Normal values and reproducibility of left ventricular filling parameters by radionuclide angiography

Background. In physiologic situations age, heart rate (HR) and left ventricular ejection fraction (EF) may influence left ventricular filling rate. In this study, we determined normal values for radionuclide angiography (RNA) derived diastolic filling parameters, the correlations with age, HR and EF and their reproducibility. Methods. The study was performed in 20 patients, 40–76 years old (mean 57), with normal findings at coronary angiography and left ventriculography. The first RNA was performed at rest (RNA1). Then, five minutes bicycle ergometry was performed and the patients were allowed five minutes rest before RNA was repeated (RNA2). From the left ventricular time activity curve we determined peak filling rate (PFR), time to peak filling rate (TPFR) and atrial contribution (AC) to ventricular filling. Results. Values for PFR1 were 2.2 ± 0.6 EDV/sec (PFR2 2.4 ± 0.7 EDV/sec, r = 0.82), for TPFR1 198 ± 22 msec (TPFR2 203 ± 24 msec, r = 0.45) and for AC1 31 ± 11% (AC2 31 ± 10%, r = 0.72). The correlations of PFR and TPFR with age were statistically significant (respectively r = - 0.68 and r = 0.48, P < 0.05). PFR was also influenced by HR and EF (resp. r = 0.51 and r = 0.50, P < 0.05). TPFR however was not influenced by HR and EF, whereas AC was positively correlated with HR (r = 0.79, P < 0.01). Conclusions. Radionuclide angiography is a reliable and reproducible method to assess parameters of diastolic left ventricular filling in individual patients. It may therefore be used to serially follow diastolic function. When used for interindividual comparison the dependency of RNA derived left ventricular filling parameters on age, HR and EF should however be considered.     

Exploration of left ventricular relaxation using gamma-angiography in 70 hypertensive subjects. Practical consequences and implications

This study was performed to evaluate the incidence ant the practical consequences of left ventricular diastolic dysfunction in hypertensive. In 70 mild to moderate hypertensive subjects group [systolic 161 +/- 16 and diastolic blood pressure 104 +/- 9 mmHg 18 women, 52 men, 51 +/- 7 years old] and in a 15 normal subjects control group, the peak filling rate (PFR) and the time to peak filling rate (TPFR) were measured with the time/activity curve of the rest equilibrium blood pool scintigraphy. The ejection fraction and the stress test were normal in all patients [EF 0.66 +/- 0.05, ranging from 0.59 to 0.88]. The PFR was not significantly different in the hypertensive group but 59/70 patients [84 p. 100] showed an individual value lower than the theoretical age and heart rate expected value. The TPFR was not significantly different (183 +/- 33 ms-vs 180, p = ns). In a Holter-defined sub-group of patients (n = 22) exhibiting a high prevalence of supra-ventricular premature beats or a paroxysmal atrial fibrillation, the PFR was significantly slower than in the total hypertensive group [1.92 +/- 0.33 EDV/s-1, p = 0.02]. Early indices of diastolic function give some instantaneous information on left ventricular filling. Determining the exact significance of individual values of PFR and TPFR requires a better knowledge of physiologic and pathologic determinants of LV filling.     

Effect of postural changes, nitroglycerin and verapamil on diastolic ventricular function as determined by radionuclide angiography in normal subjects

Whereas improvement in diastolic function indexes in response to therapeutic interventions has been attributed to a beneficial effect of the intervention, measurements of diastolic function appear to be influenced by changes in loading conditions, heart rate and sympathetic tone. To determine the effect of body position and short-term pharmacologic intervention on radionuclide angiographically determined left ventricular peak filling rate, high temporal resolution time-activity curves and absolute left ventricular volumes obtained by equilibrium-gated blood pool scans were evaluated in 12 normal subjects in the supine position at rest and in response to several postural and pharmacologic manipulations. This study confirmed the reproducibility of the technique and demonstrated that in normal subjects, peak filling rate varies in response to changes in body position and to short-term administration of sublingual nitroglycerin and intravenous verapamil. Peak filling rate ranged from 3.3 to 5.1 end-diastolic volumes (EDV)/s with a variability of 13.7% during five baseline supine measurements in the 12 subjects. Compared with values in the supine position (mean +/- SEM = 4.38 +/- 0.24 EDV/s), peak filling rate increased +16 +/- 6% to 4.75 +/- 0.27 EDV/s in the upright position (p less than 0.05) but did not change significantly with leg elevation. Peak filling rate at baseline and during postural changes correlated significantly with ejection fraction (r = +0.49), with stroke volume (r = +0.26) and inversely with end-systolic volume (r = -0.41), but did not correlate with heart rate or blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Normalized left ventricular filling indexes to detect diastolic dysfunction in hypertension and in hypertrophic cardiomyopathy.

