month period were screened for patients with LVH, normal LV ejection fraction, in sinus rhythm, and no significant valvular disease. Clinical and echocardiographic characteristics were analyzed, and patients were followed up for incident HF. RESULTS: Of 177 patients, the L wave was present in 35 (20%) (group I) and absent in 142 (group II). Patients in group I had higher early (E) to late (A) transmitral flow velocity (E/A) ratio (1.2 vs 0.8), shorter mitral E wave deceleration time (201 vs 225 milliseconds), lower pulmonary venous systolic/diastolic velocity ratio (1.1 vs 1.6), shorter LV isovolumic relaxation time (83 vs 94 milliseconds), larger left atrial volume (36 vs 23 mL/m 2 ), and higher E to early mitral annular velocity (E/E') ratio (septal E/E', 12.2 vs 9.1; lateral annular E/E', 10.9 vs 7.8) compared with group II (all P < .05). The difference between pulmonary venous atrial reversal and mitral A wave durations was > or = 30 milliseconds in more patients of group I (70% vs 6%, P < .001). During a mean follow-up of 12.0 months, 11 patients were hospitalized for HF. The L wave was associated with a hazard ratio of 4.7 ( P = .011) for incident HF, and remained a significant predictor (hazard ratio 4.2, P = .026) after adjustment for cardiovascular risk factors. CONCLUSIONS: In patients with LVH, the mitral L wave appears to be a marker of pseudonormal LV filling and predictor of future HF events.     

Left and right ventricular diastolic functions in patients with rheumatoid arthritis without clinically evident cardiovascular disease

The aim of this study was to assess the prevalence of diastolic dysfunction of the left ventricle (LV) and of the right ventricle in patients with rheumatoid arthritis (RA) without clinically evident cardiovascular manifestations and to estimate whether there is a correlation between the duration of RA and the degree of LV diastolic dysfunction. The study included 81 patients (61 females and 20 males) with RA without clinically evident heart disease (group 1) and 40 healthy subjects (29 females and 11 males) who served as a control group (group 2). Both groups were matched for age and sex. Echocardiographic and Doppler studies were conducted in all patients with RA and control subjects. There were significant differences between patients with RA vs. control group with regard to early diastolic flow velocity (E), atrial flow velocity (A) and the E/A ratio (0.68 +/- 0.19 m/s vs. 0.84 +/- 0.14 m/s, p < 0.001; 0.73 +/- 0.15 m/s vs. 0.66 +/- 0.13 cm/s, p = 0.01; and 0.97 +/- 0.3 vs. 1.32 +/- 0.37, p < 0.001, respectively). There was significant difference between groups regarding the right ventricular early diastolic (Er)/atrial (Ar) flow velocities (Er/Ar ratio) (1.07 +/- 0.3 vs. 1.26 +/- 0.3, p = 0.002). There was a weak correlation between transmitral E/A ratio and the duration of RA (r = - 0.22, p = 0.001). Myocardial performance index (MPI) appeared to differ little in patients with RA as compared with control group (0.51 +/- 0.1 vs. 0.52 +/- 0.2, p = NS). In patients with RA without clinically evident cardiovascular disease, the left ventricular diastolic function and the right ventricular diastolic function are reduced. Left ventricular wall thickness, dimensions, systolic function and MPI were found to be normal. LV diastolic function had a weak correlation with the duration of RA.     

