Prognostic value of Doppler echocardiographic mitral inflow patterns: implications for risk stratification in patients with chronic congestive heart failure
Alexander HansenMarkus HaassChristian ZugckCarsten KruegerKristina UnnebrinkRainer ZimmermannWolfgang M. KueblerHelmut F. Kuecherer
134
Citation
29
Reference
10
Related Paper
Citation Trend
Keywords:
Doppler imaging
Dilated Cardiomyopathy
Background: Hypertension is an emerging risk factor for developing heart failure with preserved ejection fraction (HFpEF). Diastolic dysfunction most frequently associated with a subclinical impairment of systolic function in patients with HFpEF. The aim of this study was to detect early impairment of left ventricular function in hypertensive patients with preserved ejection fraction using Tissue Doppler Imaging (TDI).Methods: This cross-sectional study included a total 105 subjects who were divided into three groups (group-1: 35 healthy control; group-2: 35 hypertensive patients without concentric left ventricular hypertrophy, and group-3: 35 hypertensive patients with concentric left ventricular hypertrophy having left ventricular ejection fraction (LVEF)>50% on 2D echocardiography). They underwent TDI to measure systolic dysfunction by systolic annular velocity during systole (S´) and diastolic dysfunction by diastolic filling pressure (E/E´).Results: The results were obtained in 105 subjects: group-1 (40.63±5.0years; 34.4% male); group-2 (49.57±9.7years; 34.4% male) and group-3 (55.17±8.5years; 31.2% male). LVMI and RWT were significantly higher (p<0.001) in both hypertensive groups. The presence of systolic dysfunction by TDI as evidence by systolic annular velocity (S´) was significantly reduced (p<0.001) in both hypertensive groups compared to controls (0.08±0.11 vs.06±0.01 vs. 0.05±0.01).The presence of diastolic dysfunction by TDI as evidence by diastolic filling pressure (E/E´) were significantly higher (p<0.001) in both groups of hypertensive patients. There was significant correlation between E/E´ and S´(r = -593; p= <0.001).Conclusion: TDI provided a new insight into impaired systolic function by detecting lower values of S´ and impaired diastolic function by detecting higher values of E/E´ in hypertensive patients. This study was a clear reflection of early impairment of LV function in hypertensive patients (with or without C-LVH) and it might be helpful for identifying hypertensive patients who are at high risk for heart failure.Cardiovasc. j. 2017; 9(2): 147-154
Doppler imaging
Subclinical infection
Systole
Concentric hypertrophy
Cite
Citations (0)
Nearly half of patients with symptoms of heart failure are found to have an left ventricular (LV) ejection fraction which is within normal limits. These patients have variously been labeled as having diastolic heart failure, heart failure with preserved LV function or heart failure with normal ejection fraction (HFNEF). Since recent studies have shown that systolic function is not entirely normal in these patients, HFNEF is the better term. More common in elderly females it has a mortality similar to heart failure with a reduced ejection fraction (HFREF). The exact pathophysiology of the symtpoms is still not clear and, therefore, debated. As heart failure is often episodic, the underlying abnormal mechanisms may not be completely apparent at rest. It is likely there is a mixture of systolic and diastolic dysfunction which will be different to some degree in individual patients and isolated diastolic dysfunction or primary abnormalities of relaxation are probably extremely rare. The main difference between HFNEF and HFREF is the degree of ventricular remodeling with increased ventricular volumes in HFREF. The time course of remodeling depends to some extent on the aetiology being quicker post myocardial infarction--the commonest cause of HFREF, and slower with hypertension which is the most frequent aetiological factor in HFNEF. Ventricular volumes rather than ejection fraction or the concept of a pure diastolic abnormality can be used to classify patients in a more rational manner.
Diastolic heart failure
Ventricular remodeling
Cite
Citations (3)
Objective To evaluate the relationship between acute left heart failure and segmental myocardium motion in patients with idiopathic dilated cardiomyopathy(IDC)using pulsed tissue Doppler echocardiography.Methods The patients with IDC were divided into the group with acute left heart failure and the group with chronic heart failure.Parameters derived from the transmitral flow spectral and pulsed tissue Doppler imaging were acquired in the two groups and compared with each other and normal group.Results Compared with normal group and the patients with chronic heart failure,the peak velocities of mitral ring in the early diastolic phase and in the late diastolic phase were the lowest in patients with acute left heart failure.And Clinical improvement was paralleled by gradual increase in the peak velocities of mitral ring in the early diastolic phase but not in the peak velocities of systolic phase.Conclusion In patients with IDC acute left heart failure is exclusively caused by diastolic rather than systolic failure.