In order to establish a normalizing method for left ventricular filling indexes, peak filling rate (PFR) and time to peak filling rate (TPFR), derived from resting radionuclide ventriculography using Fourier analysis with third-order harmonics, were analyzed in 45 normal subjects, 40 hypertensive patients, and 29 patients with hypertrophic cardiomyopathy. PFR was significantly negatively correlated with age (r = -0.62) and significantly positively correlated with peak ejection rate (PER) (r = 0.58) in normals. TPFR normalized for heart rate (N-TPFR) was correlated positively with age in normals (r = 0.60) and hypertensives (r = 0.49) but not in patients with hypertrophic cardiomyopathy. N-TPFR was not significantly correlated with systolic parameters. A significant relationship between PFR normalized to PER (PFR/PER) and age was observed in normals (r = -0.58) but not in patients with hypertension or hypertrophic cardiomyopathy. To cancel the ageing effect, individual data of PFR/PER and N-TPFR were expressed as a percentage of the predicted regression value in normal subjects (%PFR/PER and %N-TPFR, respectively). Per cent PFR/PER was significantly lower and %N-TPFR was significantly greater in patients with hypertension and hypertrophic cardiomyopathy compared to normals. When normal limits of these indexes were defined as %PFR/PER greater than 80% and %N-TPFR less than 120%, the sensitivity, specificity and diagnostic accuracy of differentiating normals from patients with hypertension or hypertrophic cardiomyopathy were 41 of 45 (91%), 44 of 68 (65%), and 85 of 113 (75%), respectively. These findings indicate that %PFR/PER and %N-TPFR might be more reasonably normalized parameters for describing diastolic filling and its abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ejection fraction and heart rate correlate with diastolic peak filling rate at rest and during exercise

We investigated the independent variables correlating with the multigated radionuclide peak filling rate (PFR) at rest and during supine bicycle exercise in 20 normal individuals. Independent variables were systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), ejection fraction (LVEF), time to PFR (TPFR), peak ejection rate (PER) and time to PER (TPER). Fifteen subjects completed at least five stages of exercise at 25 watts each. Correlating independent variables were selected by a forward-backward stepwise multiple linear regression (BMDP2R). A partial correlation statistical program was also used to allow control of critical independent variables. The final regression equations were: a) resting state, PFR = -2.5 + 0.03HR + 0.05LVEF + 0.02SBP-0.02DBP, and b) exercise state, PFR = -3.8 + 0.04HR + 0.08LVEF. All independent variables mentioned above correlated with PFR (simple correlations designated as zero partials). However, when LVEF and HR were held constant (second order partials), the correlation of PFR with any of the other independent variables disappeared. In summary, the radionuclide global LV PFR is predominantly correlated to LVEF and HR at rest and during exercise. These correlations should be considered when assessing exercise effects of disease states on PFR.     

Pattern of left ventricular diastolic filling in chronic aortic regurgitation: a gated blood pool assessment

