Volume variation of mastoid pneumatization in different age groups: a study by three-dimensional reconstruction based on computed tomography images

Although there have been some reports that measured the size of mastoid pneumatization, only a few studies have reported the age-related variations in the mastoid air cell system using three-dimensional (3D) reconstruction techniques of computed tomography (CT) images. We performed a retrospective, cross-sectional study. A 3D reconstruction based on CT images was performed on 199 ears of 102 patients (age range 6–84 years) without otologic disease by a surface-rendering algorithm. The results showed that mastoid pneumatization continued to grow until the third decade. Thereafter, it declined slowly, and then rapidly after the seventh decade. No statistically significant difference was found between male and female or between right and left sides. There was a significant difference between the larger and smaller sides of individuals. The volume measurement technique based on the 3D reconstruction technique reported here is widely available, highly accurate and easy to perform.     

The effect of pituitary desensitization on ovarian volume measurements prior to in-vitro fertilization.

The measurement of ovarian volume has been recently shown to predict follicular response in in-vitro fertilization (IVF), specifically a lower number of retrieved oocytes with decreasing ovarian volume. This test appears to be better than basal follicle-stimulating hormone (FSH) as a prognostic measure of ovarian reserve. However, the effect of pituitary desensitization on ovarian volume has not been previously investigated. We prospectively evaluated 38 women undergoing IVF using a long luteal leuprolide acetate (LA) protocol. All women had their ovarian volume measurements performed on day 21, the day of LA start, and again on the day of gonadotrophin start. The mean age was 30.6 +/- 3.9 years (range 23-37). Basal FSH was 5.4 +/- 1.9 IU/l (range 1.2-10.2). The mean preLA ovarian volume was 7.0 +/- 3.6 cm3 (left ovary 6.8 +/- 3.9, right ovary 7.1 +/- 3.8), compared to 6.3 +/- 4.2 cm3 postLA (left ovary 6.0 +/- 4.9, right ovary 6.5 +/- 4.8) (not significant). The mean number of small antral follicles noted in both ovaries was also unchanged after pituitary desensitization. Pituitary desensitization using LA had no effect on overall ovarian volume measurements. The total number of retrieved oocytes decreased with increasing age and decreasing ovarian volume.     

Morphological and positional relationships between the sigmoid sinus and the jugular bulb

The purpose of this study was to determine the quantitative relationships between the positions of the sigmoid sinus (SS) and jugular bulb (JB) and the influence of mastoid pneumatization upon these structures. The investigations were carried out on 116 healthy adult ears based on the axial images of computed tomography (CT). The reference system locating the displacements of the SS and JB was established and the shape and position of the SS and JB were measured. The volume of pneumatization was quantitatively measured based on the serial digital images of CT. The method of partial correlation analysis was used to find the real relationship of two variables from the complicated dependence relationships. There was a tendency for the SS in the males to be situated more laterally and more backwardly, and the JB in the males was situated more laterally with thicker lateral bone wall when compared to the females. When compared to the left side, the SS on the right side tended to protrude more deeply and was situated more laterally and with less thickness of the lateral bone wall. In male, the right SS was situated more anteriorly than the left SS. In female, the right JB was situated more posteriorly than the left JB. There was a tendency for the SS to be situated more medially, to have a thicker lateral bone wall, and to protrude more superficially in the well-pneumatized bones. When the pneumatization was well, the JB tended to be situated more backwards and have a thicker lateral bone wall. However, there was no significant difference of pneumatization between the high JB group and the low JB group. The SS position and JB position changed synchronously in forward–backward or medial–lateral directions. The results suggest that the factors that influence the shape and position of the SS and JB are multiple. The results suggest that the morphological and positional relationships between the SS and the JB are complicated but could be grasped. The development of the cranial base, the temporal bone pneumatization and non-synchronous dural venous development between the right and left sides are considered to contribute to the morphological and positional changes of the SS and JB.     