Doppler imaging
Dilated Cardiomyopathy
Diastolic heart failure
Cite
Citations (0)
Objective To determine whether patients with suspected heart failure but preserved left ventricular ejection fraction (LVEF) had systolic and diastolic dysfunction in left ventricular long axis detected by tissue Doppler echocardiographic indexes. Methods The data of 100 patients with heart failure who admitted to our hospital between August 2007 and October 2009 were collected. Heart failure with preserved LVEF was diagnosed in 50 patients and heart failure with reduced LVEF was diagnosed in another 50 patients. Fifty age-matched healthy subjects served as the control group.Tissue Doppler imaging indexes (Sm, Ea, Aa, E/Ea) and plasma BNP concentration were compared among the three groups. Results The degree of Sm decrease was more significant in heart failure patients with reduced LVEF than those with preserved LVEF. In the two subjects, the index Sm was negatively correlated with the BNP concentration (r=-0.35, P<0.05).The indexes E/Ea was positively correlated with the BNP concentration (r=0.728, P<0.05). Conclusions The LV filling index E/Ea is identified as the best index to detect diastolic dysfunction in heart failure but preserved left ventricular ejection fraction.
Key words:
Heart failure; Ventricular function; Echocardiography
Doppler imaging
Cite
Citations (0)
Objective To detect the long-term effects of cardiac resynchronization therapy(CRT)on left ventricular diastolic function in patients with congestive heart failure.Methods Eighteen patients with congestive heart failure were treated with CRT.Left ventricular ejection fraction(LVEF),the peak transmitral velocities during early(E-wave) and late(A-wave) diastolic filling were measured before and at 1st week,6th month,12th month after therapy by echocardiography.In order to detect the changes of left ventricular diastolic function,mitral annulus velocities were measured with tissue Doppler imaging(TDI) at septal and lateral annulus,respectively.Systolic velocity(Sm),early(Em) and late(Am) diastolic mitral annulus velocities were obtained.Results LVEF increased significantly from(24±8)% to(27±7)%(P0.001) after CRT at the first week.The septal Am velocity increased from(9.2±1.7) cm/s to(11.3±2.9) cm/s after CRT at 6th month(P 0.05),and increased to(12.5±3.6) cm/s at 12th months(P0.05).The lateral Am velocity increased from(11.8±2.9) cm/s to(12.1±3.2) cm/s after CRT at 6th month(P 0.05),and further increased to(13.5±3.2) cm/s at 12th month(P0.01).The Em velocity didn't change significantly after CRT.Conclusion CRT can markedly improve left ventricular diastolic function of patients with congestive heart failure induced by mechanical dyssynchrony.
Doppler imaging
Mitral annulus
Cite
Citations (0)
Isovolumic relaxation time
Diastolic heart failure
Isovolumetric contraction
Systole
Doppler imaging
Cite
Citations (38)
Doppler imaging
Diastolic heart failure
Cite
Citations (78)
Diastolic heart failure
Hypertensive heart disease
Cite
Citations (50)
Doppler imaging
Diastolic heart failure
Tissue Doppler echocardiography
Cite
Citations (16)
A reduced left ventricular ejection fraction measured by echocardiography in a patient with clinical features of heart failure demonstrates that the patient has a cardiac abnormality and that the clinical picture is, in fact, due to heart failure. As such, a reduced ejection fraction (< 0.30 or 0.35) has been used as entry criteria for almost all the large clinical trials that guide our therapy of patients with heart failure. However, it has been recently recognized that a substantial and increasing proportion of patients with heart failure have a normal ejection fraction (> 0.50). Such patients are typically elderly women with systolic hypertension. These patients are subject to the sudden development of pulmonary congestion (flash pulmonary edema). The finding of heart failure in patients with a normal ejection fraction has focused attention on the role of diastolic dysfunction in producing symptomatic heart failure. The optimal treatment of patients with heart failure and normal ejection fraction has not yet been defined, but the control of systolic hypertension and the avoidance of fluid overload are important.
Diastolic heart failure
Cite
Citations (15)