Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy

The reduction of the left ventricular long-axis early diastolic peak velocity (e') evident by early-middle age occurs in the absence of aging-related slowing of active relaxation

PURPOSE

A decrease in the left ventricular (LV) long-axis early diastolic peak velocity (e') is evident by early-middle age, but it is unknown to what extent this decrease is due to slowing of the speed of active relaxation versus a reduction in LV long-axis excursion during early diastole (EDExc).

METHODS

Pulsed-wave tissue Doppler imaging (TDI) signals were acquired from the septal and lateral borders of the mitral annulus in 62 healthy adult subjects of age 18-45 years. EDExc and LV systolic excursion (SExc) were measured as the integrals of the respective TDI signals. The speed of active relaxation was indirectly assessed using time interval measurements related to the TDI early diastolic signal, including the isovolumic relaxation time (IVRT'), the acceleration time (EDAT), and the duration (EDDur). Multiple linear regression analyses were performed to identify the relationships between e', age, EDExc, SExc, and time intervals.

RESULTS

The findings were similar for both LV walls. Age was negatively correlated with e' and EDExc, but was not correlated with SExc, IVRT', EDAT, or EDDur. The closest correlate of EDExc was SExc, and EDExc was independently correlated with both SExc and age. e' was also positively correlated with SExc, but the closest correlate of e' was EDExc, and when combined with EDExc, EDDur became an independent predictor of e'.

CONCLUSION

The aging-related decrease in e' evident by early-middle age occurs in the absence of aging-related slowing of active relaxation and therefore can be largely attributed to the accompanying reduction in EDExc.

Dobutamine effects on systolic and diastolic left ventricular long-axis excursion and timing - significance for the interpretation of s' and e'

BACKGROUND

Dobutamine effects on the relationships of the peak velocity of left ventricular (LV) long-axis systolic motion (s') with systolic excursion (SExc), systolic duration (SDur) and heart rate, of LV long-axis early diastolic excursion (EDExc) with SExc, and of the peak velocity of LV long-axis early diastolic motion (e') with EDExc, early diastolic duration (EDDur) and isovolumic relaxation time (IVRT') are unknown.

METHODS

Two groups of adult subjects, one young and healthy (n = 10), and one with impaired LV long-axis function (n = 10), were studied, with the aim of identifying consistent findings for the two groups and for the septal and lateral walls. Dobutamine was infused at doses of 5 and 10 µg/kg/min. The relationships between tissue Doppler imaging (TDI) variables acquired before and during dobutamine infusion were analysed using mixed effect multivariate regression modelling.

RESULTS

In both groups, heart rate increased and SDur decreased during dobutamine infusion, and there were independent inverse correlations of SDur with heart rate and dobutamine dose. In contrast, there was no change in EDDur during dobutamine infusion, and no consistent changes in IVRT' independent of heart rate. s' was positively correlated with SExc and inversely correlated with SDur, and there were positive correlations between EDExc and SExc and between e' and EDExc.

CONCLUSION

Dobutamine increases s' due to effects on both systolic excursion and duration and it increases e' due to the associated increases in systolic and early diastolic excursion. A lack of effect on diastolic times does not support the presence of a lusitropic effect of dobutamine.

Left atrial stiffness and strain are novel indices of left ventricular diastolic function in children: validation followed by application in multisystem inflammatory syndrome in children due to COVID-19

AIMS

We hypothesized left atrial (LA) stiffness may serve as a surrogate marker in children to differentiate elevated pulmonary capillary wedge pressure (PCWP) from normal and help detect diastolic dysfunction in myocardial injury due to multisystem inflammatory syndrome in children (MIS-C).

METHODS AND RESULTS

We validated LA stiffness in 76 patients (median age 10.5 years), 33 had normal PCWP (<12 mmHg) and 43 had elevated PCWP (≥12 mmHg). LA stiffness was applied to 42 MIS-C patients [28 with myocardial injury (+) and 14 without myocardial injury (-)], defined by serum biomarkers. The validation group consisted of a group with and without cardiomyopathies, whose PCWP values ranged from normal to severely elevated. Peak LA strain was measured by speckle-tracking and E/e' from apical four chamber views. Noninvasive LA stiffness was calculated as: LAStiffness=E/e'LAPeakStrain (%-1). Patients with elevated PCWP showed significantly elevated LA stiffness [median 0.71%-1 vs. 0.17%-1, P < 0.001]. Elevated PCWP group showed significantly decreased LA strain (median: 15.0% vs. 38.2%, P < 0.001). Receiver operator characteristic (ROC) curve for LA stiffness yielded an area under the curve (AUC) of 0.88 and cutoff value of 0.27%-1. In MIS-C group, ROC curve yielded an AUC of 0.79 and cutoff value of 0.29%-1 for identifying myocardial injury.

CONCLUSION

In children with elevated PCWP, LA stiffness was significantly increased. When applied to children with MIS-C, LA stiffness classified myocardial injury accurately. LA stiffness and strain may serve as noninvasive markers of diastolic function in the pediatric population.

The role of microRNAs in the pathophysiology, diagnosis, and treatment of diabetic cardiomyopathy

INTRODUCTION

Diabetic cardiomyopathy (DCM) is an end-point macrovascular complication associated with increased morbidity and mortality in 12% of diabetic patients. MicroRNAs (miRNAs) are small noncoding RNAs that can act as cardioprotective or cardiotoxic agents in DCM.

METHODS

We used PubMed as a search engine to collect and analyse data in published articles on the role of miRNAs on the pathophysiology, diagnosis and treatment of DCM.

RESULTS

MiRNAs play an essential role in the pathophysiology, diagnosis and treatment of DCM due to their distinct gene expression patterns in diabetic patients compared to healthy individuals. Advances in gene therapy have led to the discovery of potential circulating miRNAs, which can be used as biomarkers for DCM diagnosis and prognosis. Furthermore, targeted miRNA therapies in preclinical and clinical studies, such as using miRNA mimics and anti-miRNAs, have yielded promising results. Application of miRNA mimics and anti-miRNAs via different nanodrug delivery systems alleviate hypertrophy, fibrosis, oxidative stress and apoptosis of cardiomyocytes.

CONCLUSION

MiRNAs serve as attractive potential targets for DCM diagnosis, prognosis and treatment due to their distinctive expression profile in DCM development.

Aging and the relationships between long-axis systolic and early diastolic excursion, isovolumic relaxation time and left ventricular length-Implications for the interpretation of aging effects on e`

BACKGROUND

Both the left ventricular (LV) long-axis peak early diastolic lengthening velocity (e`) and long-axis early diastolic excursion (EDExc) decrease with age, but the mechanisms underlying these decreases are not fully understood. The aim of this study was to investigate the relative contributions to aging-related decreases in e`and EDExc from LV long-axis systolic excursion (SExc), isovolumic relaxation time (IVRT, as a measure of the speed of relaxation) and LV end-diastolic length (LVEDL).

METHODS

The study group was 50 healthy adult subjects of ages 17-75 years with a normal LV ejection fraction. SExc, EDExc, e`and IVRT were measured from pulsed wave tissue Doppler signals acquired from the septal and lateral walls. Multivariate modelling was performed to identify independent predictors of EDExc and e`which were consistent for the septal and lateral walls.