Anthropometric measurements of external ear of medical students in Uttarakhand Region

Objective: This study aimed at determining the mean values of the different morphometric measurements from right and left ears and at giving information about sex-related dimensions of ear, right-left symmetry, and age-related changes. Methodology: Measurements are taken from 177 healthy young medical students (84 women and 93 men) aged 17–25 years using a vernier calliper. The parameters measured were total ear height (TEH), ear width (EW), lobular height (LH), and lobular width (LW) for each subject's right and left ears. Result and conclusion: The mean values for TEH, EW, LH and LW, ear and lobular index in female subjects were found to be respectively 5.77 ± 0.38 cm, 2.87 ± 0.28 cm, 1.68 ± 0.21 cm, 1.95 ± 0.22 cm, 49.79 ± 4.75 cm, 116.86 ± 15.01 cm for left ear, and 0.74 ± 0.38 cm, 2.88 ± 0.22 cm, 1.67 ± 0.24 cm, 1.92 ± 0.21 cm, 50.26 ± 4.09 cm, 117.33 ± 19.28 cm for the right ear. However, in the male subjects, these values were, respectively, 6.03 ± 0.33 cm, 3.06 ± 0.25 cm, 1.69 ± 0.20 cm, 1.96 ± 0.23 cm, 50.75 ± 3.92 cm, 117.33 ± 16.70 cm for left ear, and 6.04 ± 0.36 cm, 3.02 ± 0.21 cm, 1.66 ± 0.20 cm, 1.96 ± 0.20 cm, 50.21 ± 3.88 cm, 119.07 ± 14.60 cm for the right ear. Comparisons were performed by independent t-test and paired samples t-test. All ear dimensions were significantly larger in males than in females (p < 0.001) and a significant effect of age was found.     

Abnormal left superior temporal gyrus volumes in children and adolescents with bipolar disorder: a magnetic resonance imaging study

Abnormalities in left superior temporal gyrus (STG) have been reported in adult bipolar patients. However, it is not known whether such abnormalities are already present early in the course of this illness. Magnetic resonance imaging (MRI) morphometric analysis of STG was performed in 16 DSM-IV children and adolescents with bipolar disorder (mean age+/-SD 15.5+/-3.4 years) and 21 healthy controls (mean age+/-SD 16.9+/-3.8 years). Subjects underwent a 3D spoiled gradient recalled acquisition MRI examination. Using analysis of covariance with age, gender and intra-cranial brain volume as covariates, we found significantly smaller left total STG volumes in bipolar patients (12.5+/-1.5 cm(3)) compared with healthy controls (13.6+/-2.5 cm(3)) (F=4.45, d.f.=1, 32, P=0.04). This difference was accounted for by significantly smaller left and right STG white matter volumes in bipolar patients. Decreased white matter connections may be the core of abnormalities in STG, which is an important region for speech, language and communication, and could possibly underlie neurocognitive deficits present in bipolar patients.     

Analysis of unilateral sclerotic temporal bone: how does the sclerosis change the mastoid pneumatization morphologically in the temporal bone?

Backgrounds Some disorders, such as otitis media and Eustachian tube dysfunction, may cause the temporal bone to become sclerotic. A sclerotic temporal bone has the tendency to shrink. The aim of this study was to evaluate the morphologic changes that result from sclerosis of the temporal bone. Methods We measured 9 variables on 2 axial images, and 8 variables on 2 coronal images in healthy ears and diseased ears in 37 patients with unilateral chronic otitis media. We also measured the volume of mastoid pneumatization. Results The distance from sigmoid sinus to Henle’s spine was correlated to the degree of volume reduction, and it accounted for about 17.7% of the total variation in volume reduction. There was no difference in the sigmoid sinus type in comparisons between sclerotic and pneumatic mastoids. Conclusions The sclerosis of the temporal bone was observed to reduce the volume of the mastoid pneumatization. However, a large portion of the volume reduction may result from the sclerotic change in the air cell system, rather than from shrinkage of the mastoid bone. Therefore, the location of surgically-important structures, in the middle and inner ear, is only rarely changed in sclerotic temporal bone. Presented as a poster titled as “analysis of morphologic changes in the sclerotic temporal bone by spiral high-resolution computed tomography” at XVIII IFOS World Congress (June 25–30, 2006, Rome, Italy).     

