Systo-diastolic ventricular function in patients with hypertension: an echocardiographic tissue doppler imaging evaluation study (original) (raw)
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Cardiovascular journal of Africa
Hypertension results in structural and functional changes in the heart. Early detection of abnormalities of cardiac structure and function is important in the assessment and treatment of hypertensive subjects. The aim of this study was to evaluate the utility of the tissue Doppler echocardiographic technique in characterising diastolic and systolic functions in untreated native black African hypertensive subjects. Forty consecutive, newly diagnosed, untreated hypertensives with adequate conventional echocardiographic (2-D, M-mode, transmitral and pulmonary Doppler flow velocities) and tissue Doppler echocardiographic images were recruited into the study. The control subjects were apparently normal individuals. Each arm of the study consisted of 21 male and 19 female subjects. The two groups were comparable by age (48.6 +/- 11.35 years in the hypertensives vs 48.1 +/- 11.33 years in the controls; p = 0.844) and gender distribution (M/F: 21/19 in both groups). Other baseline character...
The American Journal of Cardiology, 2007
Left ventricular (LV) diastolic dysfunction identifies patients at risk of developing heart failure and may be common in patients with hypertension. The prevalence of LV diastolic dysfunction in patients with newly diagnosed hypertension was compared using criteria provided by the Canadian Consensus, European Study Group, and American Medical Association guidelines. One hundred twenty patients with newly diagnosed untreated hypertension (mean age 46.9 ؎ 2.1 years; 62 men, 58 women) with increased blood pressure (clinic >140/90 mm Hg, daytime ambulatory >135/85 mm Hg) underwent comprehensive 2-dimensional echocardiography. Transmitral inflow velocities were measured using pulsewave Doppler with and without Valsalva's maneuver, and a comprehensive assessment of tissue Doppler velocities was performed. The prevalence of LV diastolic dysfunction varied according to criteria used. There was a high prevalence of LV diastolic dysfunction (59%; n ؍ 71) using Canadian Consensus guidelines; 27% of patients (n ؍ 32) had a pseudonormal pattern unmasked using Valsalva's maneuver and 32% (n ؍ 39) had impaired relaxation at rest. Significantly fewer patients (10%; n ؍ 12) had this diagnosis using European or American Medical Association guidelines (23%; n ؍ 27). Using tissue Doppler imaging (early-late diastolic velocity ratio <1), the prevalence of LV diastolic dysfunction was 59% (n ؍ 71), identical to findings using the Canadian Consensus guidelines. In conclusion, current national consensus guidelines defining LV diastolic dysfunction varied widely and underdiagnosed LV diastolic dysfunction in patients with newly diagnosed hypertension. Tissue Doppler imaging assessment is a rapidly and widely available tool that is as sensitive as the most stringent national guidelines and should be systematically incorporated into a more comprehensive assessment of LV diastolic dysfunction in this population.
Ultrasound in Medicine & Biology, 2005
A total of 32 patients without regional wall motion abnormality of the left ventricle underwent sequential tissue Doppler echocardiography and cardiac catheterization. Peak velocities of systolic (Sa), early diastolic (Ea), and late diastolic (Aa) motion of the mitral annulus were measured. Normal references for Sa, Ea and Aa were obtained from 138 volunteers. Indices of left ventricular (LV) systolic and diastolic function were evaluated using high-fidelity LV pressure and volume signals. By multivariate analysis, Sa, Ea and As were significantly and independently related to the maximum of the first derivative of pressure over time (dP/dt max), LV relaxation time constant (), and LV ejection fraction (EF), respectively. Using the fifth percentiles of the age-stratified normal references as cutoffs , low Sa, low Ea and low Aa identified declined dP/dt max , prolonged and reduced EF, respectively, with good sensitivities and specificities. In conclusion, mitral annulus velocities by tissue Doppler echocardiography can be used to identify patients with declined dP/dt max , prolonged and reduced EF.
