The relationship between tissue Doppler imaging and seric NTproBNP levels in sinus rhythm patients: a prospective study

N-terminal pro-brain natriuretic peptide (NTproBNP) correlates with left ventricular (LV) filling pressure. The ratio between early diastolic transmitral velocity and early mitral annular diastolic velocity (E/Ea) reflects LV filling pressure in a variety of cardiac diseases. However this relationship was not validated in some categories of patients. Our aim was to evaluate the correlation between tissue Doppler velocities of the mitral annulus and NTproBNP levels in sinus rhythm patients. Methods Echocardiography was performed in 111 consecutive patients simultaneously with NTproBNP measurement. E/Ea and E/(Ea × Sa) were calculated (Sa is the maximal systolic velocity of mitral annulus); the average of the velocities of septal and lateral mitral annulus was used. Results Simple regression analysis demonstrated a significant linear correlation between E/(Ea × Sa) and NTproBNP (r = 0.71, P < 0.0001), superior to E/Ea correlation (r = 0.58, P < 0.0001). Significant but weaker correlations were found between NTproBNP and Sa, pulmonary artery systolic pressure, Ea, mitral E/A (early/late diastolic transmitral velocity), E wave, mitral E deceleration time and LV ejection fraction (LVEF). The optimal E/(Ea × Sa) cut-off for prediction of NTproBNP levels > 900 pg/ml was 1.5 (sensitivity = 81%, specificity = 70%). Among analyzed parameters, E/(Ea × Sa) was best correlated with NTproBNP levels in patients with LVEF ≥ 50% (r = 0.80, P < 0.0001), with depressed LVEF (<50%) (r = 0.66, P < 0.0001), with regional wall motion abnormalities (r = 0.75, P < 0.0001), and with E/Ea 8 to 15 (r = 0.58, P < 0.0001). Conclusions E/(Ea × Sa) strongly correlates with NTproBNP, regardless of LVEF, and can be a simple and accurate echocardiographic index in patients in sinus rhythm, particularly in those with regional wall motion abnormalities or intermediate E/Ea.     

定量组织速度成像测量二尖瓣环运动速度

目的　应用定量组织速度成像测量二尖瓣环运动速度评价扩张型心肌病患者左室舒张功能。方法　定量组织速度成像测量 14例正常人和 14例扩张型心肌病患者二尖瓣环 6个节段 (后间隔和侧壁、前间隔和后壁、前壁和下壁 )舒张早期峰值速度Ve、左房收缩期峰值速度Va ,计算Ve Va ;多普勒超声心动图测量二尖瓣口血流快速充盈速度E峰、左房收缩充盈速度A峰 ,计算E A值。结果　正常人和扩张型心肌病患者两组间E A无显著统计学差异 ,而扩张型心肌病组二尖瓣环平均Ve Va、平均Ve较正常组显著减低 (Ve Va :0 .89± 0 .11vs 1.76± 0 .76,P =0 .0 0 1;Ve :-4 .79± 2 .2 2vs -8.42± 2 .2 7,P<0 .0 0 0 1) ;正常组中二尖瓣环平均Ve Va与E A显著相关 (r =0 .63 ,P =0 .0 0 8) ,而扩张型心肌病组二尖瓣环平均Ve Va与E A无显著相关。结论　扩张型心肌病患者二尖瓣口血流频谱表现为假性正常化 ,定量组织速度成像测量二尖瓣环运动速度可准确评价其左室舒张功能。     

多普勒组织成像鉴别陈旧性心肌梗死患者舒张功能假性正常

目的 探讨应用多普勒组织成像（DTI）检测二尖瓣环舒张期运动速度可否鉴别陈旧性心肌梗死（OMI）患者舒张功能假性正常。 方法 OMI舒张功能假性正常患者68例，正常对照组50例，应用脉冲多普勒（PWD）分别测量二尖瓣口舒张早期峰值流速（E）、舒张晚期峰值流速（A）、E／A、E峰减速时间（DT）、左室等容舒张时间（IRT）、肺静脉收缩波（S）、舒张波（D）、S／D及心房收缩波（Ar）；转换DTI速度模式，测量左室侧壁缘二尖瓣环舒张早期运动峰值速度（Ea）、舒张晚期运动峰值速度（Aa）并计算Ea／Aa。 结果 OMI舒张功能假性正常患者与正常人的年龄和血流频谱E、A、E／A、IRT、D、S／D及二尖瓣环Aa测值比较无显著性差异（P〉0.05），DT缩短和S波降低具有显著性差异（P〈0．05），肺静脉血流Ar较正常人升高，而二尖瓣环Ea及Ea／Aa较比正常人明显减低，具有显著性差异（P〈0．01）。 结论 DTI检测二尖瓣环Ea及Ea／Aa比值可鉴别OMI患者舒张功能假性正常。     