M型彩色多普勒超声心动图对原发性高血压和冠心病患者左室舒张功能的评估作用

背景左室舒张功能障碍的评价对于患者的心功能分级、诊断与治疗,具有重要的意义。但对不同收缩功能状态及E/A比值假性正常化时的左室舒张功能的研究少见有报道。目的探讨M型彩色多普勒超声心动图在研究原发性高血压和冠心病患者左室舒张功能中的作用,并与传统方法进行比较。设计以诊断为依据的病例对照研究。地点、对象和方法收集2001-11/2002-05中山大学附属三院门诊和住院患者,对照组为门诊正常体检者,自愿参加本研究。在超声心动图室收集资料。36例正常人为对照组,74例原发性高血压(essentialhy-pertension,HTN)患者(HTN组)和33例冠心病患者(冠心病组)进行了研究。采用M型彩色多普勒超声心动图进行研究。左室容量用Teichholz公式由舒张末和收缩末容积估计,然后计算射血分数和缩短分数。主要观察指标①HTN患者、正常人、冠心病患者从二尖瓣到心尖的早期充盈峰速传播速率(rateofpropagationofpeakearlyfillingflowvelocity,Vp)。②早期充盈峰速时间(timedelayrateofpropagationofpeakearlyfillingflowvelocity,TD)和Vp/E比值。③左室舒张早期、晚期跨二尖瓣血流峰速(E峰和A峰)、早期和晚期血流峰速比(E/A)和舒张晚期跨二尖瓣血流峰速时间。④肺静脉收缩期血流速度、舒张期血流速度、肺静脉返流速度和返     

Assessment of left ventricular systolic and diastolic function by Doppler tissue imaging in patients with preinfarction angina.

BACKGROUND: The aim of this study was assessment of left ventricular (LV) systolic and diastolic function by pulsed wave Doppler tissue imaging (DTI) in patients with or without preinfarction angina in acute myocardial infarction. METHODS: We prospectively evaluated 31 consecutive patients (4 women, 27 men; age 58 +/- 10 years) with a first acute myocardial infarction. LV systolic and diastolic function was assessed by classic methods and DTI on the third day during acute myocardial infarction. Patients were divided into 2 groups according to the presence (group 1; n = 10) or absence (group 2; n = 21) of preinfarction angina. Mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, the ratio of early diastolic mitral inflow velocity (E) to Em, and myocardial performance index were calculated by DTI. RESULTS: Group 1 had significantly higher Em and Em/Am than group 2 (11.3 +/- 3.34 cm/s vs 7.4 +/- 2.07 cm/s, P <.0001; 1.01 +/- 0.38 cm/s vs 0.6 +/- 0.2 cm/s, P =.001, respectively). The E/Em ratio and myocardial performance index were significantly lower in group 1 than in group 2 (5.1 +/- 2.92 vs 8.10 +/- 3.15, P=.018; 0.49 +/- 0.15 vs 0.65 +/- 0.24, P =.042, respectively). Wall-motion score index was lower in those with preinfarction angina than in those without (1.6 +/- 0.36 vs 1.9 +/- 0.39; P =.04, respectively). Peak systolic mitral annular velocity and Am were not statistically different between groups (9.4 +/- 1.84 vs 8.3 +/- 2.03, P =.172; 11.7 +/- 3.07 vs 12.1 +/- 3.34, P =.72, respectively). There were no significant differences between the 2 groups regarding transmitral E velocity, atrial contraction mitral inflow velocity (A), E/A ratio, isovolumetric relaxation time, and deceleration time of the mitral E wave (P =.91, P =.08, P =.58, P =.81, and P =.71, respectively). CONCLUSION: LV diastolic function was better in patients with preinfarction angina than in patients without. This condition could not be detected by conventional mitral inflow Doppler velocities, but could be detected by DTI. This preliminary evidence shows that DTI is better than conventional mitral Doppler indices in the assessment of a favorable LV diastolic function in patients with preinfarction angina.     

