Evaluation of the left ventricular diastolic function using three-dimensional echocardiography

The aim of this study was to evaluate the left ventricular (LV) diastolic function parameter calculated using three‐dimensional (3D) echocardiography. Method: Using 3D echocardiography and an analysis software program, the left ventricular volume through the cardiac cycle was measured automatically. We therefore calculated 25%, 50%, and 75% of the subtraction end‐systolic volume (ESV) from the end‐diastolic volume (EDV). The period that the left ventricular volume reached those volumes was calculated from the ESV. Those periods divided all diastolic periods and those calculated values were named D1/4, D1/2, and D3/4, respectively. The peak‐filling rate and 1/3 filling fraction (FF) were calculated. E/A, mitral annulus velocities (E′), E/E′, ejection fraction (EF), and left ventricular end‐diastolic pressure (LVEDP) were also measured. Results: E/A significantly correlated with D3/4. E/E′significantly correlated with the D1/4, D1/2, and 1/3 filling fraction. E′had a significantly negative correlation with the D1/4, D1/2, D3/4, and 1/3 FF. DT significantly correlated with D1/4, D1/2, D3/4, 1/3 FF, and the mean filling rate and it had a significant negative correlation with the 1/3 filling fraction. EF showed a significant positive correlation with the peak filling ratio. LVEDP demonstrated a significant correlation with D1/4 and D1/2. Conclusion: This study suggests that the LV diastolic indexes as determined by 3D echocardiography provide useful information in the clinical assessment of the diastolic LV function.     

Evaluation and prognostic significance of left ventricular diastolic function assessed by Doppler echocardiography in the early phase of a first acute myocardial infarction

AIM: To study the prognostic significance of left ventricular diastolicfunction evaluated by transmitral and pulmonary venous flowvelocities obtained in the early phase of a first acute myocardialinfarction in relation to later development of congestive heartfailure. METHODS: Pulsed Doppler echocardiography of transmitral and pulmonaryvenous flow was assessed in 65 consecutive patients with a firstmyocardial infarction within 1 h of arrival in the coronarycare unit. RESULTS: A univariate regression analysis identified age, left ventricularejection fraction 45%, mitral E deceleration time 130 ms, E/Aratio >1·5, peak pulmonary venous atrial flow velocity30 cm . s^–1 and a difference between mitral and pulmonaryvenous atrial flow duration >0 ms as variables significantlyrelated to the development of congestive heart failure. However,in a multivariate analysis only mitral E deceleration time 130ms and age were significant independent variables related tothe development of congestive heart failure during the firstweek following a first acute myocardial infarction. CONCLUSION: Assessment of left ventricular diastolic function complementsmeasurements of systolic function in the evaluation of cardiacfunction, and mitral deceleration 130 ms best identifies patientsat risk of development of congestive heart failure followingacute myocardial infarction.     

Left ventricular diastolic function in young long-term type 1 (insulin-dependent) diabetic men during exercise assessed by digitized echocardiography

Digitized M-mode echocardiograms were obtained during semisupinebicycle exercise in 10 relatively young (< 40 years) long-term( 12 years) type 1 (insulin-dependent) diabetic men, withoutovert heart disease, and 10 controls. Recordings were done atrest and during workloads of 50 and 100 W. At rest, heart ratewas similar in the groups, while at peak exercise it was higherin the diabetics whose left ventricular (LV) end-diastolic dimensionwas smaller at all study phases. From baseline to peak exercisethe diastolic period decreased in both groups, while the LVdiastolic peak rate of dimension increase, normalized for end-diastolicdimension, the rapid filling period and the LV dimension changeduring this period increased. The normalized peak rates of dimensionincrease and heart rates correlated positively in the groups.However, diabetics had a lower normalized peak rate of dimensionincrease after adjusting for heart rate by covariance analysis,both at rest (18%) and during peak exercise (20%). Thus, comparedto controls, this well defined group of type 1 diabetic menhad a consistent subclinical decrease in their peak rate ofdimension increase, both at rest and during exercise. Furthermore,the peak rate of dimension increase remained lower in the diabeticsubjects after normalization for their smaller end-diastolicdimension and after adjustment for their higher heart rate.     