The effect of stimulus intensity on the right ear advantage in dichotic listening

The dichotic listening test is non-invasive behavioural technique to study brain lateralization and it has been shown, that its results can be systematically modulated by varying stimulation properties (bottom-up effects) or attentional instructions (top-down effects) of the testing procedure. The goal of the present study was to further investigate the bottom-up modulation, by examining the effect of differences in the right or left ear stimulus intensity on the ear advantage. For this purpose, interaural intensity difference were gradually varied in steps of 3 dB from -21 dB in favour of the left ear to +21 dB in favour of the right ear, also including a no difference baseline condition. Thirty-three right-handed adult participants with normal hearing acuity were tested. The dichotic listening paradigm was based on consonant-vowel stimuli pairs. Only pairs with the same voicing (voice or non-voiced) of the consonant sound were used. The results showed: (a) a significant right ear advantage (REA) for interaural intensity differences from 21 to -3 dB, (b) no ear advantage (NEA) for the -6 dB difference, and (c) a significant left ear advantage (LEA) for differences form -9 to -21 dB. It is concluded that the right ear advantage in dichotic listening to CV syllables withstands an interaural intensity difference of -9 dB before yielding to a significant left ear advantage. This finding could have implications for theories of auditory laterality and hemispheric asymmetry for phonological processing.     

单侧慢性化脓性中耳炎颞骨CT解剖学研究

目的 研究单侧慢性化脓性中耳炎颞骨CT解剖学特征及其临床意义。 方法 回顾性分析35例单侧非胆脂瘤型慢性化脓性中耳炎患侧颞骨（病例组）与健侧颞骨（对照组）CT影像资料，比较两组咽鼓管外耳道角、岩枕角、乳突窦入口直径、咽鼓管骨部直径、咽鼓管骨部长度、咽鼓管骨部最大径与咽鼓管骨部长度之比，及乳突气化程度（良好、差）等解剖参数。 结果 患侧咽鼓管外耳道角、岩枕角分别是（137.4 ± 8.1）°、（52.5 ± 3.8）°，乳突窦入口直径、咽鼓管骨部最大径分别是（0.29±0.08）cm、（0.18±0.07）cm，咽鼓管骨部长度为（1.07±0.15）cm，咽鼓管骨部最大径与骨部长度之比为（17.1±5.4）%；健侧咽鼓管外耳道角、岩枕角分别是（138.3±7.7）°、（53.1±4.3）°，乳突窦入口直径、咽鼓管骨部最大径分别是（0.35±0.07）cm、（0.21±0.07）cm，咽鼓管骨部长度为（1.17±0.17）cm，骨部最大径与骨部长度之比为（20.9±14.3）%。患侧乳突窦入口直径、咽鼓管骨部最大径、咽鼓管骨部长度较健侧小，差异具有统计学意义（t = 4.37、3.09、－3.17，P<0.05）。患侧乳突气化较健侧差，差异具有统计学意义（χ2 = 6.34，P<0.05）。患侧与健侧咽鼓管外耳道角、岩枕角及咽鼓管骨部最大径与咽鼓管骨部长度之比差异无统计学意义（P>0.05）。 结论 单侧慢性化脓性中耳炎患侧颞骨存在解剖变异。咽鼓管骨部小、乳突气化差及乳突窦入口狭窄与单侧慢性化脓性中耳炎相关。     

Anatomical measurements of the orbitofrontal cortex in child and adolescent patients with bipolar disorder

