Left ventricular diastolic function: Evaluation by radionuclide angiography

Iskandrian, Abdulmassih S.; Heo, Jaekyeong; Segal, Bernard L.; Askenase, Alan

doi:10.1016/0002-8703(88)90905-2

Cited by 21 publications

(10 citation statements)

References 54 publications

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“…The first third filling fraction was designated as the percentage of LV filling (or SV) during the first third of diastole. All these parameters for diastolic function assessment have been previously described (19,20). EDV and end-systolic volume (ESV) (and hence SV and cardiac output) were calculated using a previously validated count ratio-based method (21).…”

Section: Rnvmentioning

confidence: 99%

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Didangelos

Arsos²,

Karamitsos³

et al. 2003

Diabetes Care

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OBJECTIVE -To investigate the relation between diabetic autonomic neuropathy (DAN) and left ventricular (LV) function in type 1 diabetic patients. RESEARCH DESIGN AND METHODS-A total of 57 type 1 diabetic patients free of coronary artery disease and arterial hypertension were studied. Diagnosis of DAN was established by autonomic nervous function (ANF) tests, and LV systolic and diastolic functions were assessed by radionuclide ventriculography at rest.RESULTS -There were 24 patients who had definite DAN, established by the presence of two or more abnormal ANF tests, and 33 subjects were without DAN. DAN patients had impaired LV filling pattern, obvious by a reduced peak filling rate (3.1 Ϯ 1.1 vs. 3.7 Ϯ 0.7 end-diastolic volume [EDV]/s, P ϭ 0.011) and first third filling fraction (35.3 Ϯ 19.5 vs. 50.8 Ϯ 16%, P ϭ 0.002) as well as an increased time to peak filling (159.4 Ϯ 45.1 vs. 134.2 Ϯ 33.4 ms, P ϭ 0.02) after correction for age and heart rate. There were no differences between the two groups with regard to ejection fraction, cardiac output, and cardiac index, whereas the peak emptying rate was greater in DAN patients (4.1 Ϯ 0.8 vs. 3.6 Ϯ 0.8 EDV/s, P ϭ 0.019), suggesting LV hypercontractility. DAN patients had an increased heart rate (83.4 Ϯ 11.9 vs. 72.7 Ϯ 9.3 bpm, P ϭ 0.001) and slightly higher systolic blood pressure. As a result, LV working load at rest was higher in DAN patients (11,109 vs. 9,096 bpm ϫ mmHg, P Ͻ 0.001). Moreover, a correlation was found between abnormal LV systolic and diastolic indexes and the number of abnormal ANF tests.CONCLUSIONS -At rest, DAN patients have impaired LV filling pattern, slightly increased LV systolic function, and a higher LV working load, in comparison to non-DAN type 1 diabetic patients. Diabetes Care 26:1955-1960, 2003C linical and epidemiological studies have confirmed that patients with diabetes appear susceptible to heart failure, which is the leading cause of death in these patients (1). Impairment of left ventricular (LV) function is frequent in patients with type 1 diabetes, even in the absence of ischemic, hypertensive, or valvular heart disease (2). Possible mechanisms for a specific diabetic cardiomyopathy include abnormalities of small intramural coronary vessels, deposition of collagen, and lipids and metabolic derangements that alter actomyosin and myosin adenosine triphosphatase activities (3). Although histopathologic and biochemical evidence for a distinct diabetic cardiomyopathy is available, it remains unclear whether these pathologic processes may cause significant LV systolic or diastolic dysfunction. Numerous studies have reported normal LV systolic function at rest in most type 1 diabetic patients (4), whereas others have suggested increased LV systolic function (5,6). Several investigators have shown abnormal LV diastolic function in the majority of type 1 diabetic patients (7-11), whereas others (12) found no evidence of LV diastolic dysfunction at rest in longterm type 1 diabetic patients. It has been suggested that LV dysfunction in type...

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Section: Rnvmentioning

confidence: 99%

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Didangelos

Arsos²,

Karamitsos³

et al. 2003

Diabetes Care

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“…Coronary artery disease patients have been shown by echocardiography, radionuclide and contrast ventriculog raphy to demonstrate a decrease and delay in the peak rate of global left ventricular filling, as well as an increased dependence on atrial systole for left ventricu lar filling [8,[14][15][16][17][18][19][20]. This altered pattern of left ventric ular filling may be detectable in the absence of systolic dysfunction and reflect regional diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, global diastolic dysfunction has been shown to be a sensitive indicator of coronary artery dis ease. Using radionuclide ventriculography, abnormal peak left ventricular filling rates were shown in 73% of coronary artery disease patients at rest and in the ab sence of systolic dysfunction [7,8]. Left ventricular fill 11].…”