RESULTS

EDExc decreased with age and the major determinant of EDExc was SExc, which also decreased with age. There was also a decrease of e`with age, and the major determinant of e`was EDExc. IVRT decreased with age and on univariate analysis was not only inversely correlated with EDExc and e`, but also with SExc. IVRT was only a minor contributor to models of EDExc which included SExc, and was an inconsistent contributor to models of e`which included EDExc. LVEDL decreased with age independent of sex and body size, and was positively correlated with SExc, EDExc and e`.

CONCLUSION

Major mechanisms underlying the decrease in e`seen during aging are the concomitant decreases in long-axis contraction and early diastolic excursion, which are in turn related in part to long-axis remodelling of the left ventricle. After adjusting for the extent of systolic and early diastolic excursion, slowing of relaxation, as reflected in prolongation of the IVRT, makes no more than a minor contribution to aging-related decreases in EDExc and e`.

Preclinical cardiovascular changes in children with obesity: A real-time 3-dimensional speckle tracking imaging study

The aims of this study were (1) to quantify changes in 3-dimensional (3D) strain in obese children using real-time 3D echocardiography (RT3DE) and 3D speckle tracking echocardiography (3DSTE), and (2) to investigate the utility of left ventricular (LV) strain variables in measuring early cardiovascular changes in children with obesity. A total of 181 obese children (study group) aged 4–18 years old were prospectively enrolled and compared with 229 healthy subjects (control group). We acquired demographic, clinical, biochemical, and 2D echocardiography/Doppler data. Also, RT3DE and 3DSTE were performed to measure LV volume, left ventricular ejection fraction (LVEF), LV mass (LVM), LV peak systolic global longitudinal strain (GLS), radial strain (GRS), circumferential strain (GCS), and global strain (GS). There were significant differences in anthropometric measurements, blood pressures, Cholesterol, C-reactive protein (CRP), Intima-media thickness (IMT), left atrium end-systolic dimension (LASD), interventricular septal end-diastolic dimension (IVSD), LV posterior wall end-diastolic dimension (LVPWD), LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD), LV end-diastolic volumes (LVEDV), and LV end-systolic volumes (LVESV), E and A velocities, E/A,e’, e’/a’, E/e’, LVM, LV mass index (LVMI), GLS, GRS, GCS, and GS between the study and control groups. The receiver operating characteristic curves (ROC) for the statistically significant echocardiographic variables showed that the range of areas of ROC curves varied from 0.76 (GLS), 0.74 (GRS), 0.72 (LASD), to 0.58 (LVESD), respectively. In conclusion, LV 3D strain variables by RT3DE and 3DSTE decrease in obese children. LV 3D strain is more sensitive than other echocardiographic and vascular ultrasound variables in detecting cardiovascular changes in children with obesity.

Quantitative Assessment of the Effect of the Out-of-Plane Movement of the Homogenous Ellipsoidal Model of the Left Ventricle on the Deformation Measures Estimated Using 2-D Speckle Tracking-An In-Silico Study

Effect of the out-of-plane (OOP) movement amplitude on estimates of global displacements (radial, circumferential) and strains (radial , circumferential ) was studied in an ellipsoidal model of the left ventricle using finite-element modeling (FEM), synthetic ultrasonic data, and short-axis view. This effect was assessed using median of the absolute relative error (RE) of the global parameters. FEM provided node displacements for synthetic ultrasonic data and reference data generation. Displacements were estimated using block-matching (BM) and B-spline (BS) methods. FEM-derived data analysis, free from errors resulting from speckle tracking, indicated that the tissue motion introduced REs of global strain estimates below 4.5%. The effect of the OOP motion amplitude on strain estimates was strain specific and depended on the displacement estimation method. In the case of , the increase of the OOP amplitude resulted in quasi-linear increase of the RE from approximately 10% to 15%. The modulus of the end-systolic (ES) errors of the estimates almost linearly increased with increasing OOP amplitude approximately from 10% to 16%. REs of the estimate were close to 80% and 40%, respectively, in the case of the BM and BS methods, and increased with increasing OOP amplitude. The modulus of the ES errors of the estimates in the case of the BS method was about -40% and showed low sensitivity to the OOP amplitude; in the BM case, these errors varied approximately from -70% to -58% for OOP amplitude from 0 to 15 mm.

Left ventricular dysfunction by conventional and tissue Doppler echocardiography in pediatric hemodialysis patients: relation with plasma brain natriuretic peptide levels

INTRODUCTION

Tissue Doppler imaging (TDI) is a relatively new echocardiography method in children with chronic kidney disease (CKD). The aims of this study were to evaluate left ventricular (LV) diastolic function in pediatric CKD patients using conventional pulsed-wave Doppler echocardiography (cPWD) and TDI methods and correlate them with BNP levels.

MATERIAL AND METHODS

Thirty children on regular hemodialysis (HD) were included. Left ventricular systolic and diastolic indices and BNP levels were measured immediately before and after HD.

RESULTS

After HD, LV and left atrium diameters were significantly decreased (p < 0.001 and p < 0.001, respectively). Transmitral E velocity and E/A ratio decreased (p < 0.001 and p < 0.001, respectively). Also, there were significant decreases in the early diastolic velocity E' of LV wall, septal wall, and anterior wall (p = 0.001, p = 0.004 and p < 0.001, respectively). Mean E/E' ratio and ratios of septal and lateral walls were decreased significantly (p = 0.004, p = 0.002 and p = 0.017, respectively). BNP levels decreased significantly during HD when comparing concentrations before and after HD (p < 0.001). BNP strongly correlated with LV diastolic function indices (before HD: mean E/E' (r = 0.401, p = 0.028), lateral E/E" (r = 0.291, p = 0.025), septal E'(r = -0.398, p = 0.029), lateral wall E' (r = -0.452, p = 0.012) and mean E' (r = -0.469, p = 0.009), after HD: mean E/E' (r = 0.38, p = 0.038) and lateral E/E" (r = 0.474, p = 0.008) and lateral wall E' (r = -0.270, p = 0.037)).

CONCLUSIONS

The cPWD and TDI-derived LV indices are influenced by HD. The diagnostic utility of BNP in the presence of deteriorating renal function may be compromised to some extent.

Possible Mechanisms Underlying Aging-Related Changes in Early Diastolic Filling and Long Axis Motion-Left Ventricular Length and Blood Pressure

Background

The transmitral E wave and the peak velocity of early diastolic mitral annular motion (e`) both decrease with age, but the mechanisms underlying these age-related changes are incompletely understood. This study investigated the possible contributions of blood pressure (BP) and left ventricular end-diastolic length (LVEDL) to age-related reductions in E and e`.

Methods

The study group were 82 healthy adult subjects <55 years of age who were not obese or hypertensive. Transmitral flow and mitral annular motion were recorded using pulsed-wave Doppler. LVEDL was measured from the mitral annular plane to the apical endocardium.

Results

Age was positively correlated with diastolic BP and septal wall thickness (SWT), inversely correlated with LVEDL (β = -0.25) after adjustment for sex and body surface area, but was not related to left ventricular end-diastolic diameter (LVEDD). Age was also inversely correlated with E (r = -0.36), septal e`(r = -0.53) and lateral e`(r = -0.53). On multivariable analysis, E was inversely correlated with diastolic BP and LVEDD, septal e`was inversely correlated with diastolic BP and positively correlated with SWT and LVEDL, after adjusting for body mass index, whilst lateral e`was inversely correlated with diastolic BP and positively correlated with LVEDL.