Assessment of left ventricular diastolic function by three-dimensional transthoracic echocardiography

Doppler echocardiography assessment of left ventricular (LV) filling pressures at rest and during exercise is the most widely used imaging technique to assess LV diastolic function in clinical practice. However, a sizable number of patients evaluated for suspected LV diastolic function show an inconsistency between the various parameters included in the flowchart recommended by current Doppler echocardiography guidelines and results in an undetermined LV diastolic function. Current three-dimensional echocardiography technology allows obtaining accurate measurements of the left atrial volumes and functions that have been shown to improve the diagnostic accuracy and prognostic value of the algorithms recommended for assessing both LV diastolic dysfunction and heart failure with preserved ejection fraction. Moreover, current software packages used to quantify LV size and function provide also volume-time curves showing the dynamic LV volume change throughout the cardiac cycle. Examining the diastolic part of these curves allows the measurement of several indices of LV filling that have been reported to be useful to differentiate patients with normal LV diastolic function from patients with different degrees of diastolic dysfunction. Finally, several software packages allow to obtain also myocardial deformation parameters from the three-dimensional datasets of both the left atrium and the LV providing additional functional parameters that may be useful to improve the diagnostic yield of three-dimensional echocardiography for the LV diastolic dysfunction. This review summarizes the current applications of three-dimensional echocardiography to assess LV diastolic function.     

Real time three-dimensional stress echocardiography: a new approach for assessing diastolic function

Objective: To assess the feasibility of utilizing real time three‐dimensional echocardiography (RT3DE) for assessment of diastolic function during stress. Methods: Rest and stress volumes were acquired in 24 patients and parameters of diastolic function—peak ventricular filling rate (PFR) and time to peak filling rate (TPFR)—were calculated. Results: Calculation of diastolic parameters was feasible in all patients. Resting PFR correlated with end‐diastolic (EDV) and stroke volumes and inversely with TPFR (r = 0.53, 0.66, –0.5). With stress, PFR increased by 93% and TPFR decreased by 23% (P < 0.001). Stress PFR correlated with stress heart rate, EDV and stroke volume (r = 0.52, 0.50, 0.62) while TPFR correlated inversely with heart rate (r =–0.71). The change in PFR with stress correlated with the change in stroke volume (r = 0.42), while the change in TPFR correlated with the change in end‐systolic volume (ESV) (r = 0.43) and inversely with the change in diastolic blood pressure (r =–0.41). Rest and stress PFR and TPFR are independent of age, gender and blood pressure and the change in PFR is independent of stress heart rate or blood pressure. E/E′ correlated with stress TPFR (r = 0.72) and change in TPFR (r = 0.67) and inversely with change in PFR (r =–0.67). Conclusions: RT3DE can assess diastolic function during stress by detecting changes in PFR and TPFR, independent of gender, age, and blood pressure. The changes in these parameters with stress are influenced by baseline filling pressures. Larger studies are required to validate the clinical significance of these observations. (Echocardiography 2011;28:676‐683)     

The role of Doppler echocardiography in the assessment of left ventricular diastolic function

