Characteristics of left ventricular diastolic function in patients with hypertension]

Left ventricular (LV) diastolic filling was examined by Doppler echocardiography in 239 patients with essential hypertension and 100 normal subjects. The Doppler study showed an inverse correlation between age and early diastolic peak velocity (PVE, r-0.201, P less than 0.05) [and a positive correlation between age and late diastolic peak velocity (PVA, r = 0.202, P less than 0.05) in normal subjects. Isovolumic relaxation time and late diastolic filling time were prolonged, PVA, A/E and Ai elevated, PVE, E/A and Ei/Ai as well as total filling time decreased in patients with hypertension as compared with the values found in the normal subjects (P less than 0.05 to 0.01). The results showed definite impairement of LV diastolic function in hypertensive patients. PVA correlated positively with systolic blood pressure (r = 0.68, P less than 0.01) and modestly with left atrial dimension in the hypertensives. No significant differences were found in FS and EF between the two study populations, indicating that LV filling abnormalities may occur early in patients with hypertension, even at a time when systolic performance has not yet been affected.     

Assessment of global and regional left ventricular diastolic function in hypertensive heart disease using automated border detection techniques

Acoustic quantification (AQ) and color kinesis (CK) are techniques that involve automated detection and tracking of endocardial borders. These methods are useful for the evaluation of global and regional left ventricular (LV) systolic function and more recently have been applied to evaluating LV diastolic performance. Assessment of diastolic dysfunction in hypertensive heart disease is a relevant clinical issue in which these techniques have proven useful. The diastolic portion of left atrium and LV AQ area waveforms are frequently abnormal in patients with left ventricular hypertrophy (LVH). Left ventricular AQ curves consistently demonstrate reduced rapid filling fraction (RFF) and peak rapid filling rate (PRFR), elevated atrial filling fraction (AFF), peak atrial filling rate (PAFR), and reductions in the ratio PRFR/PAFR. Acoustic quantification complements traditional Doppler echocardiographic evaluation of global diastolic function. Many patients with significant LVH and normal Doppler diastolic parameters can be identified as having diastolic dysfunction with AQ. In addition, CK has allowed the evaluation of regional diastolic performance in hypertensive patients. Regional filling curves obtained from CK have demonstrated that endocardial diastolic motion is commonly delayed and heterogeneous in patients with LVH.     

Abnormal left ventricular filling pattern in patients with single vessel coronary artery disease: effect of angioplasty.

To study the effect of coronary angioplasty (PTCA) on left ventricular (LV) diastolic filling, mitral Doppler flow tracings of 15 patients with isolated stenosis of the left anterior descending coronary artery (LAD) and normal systolic LV function were recorded before PTCA as well as 24 h and 3 months after successful PTCA. Compared to control subjects, patients with LAD stenosis exhibited an abnormal LV filling velocity pattern before PTCA. The day following PTCA, the ratios of the early peak diastolic velocity to the peak late diastolic velocity and of the time velocity integral of the early diastolic filling phase to the time velocity integral of the late diastolic filling phase were unchanged. Despite the absence of clinical evidence of restenosis, LV filling remained abnormal 3 months after PTCA. The results suggest that abnormalities of the LV filling velocity in patients with isolated LAD stenosis and normal systolic function may persist as long as 3 months after PTCA.     

Prevalence and determinants of left ventricular diastolic filling abnormalities in an unselected hypertensive population