Imaging studies indicate smaller orbitofrontal cortex (OFC) volume in mood disorder patients compared with healthy subjects. We sought to determine whether child and adolescent patients with bipolar disorder have smaller OFC volumes than healthy controls. Fourteen children and adolescents meeting DSM-IV criteria for bipolar disorder (six males and eight females with a mean age+/-S.D.=15.5+/-3.2 years) and 20 healthy controls (11 males and nine females with mean age+/-S.D.=16.9+/-3.8 years) were studied. Orbitofrontal cortex volume was measured using magnetic resonance imaging. Male bipolar patients had smaller gray matter volumes in medial (p=0.044), right medial (0.037) and right (p=0.032) lateral OFC subdivisions compared to male controls. In contrast, female patients had larger gray matter volumes in left (p=0.03), lateral (p=0.012), left lateral (p=0.007), and trends for larger volumes in right lateral and left medial OFC subdivisions compared with female controls. Male patients exhibit smaller gray matter volumes, while female patients exhibit larger volumes in some OFC sub-regions. Gender differences in OFC abnormalities may be involved in illness pathophysiology among young bipolar patients.     

Experimental assessment of new stent technologies: validation of a comparative paired rabbit iliac artery study model

Preventing coronary in-stent restenosis is a major challenge for physicians and industry. To assess new stent technologies, a comparative paired iliac artery model in rabbits is proposed. One tubular stent was implanted in each external iliac artery in 12 rabbits (i.e., 24 stents). An artery overdilatation level of 20% was strictly observed. Restenosis was examined at 30 days by angiography, intravascular ultrasound (IVUS) examination, and histomorphometry. On quantitative angiography, the mean loss of angiographic diameter was 9.8 +/- 4.4% in the right as compared to 9.3 +/- 55% in the left artery (p = 0.75). On IVUS, the volume of intrastent neointimal proliferation was 26.6 +/- 4.9 mm(3) in the right and 25.8 +/- 3.5 mm(3) in the left artery (p = 0.58). In histomorphometry, the neointimal proliferation area was 0.78 +/- 17 mm(2) in the right and 0.76 +/- 0.17 mm(2) in the left artery (p = 0.87). Intrastent neointimal proliferation was comparable between the left and right arteries of all rabbits. The model has three main advantages: (1) arterial dilatation and thus arterial wall aggression are controlled, (2) pairing makes each animal its own control subject, and (3) the statistical power for comparative testing is maximized. The model enables the effect of a new drug-delivery device to be assessed.     

Medial temporal lobe abnormalities in pediatric unipolar depression

In vivo anatomical magnetic resonance imaging (MRI) studies in adults with major depressive disorder (MDD) have implicated neurocircuitries involved in mood regulation in the pathophysiology of mood disorders. Specifically, abnormalities in the medial temporal lobe structures have been reported. This study examined a sample of children and adolescents with major depressive disorder to investigate anatomical abnormalities in these key medial temporal brain regions. Nineteen children and adolescents with DSM-IV major depression (mean age +/- S.D.=13.0 +/- 2.4 years; 10 unmedicated) and 24 healthy comparison subjects (mean age +/- S.D.=13.9 +/- 2.9 years) were studied using a 1.5T Philips MRI scanner. We measured hippocampus and amygdala gray matter volumes. MRI structural volumes were compared using analysis of covariance with age and total brain volumes as covariates. Pediatric depressed patients had significantly smaller left hippocampal gray matter volumes compared to healthy controls (1.89 +/- 0.16 cm(3) versus 1.99 +/- 0.18 cm(3), respectively; F=5.0, d.f.=1/39, p=0.03; effect size: eta2(p) =0.11). Unmedicated depressed patients showed a trend towards smaller left hippocampal volumes compared to medicated patients and healthy subjects (F=2.8, d.f.=2/38, p=0.07; effect size: eta2(p) =0.13). There were no statistically significant differences in mean volumes for left or right amygdala. Smaller left hippocampal volumes in children and adolescents with MDD are in agreement with findings from adult studies and suggest that such abnormalities are present early in the course of the illness. Amygdala volumes are not abnormal in this age group. Smaller hippocampal volumes may be related to an abnormal developmental process or HPA axis dysfunction.     

