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Smiseth OA, Morris DA, Cardim N, Cikes M, Delgado V, Donal E, Flachskampf FA, Galderisi M, Gerber BL, Gimelli A, Klein AL, Knuuti J, Lancellotti P, Mascherbauer J, Milicic D, Seferovic P, Solomon S, Edvardsen T, Popescu BA. Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e34-e61. [PMID: 34729586 DOI: 10.1093/ehjci/jeab154] [Citation(s) in RCA: 156] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022] Open
Abstract
Nearly half of all patients with heart failure (HF) have a normal left ventricular (LV) ejection fraction (EF) and the condition is termed heart failure with preserved ejection fraction (HFpEF). It is assumed that in these patients HF is due primarily to LV diastolic dysfunction. The prognosis in HFpEF is almost as severe as in HF with reduced EF (HFrEF). In contrast to HFrEF where drugs and devices are proven to reduce mortality, in HFpEF there has been limited therapy available with documented effects on prognosis. This may reflect that HFpEF encompasses a wide range of different pathological processes, which multimodality imaging is well placed to differentiate. Progress in developing therapies for HFpEF has been hampered by a lack of uniform diagnostic criteria. The present expert consensus document from the European Association of Cardiovascular Imaging (EACVI) provides recommendations regarding how to determine elevated LV filling pressure in the setting of suspected HFpEF and how to use multimodality imaging to determine specific aetiologies in patients with HFpEF.
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Affiliation(s)
- Otto A Smiseth
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, N° 100, Lisbon, Portugal
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France.,Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Frank A Flachskampf
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate, 10/2806 Brussels, Belgium
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, Pisa 56124, Italy
| | - Allan L Klein
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Julia Mascherbauer
- Department of Internal Medicine 3, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, Krems, Austria
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Petar Seferovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Scott Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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2
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Smiseth OA. Evaluation of left ventricular diastolic function: state of the art after 35 years with Doppler assessment. J Echocardiogr 2017; 16:55-64. [PMID: 29236226 PMCID: PMC5966482 DOI: 10.1007/s12574-017-0364-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Abstract
Left ventricular (LV) diastolic function can be evaluated by echocardiographic indices of LV relaxation/restoring forces, diastolic compliance, and filling pressure. By using a combination of indices, diastolic function can be graded and LV filling pressure estimated with high feasibility and good accuracy. Evaluation of diastolic function is of particular importance in patients with unexplained exertional dyspnea or other symptoms or signs of heart failure which cannot be attributed to impaired LV systolic function and to assess filling pressure in patients with heart failure and reduced LV ejection fraction. Furthermore, grading of diastolic dysfunction can be used for risk assessment in asymptomatic subjects and in patients with heart disease.
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Affiliation(s)
- Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation and Center for Heart Failure Research, Oslo University Hospital and University of Oslo, Rikshospitalet, 0027, Oslo, Norway.
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3
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Topography and ultrasonographic identification of the equine pulmonary vein draining pattern. Vet J 2016; 210:17-23. [DOI: 10.1016/j.tvjl.2016.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 11/03/2015] [Accepted: 01/11/2016] [Indexed: 11/22/2022]
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Doppler echocardiography in diastology: 35 years of Japanese contribution to its advancement and utility. J Echocardiogr 2011; 9:1-8. [PMID: 27279088 DOI: 10.1007/s12574-010-0065-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/03/2010] [Accepted: 08/11/2010] [Indexed: 10/19/2022]
Abstract
Echocardiography is one of the most important and clinically useful techniques in the assessment of diastolic function. Because of the prevalence of this technique, "diastology" and even the concept of diastolic heart failure have become familiar to researchers and physicians. We believe the first description by Kitabatake and his colleagues in 1982 of the use of Doppler technique to assess the transmitral flow velocity pattern in various cardiac diseases was the beginning of this development. Since then, a number of excellent works regarding echocardiographic assessment of diastolic function have emerged from Japan. Here, we review the Japanese contributions to the development of the use of Doppler echocardiography in diastology.