The independent contribution of age, sex, duration of hypertension, heart rate, clinic and ambulatory blood pressure and echocardiographic left ventricular mass to left ventricular diastolic filling abnormalities in essential hypertension was investigated in 250 subjects (145 untreated and unselected hypertensives and 105 healthy normotensive controls) undergoing Doppler and standard echocardiography and non-invasive 24-h ambulatory blood pressure monitoring. Late and early diastolic transmitral peak flow velocities and their ratio (all P less than 0.01), the rate of deceleration of early diastolic mitral flow (P less than 0.01) and the time of deceleration of early diastolic mitral flow (P = 0.018) were abnormal in the hypertensive group vs controls. None of these parameters significantly varied in the presence vs absence of LV hypertrophy. In the hypertensive group, the prevalence of abnormal age-corrected Doppler values varied up to 46% (up to 45.4% and 50% in the absence and presence of left ventricular hypertrophy, respectively; P = n.s.). In a stepwise multivariate regression analysis, age and average daytime or night-time ambulatory blood pressure showed a significant independent relationship with each of these Doppler indexes of left ventricular diastolic filling. Late transmitral peak flow velocity and the ratio of late to early peak flow velocity were also independently affected by the heart rate. Sex, duration of hypertension, clinic systolic and diastolic blood pressure and left ventricular mass index did not show any independent relationship to these Doppler parameters of left ventricular filling. In conclusion, Doppler abnormalities of diastolic transmitral blood flow were detected in up to 46% of patients in an unselected hypertensive population with a low prevalence (14.5%) of left ventricular hypertrophy. Age and ambulatory blood pressure, but not sex, duration of hypertension, clinic blood pressure and left ventricular mass itself, were the major independent determinants of these abnormalities.     

Aortic Upper Wall Tissue Doppler Image Velocity: Relation to Aortic Elasticity and Left Ventricular Diastolic Function

Background: Aortic stiffening contributes to the left ventricular (LV) afterload, hypertrophy, and substrate for diastolic dysfunction. It is also known that aortic elastic properties could be investigated with color tissue Doppler imaging (TDI) in aortic upper wall. The purpose of this study is to evaluate the relation of aortic upper wall TDI and aortic stiffness and other parameters of LV diastolic function. Methods: We examined aortic upper wall by TDI at the 3 cm above the aortic valves because of patient's chest discomfort or dyspnea. We excluded the patient with arterial hypertension or reduced left ventricular ejection fraction (LVEF) or significant valvular heart disease. So a total of 126 (mean age 53.8 ± 13.9 years, male 49.2%) patients were enrolled in this study and divided normal LV filling group (N = 31) and abnormal LV filling group (N = 95). Results: Aortic upper wall early systolic velocity and late diastolic velocity were not different between the two groups. Only aortic upper wall early diastolic velocity (AWEDV) was related to aortic stiffness index (r =−0.25, P = 0.008), distensibility (r = 0.28, P = 0.003), early diastolic (Em) (r = 0.45, P = 0.001), E/Em (r =−0.26, P = 0.003), and significantly reduced in abnormal LV filling group (6.19 ± 2.50 vs 8.18 ± 2.87, P = 0.001). Conclusions: AWEDV is decreased significantly in abnormal LV filling patients. It is statistically related to aortic stiffness, distensibility and parameters of abnormal LV filling, Em, E/Em. TDI velocity of the aortic upper wall can be a helpful tool for evaluating aortic stiffness, distensibility, and diastolic function.     

Evaluation of Left Ventricular Diastolic Performance Using Automated Border Detection

Acoustic quantification (AQ) is a noninvasive technique which provides online left ventricular (LV) area/volume waveforms. The filling portion of the AQ waveform can be used to assess LV diastolic properties. Analysis of signal-averaged AQ curves enhances the waveforms and allows reliable, quantitative, and automated analysis. From signal-averaged AQ LV waveforms, the phases of diastole can be easily detected and several parameters of diastolic performance calculated. Analysis of signal-averaged LV waveforms is complementary to that of LV AQ analysis. AQ has been used to identify diastolic dysfunction in patients with LV hypertrophy and systemic hypertension. Normal values of these parameters are age dependent and reference values will soon be available.     

Limited atrial compensation to reduced early diastolic filling in hypertensive patients with advanced left ventricular hypertrophy: A Doppler echocardiographic study