Conclusion

The above findings are consistent with higher BP being a contributor to age-related reductions in both E and e`and shortening of LVEDL with age being a contributor to the age-related reduction in e`. An implication of these findings is that slowing of myocyte relaxation is unlikely to be the sole, and may not be the main, mechanism underlying age-related decreases in E and e`.

Effect of percutaneous mitral balloon valvuloplasty on right ventricular functions in mitral stenosis: short- and mid-term results

OBJECTIVE

To evaluate the short- and mid-term effects of percutaneous mitral balloon valvuloplasty (PMBV) on right ventricular functions in mitral stenosis.

METHODS

A prospective study was conducted in 61 patients who had mitral stenosis in normal sinus rhythm (68% female, age: 42±11-16 years). Right ventricular functions were measured before, immediately after, and at 3 months and 1 year after PMBV by conventional and tissue Doppler echocardiography imaging methods. Additionally, the patients were evaluated in two groups (PAP≥40 mm Hg, n: 46; PAP<40 mm Hg, n: 15) according to the systolic pulmonary artery that was measured by echocardiography prior to PMBV.

RESULTS

Post-PMBV mean gradient, pulmonary artery pressure (PAP), and left atrial size decreased significantly, and the mitral valve area increased significantly in both patient groups. This significance in pulmonary artery pressure was lost at 1 year. The significant post-PMBV increase in tricuspid annular point systolic excursion (TAPSE), systolic velocity, early diastolic velocity, and peak myocardial velocity during isovolumic contraction (IVV), indicating right ventricular functions, disappeared at 1 year. The significant post-PMBV decrease in myocardial performance index (MPI) and late diastolic velocity lost its significance at 1 year. No significant change was observed in myocardial acceleration during isovolumic contraction (IVA). The group with pulmonary hypertension demonstrated significance similar to the results of the overall group. Post-PMBV TAPSE, systolic velocity, early diastolic velocity, IVV, and IVA increased significantly, and this increase was maintained up to 1 year in the group without pulmonary hypertension. MPI and late diastolic velocity maintained their significantly decreased values up to 1 year.

CONCLUSION

The positive effect of PMBV on right ventricular function in the acute period decreases and even disappears in the mid-term in patients developing pulmonary hypertension. Intervention in the patients prior to the development of hypertension is very important for the improvement in right ventricular functions.

Diagnostic performance of echocardiography for the detection of acute cardiac allograft rejection: a systematic review and meta-analysis

Objective

Many studies have addressed the diagnostic performance of echocardiography to evaluate acute cardiac allograft rejection compared with endomyocardial biopsy. But the existence of heterogeneity limited its clinical application. Thus, we conducted a comprehensive, systematic literature review and meta-analysis for the purpose.

Methods

Studies prior to September 1, 2014 identified by Medline/PubMed, EMBASE and Cochrance were examined by two independent reviews. We conducted meta-analysis by using Meta-DiSc 1.4 software. An assessment tool of QUADAS-2 was applied to evaluate the risk of bias and applicability of the studies.

Results

Thirty studies met the inclusion criteria of meta-analysis. The four parameters of pressure half time, isovolumic relaxation time, index of myocardial performance and late diastolic mitral annular motion velocity were included in the meta-analysis, with a pooled diagnostic odds ratio of 10.43, 6.89, 15.95 and 5.68 respectively, and the area under the summary receiver operating characteristic curves value of 0.829, 0.599, 0.871 and 0.685 respectively.

Conclusion

The meta-analysis and systematic review demonstrate that no single parameter of echocardiography showed a reliable diagnostic performance for acute cardiac allograft rejection. A result of echocardiography for ACAR should be comprehensively considered by physicians in the context of clinical presentations and imaging feature.

The Association between Glomerular Hyperfiltration and Left Ventricular Structure and Function in Patients with Primary Aldosteronism

BACKGROUND

Glomerular hyperfiltration has been recently noticed as an important issue in primary aldosteronism (PA) patients. However, its effect on the cardiovascular system remains unknown.

METHODS

We prospectively analyzed 47 PA patients including 11 PA patients with estimated glomerular filtration rate (eGFR) > 130 ml/min per 1.73 m2 (group 1), and 36 PA patients with eGFR 90-110 ml/min per 1.73 m2 (group 2). Fourteen essential hypertension (EH) patients with eGFR 90-110 ml/min per 1.73 m2 were included as the control group (group 3). Echocardiography including left ventricular mass index (LVMI) measurement and tissue Doppler imaging (TDI) was performed. Predicted left ventricular mass (LVM) was calculated. Inappropriate LVM was defined as an excess of > 35% from the predicted value.

RESULTS

The value of LVMI decreased significantly in order from groups 1 to 3 (group 1>2>3). While group 2 had a significantly higher percentage of inappropriate LVM than group 3, the percentage of inappropriate LVM were comparable in groups 1 and 2. Group 1 had a higher mitral E velocity, E/A ratio than that of group 2. In the TDI study, the E/E' ratio also decreased significantly in order from groups 1 to 3 (group 1>2>3). Group 2 had lower E' than that of group 3, although the E' of group 1 and 2 were comparable.

CONCLUSIONS

Although PA patients with glomerular hyperfiltration were associated with higher LVMI, higher mitral E velocity, higher E/E' ratio, they had comparable E' with PA patients with normal GFR. This phenomenon may be explained by higher intravascular volume in this patient group.

High-resolution tissue Doppler imaging of the zebrafish heart during its regeneration

The human heart cannot regenerate after injury, whereas the adult zebrafish can fully regenerate its heart even after 20% of the ventricle is amputated. Many studies have begun to reveal the cellular and molecular mechanisms underlying this regenerative process, which have exciting implications for human cardiac diseases. However, the dynamic functions of the zebrafish heart during regeneration are not yet understood. This study established a high-resolution echocardiography for tissue Doppler imaging (TDI) of the zebrafish heart to explore the cardiac functions during different regeneration phases. Experiments were performed on AB-line adult zebrafish (n=40) in which 15% of the ventricle was surgically removed. An 80-MHz ultrasound TDI based on color M-mode imaging technology was employed. The cardiac flow velocities and patterns from both the ventricular chamber and myocardium were measured at different regeneration phases relative to the day of amputation. The peak velocities of early diastolic inflow, early diastolic myocardial motion, late diastolic myocardial motion, early diastolic deceleration slope, and heart rate were increased at 3 days after the myocardium amputation, but these parameters gradually returned to close to their baseline values for the normal heart at 7 days after amputation. The peak velocities of late diastolic inflow, ventricular systolic outflow, and systolic myocardial motion did not significantly differ during the heart regeneration.

The Impact of Moderate Intensity Physical Activity on Cardiac Structure and Performance in Older Sedentary Adults

Background

Sedentary aging leads to adverse changes in vascular function and cardiac performance. We published improvements in vascular function with moderate intensity physical activity (PA) in continuous bouts. Whether moderate intensity PA also impacts cardiac structure and cardiovascular performance of the aging left ventricle (LV) is unknown.

