Background-Conventional Doppler measurements have limitations in the prediction of left atrial pressure(LAP) in patients with mitral valve disease(MVD), given the confounding effect of valve area, left ventricular(LV)...Background-Conventional Doppler measurements have limitations in the prediction of left atrial pressure(LAP) in patients with mitral valve disease(MVD), given the confounding effect of valve area, left ventricular(LV) relaxation, and stiffness. However, the time interval between the onset of early diastolic mitral inflow velocity(E) and annular early diastolic velocity(Ea) by tissue Doppler imaging(TDI), TE-Ea, which is well related to the time constant of LV relaxation(T) in canine and clinical studies, is not subject to these variables. We therefore undertook this study to test its usefulness in a patient population. Methods and Results-Two-dimensional Doppler and TDI echocardiography were performed simultaneously with right heart catheterization in 51 consecutive patients(mean±SD age, 64±11 years) with MVD: 35 with moderately severe to severe mitral regurgitation(MR) and 16 with moderate to severe mitral stenosis(MS). Among several Doppler measurements, only the mitral E/A ratio, isovolumetric relaxation time(IVRT), and pulmonary venous Ar duration had significant relations with mean pulmonary capillary wedge pressure(PCWP). The ratio of IVRT to TE-Ea(for MR, r=-0.92; for MS, r=-0.88; both P< 0.001) and the ratio of IVRT to τ(for MR, r=-0.74; for MS, r=-0.85; both P< 0.001) had the best correlations with PCWP. In 54 repeat studies, including those performed after MV repair or replacement, these ratios tracked well the changes in PCWP and readily identified changes in mean PCWP by ≥5mmHg. A similar correlation was noted in 13 patients with atrial fibrillation(r=-0.92, P< 0.01) and in a prospective group of 14 patients with MR(r=-0.93, P< 0.001). Conclusions-The ratio of IVRT to TE-Ea or to τcan be readily applied for estimating mean PCWP in patients with MVD and can track changes in PCWP after valve surgery.展开更多
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
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
文摘Background-Conventional Doppler measurements have limitations in the prediction of left atrial pressure(LAP) in patients with mitral valve disease(MVD), given the confounding effect of valve area, left ventricular(LV) relaxation, and stiffness. However, the time interval between the onset of early diastolic mitral inflow velocity(E) and annular early diastolic velocity(Ea) by tissue Doppler imaging(TDI), TE-Ea, which is well related to the time constant of LV relaxation(T) in canine and clinical studies, is not subject to these variables. We therefore undertook this study to test its usefulness in a patient population. Methods and Results-Two-dimensional Doppler and TDI echocardiography were performed simultaneously with right heart catheterization in 51 consecutive patients(mean±SD age, 64±11 years) with MVD: 35 with moderately severe to severe mitral regurgitation(MR) and 16 with moderate to severe mitral stenosis(MS). Among several Doppler measurements, only the mitral E/A ratio, isovolumetric relaxation time(IVRT), and pulmonary venous Ar duration had significant relations with mean pulmonary capillary wedge pressure(PCWP). The ratio of IVRT to TE-Ea(for MR, r=-0.92; for MS, r=-0.88; both P< 0.001) and the ratio of IVRT to τ(for MR, r=-0.74; for MS, r=-0.85; both P< 0.001) had the best correlations with PCWP. In 54 repeat studies, including those performed after MV repair or replacement, these ratios tracked well the changes in PCWP and readily identified changes in mean PCWP by ≥5mmHg. A similar correlation was noted in 13 patients with atrial fibrillation(r=-0.92, P< 0.01) and in a prospective group of 14 patients with MR(r=-0.93, P< 0.001). Conclusions-The ratio of IVRT to TE-Ea or to τcan be readily applied for estimating mean PCWP in patients with MVD and can track changes in PCWP after valve surgery.
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.