Summary To assess atrial contribution to left ventricular (LV) filling in hypertension, we studied, using pulsed Doppler echocardiography, 22 hypertensive patients without apparent LV hypertrophy (LVH), 12 hypertensive patients with LVH, and 24 age-matched normal subjects. From mitral flow velocity waveform, we determined peak velocity of early diastolic filling flow (peak E), peak velocity of late diastolic filling flow (peak A), and the peak A/peak E ratio (peak A/peak E). Peak E decreased in hypertensives without apparent LVH and showed a further decrease in hypertensives with LVH compared with normal subjects (57±8 [mean ± SD];P<0.001, 46±7;P<0.0001, vs 65±10 cm/s). On the other hand, peak A/peak E increased in hypertensives without apparent LVH, and greatly increased in hypertensives with LVH (1.06±0.14;P<0.001, 1.40±0.29;P<0.0001, vs 0.79±0.21). However, increased peak A was not significantly different between the hypertensive groups (60±8 vs 64±8; NS, both;P<0.001 vs 50±10 cm/s for normal subjects). In hypertensives, we found no significant correlation between peak A and the wall thickness index (WTI, determined as mean LV wall thickness normalized by LV diastolic dimension), whereas peak E was significantly correlated with WTI (r=–0.65;P<0.001). Our findings indicate that atrial contraction can not fully compensate the decrease in early diastolic filling caused by advanced LVH. We conclude that atrial compensation for reduced early diastolic filling is limited in hypertensive patients with advanced left ventricular hypertrophy.     

Above-normal left ventricular systolic performance during exercise in young subjects with mild hypertension

Debate continues on whether left ventricular (LV) systolic functionduring exercise is abnormal in young subjects with mild hypertensionand on whether the abnormal blood pressure (BP) trend observedin hypertensives during prolonged exercise is due to impairedLV function. LV function was measured by means of M-mode echocardiographyduring prolonged exercise in 13 physically trained, young, mildhypertensives and 12 age-matched, trained normotensives withsimilar working capacity. Systolic BPIend-systolic volume (SBPIESV) and end-systolic stress/ESVat rest were greater in the hypertensives (P<0.0001 and P–0.034),while LV filling was impaired (P–0.05). BP clianges duringthe first 20 min of exercise were similar in the two groups,but thereafter the between-group BP difference tended to declineprogressively. LV diastolic dimension was similar at rest. Duringexercise it slightly increased in the normotensives and slightlydecreased in the hypertensives (P–0.032). Exercise ejectionfraction (P–0.018), SBPIESV (P<0.0001) and stress/ESV(P–0.027) were greater in the hypertensives throughoutthe test. SBPIESV normalized for LV wall thickness (P<0.0001)and the changes in SBPIESV from rest to exercise were also greaterin the hypertensives (P–0.002). Stroke volume increasedto a lower extent in the hypertensives, but the between-groupdifference was not statistically significant. The increase inSBPIESV from rest to exercise was related to the concentricremodelling of the ventricle in the hypertensives (P<0.0001)and the subjects grouped together (P<0.0001), but not inthe normotensives. In conclusion, increased LV systolic performance is presentearly in hypertension not only at rest but also during vigorousexercise. It is partly due to concentric remodelling of theleft ventricle and partly to enhanced inotropic state.     

Effects of age and 24-hour ambulatory blood pressure on rapid left ventricular filling

To determine the associations of age, blood pressure (BP) and cardiac structure with left ventricular (LV) diastolic performance, 47 subjects (21 normotensives and 26 age-matched, previously untreated hypertensives) were studied by 24-hour ambulatory BP monitoring, radionuclide ventriculography and sector-guided M-mode echocardiography. Normotension was defined as an awake ambulatory BP less than 130/80 mm Hg and hypertension as an awake ambulatory BP greater than 135/85 mm Hg. Univariate analyses revealed strong negative correlations of LV filling rate with age (r = -0.67, p less than 0.001), 24-hour systolic or diastolic BP (r = -0.59 for systolic BP and -0.57 for diastolic BP, p less than 0.001 for both) and a modest positive correlation with LV ejection fraction (r = 0.42, p less than 0.05). After multivariate analysis, significant dependencies of both the left atrial index and LV mass index on ambulatory BP were found, which negated the significance of the relation of these 2 cardiac structural variables with LV filling rate. The final regression equation predicted LV filling rate from age, BP and LV ejection fraction. Age was the most important single correlate of LV filling, as evidenced by the 14 of 16 subjects (88%) over the age of 53 years (8 hypertensives, 6 normotensives) who had reduced LV filling rates compared with only 9 of the remaining 31 subjects (29%, all hypertensives) under the age of 53 years with reduced LV filling rates. These data demonstrate that LV filling rate is more dependent upon age and BP than left atrial or LV size.(ABSTRACT TRUNCATED AT 250 WORDS)     