Limited information exists regarding the pattern of left ventricular diastolic filling in moderate to severe chronic aortic regurgitation (AR). The left ventricular diastolic filling curve derived from gated blood pool scans was evaluated in 24 normal subjects and 29 patients with AR. The peak filling rate (PFR), mean filling rate (MFR), peak ejection rate (PER), PFR/MFR, PFR/PER, and the time of the rapid filling period divided by the diastolic time were determined. PFR, MFR and PER were calculated as end-diastolic volumes per second (EDV/s). PFR was lower in the AR group than in the normal subjects (2.24 +/- 0.70 vs 3.09 +/- 0.71 EDV/s, p less than 0.001). Similarly, MFR was lower in the AR group (1.31 +/- 0.40 vs 1.63 +/- 0.29 EDV/s, p less than 0.01). PER was also reduced in the AR group. Both PFR/MFR and PFR/PER were reduced, while the ratio of rapid filling period to diastolic time was longer in the AR group than in normal subjects. Clinical evidence of congestive heart failure occurred in 8 patients in the AR group. Diastolic filling variables were not significantly different from the asymptomatic subgroup of patients with AR, but were abnormal when compared with those of normal subjects. In patients with AR, an abnormal pattern of diastolic filling was noted, consisting of a reduced PFR, MFR and PFR/ with a more linear pattern of filling (reduced PFR/MFR) during a longer rapid filling period.     

Left ventricular filling is usually normal in uncomplicated coronary disease

Abnormalities in left ventricular filling have been described as an early finding in coronary artery disease (CAD) and more recently, in hypertension (HTN). The present study was undertaken to compare the prevalence and pattern of diastolic dysfunction in these two entities. Three groups of patients were studied: 10 normal volunteers (NLS), 39 HTN patients, and 30 CAD patients. The CAD patients were divided into two subgroups--one with normal ejection fraction (mean 0.60 +/- 0.06) and the second with either a depressed ejection fraction (EF) or a history of HTN (mean EF 0.44 +/- 0.15). The diastolic indices examined were peak filling rate (PFR, in end-diastolic volume [EDV]/sec), time to peak filling rate (TPFR, in msec), and first-third filling fraction (FF 1/3, in sec-1). The PFR in CAD and HTN was significantly reduced (1.86 +/- 0.63 and 2.29 +/- 0.49 vs 2.70 +/- 0.35 EDV/sec in NLS, p less than 0.025 and p less than 0.001, respectively), with the CAD group also being significantly lower than the HTN group (p less than 0.005). TPFR was prolonged in HTN, but not in CAD. FF 1/3 was reduced in both HTN and CAD (0.38 +/- 0.11 and 0.50 +/- 0.14 vs 0.61 +/- 0.06 sec-1 in NLS, p less than 0.001 and p less than 0.025, respectively), but it was significantly lower in HTN than in CAD (p less than 0.001). However, when the subgroup of CAD patients with normal global systolic function was examined separately, diastolic indices were only slightly depressed. More importantly, only one, two, and five patients had PFR, TPFR, and FF 1/3, respectively, which were below the normal values of our laboratory.     

Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure

BACKGROUND: The effects of immersion and training of patients with chronic heart failure (CHF) in warm water has not been thoroughly investigated. The aim of this study was to assess the acute hemodynamic response of immersion and peripheral muscle training in elderly patients with CHF. METHODS: Thirteen CHF patients and 13 healthy subjects underwent echocardiography on land and in a temperature-controlled swimming pool (33-34 degrees C). RESULTS: Rest. Heart rate decreased (CHF, p=0.01; control, p=0.001) and stroke volume increased (CHF, p=0.01; control, p=0.001) during water immersion in both groups, with no change in systolic or diastolic blood pressure. Ejection fraction (p<0.05) and transmitral Doppler E/A ratio (p=0.01) increased in the CHF group, with no changes in left ventricular volumes. The healthy subjects had similar responses, but also displayed an increase in cardiac output (p<0.01) and left ventricular volumes (p<0.001). Exercise. Cardiac output and systolic blood pressure increased significantly in water, in both groups. CONCLUSION: A general increase in early diastolic filling was accompanied by a decrease in heart rate, leading to an increase in stroke volume and ejection fraction in most patients with CHF during warm water immersion. These beneficial hemodynamic effects might be the reason for the previously observed good tolerability of this exercise regime.     

Diastolic filling abnormality modified by left ventricular asynchrony in essential hypertension

Left ventricular (LV) asynchrony has been demonstrated to result in diastolic dysfunction. To test the hypothesis that altered LV synchrony interferes with LV diastolic function in essential hypertensive patients (HT), we performed radionuclide ventriculography and echocardiography in 38 HT and 11 normotensive subjects. LV diastolic asynchrony was measured as the sum (total delta t) of the absolute values of the time difference between global peak filling rate (PFR) and regional PFR. Global PFR and time to PFR were significantly reduced in HT. Although total delta t did not differ between two groups, total delta t significantly correlated with PFR (r = -0.44, p less than 0.01) in HT. Moreover, total delta t positively related to LV endsystolic stress and inversely related to LV ejection fraction in HT. Thus, LV asynchrony, in part, plays a role in early diastolic filling abnormality in hypertensive patients.     