Determination of left ventricular filling pressure by new echocardiographic methods in patients with coronary artery disease

Aim The present study was designed to determine the reliability of the analysis of the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity and mean systolic strain index, and comparing them with E/E′ in the detection of increased left ventricular end-diastolic pressure (LVEDP) in patients with coronary artery disease. Methods Eighty patients (mean age: 57.2 ± 11.5 years) referred for cardiac catheterization were studied. Patients were divided into 2 groups according to LVEDP (group 1: LVEDP > 20 mmHg, n = 39 patients; group 2: LVEDP ≤20 mmHg, n = 41 patients). From the mitral inflow, peak E velocity was calculated. With tissue Doppler echocardiography, early diastolic velocity (E′) measured from the septal, lateral, inferior and lateral mitral annulus and mean value of E′ and E/E′ ratio were calculated. The time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity (T_E′-E) was calculated. From the apical chambers, the peak systolic strain value of 16 left ventricular (LV) segments was measured and the mean of these 16 segments was calculated and referred to as mean systolic strain index. Results The patients with increased LVEDP (group 1) had a higher E/E′ ratio (13.8 ± 3.4 vs. 9.9 ± 2.8, P < 0.001) and lower mean systolic strain index (11.8 ± 3.4 % vs. 13.5 ± 3.6 %, P = 0.038) than patients in group 2. The sensitivity of E/E′ > 13.42 for identifying LVEDP > 20 mmHg was 71%, with a specificity of 89%. The sensitivity of a mean systolic strain index < 10.57% for identifying LVEDP > 20 mmHg was 44%, with a specificity of 83%. T_E′-E was not significantly different between the two groups. Conclusion The decreased longitudinal function of the left ventricle is related to increased LVEDP. The E/E’ ratio, which in recent years has been used for the prediction of LV filling pressures, was a better predictor for increased LVEDP than the mean systolic strain score index and the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity in patients with coronary artery disease.     

Right ventricular diastolic abnormalities in rheumatoid arthritis and its relationship with left ventricular and pulmonary involvement. A tissue Doppler echocardiographic study

Objectives To investigate right ventricular diastolic function in rheumatoid arthritis (RA) and its relationship with left ventricular and pulmonary involvement.Methods Thirty-five RA patients and 30 healthy subjects were submitted to conventional Doppler (CE) and tissue Doppler echocardiography (TDE) to assess left and right systolic and diastolic function and to estimate maximal arterial systolic pulmonary pressure (PAP). To detect pulmonary involvement, pulmonary function tests and high-resolution computed tomography (HRCT) scans were performed in all RA patients.Results An abnormal RV filling, as expressed byan inverted tricuspid (Tr.) E/A ratio, was detected in 12 (34%) of the 35 RA patients and in 2 (7%) of the 30 controls (P<0.004). If compared to CE findings, prevalence of RV diastolic abnormalities were found higher in patients with RA by TDE (RV annulus Em/Am ratio <1 (in 31 (89%) of 35 patients) (P = 0.002). Twenty-two (63%) of 35 patients had abnormal HRCT findings. Pulmonary involvement with pulmonary hypertension (PHT) (36±5 mmHg) was detected in 10 (29%) of 35 RA. In this group, increase of RV annulus and basal Am wave, decrease of Tr. E/A ratio and RV annulus Em/Am ratio were statistically significant compared to RA (12 (34%) of 35) patients with pulmonary involvement who had normal PAP (19±5 mmHg), (P = 0.014, P = 0.006, P = 0.015, P = 0.049, respectively).Conclusions This study points out an impaired RV filling in a significant part of RA patients without overt heart failure. Impairment of RV diastolic function may be a predictor of subclinic myocardial and pulmonary involvement in patients with RA.     