Methods

We recruited and analyzed results from 102 sedentary older adults ages ≥ 50 from a randomized controlled trial with 3 study groups: control (group 1), a pedometer-only intervention (group 2), or a pedometer with an interactive website employing strategies to increase habitual physical activity (PA, group 3) for 12 weeks. Transthoracic echocardiograms were performed prior to and following the 12 week intervention period to assess cardiac morphology, left ventricular (LV) systolic performance, LV diastolic function, and arterial and LV ventricular elastance. Step count and PA intensity/distribution were measured by a pedometer and an accelerometer.

Results

We found no significant changes in cardiac morphology. Further, we found no improvement in the aforementioned cardiac functional parameters. Comparing those who achieved the following benchmarks to those who did not showed no significant changes in cardiac structure or performance: 1) 10,000 steps/day, 2) ≥ 30 min/day of moderate intensity physical activity, or 3) moderate intensity PA in bouts ≥ 10 min for ≥ 20 min/day

Conclusions

In sedentary older adults, increasing moderate intensity PA to currently recommended levels does not result in favorable changes in LV morphology or performance over 12 weeks. More prolonged exposure, higher PA intensity, or earlier initiation of PA may be necessary to see benefits.

•

We randomized sedentary older adults to one of two programs designed to increase physical activity or a control group

•

We determined the impact of increasing physical activity on left ventricular (LV) structure, LV performance and ventriculo-vascular coupling

•

There were no significant changes in any of these parameters of the 12 week intervention period

•

Increased physical activity may need to be more intense or more sustained to see beneficial physiological changes in cardiac morphology and LV function

Early detection of myocardial deformation by 2D speckle tracking echocardiography in normotensive obese children and adolescents

Objective:

To evaluate the left venticular myocardial deformation parameters in normotensive obese children and adolescents by using 2-D speckle tracking echocardiography.

Methods:

This observational cross-sectional study included 69 children and adolescents (aged between 10-18), 38 were normotensive obese and 31 were normal weighted. All children underwent detailed two- dimentional, Doppler and two-dimentional speckle tracking echocardiography. Student t-test, Mann-Whitney U test, chi-square test and Pearson’s correlation were used in statistical analysis. Multiple linear regression analysis was used the determine independent variables on global longitudinal strain (GLS).

Results:

While in normal limits, diastolic blood pressure was significantly higher in obese group. Left ventricular end-diastolic diameter (LVDd) and end-systolic diameter (LVDs), interventricular septal thickness (IVSd), left ventricular posterior wall thickness (LPWD) and left ventricular mass index (LVM)/height^2.7 were significantly higher in obese group compared to healthy peers (p=0.004, p=0.011, p<0.001, p=0.001, p<0.001) respectively. Obese subjects had reduced global longitudinal strain (GLS) values (p=0.001). Multiple linear regression analysis using the step-wise method were performed to assess the independent variables (age, body mass index, insulin resistance, systolic blood pressure, diastolic blood pressure, left ventricular diameters and LVM index (g/m^2.7) affecting the dependent variable GLS. GLS was found significantly correlated with body mass index (BMI) (β:0.440, p:0.001; 95% CI: 0.104-0.311).

Conclusion:

Left ventricular strain parameters obtained by two dimentional speckle tracking echocardiography were diminished in obese children compared to normal subjects indicating that obesity in childhood is linked to decreased myocardial deformation even in the absence of comorbidities in early stages.

Impaired resting myocardial annular velocities are independently associated with mental stress-induced ischemia in coronary heart disease

OBJECTIVES

The aim of this study was to investigate the association between resting myocardial function as assessed by tissue Doppler myocardial velocities and the propensity to develop mental stress-induced ischemia (MSIMI).

BACKGROUND

Tissue Doppler myocardial velocities detect preclinical cardiac dysfunction and clinical outcomes in a range of conditions. However, little is known about the interrelationship between myocardial velocities and the propensity to develop MSIMI compared with exercise stress-induced myocardial ischemia.

METHODS

Resting annular myocardial tissue Doppler velocities were obtained in 225 patients with known coronary heart disease who were subjected to both conventional exercise stress testing as well as a battery of 3 mental stress tests. Diastolic early (e') and late (a') as well as systolic (s') velocities were obtained, and the eas index, an integrated measure of myocardial velocities, was calculated as e'/(a' × s'). MSIMI was defined as: 1) the development or worsening of regional wall motion abnormality; 2) a reduction in left ventricular ejection fraction ≥ 8%; and/or 3) ischemic ST-segment changes during 1 or more of the 3 mental stress tests.

RESULTS

A total of 98 of 225 patients (43.7%) exhibited MSIMI. Patients developing MSIMI had significantly lower s' (7.0 ± 1.7 vs. 7.5 ± 1.2, p = 0.016) and a' (8.9 ± 1.8 vs. 10.0 ± 1.9, p < 0.001) at baseline, whereas e' did not differ (6.5 ± 1.7 vs. 6.5 ± 1.8, p = 0.85). Furthermore, the eas index was significantly higher (0.11 ± 0.04 vs. 0.09 ± 0.03, p < 0.0001). The eas index remained significantly associated with the propensity to develop MSIMI (odds ratio per 0.05-U increase: 1.85; 95% confidence interval: 1.21 to 2.82; p = 0.004) after adjustment for resting left ventricular ejection fraction, resting wall motion index score, sex, and social circumstances of living. There was no association between resting eas index and exercise stress-induced myocardial ischemia.

CONCLUSIONS

MSIMI but not exercise stress-induced myocardial ischemia is independently associated with resting abnormalities in myocardial systolic and late diastolic velocities as well as the integrated measure of the eas index in patients with known coronary artery disease. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847).

Cardiovascular involvement in patients with pseudoexfoliation syndrome

AIM

Pseudoexfoliation (PEX) syndrome, diagnosed by ocular examination, is a common disorder of the extracellular matrix. Previous studies have demonstrated accumulation of PEX material in the walls of blood vessels and myocardium. We aimed to investigate whether PEX is associated with cardiovascular involvement using carotid ultrasound measurements and myocardial tissue Doppler imaging (TDI).

METHODS

Thirty-six PEX patients and 34 age-matched and sex-matched healthy controls who had no PEX material were included. Fasting blood samples were taken and the following data were obtained from all cases: myocardial TDI measurements, the mean carotid intima-media thickness (IMT), total carotid plaque area and number.

RESULTS

There were no significant differences between the groups regarding clinical and biochemical data. The peak systolic TDI velocities at the septal (septal S) and lateral annuli (lateral S), and the isovolumic contraction velocity at the lateral annulus [lateral isovolumic contraction velocity (IVC)] were significantly lower in patients with PEX, than in controls (P = 0.001, <0.001 and 0.016, respectively) whereas IMT, total carotid plaque area and number were significantly higher (P = 0.002, 0.035 and 0.033, respectively). In a logistic regression analysis including age, septal S, lateral S, lateral IVC, IMT, total carotid plaque area and number, septal S, lateral S and IMT were significantly associated with PEX, (P = 0.035, 0.011 and 0.035, respectively).

CONCLUSION

Peak systolic TDI velocities were significantly lower and IMT was significantly increased in patients with PEX. However, PEX was weakly associated with carotid plaque measurements.