Pulmonary thallium uptake: correlation with systolic and diastolic left ventricular function at rest and during exercise

Quantified pulmonary 201-thallium uptake, assessed as pulmonary/myocardial ratios (PM) and body surface area-corrected absolute pulmonary uptake (Pc), was determined from single photon emission computed tomography studies in 22 normal subjects and 46 consecutive patients with coronary artery disease (CAD). By means of equilibrium radionuclide angiography (ERNA), ejection fraction (EF), peak ejection rate (PER) in end-diastolic volume (EDV/sec) and peak filling rate (PFR) in EDV/sec and stroke volume (SV/sec) units, PFR/PER ratio, and time to peak filling rate (TPFR) in milliseconds were computed at rest and during exercise (n = 35). Left ventricular response to exercise was assessed as delta EF, relative delta EF, delta EDV, and delta ESV. In normal subjects the PM ratios showed significant inverse correlation with PER at rest and with EF, PER, and PFRedv during exercise. For the left ventricular response to exercise, delta ESV showed significant correlation with the PM ratios. The body surface area-corrected pulmonary uptake values showed no correlation with any of the variables. In patients with CAD the PM ratios and Pc uptake showed significant inverse correlation with EF, PER, PFRedv and to exercise EF, exercise PER, and exercise PFRedv. For the left ventricular response to exercise, delta EF showed significant inverse correlation with the PM ratios but not with the Pc uptake. Neither in normal subjects nor in patients with CAD did any of the independent diastolic variables show significant correlation with the PM ratios or Pc values. Thus pulmonary thallium uptake is correlated with systolic left ventricular function at rest and during exercise in normal subjects and in patients with CAD but not with diastolic function. In normal subjects delta ESV and in patients with CAD, delta EF showed correlation with pulmonary thallium uptake.     

Relationship between regional abnormality of left ventricular rapid filling and coronary microcirculation disturbance in hypertrophic cardiomyopathy

Background and hypothesis: To investigate the mechanism of regional left ventricular diastolic filling disturbance in hypertrophic cardiomyopathy (HCM), we assessed the relationship between abnormalities of regional ventricular rapid filling and regional coronary microcirculation using radionuclide ventriculography and exercise ²⁰¹thallium (²⁰¹Tl) myocardial scintigraphy with sector analysis. Methods: Thirty patients with HCM and 14 patients with atypical chest pain syndrome (controls) were studied. Left ventricular images (left anterior oblique view) were obtained by electrocardiogram-gated ^99mtechnetium radionuclide an-giography and were divided into three sectors radiating from the geometric center. The time-activity curves and their first derivative curves were analyzed, and the peak filling rate (PFR), the ratio of the time-to-peak filling rate per diastolic interval (TPFR/T) were calculated for the global left ventricle and for the lateral and septal sectors. Exercise stress ²⁰¹Tl myocardial scintigraphy was also performed, and early and delayed images were obtained. The regional washout rate (WR) was then evaluated for the lateral and septal sectors. Results: In HCM patients, the regional PFR in the septal sector (corresponding to the region of hypertrophic myocardium) was 285 ± 76%/s, and was significantly lower than that in the controls (398 ± 90%/s, p <0.01). The regional TPFR/T in the septal sector (32 ± 10%) was prolonged compared with the value of 21 ± 5% in the controls (p <0.05). The regional WR in the septal sector was 21 ± 9%, and was significantly lower than that in the controls (43 ± 5%, p <0.01). Moreover, regional WR correlated positively with regional PFR (r = 0.5, p < 0.05) and showed a weak negative relationship with regional TPFR/T (r = -0.4, p <0.07) in the septal sector. Conclusions: These results suggest that regional impairment of rapid filling might be related to a disturbance of the coronary microcirculation in HCM.     

