Alteration of Left Ventricular Diastolic Function During Coronary Angioplasty-Induced Ischemia: A Color M-Mode Doppler Study

Duval-Moulin, Anne-Marie; Dupouy, Patrick; Brun, P; Fang, Zhuang; Pelle, Gabriel; Perez, Yvan; Teiger, Emmanuel; Castaigne, A; Guéret, Pascal; Dubois‐Randé, Jean‐Luc

doi:10.1016/s0735-1097(97)00052-1

Cited by 50 publications

(43 citation statements)

References 29 publications

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“…20 -22 Several studies have demonstrated a negative correlation between V p and invasive measures of LV relaxation during myocardial ischemia and during both blockade and stimulation of ␤-adrenergic receptors. 14,20,21 Under physiological conditions, V p has been demonstrated to be relatively preload independent. 14,23 Based on this, V p has been used in combination with peak mitral E-wave velocity to assess filling pressures and has proven useful in detecting a pseudonormalized LV filling pattern.…”

Section: Color M-mode Doppler Echocardiographymentioning

confidence: 99%

Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction

et al. 2006

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A cute myocardial infarction (AMI) is characterized by regional myocardial damage that may lead to systolic and diastolic dysfunction with a subsequent risk of left ventricular (LV) remodeling, local and systemic neurohormonal activation, and vascular dysfunction. The pathophysiology and prognosis of LV systolic dysfunction after AMI have been the focus of research for several decades. Insights from these studies have led to several therapeutic interventions that improve outcome. In addition to depressed systolic function, clinical or radiographic evidence of heart failure is a consistent and powerful predictor of outcome in patients after AMI. 1 Pulmonary congestion after infarction reflects raised LV filling pressures but is frequently seen after what appears to be only minor myocardial damage. 2 The pathophysiological mechanism for this is incompletely understood but may involve impaired active relaxation of the myocardium and increased LV chamber stiffness and hence abnormalities in diastolic function. If these are to be determined directly, cardiac catheterization with assessment of pressurevolume relationships with the use of high-fidelity micromanometer catheters is required. This highly specialized approach is not suitable for daily clinical practice. Likewise, although direct measurements of right heart or LV end-diastolic pressure are important predictors of adverse outcome after AMI in selected populations, 3,4 the risk of complications precludes routine use of indwelling catheters in all patients. There has therefore been considerable interest in using noninvasive estimates of diastolic function, particularly Doppler echocardiographic assessment of LV filling dynamics and, more recently, the volume of the left atrium (LA), to predict outcome in patients with AMI.The objective of this review is to summarize the current understanding of abnormal LV filling in the early phase after AMI with focus on the complementary prognostic information that may be gained by assessment of LV filling dynamics and LA volume with the use of 2-dimensional and Doppler echocardiography. Doppler Echocardiographic Assessment of Diastolic FunctionAfter an AMI, myocardial ischemia, cell necrosis, microvascular dysfunction, and regional wall motion abnormalities will influence the rate of active relaxation. In addition, interstitial edema, fibrocellular infiltration, and scar formation will directly affect LV chamber stiffness. Thus, abnormalities in LV filling are common in this setting. Spectral Pulsed-Wave Doppler EchocardiographyThe pulsed-wave Doppler technique allows assessment of flow velocities (Ͻ2 m/s) at a distinct spatial position, making the technique suitable for assessment of changes in inflow velocities across the mitral valve during diastole. With mitral valve opening, the early inflow velocity will be determined largely by ventricular suction and the pressure gradient between the LA and LV. [5][6][7] This is followed by a steady decrease in inflow velocity, with a normal duration of 140 to 240 ms (early mitral ...

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Section: Color M-mode Doppler Echocardiographymentioning

confidence: 99%

Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction

et al. 2006

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“…Brun et al [47] defined v p as the slope (in m. Method 2: Duval-Moulin-Garcia. As the black-tocolour transition, as defined by Brun et al, is not always clearly visible, Duval-Moulin et al [51] and Garcia et al [30] have modified this method by considering boundaries of equal velocities, so-called isovelocity boundaries instead of black-to-colour transitions [ Fig. 5(b)].…”

Section: Quantifying V P From a Colour M-mode Doppler Imagementioning

confidence: 99%

“…Studies (Table 3) in both animals and humans during coronary angioplasty-induced ischaemia [49,51,58] , during intra-coronary dobutamine infusion [47] , before and during cardiopulmonary bypass [59] , in a mixed patient population [52] and in patients with hypertrophic cardiomyopathy [60] describe a univariate correlation of the constant of isovolumic relaxation (tau) with v p as obtained from the colour M-mode Doppler images. In both animals and humans, Garcia and co-workers [59] found that left ventricular relaxation is a major determinant of v p , best described using a power function tau=592·21 v p 0·6838 (r= 0·78, P<0·001).…”