Left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients: detection and evaluation by tissue Doppler imaging

CONFLICT OF INTEREST: NONE DECLARED

The aim of the study was detection of diastolic dysfunction of myocardium with Tissue Doppler Imaging (TDI) in asymptomatic type 2 diabetic patients, in five years duration of disease, and normal cardiac function on conventional echocardiography (CE), according to the performance showed on exercise stress test.

Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study

A direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 ± 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI ≥ 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 ± 2 cm/s), peak early myocardial velocity (Am = 8.7 ± 1.3 cm/s), Em/Am ratio (1.8 ± 0.3), isovolumetric relaxation time (IVRT = 59.2 ± 8.2 ms), MPI (0.39 ± 0.03), and DI (25.5 ± 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 ± 1.2 cm/sn, 6.9 ± 0.6 cm/sn, 2.6 ± 0.2, 51.2 ± 9.6 ms, 0.34 ± 0.03, and 33.13 ± 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.

Sensitivity analysis of left ventricle with dilated cardiomyopathy in fluid structure simulation

Dilated cardiomyopathy (DCM) is the most common myocardial disease. It not only leads to systolic dysfunction but also diastolic deficiency. We sought to investigate the effect of idiopathic and ischemic DCM on the intraventricular fluid dynamics and myocardial wall mechanics using a 2D axisymmetrical fluid structure interaction model. In addition, we also studied the individual effect of parameters related to DCM, i.e. peak E-wave velocity, end systolic volume, wall compliance and sphericity index on several important fluid dynamics and myocardial wall mechanics variables during ventricular filling. Intraventricular fluid dynamics and myocardial wall deformation are significantly impaired under DCM conditions, being demonstrated by low vortex intensity, low flow propagation velocity, low intraventricular pressure difference (IVPD) and strain rates, and high-end diastolic pressure and wall stress. Our sensitivity analysis results showed that flow propagation velocity substantially decreases with an increase in wall stiffness, and is relatively independent of preload at low-peak E-wave velocity. Early IVPD is mainly affected by the rate of change of the early filling velocity and end systolic volume which changes the ventriculo:annular ratio. Regional strain rate, on the other hand, is significantly correlated with regional stiffness, and therefore forms a useful indicator for myocardial regional ischemia. The sensitivity analysis results enhance our understanding of the mechanisms leading to clinically observable changes in patients with DCM.

Left Ventricular Diastolic Function Assessment Using the Timing of Mitral Annular and Transmitral Flow Velocities

Background and aims:

Evaluation of left ventricular (LV) diastolic function plays an important role in clinical echocardiography. The relationship between mitral annular velocities from tissue Doppler imaging (TDI) (E′ and A′) and mitral inflow velocities (E and A) from Doppler echocardiography (DE) provide additional information about LV filling and diastolic function. The aims of this study are to i) assess the time differences between peak E and peak E′, peak A and peak A′, peak Ar and peak A, and ii) examine the effects of age and gender on these time intervals parameters in normal subjects.

Methods:

A total of 117 healthy subjects (age ranging from 22- to 78-years-old) were recruited for a standard of echocardiogram (ECHO). During early diastole, the time intervals from the peak of R-wave on the ECG to the peak of E-wave (R-pE), to the peak of E wave to peak of E′-wave (R-pE′) were measured. During late diastole, the time intervals from the onset of P-wave on the ECG to the peak A-wave (P-pA), to the peak Ar-wave on the pulmonary valve flow (P-pAr), to the peak A′-wave (P-pA′) were measured. Early-diastolic temporal discordance (EDTD) and late-diastolic temporal discordance (LDTD) were calculated as the differences between (R-pE) and (R-pE′), and (P-pA) and (P-pA′), respectively.

Results:

The mean EDTD and LDTD were 28.7 ± 10.6 ms and 21.2 ± 15.9 ms, respectively. Similarly, the mean time difference [(P-pA) - (P-pAr)] was 21.5 ± 14.1 ms. EDTD was not associated with age (r=0.15, p=NS), while LDTD was inversely correlated with age (r=-0.65, p<0.01). No significant differences were found for both EDTD and LDTD between genders.

Conclusion:

EDTD and LDTD, the temporal discordances between mitral annulus motion and trans-mitral flow, embody one of the earliest events at early- and late-diastole. Age is not associated with EDTD, but is accompanied by a decline in LDTD. With respect to gender, both EDTD and LDTD are not influenced.

Myocardial function in premature infants: a longitudinal observational study

OBJECTIVES

Gestational and chronological age may have an impact on myocardial function. We studied the longitudinal changes of the atrioventricular tissue Doppler velocities in premature infants through the neonatal transitional period and at expected term and explored the reproducibility of the measurements.

DESIGN

Prospective, observational and longitudinal cohort study.

SETTING

Two-centre study, from a secondary and a tertiary neonatal intensive care unit.

PARTICIPANTS

55 infants (29 males) with gestational age 31-35 weeks and birth weight 1127-2836 grams.

PRIMARY AND SECONDARY OUTCOME MEASURES

Pulsed-wave atrioventricular left, septum and right ventricular annulus tissue Doppler systolic (S'), early diastolic (E') and late diastolic (A') velocities measured by repeated echocardiographic examinations days 1, 2 and 3 and at expected term.

RESULTS

All velocities increased significantly from the neonatal period to expected term (p<0.001). We found a significant correlation between gestational age and right-sided S', E' and A' on day 1 (Pearson correlation 0.32-0.46, p<0.05), for S' in all three walls and septal E' and A' on day 2 (Pearson correlation 0.27-0.49, p<0.05). There was a moderate linear correlation between left ventricle end-diastolic length and septal and right S' at term and for septal E' and A' at day 1 (Pearson correlation 0.30-0.56, p<0.05). We found no correlation between heart rate and tissue Doppler velocities when controlling for the effect of fusion. Continuous positive airway pressure showed moderate effect where as persistence of the ductus arteriosus showed no effect on the tissue Doppler velocities. The E'/A' relationship was consistently reversed throughout the study with frequently fused diastolic tissue velocity signals.

CONCLUSIONS

Pulsed-wave atrioventricular annulus tissue Doppler velocities were related to gestational age, postnatal age and ventricular size. Right ventricle velocities showed more pronounced increase with postnatal maturation than left ventricle velocities. The degree of E'/A' fusion influenced the diastolic tissue Doppler velocities and should be reported if present.

WITHDRAWN: Association between the levels of carboxy-terminal propeptide of type I procollagen and aldosterone in patients with primary aldosteronism and essential hypertension

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Cardiac mechanics are impaired during fatiguing exercise and cold pressor test in healthy older adults

We sought to determine how the aging left ventricle (LV) responds to sympathetic nervous system (SNS) activation. Three separate echocardiographic experiments were conducted in 11 healthy young (26 ± 1 yr) and 11 healthy older (64 ± 1 yr) adults. Tissue Doppler imaging was used to measure systolic myocardial velocity (S(m)), early diastolic myocardial velocity (E(m)), and late diastolic myocardial velocity (A(m)) during isometric fatiguing handgrip (IFHG), a 2-min cold pressor test (CPT), and 5 min of normobaric hypoxia. Heart rate (HR) and mean arterial pressure (MAP) were also monitored on a beat-by-beat basis; rate pressure product (RPP) was used as an index of myocardial oxygen demand. At peak IFHG, the groups had similar increases in RPP, but the ΔS(m) was significantly greater (i.e., larger impairment) in the older subjects (-0.82 ± 0.13 cm/s) compared with the young subjects (0.37 ± 0.30 cm/s). At peak IFHG, the ΔE(m) was similar between older (-1.59 ± 0.68 cm/s) and young subjects (-1.06 ± 0.76 cm/s). In response to the CPT, both S(m) and E(m) were reduced in the older adults but did not change relative to baseline in the young subjects. Normobaric hypoxia elevated HR and RPP in both groups but did not alter Tissue Doppler parameters. These data indicate that S(m) and E(m) are reduced in healthy older adults during IFHG and CPT. We speculate that suboptimal LV adaptations to SNS stress may partly explain why acute heavy exertion can trigger myocardial ischemia.

