Differentiation between reversible and irreversible restrictive left ventricular filling patterns with the use of mitral annulus velocity.

A restrictive left ventricular filling pattern is generally recognized as an ominous prognostic sign in patients with congestive heart failure. Recently, this filling pattern has been further categorized into reversible and irreversible groups according to the changes in the mitral inflow pattern after preload reduction; furthermore, the prognosis is reported to be different for the two groups. Forty-two patients with a restrictive left ventricular filling pattern who could adequately perform Valsalva's maneuver were studied. Baseline peak early (E) and late (A) mitral inflow velocities, E/A ratio, deceleration time of E velocity, peak early (E') and late (A') diastolic mitral annulus velocities, and E'/A' ratio were obtained. During Valsalva's maneuver, the E/A ratio reversed (<1) in fifteen patients (15/42, 36%). These patients were categorized as belonging to the reversible group. Among the baseline mitral inflow and mitral annulus velocity parameters, A' > 0.05 m/s best discriminated between the reversible and irreversible restrictive left ventricular filling patterns, with a sensitivity of 80% and a specificity of 85%.     

应用超声心动图对2型糖尿病患者左心室舒张功能变化的研究

目的用超声心动图(UCG)检测2型糖尿病(DM)患者心脏的形态结构和心功能状态,评价2型DM患者左心室舒张功能的变化。方法应用脉冲多普勒超声心动图(PDE)及多普勒组织显像技术(DTI)测定了40例2型DM病人、20例健康人二尖瓣口和肺静脉血流频谱及二尖瓣环运动频谱。结果(1)DM组室间隔(IVS)、左心室后壁(LVPW)厚度及左心房内径(LAd)较对照组增大(P<0.05);(2)反映收缩功能的指标两组比较无显著性差异,DM组反映舒张功能的多项指标异常(P<0.05)。结论2型DM患者存在舒张功能异常,DTI测定二尖瓣环运动速度评价左心室舒张功能敏感性高,简便易行。     

The association between left ventricular diastolic function and a mild-to-moderate decrease in glomerular filtration rate in patients with type 2 diabetes mellitus

This prospective study evaluated the relationship between echocardiography parameters of left ventricular (LV) diastolic function and mild-to-moderate renal function impairment in 82 patients with type 2 diabetes mellitus. The mean age of the patients was 61.1 years. A significant correlation was found between estimated glomerular filtration rate (eGFR) and the ratio of peak velocity of early transmitral flow (E) to peak velocity of early diastolic mitral annular motion (E'). Cluster analysis revealed two subgroups of patients with different E' values but comparable eGFRs. The correlation between eGFR and E/E' was significant in 38 patients with E' ≤ 7.1 cm/s, but not significant in 44 patients with E' > 7.1 cm/s. The results suggest that the deterioration of LV relaxation (E') represents the underlying condition for the association between mild-to-moderate renal function impairment and the non-invasive parameter of LV end-diastolic pressure (E/E'), in patients with type 2 diabetes without any previous cardiovascular event and with well-controlled blood pressure.     

Triphasic mitral inflow velocity with middiastolic filling: clinical implications and associated echocardiographic findings.

To explore underlying mechanisms and clinical implications of middiastolic filling, we measured early and late mitral inflow velocities, deceleration time of early mitral inflow velocity, and early diastolic mitral annular velocity (E') recorded by pulsed wave Doppler echocardiography in 3 cardiac cycles of 35 patients with prominent mitral inflow (middiastolic flow velocity > or = 0.2 m/s). E' was measured at the septal corner of the mitral annulus by Doppler tissue echocardiography from the apical 4-chamber view and was found to be reduced (E' < 0.1 m/s) in all patients; early mitral inflow velocity/E' ratio was > 10 in all but 1 patient. Valsalva maneuver unmasked delayed relaxation in 15 (88%) of 17 patients and abolished middiastolic filling in 10 (59%). Triphasic mitral inflow with middiastolic flow is related to elevated filling pressure, delayed myocardial relaxation, and slow heart rate, indicating advanced diastolic dysfunction.     

应用组织多普勒及血浆脑利纳肽对2型糖尿病患者左室舒张功能变化的研究

目的利用超声心动图(UCG)检测2型糖尿病(DM)患者心脏的形态结构和心功能状态,并与血浆脑钠利肽(BNP)水平相结合,评价2型DM患者左心室舒张功能的变化。方法应用脉冲多普勒超声心动图(PDE)及多普勒组织显像技术(DTI)测定了50例2型DM病人、30例健康人二尖瓣口和二尖瓣环运动频谱,定量分析BNP,结果 (1)DM组与对照组BNP水平无明显差异(P0.05)(2)DM组左心房内径(LAd)较对照组增大(P0.05);(3)反映收缩功能的指标两组比较无显著性差异,DM组反映舒张功能的多项指标异常(P0.05)。结论 2型DM患者存在舒张功能异常,DTI测定二尖瓣环运动速度评价左心室舒张功能敏感性高。     

Evaluation of left ventricular diastolic function when mitral E and A waves are completely fused: role of assessing mitral annulus velocity.