Tissue Doppler imaging as a long-term prognostic index in left ventricular systolic dysfunction
Arquivos brasileiros de cardiologia, 2008
BACKGROUND Tissue Doppler parameters correlate with left ventricular (LV) filling pressure and can be useful as prognostic indexes for patients with heart failure. OBJECTIVE Determine whether tissue Doppler parameters can predict events during long term follow-up of outpatients with LV systolic dysfunction. METHODS Retrospective study with 73 patients (aged 60.9+/-12.1 years) who underwent Doppler echocardiogram between March 2001 and May 2004. The primary endpoint studied was death or hospitalization due to heart failure worsening. RESULTS The mean follow-up period was 1,367+/-665 days. After logistic stepwise multivariate analysis, including echocardiographic parameters, the ratio of maximal early diastolic filling wave velocity to maximal early diastolic myocardial velocity (E/E; ratio; p=0.0007), and LV ejection fraction (EF; p=0.01) remained significant predictors of the primary outcome. The optimal cutoffs for primary endpoint prediction for E/E' ratio (AUC 0.77; p=0.0001)...
Echocardiography, 2006
Objective: The evaluation of diagnostic value of pulsed tissue Doppler (TD) parameters (calculated from six points of mitral annulus and separately measured in the lateral part of mitral annulus) for the detection of pseudonormal mitral inflow pattern. Methods and Results: Among 200 persons examined by transthoracic echocardiography group with E/A value between 1 and 2 was selected and divided to normal (54 subjects, early wave deceleration time, Edt ≥ 150 msec) and pseudonormal (23 patients, Edt < 150 msec together with prolonged difference between duration of atrial reversal flow in pulmonary vein and mitral flow in atrial phase, delta Ar ≥ 20 msec) inflow. Wide spectrum of TD parameters was compared between the selected groups. In normal inflow, average peak velocities of early and atrial phase of diastolic mitral annulus motion were significantly higher: 11.0 ± 2.6 versus 8.9 ± 3.5 cm/sec; (P = 0.005) and 12.0 ± 2.2 versus 10.0 ± 3.0 cm/sec; (P = 0,002), respectively. Ratio of peak early mitral wave velocity to peak velocity of annulus motion in early phase (Ev/E'v avr) was higher in the pseudonormal pattern: 9.8 ± 3.7 versus 7.0 ± 2.0, respectively (P < 0.001). For the value of Ev/E'v avr > 10.2, 70% accuracy for the diagnosis of pseudonormalization was detected. For the parameters measured in the lateral part of mitral annulus similar relationships in the early filling phase were detected but did not reach statistical significance in the atrial phase. Conclusions: Pulsed TD offers good accuracy for the diagnosis of pseudonormalization with increased ratio of peak early mitral wave velocity to peak velocity of mitral annulus being the optimal predictor of advanced diastolic dysfunction. (ECHOCARDIOGRAPHY, Volume 23, March 2006) diastolic function, pseudonormalization, pulsed tissue Doppler, mitral annulus Echocardiographic assessment of left ventricular diastolic function plays integral role in examination of patients with heart failure. According to the guidelines of European Society of Cardiology, recent diagnostic criteria of diastolic heart failure are based mainly on echocardiographic parameters. Apart from the diagnosis of isolated diastolic heart failure, evaluation of diastolic dysfunction in patients with mixed systolic and diastolic heart failure offers usually additional prognostic information, which may be useful for treatment strategy selection. 2,3
Echocardiography, 2012
There is still some debate regarding the prognostic significance of left ventricular longitudinal systolic dysfunction as assessed by tissue Doppler (TD) imaging in patients with chronic heart failure (HF), since previous studies have included patients with postischemic wall motion abnormalities. Thus, this study was designed to ascertain whether TD-derived longitudinal systolic dysfunction may influence the outcome of patients with nonischemic chronic HF. In 200 consecutive patients with chronic HF secondary to dilated cardiomyopathy and no history of ischemic heart disease, peak systolic mitral annular velocity (S m ) was measured by pulsed TD at the septal and lateral annular sites. The end points were cardiac death or hospitalization for worsening