Frequency, time course, and possible causes of right ventricular systolic dysfunction after cardiac transplantation: a single center experience

BACKGROUND

The frequency and causes of right ventricular (RV) systolic dysfunction early after cardiac transplantation are not well defined.

METHODS

We investigated the prevalence and causes of RV dysfunction in 27 heart transplant recipients, as measured by lateral tricuspid annular plane excursion (TAPSE) and fractional area change (FAC) at a mean of 15 ± 11 days after transplant. Tissue Doppler imaging was used to assess systolic time velocity integral (TVI) of the RV basal free wall. A subset of 22 patients had follow-up TAPSE measurement at 406 ± 121 days.

RESULTS

RV systolic dysfunction, defined as TAPSE > 2 standard deviation (SD) below values in a control group, was present in 100% (27/27) of patients (P < 0.05). FAC was also significantly lower in patients compared with controls (P < 0.0001). TVI confirmed the presence of RV dysfunction in all 16 patients with both TAPSE and TVI (P < 0.05). Ischemic time (P = 0.017) and posttransplant tricuspid regurgitation (P = 0.024) were independent predictors of early RV dysfunction (r = 0.753). On follow-up, RV function improved in 15 of 22 patients but all patients remained with TAPSE > 2 SD below controls.

CONCLUSION

This study showed that 100% of patients had reduced RV function early after transplant. Two thirds of patients had partial recovery of RV function during the first year. In all patients, however, RV function remained significantly lower than in controls.

Determinants of preserved diastolic function at the lateral annulus in patients with isolated diastolic dysfunction

AIMS

The reversal of the early diastolic mitral annular velocity (e') to the late diastolic mitral annular velocity (a') ratio (e'/a' <1) develops earlier in the septum than in the lateral mitral annulus on tissue Doppler imaging (TDI). Accordingly, patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' ratio can be divided into two groups depending on the presence of a reversal of lateral e'/a'. The aim of this study was to identify the determinants of preserved diastolic function at the lateral annulus in patients with isolated diastolic dysfunction.

METHODS AND RESULTS

A total of 1166 consecutive patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' were classified on the basis of their diastolic function at the lateral mitral annulus. Two hundred and fifteen patients had a preserved lateral e'/a' (e'/a' >1) and 915 patients had a reversed lateral e'/a' (e'/a' <1). Patients with lateral e'/a' >1 were younger, male, and had a lower prevalence of diabetes and hypertension and showed less evidence of left ventricular (LV) diastolic dysfunction and structural remodelling as LV hypertrophy and LA enlargement, than those with a lateral e'/a' <1. Multivariate analysis revealed that age, septal e', septal peak systolic annular velocity, and LV mass indexed to height(2.7) (LVM/h(2.7)) were independently associated with preserved diastolic function at the lateral annulus.

CONCLUSION

The age, septal TDI, and LVM/h(2.7) were independent determinants of preserved diastolic function at the lateral annulus in patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' ratio.

The association of serum potassium level with left ventricular mass in patients with primary aldosteronism

BACKGROUND

Primary aldosteronism (PA) is associated a worse cardiovascular outcome than essential hypertension. Hypokalemia, which is one major characteristic of PA, can affect both cardiac structure and function. The goal of this study is to evaluate the influence of serum potassium level on left ventricular (LV) mass and function in PA patients.

MATERIALS AND METHODS

We prospectively analysed 85 PA patients from October 2006 to September 2008 and 27 essential hypertension patients as the control group (group 1). Thirty-two patients with serum potassium < 3·5 mmol L(-1) were defined as hypokalemia (group 2), and 53 patients with serum potassium ≥ 3·5 mmol L(-1) were defined as normokalemia (group 3). Echocardiography including tissue Doppler image (TDI) recordings was performed in all patients.

RESULTS

Group 2 patients had significant higher systolic and diastolic blood pressure (DBP), log-transformed plasma aldosterone concentration, log-transformed aldosterone-to-renin ratio and lower serum potassium level than groups 1 and 3. In echocardiographic measurement, group 2 patients had higher LV mass index (LVMI) than groups 1 and 3. In multivariate analysis for factors affecting LVMI in PA patients, only serum potassium level (P = 0·001), use of spironolactone (P = 0·004) and DBP (P = 0·005) were independent factors. In the TDI study, both groups 2 and 3 had lower e' and E/e' values than group 1.

CONCLUSIONS

Serum potassium level is significantly associated with LVMI in PA patients. Compared with essential hypertensive patients, PA patients had a greater impairment of cardiac diastolic function.

Subclinical regional left ventricular dysfunction in obese patients with and without hypertension or hypertrophy

We investigated the impact of obesity on the abnormalities of systolic and diastolic regional left ventricular (LV) function in patients with or without hypertension or hypertrophy, and without heart failure. We studied 120 individuals divided into 6 groups of 20 patients (42 ± 6 years, 60 females) using standard and pulsed-wave tissue Doppler imaging (TDI) echocardiography, and heterogeneity index (HI): nonobese (I: no hypertension, no hypertrophy, control group; II: hypertension, no hypertrophy; III: hypertension and hypertrophy) and obese (IV: no hypertension, no hypertrophy; V: hypertension, no hypertrophy; VI: hypertension and hypertrophy). The criterion for obesity was BMI ≥30 kg/m2, for hypertension was blood pressure ≥ 140/90 mm Hg, for hypertrophy in nonobese was LV mass/body surface area (BSA) >134 g/m(2) (men) and >110 mg/m2 (women), and in obese was LV mass/height(2.7) >50 (men) and >40 (women). Obese groups had normal LV ejection fraction compared with nonobese groups, but decreased longitudinal and radial systolic myocardial peak velocities (S'), and early diastolic myocardial peak velocity (E'). Also, a great variability of E' and late diastolic myocardial peak velocity (A') from the longitudinal basal region was observed in obese groups (E'basal nonobese: 11 ± 7 vs. obese 19 ± 11, P < 0.001, A'basal nonobese: 7 ± 4 vs. obese 11 ± 7, P < 0.001). Our findings were more evident when comparing groups IV with V and VI, with the latter having concentric hypertrophy and obvious segmental systolic and diastolic dysfunctions. Subclinical myocardial alterations and increased variability of the velocities were observed in obese groups, especially with hypertension and hypertrophy, reflecting impaired regional LV relaxation, segmental atrial, and systolic dysfunctions.