<Superscript>123</Superscript>I-BMIPP and <Superscript>99m</Superscript>Tc-TF discordance on myocardial scintigraphy and it’s correlation with functional recovery following acute myocardial infarction: role of conventional echocardiography

¹²³I-β-methyl-iodophenyl pentadecanoic acid (BMIPP) and ^99mTc-Tetrofosmin (TF) mismatch designated as stunned myocardium having both systolic and diastolic components. The degree of mismatch might reflect subsequent functional improvement, and this study was designed to unravel the impact of mismatched defect score (MMDS) on recovery of both systolic and diastolic function following acute myocardial infarction (AMI). Forty patients with recent AMI were recruited, and all of them underwent emergency percutaneous coronary intervention. Echocardiography and BMIPP and TF cardiac scintigraphy were performed on 7 ± 3 days of admission. Follow up echocardiography was performed after 3 months. MMDS were compared with the systolic [ejection fraction (EF) and wall motion score index (WMSI)] and diastolic [peak velocity of early diastolic filling of mitral inflow/peak early diastolic velocity of the mitral annulus(E/E′) and left atrial volume index(LAVI)] parameters. BMIPP defect score was significantly higher than the TF defect score and there was a strong positive correlation between them (r = 0.90, P < 0.00001). Thirty-two (80%) patients showed mismatched defect and rest 8(20%) showed matched defect. Of 32 patients 24(75%), 22(69%), 19(59%), and 20(62.5%) showed improved EF, WMSI, E/E′ and LAVI respectively. Conversely out of 8 only 2(25%), 1(12.5%), and 2(25%) patients showed improvement of EF, WMSI and LAVI, respectively. E/E′ was not improved in patients with matched defect. MMDS were significantly correlated with the improvement of EF (r = −0.46, P = 0.002), WMSI (r = 0.41, P = 0.007), E/E′ (r = 0.56, P < 0.0002), and LAVI (r = 0.44, P = 0.004). Mismatched defect score could predict the approximate amount of viable dysfunctional myocardium, and the degree of mismatch showed a significant correlation with the improvement of both systolic and diastolic function.     

术前评估成人房间隔缺损合并器质性二尖瓣关闭不全

目的 探讨成人房间隔缺损（ASD）合并器质性二尖瓣关闭不全（MR）的特异性超声心动图表现。方法 收集372例接受ASD心内修复术的成人患者,根据是否同时或分期行二尖瓣成形术或置换术分为两组,即病例组（n=45）和对照组（n=327）。应用多因素回归法筛选ASD合并器质性MR的术前危险因素。结果 病例组患者左心室舒张末期内径（LVEDD）、左心房内径（LAD）、肺动脉内径（PAD）和二尖瓣瓣环内径明显大于对照组（P均<0.05）;二尖瓣和三尖瓣的舒张早期峰速（Em、Et）均明显高于对照组（P均<0.05）;二尖瓣环和三尖瓣环侧壁处的舒张晚期峰速（Am''、At''）、三尖瓣侧壁瓣环处收缩期运动峰速（St''）明显小于对照组（P均<0.05）;肺动脉收缩压（PASP）明显高于对照组（P=0.004）,三尖瓣反流程度也明显大于对照组（P=0.002）。其中二尖瓣瓣环扩张、LVEDD增大、St''偏低和PAD明显扩张,是成人ASD合并器质性MR的独立危险因素。结论 二尖瓣瓣环内径明显扩大和LVEDD增大是ASD患者左心室前负荷增加的特异性超声心动图表现。     

多普勒组织成像鉴别肥厚型心肌病舒张功能假性正常

目的　探讨应用多普勒组织成像 (DTI)二尖瓣环舒张速度鉴别肥厚型心肌病舒张功能假性正常。方法　在正常人与肥厚型心肌病患者中应用脉冲多普勒技术分别测量二尖瓣口舒张早期峰值速率 (E)、舒张晚期峰值速率 (A) ,肺静脉收缩波 (S)、舒张波 (D)及心房收缩波 (Ar)。转换DTI速度模式 ,测量二尖瓣环各点舒张早期峰值速率 (Ea)、舒张晚期峰值速率 (Aa)并计算Ea/Aa。结果　肥厚型心肌病舒张功能假性正常患者与正常人二尖瓣E、A、E/A差异无显著性意义 (均 P >0 .0 5 ) ,肺静脉S、S/D、Ar差异有显著性意义 (均 P <0 .0 1) ,二尖瓣环Ea及Ea/Aa差异有显著性意义 (P <0 .0 1) ,Aa差异无显著性意义 (P >0 .0 5 )。结论　多普勒组织成像二尖瓣环Ea及Ea/Aa可鉴别肥厚型心肌病舒张功能假性正常     