V1P-terminal force evaluated by left ventricular inflow velocity patterns in pulsed Doppler echocardiography

The relationship between V1P-terminal force (V1-PT) and the characteristics of left ventricular (LV) diastolic filling and atrial contraction were evaluated using LV inflow velocity patterns obtained by pulsed Doppler echocardiography. Subjects consisted of 54 patients with old myocardial infarction, 56 with essential hypertension, 48 with angina pectoris, 19 with dilated cardiomyopathy, and 16 with miscellaneous disease other than of mitral valve lesions. The patients were classified as the positive group: V1-PT less than or equal to -0.04 mmsec, intermediate group: 0 greater than V1-PT greater than -0.04 mmsec, and negative group: V1-PT greater than or equal to 0 mmsec. The following were the results obtained: 1. In the positive group, the rapid filling wave (R) had reduced velocity, the prolonged deceleration time and the decreased acceleration and deceleration ratios. 2. In the positive group, velocity of the atrial contraction wave (A) was increased and the atrial contraction time was prolonged compared to the other groups. 3. In the positive group, the A/R was greater than in the other groups. 4. In the positive and intermediate groups, V1-PT correlated significantly with the A/R (r = 0.83, p less than 0.01), R (r = -0.58, p less than 0.01) and A (r = 0.48, p less than 0.01). In the positive group, LV inflow volume was decreased in the rapid filling phase. In the atrial contraction phase, the inflow volume was increased to compensate for loss of inflow volume in the rapid filling phase. These findings suggested that LV diastolic filling was disturbed in the positive group. In conclusion, the value of V1-PT is influenced by any disturbance of LV diastolic filling.     

Are left ventricular mass,geometry and function related to vascular changes and/or insulin resistance in long-standing hypertension? ICARUS: a LIFE substudy

Vascular hypertrophy and insulin resistance have been associated with abnormal left ventricular (LV) geometry in population studies. We wanted to investigate the influence of vascular hypertrophy and insulin resistance on LV hypertrophy and its function in patients with hypertension. In 89 patients with essential hypertension and electrocardiographic LV hypertrophy, we measured blood pressure; insulin sensitivity by hyperinsulinaemic euglucaemic clamp; minimal forearm vascular resistance (MFVR) by plethysmography; intima-media cross-sectional area of the common carotid arteries (IMA) by ultrasound; and LV mass, relative wall thickness (RWT), systolic function and diastolic filling by echocardiography after two weeks of placebo treatment. LV mass index correlated to IMA/height (r=0.36, P=0.001), serum insulin (r=-0.25, P<0.05), plasma glucose (r=-0.34, P<0.01), and showed a tendency towards a correlation to insulin sensitivity (r=0.21, P=0.051), but was unrelated to MFVR. Deceleration time of early diastolic transmitral flow positively correlated to IMA/height (r=0.30, P<0.01). The ratio between early and atrial LV filling peak flow velocity negatively correlated to MFVR(men) (r=-0.30, P<0.05). Endocardial and midwall systolic LV function were not related to vascular hypertrophy, plasma glucose, serum insulin or insulin sensitivity. In conclusion, insulin resistance was not related to LV hypertrophy or reduced LV function. However, high thickness of the common carotid arteries was associated with LV hypertrophy and high deceleration time of early diastolic transmitral flow. High MFVR was associated with low ratio between early and atrial LV filling peak flow velocity. This may suggest that systemic vascular hypertrophy contributes to abnormal diastolic LV relaxation in patients with hypertension and electrocardiographic LV hypertrophy.     

Influence of isometric exercise on left ventricular diastolic function in the normal subjects and in patients with hypertension and coronary heart disease]

