Abnormal Valsalva blood pressure response in dilated cardiomyopathy: Association with “pseudonormalization” of echocardiographic Doppler transmitral filling velocity pattern

Schwengel, Robert H.; Hawke, Mary W.; Fisher, Michael L.; Gottlieb, Stephen S.; Plotnick, Gary D.

doi:10.1016/0002-8703(93)90672-v

Cited by 6 publications

(2 citation statements)

References 16 publications

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“…Cardiology 1997:88:585-594 The present study also documents the relationship of PVF velocity patterns to some left ventricular diastolic variables. It has been shown that the abnormal mitral flow velocity pattern that is seen in patients with left ventricu lar diastolic dysfunction can be normalized in association with elevated left atrial filling pressures [8,13,[34][35][36]. In patients with impaired ventricular relaxation but with rel atively normal chamber stiffness, the reduction in early ventricular filling produces a higher atrial preload and forceful atrial contraction (low E/A ratio, increased DT and LVIRT).…”

Section: Relation O F Pvf Velocity Pattern To L V Functionmentioning

confidence: 99%

“…Switzerland. May 1995. filling in individual patients has been stressed upon [4][5][6], It has been suggested that this pattern may be more sensi tive to loading conditions than the mitral flow velocity pattern, since in patients with left ventricular (LV) dia stolic dysfunction the abnormal ratio of peak velocity of transmitral flow in early diastole (E) to that during atrial contraction (A) can be normalized when concomitant congestive heart failure occurs [7][8][9][10][11][12][13], Although Doppler PVF velocity patterns have been previously investigated, some discrepancy exists between transthoracic [14][15][16] and transesophageal [17,18] findings. Furthermore, al though it has been shown that patterns of diastolic pre dominance of PVF velocity are associated with increased pulmonary capillary wedge pressure [4], it may be diffi cult to interpret these findings as a result of impaired sys tolic function or diastolic dysfunction or both.…”

Section: Introductionmentioning

confidence: 99%

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PVF Velocity Pattern in Patients with Heart Failure: Transesophageal Echocardiographic Assessment

Vitarelli¹,

Luzzi²,

Penco³

et al. 1997

Cardiology

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In order to assess the role of the pulmonary venous flow (PVF) velocity pattern in the evaluation of patients with congestive heart failure (CHF), we studied 41 CHF patients by means of transthoracic echocardiography (TTE) and multiplane transesophageal echocardiography (TEE). The etiology of CHF was idiopathic or ischemic dilated cardiomyopathy in 19 patients and hypertensive heart disease in 22. Sixteen subjects without cardiovascular disease were selected as normal controls. PVF peak systolic and peak early diastolic (D) velocities were recorded by TEE and TTE and the systolic fraction (SF) was measured (i.e., the systolic velocity-time integral – VTI – expressed as a fraction of the sum of systolic and early diastolic VTI). TEE tracings were obtained in all patients and had more laminar-appearing spectral signals, thus were used for analysis. By TTE the mitral flow velocity patterns were also evaluated: peak early diastolic velocity (E), peak velocity at atrial contraction, E velocity normalized for VTI (E/VTI), deceleration time (DT), and left ventricular isovolumic relaxation time (LVIRT). The left ventricular ejection fraction (LVEF) was calculated by two-dimensional echocardiographic images using the modified Simpson method. The SF was lower in CHF patients as compared with normal controls (p < 0.0001). The E/VTI ratio was higher, and DT and LVIRT were shorter (p < 0.0001) in CHF patients. A significant correlation was observed between SF and LVEF in CHF patients (r = 0.76, p < 0.001). Two different PVF velocity patterns (type A: SF < 0 50%, D > 50 cm/s; type B: SF ∼ 50%, D > 50 cm/s) were recognized in patients with a low LVEF (type A) and a nearly normal or normal LVEF (type B). Patients with LVEF < 40% showed mean SF values significantly lower than patients with LVEF > 40% (33.26 ± 10.84 vs. 51.00 ± 4.00%, p < 0.0001). Mean DT and LVIRT values were not significantly different in patients with LVEF < 40% and > 40%. Thus in CHF patients TEE PVF velocity patterns help in distinguishing patients with systolic dysfunction (low LVEF and SF) from patients with predominant diastolic impairment (normal or nearly normal LVEF, high D velocities).

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Section: Relation O F Pvf Velocity Pattern To L V Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

PVF Velocity Pattern in Patients with Heart Failure: Transesophageal Echocardiographic Assessment

Vitarelli¹,

Luzzi²,

Penco³

et al. 1997

Cardiology

View full text Add to dashboard Cite

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Further Readilngs

2004

Handbook of Echo‐Doppler Interpretation

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Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: which should we use?

Srivastava

Burrell

Calafiore

2005

European Journal of Echocardiography

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Tissue Doppler echocardiography (TDE) is used in the assessment of diastolic function, however, it is unclear whether the medial (E' med) or lateral (E' lat) annulus should be used. Our aim was to compare the diagnostic utility of E' med and E' lat. In 232 subjects left ventricular (LV) systolic and diastolic function was assessed via transthoracic echocardiography with TDE measurements obtained from both annuli. LV function was normal in 91 subjects (39%), with diastolic dysfunction found in 141 subjects (61%). TDE velocities decreased with age and progressive diastolic dysfunction for either annulus. E' med recorded significantly lower myocardial velocities than E' lat. Receiver operator curves showed improved area under the curve (AUC) for E' med than E' lat. Furthermore the AUC was significantly improved compared to E/A ratio and deceleration time. For diagnosing diastolic dysfunction, an E' med<11cm/s provided a sensitivity of 78%, specificity of 67% and positive predictive value of 70%. Whilst for diagnosing elevated filling pressures an E/E' medial ratio>8 provided values of 56%, 93% and 91%, respectively. In conclusion, although either annulus can be used, E' med provides better diagnostic utility.

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Abnormal Valsalva blood pressure response in dilated cardiomyopathy: Association with “pseudonormalization” of echocardiographic Doppler transmitral filling velocity pattern

Cited by 6 publications

References 16 publications

PVF Velocity Pattern in Patients with Heart Failure: Transesophageal Echocardiographic Assessment

PVF Velocity Pattern in Patients with Heart Failure: Transesophageal Echocardiographic Assessment

Further Readilngs

Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: which should we use?

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