Pulmonary venous systolic flow fraction in patients with mitral regurgitation: transoesophageal echocardiography findings in relation to haemodynamic and angiographic evaluation

Summary. In patients with mitral regurgitation (MR), pulmonary venous systolic flow fraction (PVSF_fr) recorded using pulsed Doppler transoesophageal echocardiography (TEE) was compared with PVSF_fr in normal subjects, to angiographic grading and to haemodynamic parameters. PVSfr was calculated as the systolic flow velocity integral divided by total inflow integral. PVSfr is negative when systolic flow is reversed. Forty patients with MR were studied. PVSF_fr<0 was 100% sensitive for angiographic severe MR (specificity 83%). In 35 patents heart rate differed by 10 bpm or less between TEE and cath, either at rest or during stress. PVSF_fr was correlated with angiographic grade (r=-0.69, P<0.0001), with mean PCW (r=-0.61, P<0.0001), with the v-wave (r=-0.72, P<0.0001), with systolic blood pressure (r=0.48, P<0.005) and with left atrial diameter (r= -0.52, P<0.005). Stepwise forward multiple linear regression analysis revealed the v-wave, angiographic grading and systolic blood pressure to be independent predictors of PVSF_fr. PVSF_fr differed in normal subjects, patients with 0–2+ and patients with 3–4+ regurgitation. PVSF_fr is a valuable index in assessing mitral regurgitation. This index may be less dependent on equipment and operator than colour flow imaging.     

Left atrial appendage functions in patients with severe rheumatic mitral regurgitation

Aim The left atrial appendage (LAA) function was evaluated in patients with severe rheumatic mitral regurgitation, having sinus rhythm or atrial fibrillation, by standard and tissue Doppler echocardiographic examinations. Methods and results Sixty patients with rheumatic severe mitral regurgitation were enrolled. The patients (14 females and 6 males) having sinus rhythm were selected as group I and 20 patients (15 females and 5 males) with atrial fibrillation formed group II. 20 healthy subjects (15 female and 5 males) served as the control group (group III). In order to determine the LAA functions, LAA peak filling flow velocity (LAAPFV), LAA peak emptying flow velocity (LAAPEV) and percentage of LAA area change (LAAAC %) were measured. In the TDI records of the subjects with sinus rhythm, the first positive wave identical to the LAA late emptying wave (LEW) following the P-wave was accepted as LAA late systolic wave (LSW), and the second negative wave identical to the LAA late filling flow was accepted as late diastolic wave (LDW). In patients with atrial fibrillation, the positive wave was accepted as LAA late systolic wave (LSW), and the second negative wave identical to the LAA late filling flow was accepted as late diastolic wave (LDW). LAA outflow and inflow velocities were lower in the group having atrial fibrillation (P < 0.002, and P < 0.007, respectively). LAAAC% was also reduced in group II (P < 0.0001). The pulsed Doppler LSW and LDW velocities, measured with TDI method were found to be quite reduced in patients with AF (P: 0.002 and P: 0.001, respectively). The study parameters were statistically similar in patients with normal sinus rhythm and controls. Conclusion In this study, we found that the LAA functions are impaired in patients with severe mitral regurgitation, having AF, whereas preserved in patients with normal sinus rhythm, compared to controls.     

Evaluation of mitral regurgitation by pulmonary venous blood flow patterns. Relation to angiographic and haemodynamic parameters in subgroups of patients