Mitral inflow parameters have been used most widely in the evaluation of left ventricular (LV) diastolic function. However, when the mitral E and A waves are completely fused, mitral inflow parameters cannot provide information about the LV diastolic function. LV filling pressure, mitral inflow, mitral annulus velocity, and tau (tau) were measured in 59 patients with sinus rhythm when mitral E and A waves were completely fused with right atrial pacing. When mitral E and A waves were completely fused, tau correlated with the peak fused mitral annulus velocity (r = -0.60, P <.001), and peak fused mitral annulus velocity of less than 12.5 cm/s best discriminated prolonged (>/=50 ms) from normal tau, with a sensitivity of 78% and specificity of 69%. The peak fused mitral inflow velocity to peak fused mitral annulus velocity ratio correlated with LV filling pressure (r = 0.62, P <.001). A ratio of at least 8, could predict elevated LV filling pressure (>/=15 mm Hg) with a sensitivity of 65% and specificity of 74%. In conclusion, even when mitral E and A waves are completely fused, mitral annulus velocity can be used in the evaluation of LV diastolic function.     

超声心动图对糖尿病患者左室舒张功能变化的临床研究

目的探讨超声心动图在早期糖尿病患者心脏左室功能变化中的诊断价值。方法应用超声心动图对初次就诊和系统治疗半年后的糖尿病患者进行检测,并与健康组对照。结果糖尿病患者治疗前的体重指数、舒张压、血糖水平均高于对照组（P〈0．05）;治疗后血糖明显得到控制（P〈0．01）;糖尿病组左房内径、舒张末期内径、左室收缩末期内径、左室后壁厚度、左室重量指数均高于对照组（P〈0．05）;糖尿病患者二尖瓣血流频谱：舒张晚期峰值速度较对照组升高（P〈0．05）;肺静脉血流频谱：糖尿病患者治疗前后心房收缩期逆向血流速均高于对照组（P〈0．01）。结论早期对糖尿病性心脏病做出诊断,以及早进行系统治疗能改善左室功能,避免严重的糖尿病性心脏病的发生,降低糖尿病患者的病死率。     

Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography.

Left ventricular filling pressures can be estimated reliably by combining mitral inflow early diastolic velocity (E) and annulus velocity (E'). An increased E/E' ratio reflects elevated filling pressures and may be useful in assessing an abnormal increase in filling pressures for patients with diastolic dysfunction. The purpose of this study was to evaluate the feasibility of supine bicycle exercise Doppler echocardiography for assessing left ventricular diastolic pressure during exercise. Mitral inflow and septal mitral annulus velocities were measured at rest and during supine bicycle exercise (25-W 3-minute increments) in 45 patients (19 men; mean age, 59 years) referred for evaluation of exertional dyspnea. None had echocardiographic or electrocardiographic evidence of myocardial ischemia with exercise. Patients were classified according to E/E' ratio at rest: 26 had E/E' < or = 10 at rest (group 1) and 19 had E/E' > 10 (group 2). For group 1, 17 had no increase in E/E' during exercise (group 1A) and 9 did (group 1B). For group 2, E/E' did not increase during exercise. Despite different responses of E/E', there was no significant difference in changes of mitral inflow indices (E, A, E/A, deceleration time) between groups. Although the percentage of dyspnea as a primary reason for stopping exercise was similar for the groups, exercise duration was significantly shorter for groups 1B (7.2 +/- 2.5 minutes) and 2 (7.1 +/- 3.3 minutes) than in group 1A (10.4 +/- 3.7 minutes, P = .0129). Diastolic stress echocardiography using a supine bicycle is technically feasible for demonstrating changes in E/E' (filling pressure) with exercise. Our preliminary results suggest the hemodynamic consequences of exercise-induced increase in diastolic filling pressure can be demonstrated noninvasively with exercise Doppler echocardiography.     

Reference ranges for tissue Doppler measures of maternal systolic and diastolic left ventricular function.