Asynchronous left ventricular diastolic filling in patients with isolated disease of the left anterior descending coronary artery: assessment with radionuclide ventriculography

To study the relationship between global and regional filling of the left ventricle, we conducted resting gated radionuclide ventriculographic studies in 15 control subjects (group 1) and 22 patients with isolated disease of the left anterior descending coronary artery (group 2). None had had a previous myocardial infarction. A computer program subdivided the image of the left ventricle into four regions. The time-activity and first-derivative curves of the global and regional left ventricles were computed. In the global left ventricle, the normalized peak filling rate (PFR) was decreased (p less than .01) and the ratio of the time to PFR (time interval from global end-systole to PFR) to the diastolic time, TPFR/DT, was greater (p less than .02) in group 2 than in group 1. In the regional left ventricle, in the side perfused by the stenosed vessel (septal and apical), PFR was slightly decreased in the apical (p less than .05), but not the septal region (p = NS); TPFR/DT was greater in the apical (p less than .02) and in the septal region (p less than .01) in group 2. In the normally perfused lateral side, there were no significant differences in PFR or in TPFR/DT between group 1 and group 2. Total delta t/DT, which was defined as the ratio of the sum of the absolute values of the time differences from global PFR to regional PFR (septal, apical, and lateral) to the diastolic time, was significantly greater in group 2 (0.09 +/- 0.05 vs 0.16 +/- 0.05; p less than .001). This indicates the existence of asynchronous diastolic filling in the different regions of the left ventricle in group 2. A negative correlation existed between total delta t/DT and global PFR (r = -.64, p less than .001). Thus, in patients with one-vessel disease, asynchronous diastolic filling occurs due to the filling disturbance in the affected regions, which may cause impairment of the filling of the global left ventricle.     

Left ventricular apical rotation is related to ambulatory blood pressure and body mass in healthy elderly females

OBJECTIVE: The interaction between left ventricular (LV) apical rotation, blood pressure (BP) and body mass in elderly females may reveal mechanisms involved in the syndrome of diastolic heart failure. METHODS: Thirty-one healthy females, age 69-84 years, were studied with echocardiography, ambulatory BP and an exercise capacity (VO2peak) test. RESULTS: LV apical short-axis loops were eligible for speckle tracking analysis in 27 subjects. Peak apical rotation (PAR) correlated inversely with diastolic BP (r = -0.47, p = 0.01). PAR correlated positively with stroke volume and body weight (p<0.05), but not with VO2peak (n = 19, p = ns). PAR also correlated with peak rotation velocity in systole (r = 0.76, p<0.0001) and in diastole (r = 0.58, p = 0.001). Diastolic peak rotation velocity correlated with mitral E wave peak velocity (r = 0.48, p = 0.01). There was a significant reduction in LV volumes during the 4 years of follow-up. CONCLUSIONS: In healthy elderly females, there seems to be an interaction between LV apical rotation, BP and body mass. Peak apical rotation and peak diastolic rotation velocity correlate with indices of LV filling and ejection, indicating that suction, a crucial element for effective early LV filling, may be preserved in healthy elderly subjects. Suction deteriorates with elevations of the arterial BP. An age- and BP-related reduction in LV end-diastolic volume may represent an additional impediment to LV filling. Both features may contribute to the development of LV diastolic dysfunction and to episodes of diastolic heart failure.     

Right ventricular diastolic function in patients with hypertrophic cardiomyopathy--an invasive study.

To assess diastolic function of the right ventricle (RV) in patients with hypertrophic cardiomyopathy (HCM), biplane RV angiograms and RV pressures were analyzed in 19 HCM patients and in 13 normal subjects. RV and left ventricle (LV) pressures were measured using catheter-tip manometers. RV volumes were obtained from frame-by-frame tracings of angiograms. Ventricular relaxation was assessed by the time constant of isovolumic pressure decay (T). The peak filling rate (PFR) and the time to PFR (TPFR) were used as parameters of early diastolic filling, and the right atrial contribution to RV filling (%AF) was used as a parameter of late diastolic filling. The T for the RV was significantly prolonged in HCM patients. However, there was no significant correlation between the T for the RV and LV, nor did the T for the RV correlate with the RV ejection fraction or interventricular septal wall thickness. The TPFR, but not PFR, was significantly greater in HCM patients, and the %AF tended to be increased in HCM, but not significantly. The RV diastolic pressure-volume relations in the HCM patients shifted upward. In conclusion, impaired isovolumic relaxation and delayed diastolic filling and decreased diastolic distensibility are present in the RV of HCM patients.     