The role of Doppler echocardiography of transmitral filling velocities in the assessment of diastolic function in man has not been adequately defined. It is now appreciated that multiple interacting factors such as loading conditions influence the transmitral velocity profile independent of intrinsic left ventricular diastolic function. Extrapolating the status of diastolic function from the transmitral velocity profile is complicated by these factors. The load dependence of ventricular filling has tempered the initial enthusiasm for the clinical application of the Doppler technique. In the present review, studies examining invasive parameters of diastolic function and Doppler indices of diastolic filling are discussed to gain greater insight and understanding of the role of Doppler echocardiography in the noninvasive assessment of diastolic function. These studies have demonstrated a relatively consistent influence of left ventricular relaxation, chamber stiffness, and left atrial pressure on the transmitral velocity filling profile. Impairment of relaxation impedes early filling and may result in a compensatory increase in atrial contribution to filling. An independent decrease in left atrial pressure from altered loading conditions may also reduce filling in early diastole. Increased left ventricular chamber stiffness (i.e., noncompliant left ventricle) impairs atrial contribution to filling and may enhance early filling. Theoretically, reduced left atrial contractility may decrease atrial contribution to filling. Pulmonic vein flow demonstrating increased retrograde flow during atrial systole helps to exclude impaired left atrial contractility. An increased left atrial pressure from altered loading conditions may also augment early filling. Therefore, an invasive or clinical assessment of left atrial pressure as being increased, decreased, or normal greatly aids in the interpretation of the transmitral filling velocity profile when inferences on the status of diastolic function are being made. Diastolic dysfunction is likely when a given pattern of filling cannot be explained on the basis of left atrial pressure. In situations where reasonable estimates on the status of left atrial pressure cannot be done, striking alterations in the transmitral velocity filling profile may be useful.     

多普勒超声心动图评价小儿支气管哮喘时右心舒张功能

应用多普勒超声心动图测定了５５例支气管哮喘患儿和４１例正常小儿的右心舒张功能各指标进行对照。结果表明:正常和支气管哮喘患儿的右心舒张功能各指标有显著性差异；婴幼儿哮喘与儿童哮喘的右心舒张功能仅部分指标差异有显著性；重型较轻型支气管哮喘者右心舒张功能显著下降。提示:①支气管哮喘时患儿存在右心舒张功能异常，且随着病情的进展，其右心舒张功能显著下降。②年龄对支气管哮喘患儿心脏功能的影响不明显。③多普勒超声心动图是一种简便、易行的无创性心功能测定方法，值得临床广泛使用     

用卡托普利降低血压对左室舒张功能的影响

本文报告原发性高血压伴左室舒张功能不全病人２８例，经卡托普利正规治疗３～６个月后，进行超声心动图观察血压降低对左室舒张功能的影响。结果发现，卡托普利可使血压满意下降，但对左室舒张功能影响极小，从而说明血压的高低与左室舒张功能可能无直接关系。     

Effects of respiration on left ventricular diastolic function in healthy children

Pulsed Doppler echocardiographic indices of mitral valve fillingwere measured in 20 healthy children, between 3 and 125 yearsold, in order to evaluate the effects of spontaneous respirationon left ventricular diastolic filling patterns. There were significantrespiratory variations in four parameters of left ventriculardiastolic function: The peak early filling velocity, the ratioof early to late peak filling velocity, and the ratio of earlyto late diastolic velocity-time integral decreased significantlyduring inspiration (mean decrease 7%, P<0·05; 16%,P<0·01; and 12%, P<0·05, respectively).On the other hand there was a significant increase in late peakfilling velocity with inspiration (10% increase, P<0·05).Other variables of left ventricular diastolic filling were unchangedwith inspiration. These results suggest that assessment of leftventricular diastolic function in children should be standardizedwith regard to respiratory phases in any clinical application. (Eur Heart J 1996; 17: 453%456)     

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)     