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Feingold AD, Tighe DA, Aurigemma GP, Hill JC, Vinch CS. The utility of newly derived Doppler echocardiographic variables in the diagnosis and management of patients with heart failure. Curr Cardiol Rep 2004; 6:217-24. [PMID: 15075059 DOI: 10.1007/s11886-004-0027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Doppler echocardiography, because of its noninvasive nature, is an ideal tool to evaluate patients with heart failure (HF), offering the potential to improve early identification and management of these patients. Although traditional Doppler indices have allowed characterization of diastolic filling abnormalities associated with various HF states, important limitations are recognized. More refined Doppler techniques such as analysis of color M-mode flow propagation velocity, tissue Doppler imaging, and strain parameters can add to the ability of the noninvasive laboratory to improve the identification and management of this group of patients. These newer techniques as well as the traditional Doppler assessment of transmitral left ventricular inflow and pulmonary venous inflow velocities are reviewed as methods to improve the diagnosis and management of patients with HF.
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Affiliation(s)
- Andrew D Feingold
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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6
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Stoddard MF, Longaker RA, Calzada N. Left atrial inflow propagation rate: a new transesophageal echocardiographic index of preload. J Am Soc Echocardiogr 2002; 15:1057-64. [PMID: 12373247 DOI: 10.1067/mje.2002.121667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We postulated that the rate of blood propagating into the left atrium from the left upper pulmonic vein would be a useful measure of pulmonary capillary wedge pressure (PCWP). In 23 adult patients who were critically ill (ie, study group) and receiving mechanical ventilation, color M-mode multiplane transesophageal echocardiography was used to measure left atrial inflow propagation rate (LAIF-PR) as a potential index of PCWP measured by right heart catheterization. LAIF-PR was measured in systole and diastole as the slope of the color M-mode signal entering the left atrium from the left upper pulmonic vein. Correlation with PCWP was good for systolic (r = -0.847, P < .0001) and diastolic (r = -0.78, P < .0001) LAIF-PR. The reliability of univariate linear regression equations derived from the study group was tested in 29 subsequent patients (ie, testing group). Measured PCWP was accurately estimated within 5 mm Hg in 85% (22 of 26 patients) and 68% (17 of 25 patients) of the testing group by systolic and diastolic LAIF-PR, respectively. Color M-mode transesophageal echocardiography-derived LAIF-PR, particularly in systole, is a promising new index to estimate PCWP in patients who are critically ill.
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Affiliation(s)
- Marcus F Stoddard
- Department of Medicine, Division of Cardiology, University of Louisville, KY 40202, USA.
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Maslow A, Bert A, Schwartz C, Mackinnon S. Transesophageal Echocardiography in the noncardiac surgical patient. Int Anesthesiol Clin 2002; 40:73-132. [PMID: 11910251 DOI: 10.1097/00004311-200201000-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew Maslow
- Rhode Island Hospital, Brown University Medical Center, Providence 02903, USA
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Rusconi C, Sabatini T, Faggiano P, Ghizzoni G, Oneglia C, Simoncelli U, Gualeni A, Sorgato A, Marchetti A. Prevalence of isolated left ventricular diastolic dysfunction in hypertension as assessed by combined transmitral and pulmonary vein flow Doppler study. Am J Cardiol 2001; 87:357-60, A10. [PMID: 11165980 DOI: 10.1016/s0002-9149(00)01378-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a relatively large population of patients with treated systemic hypertension and normal left ventricular systolic function, prevalence of abnormalities of left ventricular diastolic function, as assessed by Doppler echocardiographic study of mitral and pulmonary vein flow, was high, with 51% of patients showing indirect signs of increased left ventricular end-diastolic pressure. Furthermore, our data documented that a "normal" mitral flow profile does not exclude the presence of an abnormality of left ventricular filling, which could be otherwise identified by combined analysis of a pulmonary vein flow profile.
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Affiliation(s)
- C Rusconi
- Division of Cardiology and Cardiac Rehabilitation, S. Orsola Hospital, Brescia, Italy.