HF. Mean follow-up duration was 30 months. In a time independent analysis, averaged S m calculated as the average of septal and lateral S m , resulted to be a significant predictor of outcome in the study population (area under receiver-operator characteristic curve: cardiovascular death, 0.69, P < 0.0001; cardiovascular events, 0.64, P = 0.0005). In a time-dependent analysis, average S m was associated with both cardiovascular death (hazard ratio 0.832, P = 0.0019) and cardiovascular events (hazard ratio 0.904, P = 0.039), independently of other clinical risk factors and echocardiographic parameters of systolic function. Septal S m but not lateral S m was independently associated with the outcome measures. In conclusion, the assessment of systolic mitral annular velocity by pulsed TD is a useful indicator for prognostic stratification of patients with nonischemic dilated cardiomyopathy and chronic HF. (Echocardiography 2012;29:291-297)
2005
AIM To determine if Color Doppler myocardial imaging could provide evidence of diastolic dysfunction in patients with hypertension whose pulse-wave Doppler parameters were normal. METHOD The study included 33 patients (mean age 48+/-7.3 years) and a control group of 13 sex- and age-matched healthy individuals. Patients were divided into two groups according to mean blood pressure (BP) values during 24-hour blood pressure monitoring while under antihypertensive therapy: those with uncontrolled hypertension (n=22) and those with controlled hypertension (n=11). All study participants underwent complete standard echocardiography (2D, M-mode, pulsed and continuous Doppler) and a Color Doppler myocardial imaging study. RESULTS Conventional Doppler parameters indicated relaxation disturbances in patients with uncontrolled hypertension, but were within a normal range in patients with controlled hypertension at baseline and follow-up. Parameters of global diastolic function measured by Color...
Journal of Ayub Medical College, Abbottabad : JAMC, 2011
OBJECTIVE To evaluate left ventricular systolic and diastolic function by Tissue Doppler imaging after acute myocardial infarction. METHODS It was a hospital based, prospective descriptive study, from 1st July 2010 to 31st Dec. 2010. Total of 200 patients having acute myocardial infarction underwent detailed tissue Doppler imaging (TDI) echocardiographic examination for evaluation of left ventricular systolic and diastolic function on day 3, in echocardiographic section of Govt. Lady Reading Hospital, Peshawar. Peak systolic (Sm), peak early diastolic (Em) and peak late diastolic (Am) velocities were recorded at 4 different sites of the mitral annulus. The ejection fraction and pulse wave TDI diastolic parameters were also recorded. Using SPSS version 16 data was analysed, frequencies and Mean +/- SD were determined for categorical and numerical variables, respectively. A p-value < or = 0.05 was considered significant. RESULTS Total study sample was 200 patients having acute myoc...
European Heart Journal, 2008
Aims To test the hypothesis that echocardiographic tissue Doppler imaging (TDI) reveals reduced myocardial function in hypertension, diabetes, and ischaemic heart disease (IHD) in the general population. Methods and results Within a large, community-based population study, cardiac function was evaluated in 1036 participants by both conventional echocardiography and colour TDI. Peak systolic (s 0) and early diastolic (e 0) velocities, longitudinal displacement (LD), and the ratio of mitral inflow E-wave to e 0 (E/e 0) were measured. TDI revealed significantly impaired parameters of systolic and diastolic cardiac function in hypertension [n ¼ 345; LD 10.1 (+standard deviation, SD 2.0 mm), P , 0.001; E/e 0 12.4 (Â 4SD 1.4), P , 0.001], diabetes [n ¼ 65; LD 9.8 (+SD 2.2 mm), P , 0.001; E/e 0 12.7 (Â 4SD 1.5), P , 0.001], and IHD [n ¼ 93; LD 9.4 (+SD 2.5 mm), P , 0.001; E/e 0 13.0 (Â 4SD 1.5), P , 0.001] compared with controls [n ¼ 533; LD 11.4 (+SD 2.0 mm); E/e 0 9.0 (Â 4SD 1.3)]. This pattern remained significant after adjusting for age, sex, body mass index, heart rate, and the results of conventional echocardiography. Conclusion In the general population, persons with hypertension, diabetes, or IHD have impaired cardiac function by TDI independently of the result of conventional echocardiography.