Diagnosis of left-ventricular diastolic dysfunction in patients with predialysis chronic renal failure

AIM: To specify effectiveness of different methods for assessment of diastolic function in patients with pre-dialysis chronic renal failure (CRF). MATERIAL AND METHODS: Forty non-diabetic pre-dialysis CRF patients (20 males and 20 females, mean age 51 +/- 11 years) were studied. Serum creatinine was 209.3 +/- 117.4 mcmol/l. 19 patients had chronic heart failure (CHF) of NYHA class I-III. M-mode echocardiography and Doppler echocardiography were performed. Transmitral and pulmonary venous flows were assessed by Doppler echocardiography and the flow propagation velocity (Vp) was estimated by color M-mode Doppler echocardiography. The ratio of peak E-wave velocity of transmitral flow to Vp (E/Vp) was calculated. All the patients had preserved systolic function (ejection fraction > 45%). RESULTS: Interpretation of transmitral flow was difficult in 16 (40.0%) patients. During Valsalva's manoeuvre the E-wave peak velocities, the A-wave velocities and the ratio E/A were decreasing. However, we did not reveal any correlation between E/A and NYHA class of heart failure (r = 0.18; p = 0.32). Interpretation of pulmonary venous flow was possible only in 24 (60.0%) patients. Vp estimation by color M-mode Doppler echocardiography improved evaluation of diastolic function in 15 of 16 patients with problems of transmitral flow assessment. A negative correlation was revealed between NYHA class and Vp (r = -0.39; p = 0.013) and a positive correlation was between NYHA class and E/Vp (r = 0.45; p = 0.004). CONCLUSION: Vp assessed by color M-mode Doppler echocardiography improves the diagnosis of diastolic dysfunction in patients with chronic renal insufficiency. This method has an advantage over pulmonary venous flow investigation. The Valsalva's manoeuvre is low-effective for differential diagnosis of transmitral flow types.     

脉冲波组织多普勒超声心动图评价单次血液透析治疗对终末期肾病患者左室功能的急性影响

目的 评价单次血液透析(HD)治疗对终末期肾病(ESRD)患者左室功能的急性影响.方法 57例既往无心血管疾病病史,且正处于维持性HD治疗中的ESRD患者入选本研究.所有患者于单次HD治疗前及治疗后1 h内接受超声心动图检查.常规超声心动图测量并分析左室形态及功能指标.脉冲波组织多普勒成像(PW-TDI)测量二尖瓣环运动速度.结果 单次HD治疗后,左室内径明显减小(P<0.05);PW-TDI及常规超声心动图左室收缩功能指标,包括二尖瓣环等容收缩期峰值速度(IVS)、收缩期峰值速度(Sm)及左室射血分数(LVEF)均较治疗前显著升高(P<0.05).常规超声心动图左室舒张功能指标,包括二尖瓣血流舒张早期峰值流速(E)、舒张晚期峰值流速(A)及E/A比值,较单次HD治疗前均明显减低(P<0.05);而PW-TDI左室舒张功能指标,包括二尖瓣环舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)及Em/Am比值则未见显著变化.左室充盈压相关指标E/Em比值在单次HD治疗后显著降低(P<0.05).结论 单次HD治疗可以改善ESRD患者左室收缩功能;PW-TDI技术可以在不同的前负荷状态下准确地评价左室舒张功能.     

应变率成像评估左心室不同舒张功能状态患者左心房功能

目的探讨应变率成像（SRI）评估左心室不同舒张功能状态下左心房功能的价值。方法128例受检者根据左心室不同舒张功能状态分成正常组、顺应性降低组、假性正常化组及限制性充盈障碍组。采集心尖四腔观、三腔观和二腔观组织速度图,SRI测量并计算左心室收缩期左心房平均峰值应变率（mSRs）、左心室舒张早期左心房平均值峰应变率（mSRe）、左心房收缩期左心房平均峰值应变率（mSRa）;测量包括二尖瓣口舒张早期前向血流峰值速度（E）与二尖瓣前瓣环纽织多普勒E比值（E／E′）及E与二尖瓣口M型彩色多普勒峰值血流速度Vp比值（E／Vp）等左心室舒张功能相关参数。将SRI所测左心房功能相关参数与反映左心室舒张功能相关参数作对比。结果E／Vp及E／E′随舒张功能障碍加重而增高,1．1±0．3vs1．6±0．2vs2．1±0．3VS2．6±0．4和7．4±2．4 vs 10．4±2．9VS17．6±4．2vs22．8±4．8（均P〈0．05）;4组患者mSRs、mSRe、mSRa差异有统计学意义（P〈0．05）;mSRe随舒张功能障碍加重而降低,（3．73±0．92）^-1 vs（2．84±0．54）^-1 vs（1.94±0．23）s^-1 vs（1．85±0．30）s。（均P〈0．05）,mSRs及mSRa在舒张功能降低组最高,而在限制性充盈障碍组中最低;E／E′、E／Vp与mSRe呈良好负相关（r=0．813,P〈0．01;r=-0．793,P〈0．01）。结论SRI可准确评价左心室不同舒张功能状态患者左心房功能。     