To evaluate the influence of isometric exercise on left ventricular (LV) diastolic function, transmittal flow velocity was measured by pulsed Doppler echocardiography before and after handgrip in 15 normal subjects and the patients with hypertension as well as 18 patients with coronary heart disease (CHD). Statistically significant differences in peak velocity of early rapid filling (Ev), the ratios of peak early to late diastolic velocity (Ev/Av) and early to late velocity-time integral (Ei/Ai) between normal subjects and both the patients with hypertension and CHD were noted at rest. After isometric exercise, significant increase in Av (0.70 +/- 0.13 vs 0.76 +/- 0.14, P less than 0.01) and Ai/total VTi (0.35 +/- 0.07 vs 0.42 +/- 0.08, P less than 0.05) were showed in the hypertension group. In CHD, multiple Doppler parameters changed after isometric exercise with increase in Av (0.70 +/- 0.16 vs 0.85 +/- 0.18, P less than 0.01) and Ai/total VTi (0.36 +/- 0.08 vs 0.42 +/- 0.08, P less than 0.01) as well as decrease in Ev/Av (0.95 +/- 0.22 vs 0.82 +/- 0.15, P less than 0.05) and Ei/Ai (1.64 +/- 0.51 vs 1.35 +/- 0.34, P less than 0.05). However, there was no significant difference in any Doppler indices of LV diastolic function in the present normal subjects after isometric exercise. Thus, isometric exercise further enhanced late LV diastolic filling in the patients with impaired LV diastolic function in resting states greater than normal subjects, and myocardial ischemia induced by handgrip may play partial role in more changes in Doppler indices of LV diastolic function in CHD than the patients with hypertension.     

Evaluation of left ventricular diastolic function from the pattern of left ventricular filling

The pattern of left ventricular (LV) filling can be determined by Doppler echocardiography. Normally most LV filling occurs early in diastole, with some additional filling occurring during atrial systole, late in diastole. In the absence of mitral stenosis, three patterns of LV filling indicate progressively greater diastolic dysfunction: (1) Reduced early diastolic filling with a compensatory increase in importance of atrial filling, termed a pattern of “impaired relaxation;” (2) “pseudo-normalization” with most filling early in diastole but with rapid deceleration of mitral flow; and (3) “restricted filling” with almost all filling of the LV occurring very early in diastole in association with very rapid deceleration of mitral flow. A large, prolonged atrial regurgitant flow in the pulmonary veins also indicates impaired diastolic performance. The time for early filling deceleration is predominantly determined by LV stiffness: the shorter the deceleration time, the stiffer the LV. Patients with short deceleration time have a poor prognosis.     

Effect of coronary artery bypass grafting on left ventricular diastolic function

Because left ventricular (LV) diastolic function is abnormal in patients with coronary artery disease (CAD), pulsed Doppler echocardiography was used to evaluate LV filling before and after coronary artery bypass grafting (CABG). Filling was evaluated by Doppler in 2 studies: (1) in a group of 41 unpaired patients (11 with angiographically normal coronary arteries, 14 with CAD but without CABG and 16 at 1 week after CABG) and (2) in a group of 12 patients with CAD before and 1 week after CABG. Doppler sampling at the level of the mitral anulus was analyzed for the deceleration half-time and for the ratio of peak late (A) to peak early (E) filling velocity, measures reflecting early ventricular filling and the relative contribution of atrial contraction to ventricular filling. In the first study the deceleration half-time was significantly prolonged in both CAD and CABG groups. The late to early peak transmitral velocity ratio, however, was significantly prolonged only in the nonrevascularized CAD patients. In the second group of CAD patients studied before and 1 week after surgical revascularization, both the late to early peak transmitral velocity ratio and the deceleration half-time showed significant postoperative improvement. Thus, patients with CAD showed impairment in early LV filling and a compensatory increase in the proportion of filling with active atrial contraction. Successful CABG appears to result in normalization of early filling and decreased reliance on active atrial transport.     

Cardiac involvement in hypertension

Despite improved patient detection and pharmacologic therapy, the effect of treatment of hypertension on mortality from coronary artery-related events remains unresolved. Left ventricular (LV) hypertrophy, a known consequence of hypertension, is associated with an excess mortality independent of other known cardiovascular risk factors. Recently, LV hypertrophy accompanying hypertension has been associated with ominous ventricular arrhythmias. However, it does not necessarily follow that regression of LV hypertrophy will reduce this increased mortality. Diastolic dysfunction, manifested by reduced ventricular distensibility of the hypertrophying left ventricle, appears to be an early characteristic of the hypertensive heart since echocardiographic techniques have demonstrated diastolic filling abnormalities in untreated essential hypertensives even before significant LV hypertrophy appears. Not all antihypertensive agents diminish LV mass and improve diastolic dysfunction. Certain sympatholytic agents, calcium antagonists, β-adrenergic blockers, and the angiotensin-converting enzyme inhibitors appear to diminish LV hypertrophy. However, future studies are needed to determine if these agents that appear to reverse findings of LV hypertrophy and improve diastolic dysfunction will also reduce risk of coronary artery disease and related events.     