Determination of diastolic dysfunction cut-off value by tissue Doppler imaging in adults 70 years of age or older: a comparative analysis of pulsed-wave and color-coded tissue Doppler imaging

BACKGROUND AND OBJECTIVES

The cut-off value of diastolic dysfunction by tissue Doppler imaging (TDI) is affected by aging and modalities used (pulsed-wave vs. color-coded). The purpose of this study was to investigate the diastolic function of healthy elderly people and to determine the appropriate cut-off value of diastolic dysfunction in elderly individuals.

SUBJECTS AND METHODS

Healthy volunteers (n=76) and patients with hypertension (n=51) aged ≥70 years underwent 2-dimensional and Doppler echocardiography. Mitral annulus velocities of TDI were measured at septal and lateral sites using the pulsed-wave and color-coded modalities. The appropriate cut-off value of diastolic dysfunction for healthy elderly individuals was defined as the lower limit of the 95% confidence interval for early diastolic mitral annulus velocity (Ea).

RESULTS

The mean septal and lateral Ea were 6.5±1.5 and 8.3±1.7 cm/s, respectively, by pulsed-wave TDI, and 6.1±1.4 and 7.9±1.7 cm/s, respectively, by color-coded TDI. The cut-off values for diastolic dysfunction were as follows: septal and lateral Ea were 6.1 and 7.9 cm/s by pulsed-wave TDI, and 5.7 and 7.5 cm/s by color-coded TDI, respectively. When the group was stratified by gender, Ea was significantly lower in women than men.

CONCLUSION

When interpreting diastolic function as measured by TDI in elderly subjects, different cut-off values should be considered based on the TDI modality, annulus site, and gender.

Evaluating the effectiveness of rosuvastatin in preventing the progression of diastolic dysfunction in aortic stenosis: A substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study

Background

Tissue Doppler imaging (TDI) is a noninvasive echocardiographic method for the diagnosis of diastolic dysfunction in patients with varying degrees of aortic stenosis (AS). Little is known however, on the utility of TDI in the serial assessment of diastolic abnormalities in AS.

Objective

The aim of the current proposal was to examine whether treatment with rosuvastatin was successful in improving diastolic abnormalities in patients enrolled in the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin (ASTRONOMER) study.

Methods

Conventional Doppler indices including peak early (E) and late (A) transmitral velocities, and E/A ratio were measured from spectral Doppler. Tissue Doppler measurements including early (E') and late (A') velocities of the lateral annulus were determined, and E/E' was calculated.

Results

The study population included 168 patients (56 ± 13 years), whose AS severity was categorized based on peak velocity at baseline (Group I: 2.5-3.0 m/s; Group II: 3.1-3.5 m/s; Group III: 3.6-4.0 m/s). Baseline and follow-up hemodynamics, LV dimensions and diastolic functional parameters were evaluated in all three groups. There was increased diastolic dysfunction from baseline to follow-up in each of the placebo and rosuvastatin groups. In patients with increasing severity of AS in Groups I and II, the lateral E' was lower and the E/E' (as an estimate of increased left ventricular end-diastolic pressure) was higher at baseline (p < 0.05). However, treatment with rosuvastatin did not affect the progression of diastolic dysfunction from baseline to 3.5 year follow-up between patients in any of the three predefined groups.

Conclusion

In patients with mild to moderate asymptomatic AS, rosuvastatin did not attenuate the progression of diastolic dysfunction.

Early cardiac abnormalities and increased C-reactive protein levels in a cohort of children with sleep disordered breathing

BACKGROUND

This study aims to evaluate left ventricular (LV) structure and function and inflammation in a paediatric population with sleep disordered breathing (SDB) and in control subjects.

METHODS

Forty-nine children with SDB and 21 healthy, age-matched subjects were enrolled. The diagnosis of obstructive sleep apnoea syndrome (OSAS) was confirmed by the laboratory polysomnography, showing an obstructive apnoea/hypopnoea index of more than one per hour, according to the criteria of the American Academy of Sleep Medicine and modified for paediatric population. Fasting blood samples for the biochemical evaluation (including high-sensitivity C-reactive protein (hsCRP) were drawn in the morning, after the polysomnographic examination in all patients with SDB and in the control group. All children underwent a two-dimensional colour Doppler cardiac examination with LV mass assessment and systolic and diastolic function evaluation.

RESULTS

Higher hsCRP levels were observed in subjects with OSAS than in children with primary snoring and in controls (0.8 ± 0.7 vs 0.3 ± 0.1 ng/dl, p = 0.001, and 0.4 ± 0.2 ng/dl, p = 0.01, respectively). The LV diastolic dysfunction was significantly more frequent in patients with severe OSAS and higher hsCRP levels than in control group.

CONCLUSIONS

This study shows that OSAS in children is associated with higher LV mass, early LV diastolic dysfunction and a pro-inflammatory state (high CRP levels). These findings might help to explain the higher incidence of cardiovascular morbidity in patients with OSAS.

Transmitral E/A ratio decreases in association with abdominal fat accumulation in patients with impaired glucose tolerance or mild diabetes without left ventricular hypertrophy

An abnormal left ventricular (LV) diastolic function is an early sign of diabetic cardiomyopathy, which is characterized by an impaired diastolic and/or systolic function of the left ventricle in the absence of ischemic, valvular, or hypertensive heart disease, and serves as a marker of cardiovascular risk. However, it is unclear whether LV diastolic abnormalities can be detected in patients with impaired glucose tolerance (IGT) or mild diabetes without LV hypertrophy (LVH). We examined echocardiographic data from 92 consecutive Japanese patients aged 45-79 years with or without IGT or mild diabetes in the absence of LVH. Impaired glucose tolerance or mild diabetes was defined as the presence of one or more of the following criteria: fasting plasma glucose >110 mg/dl, hemoglobin A1c >5.6%, homeostasis model assessment ratio >1.73, or the taking of oral antihyperglycemic drugs. Left ventricular hypertrophy was defined as an LV mass index (LVMI) >116 g/m(2) in men and >104 g/m(2) in women. Patients with ischemic, valvular, or hypertensive heart disease were excluded. The age, blood pressure, heart rate, and LVMI were similar between patients with (IGT/DM group, n = 43) and without IGT or mild diabetes (non-IGT/DM group, n = 49), whereas the body mass index and waist circumference (WC) were greater in the IGT/DM compared to the non-IGT/DM group (P < 0.05 and P < 0.001, respectively). The transmitral E/A ratio was lower and the deceleration time longer in the IGT/DM than in the non-IGT/DM group (both P < 0.05). Stepwise regression analysis revealed that age and WC were independent determinants of the E/A ratio. In conclusion, diastolic abnormalities without LVH can be detected in Japanese patients with IGT or mild diabetes. The E/A ratio decreases in association with abdominal fat accumulation.

Tissue doppler imaging can be useful to distinguish pathological from physiological left ventricular hypertrophy: a study in master athletes and mild hypertensive subjects

Background

Transthoracic echocardiography left ventricular wall thickness is often increased in master athletes and it results by intense physical training. Left Ventricular Hypertrophy can also be due to a constant pressure overload. Conventional Pulsed Wave (PW) Doppler analysis of diastolic function sometimes fails to distinguish physiological from pathological LVH.