Differences between diabetic and non-diabetic nephropathy patients in cardiac structure and function at the beginning of hemodialysis and their impact on the prediction of mortality

ObjectivesTo characterize differences in cardiac structure and function in hemodialysis (HD) patients with diabetic nephropathy (DN) and in those without using echocardiography and to determine their impact on the prediction of mortality using echocardiographic parameters.MethodsClinical, laboratory, and echocardiographic data were collected from patients commencing HD.ResultsCompared with those without DN, patients with DN had lower peak velocity of the early diastolic wave (e′), larger left atria, and higher peak early diastolic velocity (E)/e′ and peak velocity of tricuspid regurgitation (TR). In addition, a larger proportion of DN patients had a combination of left ventricular (LV) diastolic dysfunction, cardiac valve calcification, moderate-to-severe cardiac valve regurgitation (CVR), and at least moderate pericardial effusion (PE). After accounting for age, sex, smoking, hypertension, hemoglobin, and albumin, DN was responsible for e′  < 10 cm/s, E/e′ >13 m/s, TR >2.8 m/s, LV diastolic dysfunction, CVR, and PE. LV diastolic dysfunction and E/e′ >13 were the most useful predictors of mortality in patients with DN.ConclusionsPatients with DN who undergo HD tend to have worse LV diastolic function and are more likely to have heart valve problems. LV diastolic dysfunction and E/e′ are predictors of death in DN patients.     

Factors influencing left ventricular diastolic function in elderly patients with chronic heart failure

The purpose of the study was to define factors influencing the diastolic left ventricular (LV) function in elderly patients with chronic heart failure (CHF). Ninety-seven I to IV functional class CHF patients aged 65 to 88 (mean age 76.6+/-5.1 yr), 61 women and 36 men, were examined. CHF was caused by coronary artery disease in 22 (22.7%) patients, by arterial hypertension in 14 (14.4%) patients, and by both in 61 (62.9%) patients. Fourteen (14.4%) patients had type 2 diabetes. Hemoglobin level lower than 130g/l in men or 120g/l in women was considered anemia. Glomerular filtration speed (GFS) was calculated using Cockcroft-Gault formula. EchoCG and Doppler EchoCG were performed in all patients. LV hypertrophy (LVH) was revealed in 90 (92%) of the patients; 52patients had concentric L VH and 38 patients had eccentric LVH. Ejection fraction was less than 45% in 17 (17.5%) patients. Isovolemic relaxation time (IVRT) was over the normal limit in 73 (75.3%) patients; the time of early diastolic flow slowing (DT) changed in different directions and was 211.2+/-55.6 msec. A type of transmitral blood flow with relaxation disorder was found in 58 (59.8%) patients, a pseudonormal type was revealed in 32 (33%), and a restrictive type was found in 7 (7.2%) of patients. The study found a reverse independent correlation between hemoglobin level and the speed of LV filling during atrial systole. An independent correlation between the degree of renal dysfunction (GFS) and disorder of LV relaxation was found: the lower GFS, the longer IVRT and DT. Thus, in addition to age and structural changes in the heart, factors that have adverse effects on diastolic filling parameters are anemia, lowered renal function, and the level of systolic and diastolic pressure.     

