The diagnostic usefulness of the mitral E/E′ratio(derived from tissue Doppler imaging) as an estimate of left ventricular filling pressures was studied in 28 patients with diastolic heart failure(defined by heart fai...The diagnostic usefulness of the mitral E/E′ratio(derived from tissue Doppler imaging) as an estimate of left ventricular filling pressures was studied in 28 patients with diastolic heart failure(defined by heart failure signs and symptoms but with preserved ejection fraction) and in 46 patients with systolic heart failure(heart failure signs and symptoms and reduced ejection fraction). E/E′was reflective of filling pressures in subjects with diastolic and systolic heart failure and may be of special use in ruling out elevated filling pressures in subjects with suspected diastolic heart failure.展开更多
Objective: Ventricular filling takes place during the conduit and pump functio ns of the atrium. While studying whether relief of mitral valve obstruction impr oves atrial filling, the effect of age on atrial contribu...Objective: Ventricular filling takes place during the conduit and pump functio ns of the atrium. While studying whether relief of mitral valve obstruction impr oves atrial filling, the effect of age on atrial contribution to ventricular fil ling was studied before and after balloon mitral valvuloplasty (BMV) and on foll ow-up at 1 year. Methods: Patients with mitral stenosis (MS) and sinus rhythm ( n=59) were divided into group I (< 18 years, n=13), group II (< 30 years, n=29) and group III (>30 years, n=17). Two-dimensional mitral valve area (MVA in cm2) , transmitral mean gradient (MG in mm Hg), velocity time integral (VTI in cm) of mitral valve flow, VTI contributed by atrial systole (A-VTI), difference betwe en total VTI and A-VTI (E-VTI), percentage contribution of A-VTI to the total VTI (A-%) and difference between A-%before and after BMV (δ-A-%) were n oted. Follow-up data was obtained at 1 year. The change in A-%at follow-up ( A-%-FU) was calculated as the difference between A-%before BMV and A-%at follow-up. Results: There was a similar increase in MVA with a reduction in MG among the three groups. Among the three groups, total VTI and E-VTI before and after BMV were similar. Before BMV, in all the groups, A-VTI and A-%were simi lar. After BMV, there was increase in A-VTI and A-%in all the groups with a t rend to be more in younger patients. A-VTI was significantly higher in group I only. But E-VTI had decreased significantly in all groups and tended to be less in younger patients. In younger patients, δ-A-%after BMV was significantly higher (13.2±7.6, 7.9±5.1 and 6.5±4.5, respectively, in groups I, II and III; p< 0.01). Correlation coefficient of age against δ-A-%was -0.55 (p< 0.01). Correlation coefficients of δ-A-%against post-BMV-MVA and MG were not goo d. At follow-up of 11.3±1.2 months, changes achieved in total VTI, A-VTI, EVT I and A-%were maintained. Total VTI, A-VTI, E-VTI and A-%were similar at t he time of follow-up on comparing the three groups. But younger patients had si gnificantly higher A-%-FU (12.1±5.8, 9.4±4.6 and 7.3±3.1, respectively, in groups I, II and III; p< 0.01). Conclusions: Prior to BMV, there is an age rela ted reduction in atrial contribution to ventricular filling that improves with r elief of MS. Advancing age reduces the immediate and late recovery of atrial con tribution after BMV. This may be due to increasing left atrial fibrosis with age that prevents an improvement in atrial pump function. The differential improvem ent in atrial function in younger patients warrants earlier intervention in MS to achieve better recovery of atr ial function.展开更多