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9
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de Marchi SF, Bodenmüller M, Lai DL, Seiler C. Pulmonary venous flow velocity patterns in 404 individuals without cardiovascular disease. Heart 2001; 85:23-9. [PMID: 11119456 PMCID: PMC1729579 DOI: 10.1136/heart.85.1.23] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the pulmonary venous flow velocity (PVFV) values in a large normal population. DESIGN Prospective study in consecutive individuals. SETTING University hospital. METHODS Among 404 normal individuals, the flow velocity pattern in the right upper pulmonary vein was recorded in 315 subjects using transthoracic echocardiography, and in both upper pulmonary veins in 100 subjects using transoesophageal echocardiography. Subjects were divided into five age groups. The PVFV values were compared between transthoracic and transoesophageal echocardiography within the age groups, and intraindividually between the right and left upper pulmonary veins in transoesophageal echocardiography. RESULTS Normal PVFV values for the right upper pulmonary vein in transthoracic and transoesophageal echocardiography are presented. The duration of flow reversal at atrial contraction was overestimated using transthoracic echocardiography (mean (SD): 96 (21) ms in transoesophageal echocardiography, 120 (28) ms in transthoracic echocardiography, p < 0.0001). Systolic to diastolic peak flow velocity ratio (S:D) increased earlier with advancing age with transoesophageal echocardiography than with transthoracic echocardiography. Similar results were found for the corresponding time-velocity integrals. Data from the left and right upper pulmonary veins differed with respect to onset and deceleration of flow velocities, but not for flow durations or peak velocities. CONCLUSIONS Normal PVFV values generally show a wide range. The data presented will be of value in assessing left ventricular diastolic function and mitral regurgitation using the PVFV pattern.
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Affiliation(s)
- S F de Marchi
- Swiss Cardiovascular Centre Bern, Cardiology, University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland.
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Zhang G, Yasumura Y, Uematsu M, Nakatani S, Nagaya N, Miyatake K, Yamagishi M. Echocardiographic determination of left atrial function and its application for assessment of mitral flow velocity pattern. Int J Cardiol 1999; 72:19-25. [PMID: 10636629 DOI: 10.1016/s0167-5273(99)00137-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We determined left atrial (LA) volume changes to evaluate LA function, and to correlate the Doppler-determined mitral flow velocity (MFV) pattern. Twenty-four patients with ischemic heart disease who showed 'normal' MFV pattern by pulsed Doppler echocardiography were studied. The patients were divided into 14 patients with left ventricular end diastolic pressure < 18 mmHg (true normals) and 10 patients with > or = 18 mmHg (pseudo normals). The changes in LA volume were determined by echocardiography from apical two- and four-chamber views with modified Simpson's method. The volume measurements were done at the time of mitral valve opening (Vmax), at onset of atrial systole (Va) and at mitral valve closure (Vmin). Then the passive LA emptying volume was calculated by subtracting Va from Vmax, and the active LA emptying volume by subtracting Vmin from Va. The LA ejection fraction was calculated by the formula: [(Va-Vmin)Va] x 100. There was no significant difference in LA ejection fraction in pseudo normal (39+/-6%) and in true normal (41+/-13%) patients. Although the passive LA emptying volume was 16+/-4 ml/beat in true normal and was 11+/-3 ml/beat in pseudo normal (NS), the active LA emptying volume was significantly greater in pseudo normals (22+/-4 m/beat) than in true normals (12+/-2 ml/beat, P<0.001). Thus, the ratio of passive and active LA emptying volume was markedly greater in true normals (1.28+/-0.35) than in pseudo normals (0.52+/-0.19, P<0.001), facilitating the differentiation of these two groups. These results indicate that two-dimensional echocardiographic measurement of LA volume can be valuable in assessing the LA function, providing an alternative method for differentiating pseudo normal from true normal MFV pattern in clinical settings, although several technological shortcomings should be resolved.