Summary. Objectives: to study the relationship between pulmonary venous systolic flow fraction (PVSFfr) recorded using pulsed Doppler transesophageal echocardiography and angiographic grading and haemodynamic parameters in subgroups of patients with mitral regurgitation. Background: reversed systolic pulmonary venous flow is a sensitive sign of severe mitral regurgitation. Scarse data are available regarding the effects of atrial fibrillation and coronary artery disease. Methods: PVSFfr was calculated as the systolic flow velocity integral divided by the total inflow integral. PVSFfr is negative when systolic flow is dominantly reversed. 111 patients were studied. Results: PVSFfr<0 was 91% sensitive for angiographic severe mitral regurgitation (MR) (specificity 75%). In patients with sinus rhytm and without coronary artery disease the sensivity was 100% and specificity was 86% (n= 25). PVSFfr correlated to angiographic grade (r= -0.63, P= 0.0001), mean PCW (r= -0.63, P= 0.0001), v-wave (r=-0.72, P= 0.0001), systolic blood pressure (r= 0.28, P= 0.003) and left atrial diameter (r= -0.42, P= 0.0001) (n= 111). Stepwise linear regression analysis revealed the v-wave, angiographic grading, left atrial diameter and systolic blood pressure to be independent predictors of PVSFfr. Subgroup analysis revealed a correlation (r= 0.85, n= 25) between angiographic grading and PVSFfr in patients with sinus rhythm without CAD and (r= 0.35, n= 23) in patients with CAD in atrial fibrillation. Conclusions: PVSFfr is valuable in assessing mitral regurgitation. In the presence of atrial fibrillation and coronary artery disease the correlation with angiographic grading decreases indicating the dynamic nature of this valvular lesion.     

Association of carotid arterial distensibility with Doppler indices of left ventricular filling in 50-year-old subjects

Doppler indices of left ventricular diastolic filling are associated with various cardiac and extracardiac factors. Afterload is one of the extracardiac factors influencing left ventricular diastolic filling. The distensibility of the great arteries is one of the components of afterload. In this study, the relation between Doppler indices of left ventricular filling and the distensibility of the common carotid arteries was investigated. We studied 237 subjects at 50 years of age with Doppler echocardiography and ultrasound examination of the common carotid arteries. The following Doppler indices of left ventricular filling were studied: peak early diastolic velocity E-wave, peak atrial diastolic velocity A-wave and early to atrial peak velocity ratio, E/A. Carotid arterial characteristics were: distensibility coefficient, carotid arterial diameter change in systole and fractional change in the carotid arterial diameter. The relation between Doppler indices of left ventricular filling and carotid arterial characteristics was assessed by univariate and multivariate regression analysis. There was a significant univariate, positive association between E/A ratio and carotid arterial distensibility (r = 0·27, P<0·001), carotid arterial systolic diameter change (r = 0·19, P<0·005) and fractional change of the carotid arterial diameter (r = 0·20, P<0·005). In multivariate analysis, E/A ratio was independently associated with carotid arterial distensibility (P<0·005), after adjusting for heart rate, body mass index and gender. Decreased carotid arterial distensibility was associated with a reduction in E/A ratio, suggesting that arterial distensibility may have an effect on left ventricular diastolic filling or that changes in the arterial elastic properties are associated with corresponding structural changes in the left ventricle.     

The use of transthoracic echocardiography for the assessment of left ventricular systolic and diastolic function in patients with suspected or ascertained chronic heart failure

Several indices are available to assess left ventricular (LV) function. Although ejection fraction (EF) is widely used, it has many limitations. An assessment of LV longitudinal function should be therefore provided as it precedes the impairment of EF. In this context, speckle tracking derived global longitudinal strain is the gold standard but S’ velocity of mitral annulus (by pulsed tissue Doppler) and mitral annular plane systolic excursion (by M-mode) represent more than simple surrogates. LV diastolic assessment should be oriented not to the simple classification of transmitral patterns (E/A ratio and E velocity deceleration time) but to non-invasive estimation of LV filling pressures. This can be mainly obtained from E/e’ ratio, with additional calculation of other measurements such as pulmonary flow atrial reverse velocity, systolic pulmonary arterial pressure and left atrial volume index. This comprehensive assessment could also be useful to differentiate heart failure with reduced and preserved EF in particular.     