OBJECTIVES: Tissue Doppler imaging (TDI) is an echocardiographic technique that evaluates longitudinal myocardial tissue velocities during left ventricular systolic and diastolic function, relatively independently of loading conditions. Limited data are available regarding maternal cardiac function using TDI. The aim of this study was to construct reference charts for TDI indices in normal pregnancy. METHODS: This was a cross-sectional study on 104 pregnant women at 11-38 weeks of gestation and 19 non-pregnant controls. Doppler echocardiography was used to assess transmitral inflow velocities during diastole (peak velocity of early (E) and late (A) atrial filling), whilst TDI at the septal and lateral margins of the mitral annulus measured diastolic velocities (peak velocity of early (E') and late (A') diastolic filling) and peak systolic velocity (S'). The left ventricular filling index (E : E' ratio) was derived. The Tei index (ratio of isovolumetric time to ejection time) was measured. RESULTS: Systolic function assessed by TDI S' velocity was unaltered at the septal and lateral margins, although S' velocity at the lateral margin was higher (12%, P = 0.028) in the first two trimesters, compared to non-pregnant controls. Diastolic function was modified as demonstrated by an increase in A velocity (P P = 0.024). Similarly, A' increased at the septal and lateral margins ( P < 0.001 and P = 0.02, respectively), resulting in a decrease in E' : A' ratios at the septal and lateral mitral margins ( P = 0.001 and P = 0.001, respectively). E : E' at both mitral margins and Tei index were unaltered. CONCLUSION: This study gives normal ranges for TDI indices in pregnancy. TDI demonstrated modified longitudinal systolic and diastolic function. Future studies will evaluate the potential of this technique in pregnancies complicated by hypertension and cardiac disease. Published by John Wiley & Sons, Ltd.     

Effect of smoking on relaxation and filling behavior of the left ventricle in healthy probands. An echocardiography study

To examine the impact of acute nicotine consumption echocardiographic examination was performed in 22 healthy subjects (nine women, 13 men, 20 to 50 cigarettes/day over a minimum of five years) without any evidence of organic heart disease (normal 2D and Doppler echo, normal ECG at rest and during exercise) aged 20 to 51 years (mean +/- SD: 37 +/- 9 years) before and after cigarette smoking (0.9 mg nicotine). Left ventricular filling parameters were derived by transmitral pulsed Doppler ultrasound with the flow profile along the mitral valve being characterized by the early diastolic (E-wave) and late diastolic (A-wave) inflow into the left ventricle. The isovolumetric relaxation period was determined by simultaneous M-mode registrations over the aortic and mitral valve. During smoking the early diastolic peak velocity decreased from 56 to 52 cm/s (p less than .01) and the early diastolic flow integral fell from 64 to 56 mm (p less than .01). The A/E ratio of the peak velocities rose from 68 to 82% (p less than .001), the A/E ratio of the flow integrals increased from 46 to 56% (p less than .001) and the atrial contribution to ventricular filling rose from 33 to 36% (p less than .001). Furthermore during cigarette smoking the isovolumetric relaxation period rose from 70 to 77 ms (p less than .001). -CONCLUSION: In healthy subjects cigarette smoking causes an increase of the atrial contribution to ventricular filling and the isovolumetric relaxation period. Thus, acute nicotine consumption significantly impairs the energy-consumpting process of early diastolic relaxation, independently of its role as a risk factor for atherosclerosis.     

Impact of mitral E/A ratio on the accuracy of different echocardiographic indices to estimate left ventricular end-diastolic pressure

The objective was to determine the influence of left ventricular (LV) inflow pattern on the accuracy of different echocardiographic indices for estimation of LV end-diastolic pressure (LVEDP). Echocardiography with color tissue Doppler imaging (TDI) and LVEDP measurements using fluid-filled catheters were performed in 176 consecutive patients on the same day. Mitral peak diastolic velocities (E, A) and the difference in duration between pulmonary venous retrograde velocity and mitral A-velocity (PV(R)-A) were recorded by pulsed Doppler. Propagation velocity of the early mitral inflow (V(P)) was assessed using color M-mode. Early diastolic longitudinal (E'(lat)) and radial (E'(radial)) velocities of mitral annulus were measured by TDI. Area under ROC curve (AUC) for prediction of elevated LVEDP (> or =15 mm Hg) was computed for each parameter. For E/A > or =1 (98 patients, 46 with elevated LVEDP), the AUC values were: PV(R)-A: 0.914; E/E'(lat): 0.780; E/E'(radial): 0.729; E/V(P): 0.712 (p < 0.001). When E/A <1 (78 patients, 26 with elevated LVEDP), only PV(R)-A reached statistical significance (AUC = 0.893, p < 0.001). The conclusions were: PV(R)-A enabled the most accurate noninvasive estimation of LVEDP irrespective of LV filling profile and combined indices E/V(P), E/E'(lat) and E/E'(radial) represent more feasible alternatives for patients with mitral E/A-1.     