Slowed heart rate(HR) recovery after exercise is strongly predictive of increased long-term mortality. The factors responsible for impaired HR regulation are not fully understood. We performed echocardiography with ti...Slowed heart rate(HR) recovery after exercise is strongly predictive of increased long-term mortality. The factors responsible for impaired HR regulation are not fully understood. We performed echocardiography with tissue Doppler imaging in 121 patients before maximal exercise testing. HR recovery was measured 1 minute after the end of exercise in the supine position. The best echocardiographic correlate of HR recovery was the ratio of early mitral flow velocity(E) to early diastolic mitral annular velocity(Ea; r=-0.781, p< 0.001). This correlation was not affected by the use of negative chronotropic agents. Patients whose E/Ea was < 10 had a faster 1-minute HR recovery and a greater chronotropic response during exercise than did those whose E/Ea was ≥10. Receiver-operator characteristic analysis showed that an E/Ea ≥10.3 predicted 1-minute HR recovery of ≤18 beats/min, with 83%sensitivity and 100%specificity. Neither left ventricular ejection fraction nor the presence of a “slow relaxation”mitral inflow pattern(E/A <1.0) was predictive of impaired HR recovery. Thus, slowed HR recovery is strongly associated with increased E/Ea, a marker of increased left ventricular filling pressures. E/Ea at rest may become a simple, reliable, and sensitive predictor of increased long-term mortality, even in the absence of overt heart failure.展开更多
OBJECTIVES: The purpose of this research was to study the effect of dobutamine on left ventricular(LV) filling in ischemic cardiomyopathy(ICM) and to determine whether restrictive filling pattern(RFP) at peak stress h...OBJECTIVES: The purpose of this research was to study the effect of dobutamine on left ventricular(LV) filling in ischemic cardiomyopathy(ICM) and to determine whether restrictive filling pattern(RFP) at peak stress has prognostic value. BACKGROUND: The prognostic value of RFP at peak stress in ICM is unknown. METHODS: A total of 69 patients with ICM were studied by Doppler echocardiography at rest and stress; RFP was defined as transmitral E∶A ratio ≥1.0, isovolumic relaxation time(IVRT)< 80 ms, and E-wave deceleration time(EDT)< 120 ms. RESULTS:A total of 42 of 69 had RFP at rest, which reverted to non-RFP at stress in 24(EA), but persisted in 18(EE); 27 of 69 had non-RFP at rest and peak stress(AA). In EA, IVRT and EDT lengthened(by 43 ms and 46 ms), and tricuspid regurgitation(TR) decreased(by 26 mm Hg, p< 0.01), suggesting a fall in left atrial(LA) pressure. The stress response in AA was similar to EA. In EE, IVRT and EDT shortened(by 21 ms) and TR increased(by 13 mm Hg, p< 0.01), suggesting a rise in LA pressure. Peak aortic acceleration(LV inotropy)increased by 0.8 g in EA but only by 0.2 g in EE(difference p< 0.001). Median follow-up(interquartile range) was 34(20 to 57) months. Three-year survival for EE, EA, and AA was 49%, 79%, and 89%, respectively(p< 0.001). Compared with AA, the hazard ratio for EE was 9.5(p< 0.001) and for EA was 1.9(p=0.30). CONCLUSIONS: In ischemic cardiomyopathy, persistence of restrictive filling during stress implies a striking rise in LA pressure, greatly attenuated LV inotropic response, and markedly reduced survival. Stress echocardiography uniquely identifies these high-risk patients.展开更多
文摘The diagnostic usefulness of the mitral E/E′ratio(derived from tissue Doppler imaging) as an estimate of left ventricular filling pressures was studied in 28 patients with diastolic heart failure(defined by heart failure signs and symptoms but with preserved ejection fraction) and in 46 patients with systolic heart failure(heart failure signs and symptoms and reduced ejection fraction). E/E′was reflective of filling pressures in subjects with diastolic and systolic heart failure and may be of special use in ruling out elevated filling pressures in subjects with suspected diastolic heart failure.