Early diastolic motion of the posterior aortic root as an index of left ventricular filling

Aortic root motion on M-mode echocardiography is related to left atrial volume change. Early diastolic motion of the aortic root has been quantified by the atrial emptying index. This index has been shown by some investigators to assess early diastolic left ventricular filling, while other investigators report conflicting findings. To evaluate further early diastolic motion of the posterior aortic root, we describe a new echocardiographic parameter—the slope of early diastolic posterior aortic root motion. This parameter appears superior to the atrial emptying index in assessing early diastolic left ventricular filling. Forty-one patients were studied by M-mode echocardiography and were divided into group I (17 patients) with diminished E to F mitral value slopes (<70 mm/sec) and group II (24 patients) with normal E to F mitral valve slopes (≥70 mm/sec). Patients in group I and group II had comparable left atrial sizes and left ventricular dimensions. The aortic root slope and normalized aortic root slope (normalized for left atrial dimension) in group I (3.7 ± 1.4 cm/sec and 1.0 ± 0.4 sec^?1, respectively) were significantly less than in group II (6.4 ± 1.4 cm/sec and 1.9 ± 0.6 sec^?1, respectively). The atrial emptying index and atrial emptying index normalized for heart rate were not different between the two groups. When the 41 patients were analyzed according to the presence or absence of left ventricular hypertrophy by echocardiography, only the normalized aortic root slope was significantly different in patients with or without left ventricular hypertrophy. A significant linear correlation (r = 0.84, P < 0.0005) was found between the aortic root slope or normalized aortic root slope and the E to F slope of the mitral valve. Significant correlations also existed between the aortic root slope and the slope of early diastolic left ventricular rapid filling. Therefore, the slope of early diastolic motion of the posterior aortic root appears to be a useful and easily obtainable echocardiographic parameter to assess early diastolic left ventricular filling.     

Reduced left ventricular relaxation velocity after acute myocardial infarction

Diastolic left ventricular function is usually described using Doppler recording of the early to atrial (E/A) ratio. However, because of pseudonormalization in patients with moderately impaired diastolic function, the E/A ratio does not allow a meaningful comparison between a group of patients with varying degrees of dysfunction, e.g. after acute myocardial infarction (AMI), and a group of healthy control subjects. In this study, diastolic function was assessed using the E/A ratio, deceleration time of early mitral inflow and maximal longitudinal relaxation velocity. The relaxation velocity was measured using echocardiographic M-mode recording of mitral annulus motion. Mitral annulus motion was recorded in four- and two-chamber views. Relaxation velocities were measured in the septal, lateral, anterior and posterior parts of the mitral annulus and the mean value (RV_m) was calculated. Twenty-two consecutive patients were investigated 3–21 days after first transmural AMI. Twenty-two healthy subjects of similar age served as a control group. The group of patients with AMI had an RV_m of 40·9 ± 15·4 mm s^?1 compared with 68·5 ± 12·4 mm s^?1 in the control group (P<0·0001). In contrast, the E/A ratio, deceleration time and heart rate did not differ significantly between the two groups. The results suggest that maximal longitudinal relaxation velocity is a simple and appropriate measure of diastolic function in patients with transmural AMI.     

Cardiac resynchronization therapy acutely improves diastolic function.

BACKGROUND: Invasive studies have shown that cardiac resynchronization therapy (CRT) acutely improves left ventricular (LV) systolic performance and lowers filling pressures in a majority of patients with medically-refractory severe heart failure. Measurements included LV volume, ejection fraction, PWD early (E-wave) and atrial (A-wave) velocities, diastolic filling time (DFT), and DTI early diastolic mitral annular velocity (Em) at the lateral and septal annulus; PWD mitral E-wave/Em and E/FP were calculated to estimate LV filling pressures. RESULTS: Immediately after CRT, LV volumes decreased and LVEF increased significantly. PWD mitral E-wave velocity decreased and E-wave duration and DFT increased significantly; mitral E/FP ratio also decreased significantly, consistent with a decrease in LV filling pressure. Patients with a pre-CRT mitral E/A ratio >1 (n = 20), demonstrated improvements in LV diastolic filling and lower filling pressures whereas those with an E/A ratio < or =1 (n = 21) did not show significant changes in diastolic indices. CONCLUSIONS: The acute effects of CRT include echocardiographic evidence of reduced LV volumes and increased LVEF with improved diastolic filling and lower filling pressures; LV relaxation is not significantly altered. The benefits in diastolic function are dependent on the PWD-determined LV filling characteristics prior to CRT.     

Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation.

