Hemodynamic correlates of the normal aortic valve echogram. A study of sound, flow, and motion.

Laniado, Shlomo; Yellin, Edward L.; Terdiman, Reuven; Meytes, Ilan; Stadler, Jona

doi:10.1161/01.cir.54.5.729

Cited by 41 publications

(17 citation statements)

References 24 publications

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“…22 The definitions of end ejection used in this investigation were 1) the time from the peak of the R wave to the first frame on the radionuclide LV timevolume and 2) the time from the peak of the R wave to zero systolic flow as approximated by the aortic dicrotic notch. 34 The aortic dicrotic notch was clearly defined in the control patients and patients with mitral regurgitation, but in the patients with aortic regurgitation, a clear dicrotic notch could not be defined in six patients. Consequently, tangential lines were drawn on the central aortic pressure tracing to demarcate the early rapid decline from peak aortic pressure, which occurred before peak (-)-dP/dt, and a second slower decline in the aortic pressure tracing, which occurred after peak(-)-dP/dt.…”

Section: Radionuclide Angiographymentioning

confidence: 83%

Dissociation of end systole from end ejection in patients with long-term mitral regurgitation.

Brickner

Starling

1990

Circulation

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To determine whether left ventricular (LV) end systole and end ejection uncouple in patients with long-term mitral regurgitation, 59 patients (22 control patients with atypical chest pain, 21 patients with aortic regurgitation, and 16 patients with mitral regurgitation) were studied with micromanometer LV catheters and radionuclide angiograms. End systole was defined as the time of occurrence (Tmax) of the maximum time-varying elastance (Emax), and end ejection was defined as the time of occurrence of minimum ventricular volume (minV) and zero systolic flow as approximated by the aortic dicrotic notch (Aodi). The temporal relation between end systole and end ejection in the control patients was Tmax (331±42 [SD] msec), minV (336±36 msec), and then, zero systolic flow (355+±23 msec). This temporal relation was maintained in the patients with aortic regurgitation. In contrast, in the patients with mitral regurgitation, the temporal relation was Tmax (266±49 msec), zero systolic flow (310±37 msec, p<0.01 vs. Tmax), and then, minV (355+±37 msec,p<0.001 vs. Tmax andp<0.01 vs. Aodi). Additionally, the average Tmax occurred earlier in the patients with mitral regurgitation than in the control patients and patients with aortic regurgitation (p<0.01, for both), whereas the average time to minimum ventricular volume was similar in all three patient groups. Moreover, the average time to zero systolic flow also occurred earlier in the patients with mitral regurgitation than in the control patients (p<0.01) and patients with aortic regurgitation (p<0.05). Because of the dissociation of end systole from minimum ventricular volume in the patients with mitral regurgitation, the end-ejection pressure-volume relations calculated at minimum ventricular volume did not correlate (r= -0.09), whereas those calculated at zero systolic flow did correlate (r= 0.88) with the Emax slope values. We conclude that end ejection, defined as minimum ventricular volume, dissociates from end systole in patients with mitral regurgitation because of the shortened time to LV end systole in association with preservation of the time to LV end ejection due to the low impedance to ejection presented by the left atrium. Therefore, pressure-volume relations calculated at minimum ventricular volume might not be useful for assessing LV chamber performance in some patients with mitral regurgitation. (Circulation 1990;81:1277-1286

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Section: Radionuclide Angiographymentioning

confidence: 83%

Dissociation of end systole from end ejection in patients with long-term mitral regurgitation.