mentioning

confidence: 99%

Regional Relaxation Abnormalities in Coronary Artery Disease

Lawson¹,

Swinford²,

Brown³

et al. 1988

Am J Noninvas Cardiol

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Global left ventricular diastolic dysfunction may be detected in chronic coronary artery disease patients with normal systolic function. M-mode echocardiography was used to investigate the regional left ventricular wall thickening/thinning dynamics that might be responsible for abnormal left ventricular filling in patients with normal or mildly decreased left ventricular ejection fraction. Regional thinning was evaluated in 22 patients with coronary artery disease; comparison regional thickening and thinning indices were derived from 8 angiographically normal control subjects. Regional peak left ventricular posterior wall thinning and early fractional filling decreased from 99 to 65.3 mm/s and from 0.73 to 0.65, respectively, in segments with decreased thickening. By contrast, in posterior wall segments with normal contractility, peak thinning and early fractional filling remained unchanged at 98.2 mm/s and 0.71, respectively. During atrial systole, the peak rate of posterior wall thinning increased in normal and decreased thickening segments from 30.2 to 47.2 and to 44.2 mm/s, respectively. The increase in fractional thinning with atrial systole was only significant, however, in areas with decreased thickening (from 0.15 to 0.25). Thus, in coronary disease patients the results show: (1) areas with decreased systolic function may show disproportionate diastolic dysfunction; (2) ‘compensatory’ early diastolic changes in wall thinning are not demonstrated by areas with normal systolic function, and (3) atrial systole assumes increased importance in maintaining left ventricular diastolic function. These findings suggest that the mechanism for the increased sensitivity of measures of global diastolic function for detecting coronary artery disease may result from a decrease in early relaxation in segments with systolic dysfunction and an inadequate compensatory hyperrelaxation of segments with normal systolic function. Active atrial contraction becomes a major compensatory mechanism for maintaining ventricular filling with diastolic dysfunction.

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“…These diastolic properties have been recently evaluated noninvasively by radionuclide [7] and Doppler techniques [8][9][10][11][12][13]. Most of the studies have reported a decrease in rapid filling and a compensatory increase in the atrial contri bution to ventricular filling as the characteristic abnor malities [8][9][10][11][12][13].…”

mentioning

confidence: 99%

Influence of Left Ventricular Preload Reduction by Hemodialysis on the Doppler-Derived Left Ventricular Filling Profile

Miyaguchi¹,

Iwase²,

Yokota³

et al. 1990

Am J Noninvas Cardiol

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The influence of left ventricular preload alterations on left ventricular diastolic filling was examined by performing M mode and pulsed Doppler echocardiography in 18 patients with chronic renal failure both before and after hemodialysis. Hemodialysis caused an average 3.2-liter volume loss, but blood pressure and heart rate did not change significantly. Hemodialysis diminished the left atrial dimension (35 ± 5 to 31 ± 5 mm; p < 0.001) and the left ventricular end-diastolic dimension (55 ± 6 to 50 ± 5 mm; p < 0.01), indicating that it reduced left ventricular preload. Although hemodialysis decreased both the peak velocity during rapid filling (R; 54 ± 10 to 36 ± 11 cm/s; p < 0.001) and the peak velocity during atrial contraction (A; 68 ± 9 to 58 ± 10 cm/s; p < 0.001), it increased the A/R ratio (1.29 ± 0.24 to 1.71 ± 0.41; p < 0.001) substantially. Reduction of uremic toxins and/or correction of electrolyte imbalances might be expected to improve both left ventricular relaxation and systolic function. However, following left ventricular preload reduction after hemodialysis, the Doppler-derived transmitral flow velocity profile mimicked previously reported patterns of impaired diastolic function. These results indicate that the atrial contribution to ventricular filling was more effective afterwards than before hemodialysis and that under depressed left ventricular diastolic function, the atrial contribution decreased as preload increased further. This decrease in the A/R ratio with an elevation of left ventricular preload could be termed ‘pseudonormalization’ of the transmitral flow velocity profile. To differentiate this ‘pseudonormalized’ profile from a truly normal one, left ventricular preload must be considered.

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Left ventricular diastolic function: Evaluation by radionuclide angiography

Cited by 21 publications

References 54 publications

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Regional Relaxation Abnormalities in Coronary Artery Disease

Influence of Left Ventricular Preload Reduction by Hemodialysis on the Doppler-Derived Left Ventricular Filling Profile

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