This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function in patients with atrial fibrillation. Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. The clinical usefulness of conventional Doppler indexes is limited in atrial fibrillation because of the altered left atrial pressure and loss of synchronized atrial contraction. Mitral inflow and mitral annulus velocities were measured simultaneously with tau in 27 patients with nonrheumatic atrial fibrillation at the cardiac catheterization laboratory. Among deceleration time of mitral inflow, peak mitral inflow velocity (E), and peak diastolic mitral annulus velocity (E), only E correlated with tau (r = 0.51, P =.007). Prolonged tau (>/=50 ms) could be predicted by E <8 cm/s with a sensitivity of 73% (16 of 22) and a specificity of 100% (5 of 5). The E/E ratio correlated with left ventricular filling pressure (r = 0.79, P <.001). The E/E ratio of >/=11 could predict elevated left ventricular filling pressure (>/=15 mm Hg) with a sensitivity of 75% (9 of 12) and a specificity of 93% (14 of 15). Mitral annulus velocity is useful in the detection of impaired left ventricular relaxation and estimation of filling pressure even in patients with atrial fibrillation.     

Changes in transmitral and pulmonary venous flow patterns in the first day of life

The purpose of this study was to see the relationship between changes in pulmonary venous flow velocities and those in transmitral flow velocities during the first day of life. A serial Doppler echocardiography was performed in 24 normal neonates at 2, 12, and 24 hours of age. The size of the ductus arteriosus was 4.3 ± 0.5 mm at 2 hours and 2.1 ± 0.7 mm at 12 hours, and closed in 21 of 24 neonates at 24 hours. The peak systolic pulmonary venous flow (peak S), peak diastolic pulmonary venous flow (peak D), peak D/S, peak velocity at early diastolic filling (peak E), and peak E/A, which were high at 2 hours, decreased significantly at 12 hours but remained constant thereafter. The size of the ductus arteriosus was found to be correlated with peak S, peak D, and peak D/S. There was a direct correlation between peaks E and D (r: 0.64, p < 0.01) as well as a direct correlation between peaks E/A and D/S (r: 0.36, p < 0.05). These results indicate that the diastolic pulmonary venous flow is determined by the same factors that influence the transmitral flow. These waveforms may reflect the increase in pulmonary circulatory volume by left-to-right shunting through the ductus arteriosus. © 1995 John Wiley & Sons, Inc.     

血流向量成像技术评估心房颤动患者窦性心律下左心室能量损耗

目的 采用血流向量成像技术（VFM）定量评估心房颤动（AF）患者窦性心律下左心室血流能量损耗（EL）。方法 对54例AF患者（AF组）及29名健康志愿者（对照组）行VFM检查,分析等容收缩期（T1）、收缩早期（T2）、收缩晚期（T3）、舒张早期（T4）和心房收缩期（T5）左心室基底段、中间段和心尖段EL,比较2组一般资料、心功能参数以及EL的差异。以与对照组相比5个时相均有统计学意义的EL为应变量、一般资料和心功能参数为自变量,采用多元逐步回归分析各时相EL增高的危险因素。结果 AF组体表面积、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心房最大容积指数（LAVI_max）、二尖瓣舒张早期血流峰值（E）/心房收缩期血流峰值（A）及E/二尖瓣环运动速度（e''）均高于对照组,而A和e''低于对照组（P均<0.05）。各时相基底段EL及T4中间段、心尖段EL,T1、T2心尖段EL明显增高（P均<0.05）;其他时相各节段差异均无统计学意义（P均>0.05）。各时相基底段EL增高的危险因素分别为T1：年龄、E/A;T2：LVESV;T3：LVESV;T4：E/A、E、e'';T5：A、年龄。结论 AF可致左心室各时相基底段EL增高;采用VFM技术定量评估AF患者左心室EL,为观察AF对左心室血流模式的影响提供了新的思路。     

多普勒组织成像探测二尖瓣环e/a比率评价左室舒张功能价值的探讨

目的：探讨二尖瓣环舒张早期与心房收缩期峰值运动速度ｅ／ａ比率评价左室舒张功能的价值。方法：应用多普勒组织成像技术探测正常对照组及原发性高血压患者二尖瓣环侧壁的峰值运动速度ｅ／ａ比率,同时探测二尖瓣血流舒张早期与心房收缩期峰值速度Ｅ／Ａ比率、肺静脉血流收缩期与舒张早期峰值速度Ｓ／Ｄ比率作对照。结果：根据二尖瓣血流Ｅ／Ａ比率,分别讨论：１．Ｅ／Ａ〈１（左室舒张早期功能受损）,二尖瓣环ｅ／ａ比率评价左室