Brickner

Starling

1990

Circulation

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“…Observations of the aortic root in the beating heart has been done both indirectly and directly. Indirect methods include X-ray techniques, with either contrast material (human study) [22], radiopaque markers (animal studies in dogs and sheep) [9, 23–25] or sonomicrometry (animal studies in sheep) [11, 26] as well as echocardiography (animal study in dogs and a human study) [27, 28]. Direct observation of the aortic root in dogs can be achieved with cinematographic techniques (animal study in dogs), in which blood can be a disturbing factor [29] or electromagnetic induction (animal study with dogs) [30].…”

Section: Discussionmentioning

confidence: 99%

Aortic root dimension changes during systole and diastole: evaluation with ECG-gated multidetector row computed tomography

Heer

Budde

Mali

et al. 2011

Int J Cardiovasc Imaging

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Cardiac pulsatility and aortic compliance may result in aortic area and diameter changes throughout the cardiac cycle in the entire aorta. Until this moment these dynamic changes could never be established in the aortic root (aortic annulus, sinuses of Valsalva and sinotubular junction). The aim of this study was to visualize and characterize the changes in aortic root dimensions during systole and diastole with ECG-gated multidetector row computed tomography (MDCT). MDCT scans of subjects without aortic root disease were analyzed. Retrospectively, ECG-gated reconstructions at each 10% of the cardiac cycle were made and analyzed during systole (30–40%) and diastole (70–75%). Axial planes were reconstructed at three different levels of the aortic root. At each level the maximal and its perpendicular luminal dimension were measured. The mean dimensions of the total study group (n = 108, mean age 56 ± 13 years) do not show any significant difference between systole and diastole. The individual dimensions vary up to 5 mm. However, the differences range between minus 5 mm (diastolic dimension is greater than systolic dimensions) and 5 mm (vice versa). This variability is independent of gender, age, height and weight. This study demonstrated a significant individual dynamic change in the dimensions of the aortic root. These results are highly unpredictable. Most of the healthy subjects have larger systolic dimensions, however, some do have larger diastolic dimensions.

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“…Thus, measuring the SEP from the second LV-aortic pressure crossover may be erroneous. The aortic incisura may be a more accurate landmark of endejection, 9 and this criterion is used by some authors to calculate Q . 10 -12 However, whatever landmark is used to define end-ejection, not only flow but also ⌬P should be averaged for the full SEP.…”

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confidence: 99%

Estimation of the End of Ejection in Aortic Stenosis

et al. 2004

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Background-All indices of aortic stenosis (AS) rely on measurements of mean transvalvular pressure gradient (⌬P) and flow rate. Because the gradient is reversed during late ejection, the late systolic left ventricular (LV)-aortic pressure crossover may be an erroneous landmark of end-ejection. The aortic incisura should be a better reference to calculate indices of AS invasively. Methods and Results-The accuracy of the pressure crossover and the incisura to define end-ejection was assessed in a chronic AS experimental model (9 dogs) with the use of an implantable flowmeter and Doppler echocardiography as reference. In 288 hemodynamic recordings analyzed (aortic valve area [AVA]: 0.74Ϯ0.46 cm 2 ), ejection ended 37Ϯ29 ms after the pressure crossover but almost simultaneously with the incisura (2Ϯ17 ms). Pressure crossover error accounted for significant errors in the measurement of ⌬P (95% limits of agreement, ϩ0 to ϩ7 mm Hg) and AVA (Ϫ0.1 to ϩ0.2 cm 2 ). These errors were reduced to less than half with the use of the incisura to define end-ejection. Additionally, the agreement with Doppler-derived AS indices was best with use of the incisura. Pressure crossover error was maximal in situations of higher output, moderate orifice narrowing, higher arterial compliance, and lower vascular resistance. In 32 consecutive patients undergoing cardiac catheterization for AS, the pressure crossover induced a clinically important overestimation of the ⌬P from ϩ22 to ϩ50%. Errors in AVA estimation were considerably smaller (Ϫ2% to ϩ6%) because of simultaneous and offsetting errors in the measurements of ⌬P and flow. Conclusions-The aortic incisura and not the second pressure crossover should be used to obtain invasive indices of AS.

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Hemodynamic correlates of the normal aortic valve echogram. A study of sound, flow, and motion.

Cited by 41 publications

References 24 publications

Dissociation of end systole from end ejection in patients with long-term mitral regurgitation.

Dissociation of end systole from end ejection in patients with long-term mitral regurgitation.

Aortic root dimension changes during systole and diastole: evaluation with ECG-gated multidetector row computed tomography

Estimation of the End of Ejection in Aortic Stenosis

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