超声心动图观察健康人舒张功能减退与左房增大的相关性及临床意义

目的探讨健康人生理性舒张功能减退与左房增大的相关性及临床意义.方法应用超声心动图方法观察4575例年龄20～97岁健康人的心脏结构、血流及功能,其中男性2150例,女性2425例,取胸骨旁左室长轴切面测量左房、左室,计算左室射血分数.应用多普勒超声心动图测量二尖瓣舒张早期血流峰值速度（EPFV）及心房收缩期血流峰值速度（APFV）.以10岁为一年龄段分为7个年龄组,观察各年龄段心脏结构及心功能是否存在差异.同时观察年龄与心脏结构及心功能的相关性.结果各年龄段左室内径、左室射血分数无统计学差异.随年龄段增加,左房增大,EPFV减慢,APFV增快,E/A比值减小,除80年龄组外,左房内径、EPFV及APFV各年龄段均有统计学差异（均P＜0.05）.年龄与EPFV及E/A比值呈显著负相关,与左房内径、APFV呈显著正相关;左房内径与EPFV及E/A比值呈显著负相关,与APFV呈显著正相关（均P＜0.01）.结论随年龄增长,左房增大,左室舒张功能减退,而左室内径及左室收缩功能无明显变化.左房内径与左室舒张充盈的各项指标具有良好的相关性,提示左房增大可能是左室舒张功能减退的重要表现之一.     

Impact of diabetes on left ventricular diastolic function in patients with arterial hypertension

AIMS: To analyse the effect of diabetes (DM) on diastolic function in hypertensive patients. METHODS: 439 hypertensive patients were selected for participation in this study. All participants had an echocardiographic evaluation of systolic and diastolic function. The overall degree of diastolic function and specific parameters (e.g. E/Ea ratio) were analysed. RESULTS: We divided the cohort (63+/-10 years) into those with diabetes mellitus (DM(+), n=124) and without diabetes mellitus (DM(-), n=315). The prevalence of normal diastolic function was lower in DM(+) than DM(-) (19.4% vs. 30.8%); mild (65.3% vs. 60.0%) and moderate/ severe diastolic dysfunction were more frequent in DM(+) (15.3% vs. 9.2%, p=0.022). The E/Ea ratio, an estimate of left ventricular end-diastolic pressure, was significantly higher in DM(+) (12.3+/-4.4) as compared to DM(-) (10.8+/-3.6, p<0.001). Sex-specific analysis revealed that the effect of DM on diastolic function was mainly limited to the male subgroup. Multivariate logistic regression analysis showed that diabetes affected diastolic function in males independent of blood pressure, left ventricular mass index, concomitant medication and prevalence of coronary artery disease. CONCLUSION: Diabetes negatively affects diastolic function in patients with arterial hypertension. This effect is mainly confined to the male subgroup.     

Evaluation of left ventricular function in cardiomyopathic mice by tissue Doppler and color M-mode Doppler echocardiography

Tissue Doppler imaging (TDI) and color M-mode Doppler flow propagation velocity (Vp) are used to assess cardiac function in humans, but the feasibility and applicability of these measurements to murine cardiomyopathic models of heart failure remain unclear. Left ventricular (LV) function was measured by TDI and Vp among mice exhibiting severe dilated cardiomyopathy (TOT), pressure-overload hypertrophy (TAC), and normal controls (NTG). Transmitral flow pattern in TACs and TOTs showed a restrictive filling pattern, but early diastolic mitral annulus velocity was comparable among the three studied groups. Propagation velocity in an anesthetized state was comparable in all three groups. However, while Vp increased in all three groups in the conscious state, the increase in NTGs was statistically greater than in TACs and TOTs. Collectively, results indicate that color M-mode Doppler echocardiography can be used to assess LV function in mice. Furthermore, Vp is depressed by anesthesia, a complication that can lead to misinterpretation of LV function in normal hearts.     

Correlation between LV regional strain and LV dyssynchrony assessed by 2D STE in patients with different levels of diastolic dysfunction