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Affiliation(s)
- G Zhang
- Cardiology Division of Medicine, National Cardiovascular Center, Suita, Osaka, Japan
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11
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Nakatani S, Garcia MJ, Firstenberg MS, Rodriguez L, Grimm RA, Greenberg NL, McCarthy PM, Vandervoort PM, Thomas JD. Noninvasive assessment of left atrial maximum dP/dt by a combination of transmitral and pulmonary venous flow. J Am Coll Cardiol 1999; 34:795-801. [PMID: 10483962 DOI: 10.1016/s0735-1097(99)00263-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The study assessed whether hemodynamic parameters of left atrial (LA) systolic function could be estimated noninvasively using Doppler echocardiography. BACKGROUND Left atrial systolic function is an important aspect of cardiac function. Doppler echocardiography can measure changes in LA volume, but has not been shown to relate to hemodynamic parameters such as the maximal value of the first derivative of the pressure (LA dP/dt(max)). METHODS Eighteen patients in sinus rhythm were studied immediately before and after open heart surgery using simultaneous LA pressure measurements and intraoperative transesophageal echocardiography. Left atrial pressure was measured with a micromanometer catheter, and LA dP/dt(max) during atrial contraction was obtained. Transmitral and pulmonary venous flow were recorded by pulsed Doppler echocardiography. Peak velocity, and mean acceleration and deceleration, and the time-velocity integral of each flow during atrial contraction was measured. The initial eight patients served as the study group to derive a multilinear regression equation to estimate LA dP/dt(max) from Doppler parameters, and the latter 10 patients served as the test group to validate the equation. A previously validated numeric model was used to confirm these results. RESULTS In the study group, LA dP/dt(max) showed a linear relation with LA pressure before atrial contraction (r = 0.80, p < 0.005), confirming the presence of the Frank-Starling mechanism in the LA. Among transmitral flow parameters, mean acceleration showed the strongest correlation with LA dP/dt(max) (r = 0.78, p < 0.001). Among pulmonary venous flow parameters, no single parameter was sufficient to estimate LA dP/dt(max) with an r2 > 0.30. By stepwise and multiple linear regression analysis, LA dP/dt(max) was best described as follows: LA dP/dt(max) = 0.1 M-AC +/- 1.8 P-V - 4.1; r = 0.88, p < 0.0001, where M-AC is the mean acceleration of transmitral flow and P-V is the peak velocity of pulmonary venous flow during atrial contraction. This equation was tested in the latter 10 patients of the test group. Predicted and measured LA dP/dt(max) correlated well (r = 0.90, p < 0.0001). Numerical simulation verified that this relationship held across a wide range of atrial elastance, ventricular relaxation and systolic function, with LA dP/dt(max) predicted by the above equation with r = 0.94. CONCLUSIONS A combination of transmitral and pulmonary venous flow parameters can provide a hemodynamic assessment of LA systolic function.
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Affiliation(s)
- S Nakatani
- Cardiovascular Imaging Center and the Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA
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12
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Farias CA, Rodriguez L, Garcia MJ, Sun JP, Klein AL, Thomas JD. Assessment of diastolic function by tissue Doppler echocardiography: comparison with standard transmitral and pulmonary venous flow. J Am Soc Echocardiogr 1999; 12:609-17. [PMID: 10441216 DOI: 10.1053/je.1999.v12.a99249] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to determine the utility of Doppler tissue echocardiography in the evaluation of diastolic filling and in discriminating between normal subjects and those with various stages of diastolic dysfunction. We measured myocardial velocities in 51 patients with various stages of diastolic dysfunction and in 27 normal volunteers. The discriminating power of each of the standard Doppler indexes of left ventricular filling, pulmonary venous flow, and myocardial velocities was determined with the use of Spearman rank correlation and analysis of variance F statistics. Early diastolic myocardial velocity (E(m)) was higher in normal subjects (16.0 +/- 3.8 cm/s) than in patients with either delayed relaxation (n = 15, 7.5 +/- 2.2 cm/s), pseudonormal filling (n = 26, 7.6 +/- 2.3 cm/s), or restrictive filling (n = 10, 7.4 +/- 2.4 cm/s, P <.0001). E(m ) was the best single discriminator between control subjects and patients with diastolic dysfunction (P =.7, F = 64.5). Myocardial velocities assessed by Doppler tissue echocardiography are useful in differentiating patients with normal from those with abnormal diastolic function. Myocardial velocity remains reduced even in those stages of diastolic dysfunction characterized by increased preload compensation.
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Affiliation(s)
- C A Farias
- Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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13
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Abstract
Doppler echocardiography is one of the most useful clinical tools for the assessment of left ventricular (LV) diastolic function. Doppler indices of LV filling and pulmonary venous (PV) flow are used not only for diagnostic purposes but also for establishing prognosis and evaluating the effect of therapeutic interventions. The utility of these indices is limited, however, by the confounding effects of different physiologic variables such as LV relaxation, compliance and filling pressure. Since alterations in these variables result in changes in Doppler indices of opposite direction, it is often difficult to determine the status of a given variable when a specific Doppler filling pattern is observed. Recently, color M-mode and tissue Doppler have provided useful insights in the study of diastolic function. These new Doppler applications have been shown to provide an accurate estimate of LV relaxation and appear to be relatively insensitive to the effects of preload compensation. This review will focus on the complementary role of color M-mode and tissue Doppler echocardiography and traditional Doppler indices of LV filling and PV flow in the assessment of diastolic function.