Correlates of diastolic filling abnormalities in hypertension: a Doppler echocardiographic study

Hypertension and aging are both associated with changes of left ventricular (LV) diastolic filling and increased LV mass. To determine whether diastolic filling abnormalities are present in hypertension independent of aging and significant hypertrophy, we studied 19 hypertensive patients following a period of 4 weeks when they were not receiving therapy and 18 normotensive subjects matched for sex, age, and LV mass. All subjects had normal systolic function and ejection fraction as assessed by radionuclide angiography. We measured peak velocity of early filling (E), late filling (A), and their ratio (E/A) by Doppler echocardiography. Filling indices were abnormal in hypertensive patients, but none of the filling indices were significantly correlated with LV mass. E was inversely related to age (r = -0.62; p less than 0.01) and diastolic blood pressure (r = 0.45; p less than 0.05) in normotensive individuals, but these correlations were not significant in hypertensive patients. E was not significantly correlated to LV mass or wall thickness. In contrast, A was influenced by septal wall thickness and blood pressure in both groups. E/A correlated inversely with age in both normal individuals (r = -0.74) and hypertensive patients (r = -0.51). These findings indicate that diastolic filling abnormalities in hypertension are not solely caused by either LV hypertrophy or by aging and therefore must be in part related to the hemodynamic load or altered myocardial or chamber properties.     

Right ventricular diastolic function in systemic hypertension

Right (RV) and left ventricular (LV) diastolic function was evaluated in 50 patients with mild, uncomplicated essential hypertension using pulsed-wave Doppler echocardiography. Patients with pulmonary, valvular or coronary artery disease were excluded and antihypertensive drugs were discontinued for the 2 weeks preceding the study. Ten normotensive patients without heart disease acted as control subjects. In the hypertensive patients, RV peak velocity of atrial filling was higher (42 +/- 10 vs 31 +/- 7 cm/s, p less than 0.01) and deceleration half-time was prolonged (96 +/- 20 vs 83 +/- 10 ms, difference not significant); ratio of early/atrial filling velocity (1.1 +/- 0.3 vs 1.7 +/- 0.4, p less than 0.001) and peak filling rate corrected to stroke volume (3.6 +/- 0.7 vs 5.3 +/- 0.9 SV/s, p less than 0.001) were lower. LV filling parameters showed similar changes. RV filling parameters did not correlate with age, LV mass or septal thickness but correlated weakly with LV radius/thickness ratio. There was good correlation between RV and the following corresponding LV filling parameters: peak filling rate, r = 0.68, p less than 0.001; ratio of early/atrial filling, r = 0.88, p less than 0.0001; and deceleration half-time, r = 0.62, p less than 0.001. Data indicate that RV diastolic function is abnormal in essential hypertension and these abnormalities are closely related to those of LV diastolic function.     

Left Ventricular Diastolic Filling With an Implantable Ventricular Assist Device: Beat to Beat Variability With Overall Improvement

