Dyspnoea of cardiac origin in 67 year old men: (2). Relation to diastolic left ventricular function and mass. The study of men born in 1913.

Abstract

SUMMARYThe relation of cardiac dyspnoea to diastolic left ventricular dysfunction was examined in a sample of67 year old men from the general population of Gothenburg, Sweden. Forty two men with cardiac dyspnoea and 45 controls were selected from the screened cohort of 644 men. M mode echocardiography, apexcardiography, and phonocardiography were used to evaluate heart sounds, diastolic time intervals, aortic root motion (atrial emptying index); peak rate of change in left ventricular dimension, left atrial and ventricular size; and left ventricular mass. There was a significant relation between dyspnoea grade and left ventricular mass and posterior wall thickness. Dyspnoea grade also correlated significantly with the amplitude of the rapid filling wave and the third heart sound, atrial emptying index and left atrial size, the pulmonary component of the second heart sound, and the dimension of the right ventricle. In mild to moderate dyspnoea fractional shortening was normal, but posterior wall thickness and left atrial dimension were increased. The time from the second heart sound to the 0 point ofthe apexcardiogram, adjusted for heart rate, was significantly prolonged in mild to moderate dyspnoea, but not in severe dyspnoea. There was a significart decrease of rate adjusted isovolumic relaxation time, probably secondary to altered loading conditions, in severe dyspnoea, but not in mild to moderate dyspnoea. When the effect of systolic function was excluded multivariate analyses showed that the relation between dyspnoea grade and left atrial dimension persisted.The finding that diastolic abnormalities of the heart contributed to the generation of cardiac dyspnoea may have implications for treatment.

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“…The left ventricular (LV), septal and posterior wall diastolic dimensions were measured from M-mode tracings, according to guidelines of the American Society of Echocardiography. LV mass index (LVMI) was computed as described previously [29].…”

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“…E-point septal separation was measured as the distance between the E-point on the mitral valve and the interventricular septum [12]. The atrial emptying index, an estimate of early LV filling properties, was calculated from the posterior aortic wall motion by means of a digitizer and a computer as previously described [13].…”

Dyspnea of Cardiac Origin in 67-Year-Old Men: Relation to Clinical and Noninvasive Measures of Cardiac Function

“…M-mode échocardiographie recordings were obtained at a paper speed of 50 mm/s for the analysis of cardiac dimensions and at 100 mm/s for the analysis of aortic root motion, with a simultaneous electrocardiogram (lead II) and a phonocardiographic tracing of the second heart sound on all recordings, as previously described [6,7], The left ventricular dimensions were measured (leading edge tech nique) at the beginning of the electrocardiographic Q wave, and at end-systole (the shortest distance between the septum and posterior wall at or before the initial vibrations of the second heart sound). Left ventricular fractional shortening was calculated as (diastolicsystolic)/diastolic dimension, and ejection fraction was calculated by means of the cube formula [6].…”

“…The E-point to septal separation was measured from the E-point of the anterior mitral leaflet to the interventricular septum [12]. From the aortic root tracings we calcu lated the atrial emptying index and measured the left atrial size at end-systole [7].…”

“…and systolic [6] as well as diastolic [7] left ventricular function. Echocardiographie fractional shortening was the systolic variable to which dyspnea grade was most closely related [6], and in multivariate analysis atrial emptying index and atrial dimension were the only dia stolic variables to which dyspnea grade was indepen dently related [7], The heart rate adjusted interval be tween A2 and the apexcardiographic O-point (A2-0%) measuring left ventricular relaxation and early filling time, although without a linear relationship to dyspnea grade, was an early marker of diastolic impairment.…”