Backgrounds: Little is known about left ventricular (LV) circumferential, radial, and longitudinal functions in patients with diastolic dysfunction (DD). The aims of this study were: (1) to characterize circumferential, radial, and longitudinal strain and (2) to use 2D speckle tracking echocardiography (STE) to evaluate LV dyssynchrony in different DD grades. Methods and results: We studied 128 subjects (90 with DD, 38 healthy controls). DD was divided into three groups according to grade (group 1; mild, group 2; moderate, and group 3; severe). Regional strains were measured by 2D STE. Global LV CS was significantly lower in group 3 (-17.4 ± 5.2) compared with healthy controls (-21.2 ± 3.6), group 1 (-20.7 ± 3.9), and group 2 (-20.2 ± 4.0) (P < 0.0001 for each comparison). Global LV RS and LS were significantly lower in all three groups than in controls. Conclusion: LV, LS, and RS were lower in patients with mild to severe DD than in healthy controls. However, LV CS was similar to normal control values in patients with mild to moderate DD but was lower in patients with severe DD. Circumferential segmental LV motion is likely to compensate for impaired longitudinal and radial LV motion in patients with DD. LV dyssynchrony also occurred significantly more frequently in patients with DD with normal EF than in healthy controls. These results suggest that, in patients with DD and normal EF, contraction of the myocardium is not synchronized and that LV dyssynchrony plays a role in producing diastolic heart failure.     

超声评价原发性扩张型心肌病舒张功能障碍及其与收缩功能的关系

目的 :探讨原发性扩张型心肌病 （DCM）是否存在主动舒张功能障碍及舒张功能障碍与收缩功能障碍的关系。方法 :DCM患者 5 6例 ,彩色超声诊断仪常规方法测量 L VEDD,L AD,L VEF,L VEDV,L VESV,E,A,E/ A ,IVRT,DT。结果 :1仅有舒张功能障碍 8例 （14%） ,收缩功能障碍和舒张功能障碍并存者 48例 （86 %）。 2主动舒张功能障碍 ,即 IVRT≥ 10 0 m s者 2 1例 （38%） ,IVRT<10 0 ms者 35例 （6 2 %） ,两组比较 ,前者 L VEF高 ,L AD小 ,E低 ,A高 ,E/ A大 （P<0 .0 5 ）。IVRT≥ 10 0 ms时 ,控制变量 L VEF情况下 ,IVRT与 L VEDD呈正相关 （r=0 .39,P<0 .0 5 ） ,未发现 L VEF与 E/ A或 E相关 （均 r=- 0 .2 2 ,P>0 .0 5 ） ;以 IVRT 110 ms为分界点分成两组 ,IVRT≥110 ms组较 <110 ms组 L VEDD大 （74± 9vs 6 6± 10 m m,P<0 .0 5 ） ,而 L VEF无显著差别。 3DT≥ 15 0 m s者 2 1例 ,DT<15 0 m s者 35例 ,两组比较 ,前者 IVRT长 ,L VEDV小 （P<0 .0 5 ） ,而 L VEF,L AD,L VEDD,E,A,E/ A,L VESV无显著差别。结论 :DCM存在主动舒张功能障碍 ,随着主动舒张功能障碍加重 ,收缩功能下降增剧。     

组织多普勒成像与全方位M-型超声评价左心室舒张功能的临床研究

目的:探讨组织多普勒成像(TDI)与全方位M-型超声心动图对左心室舒张功能诊断的价值。方法:将29例结合常规超声和左心导管证实的左心室舒张功能障碍患者,分为A组:松弛延迟组(11例);B组:“假性正常化”组(12例);C组:限制性充盈组(6例)及15例左心室舒张功能正常对照组;使用TDI于心尖四腔心切面、左心室两腔心切面和心尖三腔心切面测定二尖瓣环运动Ea峰及Aa峰,并计算Ea/Aa。全方位M-型超声测定收缩期最大运动速度(VS)和舒张早期运动速度(VD),计算VD/VS比值。并比较二者的特异性及敏感性。结果:TDI与全方位M-型超声对左心室舒张功能减低诊断的特异性分别为96.7%和94.4%。TDI评价各阶段左心室舒张功能障碍的敏感性,分别为71.2%,90.3%,97.7%。全方位M-型超声对左心室舒张功能评价(将标准定为VD/DS≤1)时,对各阶段左心室舒张功能减低的敏感性分别为56.1%,65.3%,96.5%。结论:二者均可作为评价左心室舒张功能障碍的指标,而TDI有较高的敏感性。     