Echocardiographic predictors of change in left ventricular diastolic pressure in heart failure patients receiving nesiritide

Background: To evaluate the usefulness of currently accepted echocardiographic parameters of diastolic function to assess the acute change in left ventricular end‐diastolic pressure (LVEDP) following the administration of nesiritide in a heart failure population. Methods: In 25 heart failure patients (15 with systolic dysfunction, 10 with preserved ejection fraction [EF]), Doppler echocardiography, right and left heart catheterization, and invasive biventricular pressure hemodynamics were obtained at baseline and 30 minutes after nesiritide infusion. Results: Twenty‐four patients had sufficient echocardiographic images for analysis. The mean age was 60 ± 11 years, 48% were male, 56% had coronary artery disease, and 64% had hypertension. Right ventricular systolic pressure (RVSP) had the highest correlation with LV filling pressure: pulmonary capillary wedge pressure (PCWP), pre‐A wave LV, and LVEDP (r = 0.66, P = 0.0009; r = 0.63, P = 0.002; r = 0.72, P = 0.0002, respectively). Following nesiritide administration, the mean PCWP decreased from 17.1 ± 7.8 mmHg at baseline to 9.6 ± 6.2 mmHg (P < 0.001). Change in RVSP had the highest correlation with change in PCWP (r =?0.67, P = 0.10) and change in LVEDP (r =?0.71, P = 0.07). Conclusion: Echocardiographic parameters are frequently assessed in attempts to estimate left heart diastolic pressures. In heart failure patients, RVSP appears to be the best predictor of LVEDP, outperforming tissue Doppler E/E′. RVSP was found to be the best echocardiographic predictor of change in LV filling pressure with intravenous vasodilator therapy in heart failure patients. RVSP may provide a noninvasive means of assessing response to cardiac therapy.     

Evaluation of left ventricular early diastolic function after coronary artery bypass grafting relating to myocardial damage

This clinical study was undertaken to evaluate resting left ventricular early diastolic function relating to perioperative myocardial damage after coronary artery bypass graft (CABG) with radionuclide ventriculography. Forty-eight cases undergoing CABG were divided into two groups--Group I: not complicated with perioperative myocardial infarction (PMI), and Group II: complicated with PMI. In group I (42 cases), early diastolic parameters such as peak filling rate (1/3 PFR) and mean filling rate (1/3 FR(m)) during first third diastole were not impaired in the postoperative and follow up periods. In contrast, in Group II (6 cases), early diastolic parameters were significantly decreased to 157 +/- 74% EDV/sec of 1/3 PFR(pre op: 234 +/- 74, p less than 0.05) and 153 +/- 80% EVD/sec of 1/3 FR(m) (pre op: 231 +/- 86, p less than 0.05) in the postoperative period, and these parameters were still decreased in follow up period. The time to peak filling rate, normalized to diastolic time (TPFR/DT) of Group II cases, was severely prolonged in both periods. From these results, the complication of perioperative myocardial infarction was suggested by the decrease of early diastolic function and the prolongation of the time to peak filling rate. Early diastolic function was a more sensitive parameter than systolic function in the detection of impaired cardiac function in those cases with perioperative myocardial damage after CABG.     

Rapid left ventricular filling in untreated hypertensive subjects with or without left ventricular hypertrophy.

In this study, independent contribution of age, HR, BMI, casual and ambulatory blood pressure, LVM and LVEF in evaluating diastolic filling have been investigated in 34 never-treated hypertensive patients and in 15 healthy normotensive subjects. All the subjects were free from coronary artery disease, valvular disease, heart failure, renal disease and psychiatric problems. All the hypertensive subjects (never treated) were subgrouped according to presence or absence of LVH. The PFR decreased significantly and tPFR increased significantly in hypertensive patients in comparison with normotensive subjects and they did not change in the presence vs absence of LVH. The PFR was inversely correlated with BMI, age, 24-h mean SBP and with 24-h DBP. In multiple regression analysis, PFR decreased with BMI, age, 24-h mean SBP and DBP but not with LVMI. These results suggest that BMI, age and 24-h mean blood pressure were the major determinants of PFR abnormalities in hypertensive patients.     