Objectives. We studied the effects of left ventricular (LV) unloading by an implantable ventricular assist device on LV diastolic filling.Background. Although many investigators have reported reliable systemic and peripheral circulatory support with implantable LV assist devices, little is known about their effect on cardiac performance.Methods. Peak velocities of early diastolic filling, late diastolic filling, late to early filling ratio, deceleration time of early filling, diastolic filling period and atrial filling fraction were measured by intraoperative transesophageal Doppler echocardiography before and after insertion of an LV assist device in eight patients. A numerical model was developed to simulate this situation.Results. Before device insertion, all patients showed either a restrictive or a monophasic transmitral flow pattern. After device insertion, transmitral flow showed rapid beat to beat variation in each patient, from abnormal relaxation to restrictive patterns. However, when the average values obtained from 10 consecutive beats were considered, overall filling was significantly normalized from baseline, with early filling velocity falling from 87 ± 31 to 64 ± 26 cm/s (p < 0.01) and late filling velocity rising from 8 ± 11 to 32 ± 23 cm/s (p < 0.05), resulting in an increase in the late to early filling ratio from 0.13 ± 0.18 to 0.59 ± 0.38 (p < 0.01) and a rise in the atrial filling fraction from 8 ± 10% to 26 ± 17% (p < 0.01). The deceleration time (from 112 ± 40 to 160 ± 44 ms, p < 0.05) and the filling period corrected by the RR interval (from 39 ± 8% to 54 ± 10%, p < 0.005) were also significantly prolonged. In the computer model, asynchronous LV assistance produced significant beat to beat variation in filling indexes, but overall a normalization of deceleration time as well as other variables.Conclusions. With LV assistance, transmitral flow showed rapidly varying patterns beat by beat in each patient, but overall diastolic filling tended to normalize with an increase of atrial contribution to the filling. Because of the variable nature of the transmitral flow pattern with the assist device, the timing of the device cycle must be considered when inferring diastolic function from transmitral flow pattern.     

Sibling resemblance for left ventricular structure,contractility, and diastolic filling

Although there is evidence that left ventricular (LV) function is genetically controlled, the contribution of familial factors to variation and covariation of LV diastolic filling, contractility, and structure is unknown. Single- and cross-trait sibling correlations were estimated using bivariate familial correlation models in 200 white (400 pairs) and 374 black (539 pairs) hypertensive sibships. LV transmitral early and late peak filling velocities, isovolumic relaxation time, atrial filling fraction, stress-corrected midwall shortening, and LV mass and structure were measured and adjusted for important covariates in race-specific linear regression models. Single-trait sibling correlation was strongest for early peak filling velocity. Significant cross-trait sibling correlation was detected between early and late peak filling velocities. In whites, early peak filling velocity and atrial filling fraction, and isovolumic relaxation time and end-diastolic posterior wall thickness, were also significantly correlated. Familial factors common to early and late peak filling velocities contributed to 64% and 54% of sibling resemblance in early peak filling velocity and to 76% and 77% in late peak filling velocity in blacks and whites, respectively. In whites, 100% of sibling resemblance in isovolumic relaxation time was shared by posterior wall thickness, whereas 75% of sibling influence in posterior wall thickness was common to isovolumic relaxation time. In conclusion, significant cross-trait sibling resemblance was detected between (1) early and late filling parameters and (2) isovolumic relaxation time and posterior wall thickness, suggesting pleiotropy and/or common environment on these traits. These data have potential importance in understanding heritability of LV diastolic function in hypertension.     

Left ventricular filling abnormalities in asymptomatic morbid obesity.

Indexes of left ventricular (LV) diastolic filling were measured by pulse Doppler echocardiography in 16 asymptomatic morbidity obese patients presenting for bariatric surgery and were compared with an age- and sex-matched lean control population. No patient had concomitant disorders known to affect diastolic function. All patients had normal systolic function. LV wall thickness and internal dimension were measured in order to calculate LV mass. Fifty percent of morbidly obese patients had LV diastolic filling abnormalities as assessed by the presence of greater than or equal to 2 abnormal variables of mitral inflow velocity. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in obese compared with control patients (1.16 +/- 0.26 vs 1.66 +/- 0.30, p less than 0.001). The peak velocity of early LV diastolic filling was significantly reduced in obese patients (75 +/- 15 vs 98 +/- 19 cm/s, p less than 0.001). The atrial contribution to stroke velocity as assessed by the time-velocity integral of late compared with total LV diastolic filling was significantly increased in obese patients (36 +/- 7 vs 27 +/- 4%, p less than 0.001). Obese patients had significantly increased LV mass (214 +/- 45 vs 138 +/- 37 g, p less than 0.001), even when corrected for body surface area (95 +/- 16 vs 76 +/- 16 g/m2, p less than 0.002). However, increased LV mass did not correlate with indexes of abnormal diastolic filling in obese patients. These data suggest that abnormalities of diastolic function occur frequently in asymptomatic morbidly obese patients and may represent a subclinical form of cardiomyopathy in the obese patient.