The aim of this study is to evaluate the role of Pulsed Wave Tissue Doppler Imaging in differentiating pathological from physiological LVH in the middle-aged population.

Methods

we selected a group of 80 master athletes, a group of 80 sedentary subjects with essential hypertension and an apparent normal diastolic function at standard PW Doppler analysis. The two groups were comparable for increased left ventricular wall thickness and mass index (134.4 ± 19.7 vs 134.5 ± 22.1 gr/m2; p > .05). Diastolic function indexes using the PW technique were in the normal range for both.

Results

Pulsed Wave TDI study of diastolic function immediately distinguished the two groups. While in master athletes the diastolic TDI-derived parameters remained within normal range (E' 9.4 ± 3.1 cm/sec; E/E' 7.8 ± 2.1), in the hypertensive group these parameters were found to be constantly altered, with mean values and variation ranges always outside normal validated limits (E' 7.2 ± 2.4 cm/sec; E/E' 10.6 ± 3.2), and with E' and E/E' statistically different in the two groups (p < .001).

Conclusion

Our study showed that the TDI technique can be an easy and validated method to assess diastolic function in differentiating normal from pseudonormal diastolic patterns and it can distinguish physiological from pathological LVH emphasizing the eligibility certification required by legal medical legislation as in Italy.

Tissue Doppler is a More Reliable Method in Early Detection of Cardiac Dysfunction in Patients with AA Amyloidosis

OBJECTIVE

Cardiac deposition of AA amyloidosis may result in increasing left ventricular mass and systolic and diastolic dysfunction (DD). The aim of this study was to investigate the left ventricular systolic and diastolic functions by both tissue Doppler imaging (TDI) and pulsed wave Doppler echocardiography (PWD) in patients with AA amyloidosis without congestive heart failure symptoms or arrthymia.

METHODS AND RESULTS

Twenty-four patients with AA amyloidosis without congestive heart failure symptoms or arrthymia (15 men and nine women; mean age 44.3 +/- 16.7 years) and 25 healthy subjects (19 men and six women; mean age 43.1 +/- 9.2 years) as controls were included in the study. M-mode, two-dimensional, PWD, and TDI were performed. Peak transmitral filling velocity (E wave), peak transmitral atrial filling velocity (A wave), deceleration time, and isovolumic relaxation time were measured by PWD recordings. Peak myocardial systolic velocity (Sm), peak myocardial early (Em), and late diastolic velocities (Am) were also recorded by TDI. E/A ratio less than one was accepted as DD for both methods. Ejection fraction (EF) was calculated by Teicholtz method. The subjects were divided into three groups as follows: healthy controls (group 1), patients without DD (group 2), and patients with DD (group 3) according to the PWD findings. PWD echocardiography showed that DD was present in 50% of the patients, whereas TDI showed DD in 66% of such cases. In subgroup analysis, Sm wave as a systolic function index was lower in group 3 than in groups 1 and 2, whereas mean EF values were similar in all groups.

CONCLUSION

Although AA amyloidosis uncommonly causes cardiac symptoms and findings, according to our results, patients with AA amyloidosis may have systolic and diastolic dysfunction eventhough they are asymptomatic. Also, tissue Doppler imaging is a more reliable method in the early detection of cardiac dysfunction in such patients.

Noninvasive evaluation of left ventricular noncompaction: what's new in 2009?

Significant interest in clinical practice as well as the medical literature exists regarding the presentation and outcome of children and adults with left-ventricular noncompaction (LVNC). The mainstay in the diagnosis of LVNC has been the anatomic definition of the ventricular myocardium by two-dimensional echocardiographic imaging. Although helpful, this approach lacks diagnostic precision and fails to evaluate the functional impact of this abnormal myocardial architecture on global and regional myocardial performance. This review will focus on the use of novel echocardiographic modalities of tissue Doppler, strain, and strain rate imaging to identify and characterize abnormalities of regional myocardial function in patients with LVNC.

Is the aging heart similar to the diabetic heart? Evaluation of LV function of the aging heart with Tissue Doppler Imaging

BACKGROUND AND AIMS

Left ventricular (LV) function in the healthy aging heart is modified by biochemical changes with advancing age. We employed for the first time Tissue Doppler Imaging (TDI), to identify which phase of the cardiac cycle is involved.

METHODS

TDI was performed in 175 aging subjects, free of cardiovascular and/or respiratory disease (group II), and in 182 healthy adults enrolled as the control group (group I), to calculate the Myocardial Performance Index (MPI). The index derives from the values of Isovolumetric Contraction Time (ICT), Isovolumetric Relaxation Time (IRT) and Left Ventricular Ejection Time (LVET) measured in ms, according to the formula: (ICT+IRT)/LVET.

RESULTS

An increase in MPI in group II was shown, with significant lengthening of IRT in comparison with the same value obtained in the control group (group I), ICT and LVET were unchanged.

CONCLUSIONS

The rise in IRT in the aging healthy heart is dependent on diastolic LV dysfunction consequent upon the formation of Advanced Glycosilation End-product (AGE) crosslinks with connectival proteins of interstitial myocardial tissue. Agerelated increase in oxidative stress also modifies some interstitial compounds, favoring hardening of ventricular walls. These changes are similar to those happening in the diabetic heart, and TDI seems to be able to define non-invasively which phase of the cardiac cycle is impaired.

Myocardial and aortic stiffening in the early course of primary aldosteronism

BACKGROUND

Primary aldosteronism (PA) has been experimentally and clinically linked to myocardial and vascular fibrosis, and it has been further associated with left ventricular (LV) structural adaptations.

HYPOTHESIS

Functional cardiovascular adaptations in hypertensive patients with PA precede structural alterations in the early stages of the disease.

METHODS

We studied 17 hypertensive subjects with a recent diagnosis of PA (10 male patients, aged approximately 55 y, with office blood pressure [BP] of 137/88 mm Hg), and 30 essential hypertensives matched for age, sex, office BP levels, treatment status, and LV mass index (LVMI). Apart from standard 2-Dimensional (2-D) and conventional Doppler parameters, tissue Doppler imaging (TDI) methodology was used to assess LV diastolic function; averaging early and late diastolic mitral annular peak velocities (Emav/, Amav, Emav/Amav ratio) from 4 separate sites of measurement (septal, lateral, anterior, and inferior walls). Aortic stiffness was evaluated by means of carotid-femoral pulse wave velocity (cf-PWV) measurements.

RESULTS

Although transmitral E/A ratio was similar in both groups (0.95+/-0.26 versus 0.98+/-0.24, p=0.66), hypertensive subjects with PA compared with essential hypertensives are characterized by significantly higher relative wall thickness (0.50+/-0.07 versus 0.41+/-0.06, p<or=0.001), decreased values of Emav (7+/-1.7 versus 8.1+/-1.8 cm/s, p=0.048), and Emav/Amav ratio (0.63+/-0.16 versus 0.77+/-0.17, p=0.015). The higher PWV in the PA population failed to reach statistical significance (8.5+/-1.6 versus 7.9+/-0.9 msec, p=0.19).

CONCLUSION

Our study demonstrates altered LV geometry and TDI-revealed diastolic dysfunction in hypertensives with PA compared with demographically- and LVMI-matched essential hypertensives. Furthermore, the increased aortic stiffening in PA patients failed to reach statistical significance.