Bony landmarks as an aid for intraoperative facial nerve identification

Identification of the facial nerve trunk is essential during surgery of the parotid gland. Numerous landmarks have been researched and used. The relation between the facial nerve to two constant bony landmarks, the tip of the mastoid process and the central point of the transverse process of the atlas was investigated. Forty cadavers were dissected. A preauricular incision exposed the nerve trunk. Bony landmarks were identified and marked. The distance from the nerve trunk to the mastoid process and the atlas was measured. The mean distance between the mastoid process and nerve for the left was 9.18 +/- 2.05 mm and for the right, 9.35 +/- 1.67 mm. The mean distance between the atlas and the nerve for the left was 14.31 +/- 3.59 mm and for the right, 13.76 +/- 4.65 mm. Confidence intervals were determined. The importance of the aforementioned data revolves around minimizing the chance of injury to the facial nerve during surgery. The applicability of these landmarks needs to be studied in the clinical setting.     

Effect of Blalock Taussig shunt on clinical parameters, left ventricular function and pulmonary arteries

Twenty children (mean age 3.25 years) with congenital cyanotic heart disease undergoing modified left Blalock-Taussig (BT) shunt were studied. The mean follow-up period was 9.5 months (range 6 months to 1 year). The shunt was performed for cyanotic spells in 15 (75%) and hypoplastic pulmonary arteries in 5 (25%) patients. There were no immediate or late complications. None had cyanotic spell after the shunt. The mean arterial oxygen saturation improved from 66.47 +/- 11.9 to 76.97 +/- 8.16% (p = 0.0003) and mean hematocrit decreased from 51.55 +/- 9.5 to 46.5 +/- 9.7 (p = 0.002) after the shunt. The left atrial systolic volume and left ventricular diastolic volume also increased significantly following the shunt (from 15.82 +/- 6.37 to 20.83 +/- 8.91 ml p = 0.006 and from 36.13 +/- 16.08 to 41.08 +/- 20.07 ml (p = 0.01) respectively. There was significant growth of main, right and left pulmonary arteries and pulmonary valve annulus after the procedure.     

Infra-renal angles, entry into inferior vena cava and vertebral levels of renal veins.

Current norms for renal vasculature hold true in only half the population. Standard textbooks perpetuate old misconceptions regarding renal venous anatomy. This study is aimed to determine left and right infra-renal angles (L-IRA, R-IRA); entry level of renal veins into the inferior vena cava (IVC), and height of IVC under renal vein influence; and their vertebral level. One hundred morphologically normal en-bloc renal specimens randomly selected from post-mortem examinations were dissected and resin casted. IRA were also measured from venograms of 32 adult and 11 foetal cadavers, as were vertebral entry levels. IRA measurements (degrees) were as follows: left, 55 degrees +/- 16 degrees (20 degrees -102 degrees ); right, 60 degrees +/- 17 degrees (10 degrees -93 degrees ). Left vein entered IVC higher than right 54%, lower 36%, and opposite each other 10%. Vertical distance between lower borders of veins was 1.0 +/- 0.9 cm. Vertical distance of IVC under renal vein influence was 2.3 +/- 1.0 cm. Vertebral level of veins in adults lies between TI2-L2. In foetuses, IRA was as follows: left, 65 degrees +/- 12 degrees (45 degrees -90 degrees ); right, 58 degrees +/- 7 degrees (40 degrees -70 degrees ); vertebral level between T12 and L3. Similar IRA values from literature noted on right, 51 degrees (26 degrees -100 degrees ); differences on left, 77 degrees (43 degrees -94 degrees ), clearly differing from Williams et al. (Gray's Anatomy, 37(th) ed, 1989) statement that renal veins "open into the inferior vena cava almost at right angles." Large variations of IRA are not surprising since kidneys are considered normally "floating viscera," varying position with posture and respiratory movement as well as in live vs. cadaveric subjects. The entry level into the IVC also differs from Williams et al. This study uniquely quantitated actual height difference between lower borders of left and right veins. The data presented appears to be the first documentation of vertebral level of entry of renal veins into IVC in foetuses. These findings are clinically important for the angiographer, catheter design, and planning porto-renal shunt procedures.     