Section: Left Ventricular Relaxationmentioning

confidence: 99%

“…A study of Duval-Moulin et al [51] concludes that during ischaemia, the premature cessation of late filling is associated with increased diastolic pressures. Also, in a univariate analysis, several investigators found a significant correlation between left atrial pressure, left ventricular minimal pressure or left ventricular enddiastolic pressure on one hand and v p on the other hand [47][48][49]52,58,59,61] .…”

Section: Filling Pressurementioning

confidence: 99%

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Diastolic Filling and Pressure Imaging: Taking Advantage of the Information in a Colour M-mode Doppler Image

Mey

Sutter

Vierendeels

et al. 2001

European Journal of Echocardiography

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The ability to derive non-invasively information on left ventricular diastolic function on one hand and pressure gradients on the other hand, makes Doppler ultrasound a very attractive tool in clinical practice. However, the limitations of the standard Doppler approaches in differentiating between normal and pseudonormal filling patterns, together with the limitations of the simplified Bernoulli equation for assessing pressure gradients, are well described. In this manuscript the role of colour M-mode Doppler echocardiography as a tool that can overcome these limitations is discussed. Relevant key concepts of the haemodynamics of left ventricular filling and its relationship with colour M-mode Doppler echocardiography are introduced.

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“…Color M-mode Doppler echocardiography provides flow propagation velocity (FPV) of early diastolic filling flow, which has become an established tool to evaluate LV diastolic function [11][12][13][14][15][16][17]. It has been reported that FPV and its ratio to early transmitral filling velocity (FPV/E) are diastolic indexes that do not pseudonormalize and reflect well the time constant of LV pressure decay [14].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Left Ventricular Diastolic Dysfunction Assessed by Color M-mode Doppler Echocardiography in Patients With Chronic Left Ventricular Systolic Dysfunction

et al. 2004

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Background. Color M-mode Doppler echocardiography provides accurate evaluation of LV diastolic function noninvasively and is reportedly preload independent compared with pulsed Doppler transmitral velocity indexes. This study aimed to determine the prognostic significance of left ventricular (LV) diastolic function in patients with different degrees of chronic LV systolic dysfunction using color M-mode Doppler echocardiography. Methods.A total of 98 consecutive subjects (mean age 57 years, 78 males) with LV systolic dysfunction (61 with previous myocardial infarction and 37 with dilated cardiomyopathy) underwent clinical and echocardiographic evaluation to determine functional status. Measurements of LV and left atrial dimensions, LV ejection fraction (EF), the peak of early and late diastolic transmitral velocities (E and A, respectively), the E/A ratio, deceleration time of E velocity and isovolumic relaxation time using conventional echo-Doppler techniques, and LV flow propagation velocity (FPV) and FPV/E using color M-mode Doppler echocardiography were taken.Results. During the mean follow-up period of 37±28 months, 26 patients had cardiovascular events (death in 4, congestive heart failure in 13, ventricular tachycardia in 6, and cerebral infarction in 3). EF was the single independent predictor of cardiovascular events. While, in the subgroup with EF <0.35, the functional class was the single significant predictor of cardiovascular events, FPV/E was the single best predictor of cardiovascular events in the subgroup with EF ≥0.35.Conclusions. The evaluation of LV diastolic function using color M-mode Doppler-derived FPV/E contributes to predicting clinical outcomes of patients with mildly depressed LV systolic function. (J Echocardiogr 2004; 2: 68-77)

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Alteration of Left Ventricular Diastolic Function During Coronary Angioplasty-Induced Ischemia: A Color M-Mode Doppler Study

Abstract: The analysis of flow propagation velocity showed that early filling is highly dependent on left ventricular relaxation rate, particularly through the phenomenon of asynchrony. During ischemia, the premature cessation of late filling is associated with increased diastolic pressures.

Cited by 50 publications

References 29 publications

Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction

Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction

Diastolic Filling and Pressure Imaging: Taking Advantage of the Information in a Colour M-mode Doppler Image

Prognostic Significance of Left Ventricular Diastolic Dysfunction Assessed by Color M-mode Doppler Echocardiography in Patients With Chronic Left Ventricular Systolic Dysfunction

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