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Affiliation(s)
- M J Garcia
- Cardiovascular Imaging Center, Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
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Richards DR, Gilliland Y, Bernal JA, Smart FW, Stapleton DD, Ventura HO, Cheirif J. Mitral inflow and pulmonary venous Doppler measurements do not predict pulmonary capillary wedge pressure in heart transplant recipients. Am Heart J 1998; 135:641-6. [PMID: 9539480 DOI: 10.1016/s0002-8703(98)70280-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Noninvasive estimation of pulmonary capillary wedge pressure (PCWP) with Doppler-derived mitral inflow pattern has been shown to correlate well with invasively measured PCWP; however, it has not yet been determined whether Doppler-derived mitral inflow pattern can be used to estimate PCWP accurately in heart transplant recipients. METHODS To determine if mitral and pulmonary venous inflow data can be applied to calculate PCWP in heart transplant recipients, some-day echocardiograms and right heart catheterizations were reviewed and 83 echocardiograms with adequate mitral inflow patterns in 53 patients were studied. Twenty-eight studies that also had adequate pulmonary venous inflow patterns were selected for offline analysis. RESULTS Using a previously published formula [PCWP = 17 + (5.3 x E/A) - (0.11 x IVRT)], where E/A is the ratio of early to late mitral inflow velocities and IVRT is the isovolumic relaxation time, we derived a calculated PCWP, the results of which compared poorly with the measured PCWP (r = 0.33; p = 0.002). Linear regression analysis of measured PCWP versus mitral inflow Doppler flow velocity parameters also revealed poor to modest correlation. Adding parameters derived from the pulmonary venous inflow patterns failed to improve this correlation. CONCLUSION Doppler-derived estimation of PCWP with mitral and pulmonary venous inflow patterns cannot be used to reliably predict PCWP in heart transplant recipients.
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Affiliation(s)
- D R Richards
- Department of Internal Medicine, Ochsner Medical Institutions, New Orleans, LA, USA
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Hondo T, Okamoto M, Kawagoe T, Yamane T, Karakawa S, Yamagata T, Matsuura H, Kajiyama G. Effects of volume loading on pulmonary venous flow and its relation to left atrial functions. JAPANESE CIRCULATION JOURNAL 1997; 61:1015-20. [PMID: 9412866 DOI: 10.1253/jcj.61.1015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Although pulmonary venous (PV) flow is closely related to left atrial (LA) pressure dynamics, few investigators have discussed it in relation to LA functions, i.e., reservoir, conduit, and booster pump functions. We examined changes in PV flow rate, LA dimension, and left ventricular filling volume in 11 dogs, and assessed the effects of multistaged volume loading on PV flow and LA functions. Systolic PV flow rate (S) increased significantly and reached a plateau, reflecting a limited LA reservoir function. Diastolic PV flow rate (D) increased significantly with an increase in LA pressure. S/D ratio increased non-significantly from 0.87 +/- 0.07 before volume loading to 0.96 +/- 0.08 until S reached a plateau and then decreased to 0.76 +/- 0.08 (p < 0.05) because of a significant increase in D without an increase in S at the higher stages of volume loading. During atrial contraction, increases in LA active shortening and left ventricular filling volume were limited, indicating a limited LA forward ejection. The difference between PV flow rate just before and at the end of atrial contraction increased and correlated positively with left ventricular end-diastolic pressure (r = 0.57, p < 0.01). PV flow varies according to the degree of volume loading and reflects LA functions, which exhibit limited increases in response to volume loading.
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Affiliation(s)
- T Hondo
- First Department of Internal Medicine, Hiroshima University School of Medicine, Japan
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Cottini E, Giacone G, Cosentino M, Cirino A, Rando G, Vintaloro G. Evaluation of left ventricular diastolic function by pulmonary venous and mitral flow velocity patterns in endurance veteran athletes. Arch Gerontol Geriatr 1996; 22 Suppl 1:179-86. [DOI: 10.1016/0167-4943(96)86932-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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