Electroencephalographic and reaction time asymmetries to musical chord stimuli

EEG was recorded over left and right hemispheres at temporal leads (T3, T4) referred to the vertex (Cz) in 16 right-handed male subjects. Musical chords were presented randomly in monaural sequence, during a task which required a selective motor response to stimuli presented to one ear. The integrated amplitude of the 8-13 Hz alpha rhythm was measured when subjects listened passively. Under all conditions, a lower mean alpha amplitude was recorded over the right hemisphere than the left, regardless of which ear was stimulated. Alpha suppression over the right temporal area was accentuated when the performance task directed attention to the stimulus. Reaction time to left ear stimulation was shorter than that for the right ear. With monaural stimulus presentation behavioral asymmetry, and various EEG asymmetries can be observed. There is hemispheric asymmetry associated with attention to task relevant stimuli indicated by reduction in the alpha rhythm over the right temporal area and asymmetry in reaction time with greater efficiency of the left ear to muscial chords.     

Craniofacial morphology of the tricho-dento-osseous syndrome

Tricho-dento-osseous syndrome (TDO) is characterized by abnormal bone, hair, and tooth morphology. However, the reported craniofacial abnormalities are not well characterized. The purpose of this study was to compare the craniofacial parameters of 25 subjects affected with TDO (A) with those of 15 unaffected relatives (U). Standardized lateral cephalograms were traced and digitized. Each subject's data were compared by age and sex to cephalometric standards (Bolton, Behrents); severity was scored by standard deviations from the standard mean, and then grouped into A vs. U. All cephalograms were evaluated for frontal sinuses, mastoid pneumatization, diploe, and bone density, and cranial thickness was measured. Cranial base length (SN; NBa), cranial base angle (BaSN), and mandibular body length (GoPg) were greater in A than in U (p < 0.05). Both groups had longer total and lower facial heights (NMe; ANSMe) compared with normal standards. Frontal sinuses, mastoid pneumatization and diploe were visible less often in A than in U (p < 0.05). Parietal bone and bone at lambda was significantly thicker (p < 0.05) in A than in U. Variability was substantial in many measures in both A and U. The major TDO craniofacial features involve the cranial base, mandibular body length, absence of visible pneumatized mastoids, frontal sinuses and diploe, and thicker cranial bone.     

Combined left and right ventricular volume determination by radionuclide angiocardiography using double bolus and equilibrium technique

Eighteen patients with ischaemic heart disease were studied. Left and right ventricular volumes including cardiac output (forward flow) were determined by radionuclide angiocardiography using a double bolus and equilibrium technique. As reference, cardiac output was simultaneously measured by indicator dilution. The radionuclide technique comprised four steps: (1) a first-pass study of right ventricle; (2) a bolus study of left ventricle; (3) an equilibrium study of left ventricle; (4) determination of the distribution volume of red blood cells. Absolute volumes of left ventricle were determined from steps 2 + 3 + 4. Absolute volumes of right ventricle were calculated from stroke volume and right ventricular ejection fraction (EF) which in turn was determined from step 1 by creating composite systolic and composite diastolic images. There was an acceptable agreement between stroke volume determinations by radionuclide angiocardiography and indicator dilution (r = 0.74; P less than 0.001). Stroke volume determination by radionuclide was 83 +/- 20 ml (mean +/- SD) and by indicator dilution 84 +/- 20 ml with a difference of -1 +/- 15 ml (NS). Cardiac output determination by radionuclide was 5.24 +/- 1.37 l min-1 and by indicator dilution 5.28 +/- 1.23 l min-1 with a difference of -0.04 +/- 0.95 l min-1 (NS). Left ventricular EF was 0.44 +/- 0.14 and right ventricular EF 0.57 +/- 0.10. The intra-observer coefficient of variation for duplicate calculations of the radionuclide determinations was 5.5% for stroke volume, 2.5% for left ventricular EF and 4.8% for right ventricular EF.     