房间隔应变率成像鉴别左室舒张功能假性正常表现

目的探讨房间隔应变率成像技术判定左室舒张功能假性正常的应用价值。方法30例正常人与左室舒张功能下降患者52例,脉冲多普勒测量二尖瓣口血流,组织多普勒测量二尖瓣环左室侧壁处速度,应变率成像观察房间隔应变率(SR)曲线、应变(S)曲线变化,SR曲线测量舒张早期峰值SRe,舒张晚期峰值SRa;S曲线测量舒张晚期峰值Sa,测量结果各组进行对照分析。结果左室舒张功能受损各组别SRe、Sa及SRe/SRa明显低于正常组(P<0.01)。结论房间隔应变率成像可鉴别左室舒张假性正常,并可定量评价左室舒张功能下降。     

Left ventricular diastolic function assessment by tissue Doppler echocardiography in relation to hormonal replacement therapy in postmenopausal women with diastolic dysfunction

The objective of this study was to evaluate the effect of hormone replacement therapy (HRT) regimens on left ventricular diastolic function by using mitral pulsed wave Doppler (MPWD) and tissue Doppler velocities (TDE). Seventy-eight postmenopausal women with normotensive and impaired diastolic left ventricular filling were included in the study. All the patients began a six-cycle HRT course. This formulation consisted of E2 valerate plus Medroxy progesterone acetate (MPA). Left ventricular diastolic function at rest was evaluated by M-mode, two-dimensional, MPWD and TDE in 78 postmenopausal women with normal blood pressure before the treatment for 6 months of HRT. The M-mode, two-dimensional, and MPWD parameters assessed were heart rate, systolic blood pressure, diastolic blood pressure, left ventricular mass index, ejection fraction of the left ventricle (EF), septal (IVS) and posterior wall (PW) thickness, left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) diameter, left atrial diameter, peak early diastolic velocity (E), peak atrial velocity (A), E/A ratio, E acceleration time, E deceleration time, diastolic filling period, and isovolumic relaxation time (IVRT). The TDE parameters assessed were peak early diastolic velocity (E'), peak late diastolic velocity (A'), peak systolic velocity, E'/A' ratio, E' acceleration time, E' deceleration time, IVRT', and E/E' ratio. Quantitative data were analyzed using Student t test. Among the MPWD parameters, peak A velocity, E deceleration time, and IVRT significantly decreased, while peak E velocity and E/A ratio increased after a 6-month treatment. From the point of TDE parameters, E' velocity and E'/A' ratio increased, while A' velocity, E' deceleration time, E/E' ratio and IVRT' decreased. Some MPWD and TDE parameters were partially reversed after HRT. TDE velocities and especially E/E' ratio may provide better and true information of the diastolic function. TDE parameters were independent from the preload and did not produce pseudonormal pattern. HRT may cause increase in the blood volume and produce pseudonormal pattern in transmitral flow. In that case, TDE may be a beneficial method for evaluation of diastolic function.     

Tissue Doppler echocardiography and myocardial performance index in patients with scleroderma

In this study, left and right ventricular functions were examined echocardiographically in 22 patients with scleroderma and 22 healthy volunteers. Conventional and tissue Doppler echocardiography and myocardial performance indexes were used as measures of right and left ventricular global functions. Mitral early diastolic E wave deceleration time, isovolumetric contraction time and left ventricular myocardial performance index and peak tricuspid A wave velocity were significantly higher in the scleroderma group compared with the control group. Mitral and tricuspid E/A ratios were significantly lower in patients with scleroderma. In addition, mitral annular and tricuspid annular isovolumetric relaxation times and the tricuspid E/E' ratio were significantly increased in scleroderma patients compared with the control group. In conclusion, in scleroderma patients the global left ventricular functions were depressed and diastolic function abnormalities were seen in both right and left ventricles. In addition, longitudinal muscle functions of the ventricles were depressed in scleroderma patients, as shown by tissue Doppler imaging parameters.     

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.     