Improvement in left ventricular diastolic filling by septal myectomy in hypertrophic cardiomyopathy

Abnormalities in left ventricular diastolic function or filling are considered to be responsible for some of the symptoms in patients with hypertrophic cardiomyopathy. To clarify whether the abnormalities in left ventricular diastolic filling are improved by septal myectomy, 13 patients with hypertrophic cardiomyopathy and intracavitary pressure gradient were studied preoperatively and postoperatively by use of pulsed Doppler echocardiography. Peak early diastolic filling velocity (E), the ratio of peak early diastolic filling to peak atrial filling velocities (E/A ratio), and deceleration time were measured from the transmitral flow velocity pattern before and after septal myectomy. Although E and E/A ratio did not change after septal myectomy, deceleration time significantly shortened from 314 +/- 72 to 271 +/- 53 milliseconds (n = 10; p less than 0.05). Further, if seven patients with significant changes in heart rate (greater than 30%) or in the Doppler-determined severity of mitral regurgitation (more than one degree) were excluded (because these parameters may effect E and E/A ratio), there were also significant changes in E (81 +/- 21 versus 98 +/- 25 cm/sec, p less than 0.05) and in E/A ratio (0.84 +/- 0.17 versus 1.14 +/- 0.33, p less than 0.05). Because left ventricular systolic function has been demonstrated to remain constant or to decrease by most measures after septal myectomy, relief of some symptoms may be largely the result of the improvement in diastolic filling suggested by these criteria.     

Preload dependence of color M-mode Doppler flow propagation velocity in controls and in patients with left ventricular dysfunction.

The purpose of this study was to assess the effects of preload alterations on color M-mode flow propagation velocity (Vp) in volunteers with normal left ventricular (LV) function and in patients with depressed LV function. Color M-mode Doppler echocardiography was performed during Valsalva maneuver, passive leg lifting, and after administration of nitroglycerin in 30 healthy volunteers and in 30 age- and sex-matched patients with previous myocardial infarction (MI). Mean Vp in controls was 74 +/- 15 cm/s at baseline and 46 +/- 15 cm/s in MI patients (P <.0005). In both groups, minor changes in Vp were seen during preload alterations; however, these were not significant (control P =.72, MI P =.31). In both groups, peak E-wave velocity (P <.0005), ratio of early-to-late peak velocities (P <.0005), and E-wave deceleration time (P <.0005) were found to change during preload alterations. In conclusion, we found that in controls and patients with previous MI, the color M-mode flow propagation velocity is not affected significantly by preload.     

Usefulness of early diastolic flow propagation velocity measured by color M-mode Doppler technique for the assessment of left ventricular diastolic function in patients with hypertrophic cardiomyopathy.

Flow propagation velocity (FPV) of left ventricular (LV) filling flow has been shown to be a useful index for the evaluation of LV diastolic function, which is relatively independent of preload in myocardial infarction and dilated cardiomyopathy, but the usefulness of FPV for hypertrophic cardiomyopathy (HCM) has not yet been determined. In 23 HCM patients and 26 control subjects, peak transmitral flow velocities in early diastole (E) and during atrial contraction (A), E/A ratio, deceleration time of E velocity, and isovolumic relaxation time were measured with the conventional Doppler technique, and FPV was measured from color M-mode Doppler images of LV filling flow. The time constant of LV isovolumic pressure decay (tau) was measured by a micro-manometer-tipped catheter in all HCM patients and 13 control subjects. Flow propagation velocity was significantly lower and deceleration time was significantly greater in HCM patients than in the control subjects, though no significant differences were observed in the other noninvasive indexes. Tau was significantly prolonged in HCM patients compared with that of control subjects (54+/-12 cm/s and 32 +/-7 cm/s, respectively; P<.0001). While the conventional indexes did not correlate with tau among the 36 patients in whom invasive studies were performed, FPV correlated well with tau (r = -0.76, P<.0001). Flow propagation velocity is a useful noninvasive index for the assessment of LV diastolic function in patients with HCM.