文摘Objective: Ventricular filling takes place during the conduit and pump functio ns of the atrium. While studying whether relief of mitral valve obstruction impr oves atrial filling, the effect of age on atrial contribution to ventricular fil ling was studied before and after balloon mitral valvuloplasty (BMV) and on foll ow-up at 1 year. Methods: Patients with mitral stenosis (MS) and sinus rhythm ( n=59) were divided into group I (< 18 years, n=13), group II (< 30 years, n=29) and group III (>30 years, n=17). Two-dimensional mitral valve area (MVA in cm2) , transmitral mean gradient (MG in mm Hg), velocity time integral (VTI in cm) of mitral valve flow, VTI contributed by atrial systole (A-VTI), difference betwe en total VTI and A-VTI (E-VTI), percentage contribution of A-VTI to the total VTI (A-%) and difference between A-%before and after BMV (δ-A-%) were n oted. Follow-up data was obtained at 1 year. The change in A-%at follow-up ( A-%-FU) was calculated as the difference between A-%before BMV and A-%at follow-up. Results: There was a similar increase in MVA with a reduction in MG among the three groups. Among the three groups, total VTI and E-VTI before and after BMV were similar. Before BMV, in all the groups, A-VTI and A-%were simi lar. After BMV, there was increase in A-VTI and A-%in all the groups with a t rend to be more in younger patients. A-VTI was significantly higher in group I only. But E-VTI had decreased significantly in all groups and tended to be less in younger patients. In younger patients, δ-A-%after BMV was significantly higher (13.2±7.6, 7.9±5.1 and 6.5±4.5, respectively, in groups I, II and III; p< 0.01). Correlation coefficient of age against δ-A-%was -0.55 (p< 0.01). Correlation coefficients of δ-A-%against post-BMV-MVA and MG were not goo d. At follow-up of 11.3±1.2 months, changes achieved in total VTI, A-VTI, EVT I and A-%were maintained. Total VTI, A-VTI, E-VTI and A-%were similar at t he time of follow-up on comparing the three groups. But younger patients had si gnificantly higher A-%-FU (12.1±5.8, 9.4±4.6 and 7.3±3.1, respectively, in groups I, II and III; p< 0.01). Conclusions: Prior to BMV, there is an age rela ted reduction in atrial contribution to ventricular filling that improves with r elief of MS. Advancing age reduces the immediate and late recovery of atrial con tribution after BMV. This may be due to increasing left atrial fibrosis with age that prevents an improvement in atrial pump function. The differential improvem ent in atrial function in younger patients warrants earlier intervention in MS to achieve better recovery of atr ial function.
文摘Slowed heart rate(HR) recovery after exercise is strongly predictive of increased long-term mortality. The factors responsible for impaired HR regulation are not fully understood. We performed echocardiography with tissue Doppler imaging in 121 patients before maximal exercise testing. HR recovery was measured 1 minute after the end of exercise in the supine position. The best echocardiographic correlate of HR recovery was the ratio of early mitral flow velocity(E) to early diastolic mitral annular velocity(Ea; r=-0.781, p< 0.001). This correlation was not affected by the use of negative chronotropic agents. Patients whose E/Ea was < 10 had a faster 1-minute HR recovery and a greater chronotropic response during exercise than did those whose E/Ea was ≥10. Receiver-operator characteristic analysis showed that an E/Ea ≥10.3 predicted 1-minute HR recovery of ≤18 beats/min, with 83%sensitivity and 100%specificity. Neither left ventricular ejection fraction nor the presence of a “slow relaxation”mitral inflow pattern(E/A <1.0) was predictive of impaired HR recovery. Thus, slowed HR recovery is strongly associated with increased E/Ea, a marker of increased left ventricular filling pressures. E/Ea at rest may become a simple, reliable, and sensitive predictor of increased long-term mortality, even in the absence of overt heart failure.
文摘OBJECTIVES: The purpose of this research was to study the effect of dobutamine on left ventricular(LV) filling in ischemic cardiomyopathy(ICM) and to determine whether restrictive filling pattern(RFP) at peak stress has prognostic value. BACKGROUND: The prognostic value of RFP at peak stress in ICM is unknown. METHODS: A total of 69 patients with ICM were studied by Doppler echocardiography at rest and stress; RFP was defined as transmitral E∶A ratio ≥1.0, isovolumic relaxation time(IVRT)< 80 ms, and E-wave deceleration time(EDT)< 120 ms. RESULTS:A total of 42 of 69 had RFP at rest, which reverted to non-RFP at stress in 24(EA), but persisted in 18(EE); 27 of 69 had non-RFP at rest and peak stress(AA). In EA, IVRT and EDT lengthened(by 43 ms and 46 ms), and tricuspid regurgitation(TR) decreased(by 26 mm Hg, p< 0.01), suggesting a fall in left atrial(LA) pressure. The stress response in AA was similar to EA. In EE, IVRT and EDT shortened(by 21 ms) and TR increased(by 13 mm Hg, p< 0.01), suggesting a rise in LA pressure. Peak aortic acceleration(LV inotropy)increased by 0.8 g in EA but only by 0.2 g in EE(difference p< 0.001). Median follow-up(interquartile range) was 34(20 to 57) months. Three-year survival for EE, EA, and AA was 49%, 79%, and 89%, respectively(p< 0.001). Compared with AA, the hazard ratio for EE was 9.5(p< 0.001) and for EA was 1.9(p=0.30). CONCLUSIONS: In ischemic cardiomyopathy, persistence of restrictive filling during stress implies a striking rise in LA pressure, greatly attenuated LV inotropic response, and markedly reduced survival. Stress echocardiography uniquely identifies these high-risk patients.