Effect of the Mueller manoeuvre at different lung volumes on left ventricular performance in normal subjects

The effect of reduced intrathoracic pressure at different lung volumes on cardiac function was assessed by echocardiographic measurements of left ventricular size in normal subjects who performed the Mueller manoeuvre at two preselected lung volumes. At functional residual capacity (FRC), both mean end-diastolic dimension and mean end-systolic dimension increased (5.1 +/- 0.4 to 5.4 +/- 0.5 cm; P less than 0.001 and 3.7 +/- 0.4 to 3.9 +/- 0.4 cm; P less than 0.025, respectively). At high lung volume (HLV), midway between FRC and total lung volume, mean end-diastolic dimension increased from 5.1 +/- 0.5 to 5.3 +/- 0.5 cm (P less than 0.001), less than than the increase at FRC, and mean end-systolic dimension increased from 3.5 +/- 0.4 to 3.9 +/- 0.4 cm (P less than 0.001), similar to the increase at FRC. Thus, mean stroke dimension and shortening fraction were reduced at HLV (1.5 +/- 0.2 to 1.3 +/- 0.2 cm and 30 +/- 4 to 26 +/- 2% respectively, P less than 0.025). At FRC and HLV respectively, mean left ventricular transmural pressure increased from 111 to 129 Torr (P less than 0.001) and from 111 to 128 Torr (P less than 0.001) in response to the Mueller manoeuvre, although intraesophageal (intrathoracic) pressure was significantly lower (P less than 0.001) during the Mueller manoeuvre at HLV. These results show that lung volume affects the left ventricular response to the Mueller manoeuvre. Furthermore, the changes in left ventricular dimensions induced by the Mueller manoeuvre are determined by the level of reduced intrathoracic pressure, through differing effects on left ventricular afterload and filling.     

Pulsed Doppler echocardiographic study of left ventricular diastolic function in patients with idiopathic dilated cardiomyopathy

Dilated cardiomyopathy is basically regarded as a disease of left ventricular systolic dysfunction. There are only a few studies evaluating diastolic function in patients with dilated cardiomyopathy. To assess the LV diastolic function, 25 patients with idiopathic dilated cardiomyopathy and 20 age and sex matched normal subjects were studied with transmitral spectral tracings derived from pulsed Doppler echocardiography. All cardiomyopathy patients were in New York Heart Association class III to IV with dilated left ventricles and reduced systolic function (mean ejection fraction of 36.6 +/- 6.7 Vs 65 +/- 6 in normal subjects, p < 0.001). Patients with cardiomyopathy demonstrated an increased ratio of early to late diastolic velocity (E/A) (1.89 +/- 0.59 Vs 1.50 +/- 0.27 m/sec, p < 0.05), short deceleration time (E-E/2) (57.05 +/- 13.36 Vs 70.20 +/- 16.56 msec, p < 0.01) and short isovolumic relaxation time (IVRT) (53.5 +/- 22.7 Vs 72 +/- 12 msec, p < 0.05) as compared to normal subjects. The early filling fraction (EFF) was higher (0.71 +/- 0.11 Vs 0.66 +/- 0.06, p < 0.05) and atrial filling fraction (AFF) was lower (0.28 +/- 0.11 Vs 0.33 +/- 0.06, p < 0.05) in cardiomyopathy patients than in normal subjects. Our observations in a select group of dilated cardiomyopathy patients with advanced disease demonstrate a restrictive pattern on pulsed Doppler echocardiography.