组织多普勒显像技术评价初发心肌梗死患者左室功能

目的探讨组织多普勒显像（DTI）技术在评价初发心肌梗死患者左室功能中的应用价值。方法常规超声心动图检查显示左室收缩及舒张功能正常的初发心肌梗死患者18例及与其年龄匹配的健康对照者15例入选本研究。应用DTI技术二尖瓣环平均运动速度指标评价两组对象的左室功能。同时计算二尖瓣血流舒张早期峰值速度与二尖瓣环舒张早期峰值速度的比值（E／Em）,以评估左室平均充盈压。结果心肌梗死患者组二尖瓣环收缩期峰值速度（Sm）、舒张早期速度（Em）及晚期峰值速度（Am）均明显低于正常对照组（P〈0．05）;心肌梗死组E／Em比值明显高于正常对照组（P〈0．05）。结论DTI技术可以较常规超声心动图更加敏感地检测出初发心肌梗死患者的左室功能异常。     

多普勒组织成像评价高血压病患者左室舒张功能

目的　探讨应用多普勒组织成像 (DTI)技术检测二尖瓣环运动速度评估原发性高血压病左室舒张功能的应用价值。方法　应用DTI技术 ,对 5 6例原发性高血压病患者和 5 0例正常对照者二尖瓣环运动速度进行测定 ,并与常规多普勒超声心动图检查结果对照分析。结果　与正常组相比 ,高血压病患者收缩期DTI速度峰值 (S)差异无显著性意义 ,舒张早期DTI速度峰值 (Ve)显著减低 (P <0 .0 5 ) ,舒张晚期DTI速度峰值 (Va)无显著变化 ,舒张早期与舒张晚期DTI速度峰值的比值 (Ve Va)显著减低 (P <0 .0 5 )。Ve Va值与二尖瓣血流频谱E A值之间存在高度相关性。结论　DTI技术检测二尖瓣环舒张期运动速度参数可用于无创评价原发性高血压病左室舒张功能。     

健康人左室质量与舒张功能的关系

目的：探讨健康人左室质量与左室舒张功能的关系。方法：随机选取健康教师320名，行彩色多普勒超声心动图检查，结果：相关分析显示：伴随左室质量的增加E波的峰值速度下降，A波的峰值增加，二者比值下降，等容松驰时间延长，肺静脉收缩波峰值与舒峰值之比增加，但多元回归显示年龄增长、心率加快、体重指数大、血压高和男性是舒张功能减退的独立因素，左室质量指数进入多元回归方程，结论：决定健康人左室舒张功能的因素是年龄、心率、体重指数，血压和性别而不是左室质量。     

多普勒组织成像评价小儿心脏移植术后心功能

目的用超声心动图二维、M型、彩色多普勒及脉冲多普勒组织成像(PW-DTI)等方法对小儿心脏移植术后非排异期心脏的结构、形态、血流、功能等状态进行综合评价，重点探讨PW-DTI对小儿心脏移植术后非排异期心功能评价的意义。方法移植组和对照组各36例，应用超声心动图、PW-DTI测量左室舒张末期内径，室间隔厚度，左室后壁厚度，左室质量，左室短轴缩短率，二、三尖瓣前向血流舒张早、晚期峰值速率及心率；将PW-DTI取样容积置于二尖瓣瓣环水平左室侧壁、室间隔及三尖瓣环水平右室壁采样，获取收缩期和舒张早、晚期PW-DTI运动速度曲线。结果移植组的所有PW-DTI速度曲线参数均较对照组低。二尖瓣瓣环水平左室侧壁舒张早期峰值速率，室间隔及三尖瓣环收缩期峰值速率，舒张早、晚期峰值速率与对照组差异有显著性意义；而其他指标移植组与对照组基本相同。结论PW-DTI速度曲线参数的结果提示心脏移植术后非排异期患儿在常用的心功能指标测值正常时，已存在右室收缩、舒张功能及左室舒张功能的减低，以右心功能减低为明显。PW-DTI是一种敏感、简便的测量小儿心脏移植后左、右心功能的方法．     

应变率成像评价2型糖尿病患者左室局部功能早期损害的临床研究

目的探讨应变率成像技术评价2型糖尿病患者左室局部功能早期损害的临床价值。方法选取左室构型正常的2型糖尿病患者（糖尿病组）20例,健康者20例为对照组。应用常规超声心动图测量二尖瓣口舒张期血流E峰、A峰,计算E／A,应变率成像技术测量左室长轴方向18节段的心肌收缩期峰值应变率（SRs）、舒张早期峰值应变率（SRe）和舒张晚期峰值应变率（SRa）,并计算SRe／SRa,比较两组各参数的差异。结果糖尿病组E峰、E／A低于对照组,A峰高于对照组,糖尿病组各节段室壁运动收缩期SRs低于对照组,糖尿病组舒张期SRe、SRa和SRe／SRa均低于对照组（均P〈0．05）。结论应变率成像技术可以定量评价糖尿病患者的左室局部心肌应变率异常,SRs可以作为评价左室局部收缩功能的有效指标,SRe、SRa和SRe／SRa可以作为评价左室局部舒张功能的有效指标。