左室壁内缩短分数评价收缩功能及其与舒张功能相关性的研究

目的:探讨左室壁内缩短分数(mFS )评价高血压患者收缩功能及其与左室舒张功能的关系.方法:收集高血压组51例,正常对照组47例.分析临床特点,行超声心动图检查.收缩功能测定左室室壁厚度,左室内径,左室容量,测定射血分数(EF),缩短分数(FS)以及左室mFS.心脏舒张功能,取二尖瓣血流频谱,记录二尖瓣舒张期血流频谱,记录舒张早期(E)和舒张晚期(A)血流速度峰值.采用组织速度多普勒成像技术测定二尖瓣环室间隔侧和侧壁侧的舒张早期心肌运动速度(Em)和舒张晚期心肌运动速度(Am),取平均值.探讨左室收缩功能和舒张功能的相关性.结果:①收缩功能:高血压组与正常对照组比较:左室舒张末间隔厚度明显增加[(1.18±0.28):(0.95±0.13),P<0.001]、左室舒张末后壁厚度明显增加[(1.01± 0.17):(0.89±0.17),P<0.01]、左室mFS明显降低[( 18.0± 4.9) vs (22.3±5.9), P<0.01],而2组间左室EF和FS差异无统计学意义.②舒张功能:高血压组与对照组比较,二尖瓣血流频谱差异无统计学意义;组织多普勒成像显示,二尖瓣环Em明显降低[(8.22± 2.23):(9.91±2.52),P<0.05],二尖瓣环Em/Am明显降低[(0.72± 0.23):(0.98±0.26),P<0.01]、二尖瓣E/Em明显增加[(9.38±3.19):(7.45±2.10), P<0.01].③mFS与Em/Am显著正相关(r=0.55,P<0.001 )、与E/Em显著负相关(r=-0.38,P<0.05).左室EF和FS与上述指标无相关性.结论:左室mFS是评价高血压患者收缩功能的有力指标,与早期舒张功能受损有关.     

Fosinopril improves left ventricular diastolic function in young mildly hypertensive patients without hypertrophy

To clarify whether fosinopril monotherapy can improve left ventricular diastolic function (LVDF) in young mildly hypertensives without hypertrophy, we studied 66 patients (pts) with diastolic blood pressure 90–100 mmHg, aged <45 years, with normal 2-dimensional echocardiography (2-D echo), and impaired DF. Impaired DF was defined as a Doppler transmitral early (E) to atrial (A) filling velocity ratio (E/A ratio) <1. Thirty-eight pts were selected for fosinopril monotherapy. Mean age was 36 years. Duration of documented hypertension was 5.4 years. Mean daily dose of fosinopril was 20 mg. Twenty-eight controls were treated with hydrochlorothiazide and hydralazine combination. Sixty-six age- and sex-matched healthy subjects served to establish normal reference values of 2-D and Doppler echo measurements. All hypertensives were treated for 30 months and re-examined 4 weeks after cessation of treatment. The fosinopril-treated group showed improvements in transmitral E (52 ± 8 cm/s, vs. 61 ± 9 cm/s, p < 0.01), A (56 ± 9 cm/s, vs. 47 ± 6 cm/s, p < 0.05), and E/A ratio (0.93 ± 0.16, vs. 1.29 ± 0.18, p < 0.01). Moreover, the early to atrial velocity-time integral ratio (1.31 ± 0.10, vs. 2.24 ± 0.10, p < 0.001) improved. The pulmonary venous flow pattern normalized after fosinopril therapy. LV mass index, relative wall thickness, LV dimension, left atrial dimension, fractional shortening, heart rate, and body mass index did not change. The hydrochlorothiazide-hydralazine combination-treated group did not show an improved diastolic function. It is concluded that long-term fosinopril monotherapy leads to an improvement of impaired LVDF in young mildly hypertensives without hypertrophy.