Resting heart rate and cardiac function in dilated cardiomyopathy

We hypothesized that, within the normal range of resting heart rate, heart rate and left ventricular ejection fraction would be inversely correlated and heart rate and left ventricular filling would be correlated in patients with dilated cardiomyopathy and not correlated in patients with normal cardiac function. At rest, heart rate, left ventricular ejection fraction, and three measures of diastolic filling (time to peak filling rate, peak filling rate, and first half filling fraction) were recorded using radionuclide ventriculography in subjects with no cardiac disease, patients with idiopathic dilated cardiomyopathy, and patients with dilated cardiomyopathy associated with ischemic heart disease. Heart rate had significant inverse correlations with left ventricular ejection fraction (r=-0.55, P=0.0007) and time to peak filling rate (r=-0.47, P=0.005) and a positive correlation with peak filling rate (r=0.73, P<0.0001) in patients with idiopathic dilated cardiomyopathy; heart rate was correlated only weakly with these measures in the absence of cardiac disease and essentially was not correlated in dilated cardiomyopathy due to ischemic heart disease. The change in resting heart rate with left ventricular ejection fraction and time to peak filling rate were significantly (P<0.05) different between patients with no cardiac disease and those with idiopathic dilated cardiomyopathy. Thus, resting heart rate correlated significantly with left ventricular ejection fraction and diastolic filling in patients with idiopathic dilated cardiomyopathy.     

Dobutamine stress echocardiography Doppler estimation of cardiac diastolic function: a simultaneous catheterization correlation study

Background: Doppler echocardiography using the ratio of early diastolic transmitral velocity to early diastolic mitral annular tissue velocity (E/E′) is routinely used to evaluate left ventricular (LV) filling pressures at rest. We tested the hypothesis that measurement of E/E′ in patients undergoing dobutamine stress echocardiography (DSE) will detect changes in LV filling pressures. Methods: In this prospective study, 16 patients with normal LV ejection fraction and normal coronary arteries by angiography underwent a standard DSE protocol with simultaneous LV filling pressure monitoring with a fluid filled pigtail catheter. Doppler echocardiographic assessment of LV diastolic function was performed using E/E′ at rest and during DSE. Results: The average age of the study participants was 57 ± 8 years. Average heart rate was 61 ± 11 bpm at baseline and 141 ± 12 bpm at peak stress. LV mean diastolic pressure decreased from 12.3 ± 2.6 mmHg at baseline to 9.0 ± 2.3 mmHg at peak stress (P = 0.0001). Baseline E/E′ at the septum and lateral annulus were 8.7 ± 2.2 and 7.5 ± 1.9 and during peak stress were 8.3 ± 3.1 and 7.9 ± 3.5, respectively. There was no significant change in E/E′ at either the septum or the lateral annulus (P = 0.55, P = 0.66). There was no significant correlation between LV mean diastolic pressure and E/E′ with dobutamine stress. Conclusions: In patients with normal LV ejection fraction and no significant coronary artery disease undergoing DSE, the ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/E′) at peak stress with dobutamine does not predict changes in LV filling pressures. (Echocardiography 2011;28:442‐447)     

Left ventricular diastolic function and ventricular arrhythmias in coronary heart disease

In 70 patients suffering from coronary heart disease, to a large extent after myocardial infarction, left ventricular diastolic function was examined with a nuclear stethoscope using Peak Filling Rate (PFR) and Time to Peak Filling Rate (TPFR). Ventricular arrhythmias were recorded by 24-hour ECG and the arrhythmias were analyzed according to the Lown classification. The parameters severing the ventricular arrhythmias were correlated with the previously mentioned parameters of diastolic left ventricular function. A correlation was found between PFR and TPFR and the severity of ventricular arrhythmias, whereby the difference in the PFR between Lown classes 0 and III and also between 0 and IVa was statistically significant. For TPFR a statistically significant distribution could be found only between Lown 0 and III.