Measurement of left atrial systolic time intervals in hypertensive patients using Doppler echocardiography: Relation to fourth heart sound and left ventricular wall thickness

Abe, Hitoshi; Yokouchi, Masatoshi; Deguchi, Fujio; Saitoh, Fumio; Yoshimi, Hiroki; Arakaki, Yoshio; Nishizaki, Takashi; Kawano, Yuhei; Yoshida, Kaoru; Kuramochi, Morio; Ito, Keiichi; Omae, Teruo

doi:10.1016/0735-1097(88)90214-8

Cited by 19 publications

(12 citation statements)

References 17 publications

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“…The patients were in a partial left lateral decubitus position when they were examined, and special attention was taken to avoid misleading angulation of the left ventricular long axis in relation to the ultrasound beam. 26 All echocardiograms were taken by an experienced examiner and were read independently by two investigators. Left ventricular dimensions and wall thickness were measured using the leading edge technique, according to the recommendation of the American Society of Echocardiography.…”

Section: Measurementsmentioning

confidence: 99%

Acute depressor effect of alcohol in patients with essential hypertension.

et al. 1992

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To investigate the time course of the effects of alcohol on blood pressure, we studied the response of ambulatory blood pressure, neurohumoral variables, and hemodynamics to a single moderate dose of alcohol in hypertensive patients. Sixteen Japanese men (22-70 years old) with essential hypertension who were habitual drinkers were examined under standardized conditions. On the alcohol intake day, they ingested 1 ml/kg ethanol (vodka) at dinner, and on the control day they consumed a nonalcoholic beverage. The order of the two periods was randomized. Mean ambulatory blood pressure was lower in the alcohol intake period than in the control period (125±3/74±2 versus 132±4/78±2 mm Hg,p<0.05), and the significant depressor effect of alcohol lasted for up to 8 hours after drinking. Blood pressure on the next day did not differ with or without alcohol intake. The acute hypotensive effect of alcohol was associated with an increase in heart rate and cardiac output and with a decrease in systemic vascular resistance as determined by echocardiography. Plasma catecholamlne levels and renin activity rose significantly at 2 hours after dinner, whereas vasopressin and potassium levels fell on the alcohol day. Blood glucose and serum insulin levels were comparable between the two periods. Three patients with marked alcohol-induced flush had greater hypotensive and tachycardic responses than those who did not show an alcohol-induced flush. The change in mean blood pressure induced by alcohol was negatively correlated with age, the baseline blood pressure, and the change in plasma norepinephrine. These results indicate that the major effect of acute alcohol intake is to lower blood pressure through systemic vasodilatation in hypertensive subjects. Ambulatory blood pressure monitoring may be useful for assessing blood pressure in habitual drinkers. T he relation between alcohol and hypertension is well known. A positive association between the level of habitual alcohol intake and blood pressure has been shown in many reports, 1 " 5 and this relation has been observed in whites, blacks, and Asians. It has also been reported that abstinence from alcohol results in a decrease of blood pressure in drinkers. 6 -9 However, these observations depended on casual blood pressure measurements taken in the daytime, while most habitual drinkers consume alcohol in the evening and at night. Alcohol has an acute vasodilatory action, 1011 and it has been our experience that many hypertensive patients note a decrease in their blood pressure after alcohol ingestion at home. It has been recommended that the relation between the time of the last alcohol intake and that of blood pressure measurement should be considered, 2 but this has generally been ignored. Inconsistent results have been reported about

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Section: Measurementsmentioning

confidence: 99%

Acute depressor effect of alcohol in patients with essential hypertension.

et al. 1992

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“…Figure 3 shows that on average, patients with an S 4 had a leftward-and upward-shifted EDPVR curve, signifying that these patients had stiffer ventricles. Because the β-coefficient, but not the α-coefficient, correlated with the S 4 , it was important to show that the EDV 20 (the calculated EDV at an idealized EDP of 20 mmHg) was smaller in patients with an S 4 compared with those without an S 4 . This finding shows that when the α-and β-coefficients are examined together in the equation EDP = αEDV β , they combine to produce an EDPVR curve that is leftward and upward shifted in the S 4 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Specifically, we found that several diastolic stiffness parameters, including the EDP/SV and E/E'/SV ratios, and a leftward-and upward-shifted EDVPR curve, were all independently associated with the S 4 . By performing a comprehensive invasive-and non-invasive study of the S 4 , we were able to go beyond prior studies which were limited by studying only mitral inflow characteristics on echocardiography (4,5,18), or which included smaller numbers of patients (2,4,5).…”

Section: Discussionmentioning

confidence: 99%

“…Investigators have shown that the S 4 is associated with the A wave on left atrial pressure tracing (2), increased height and rate of rise of A wave on apexcardiography (3), decreased ratio of early to late mitral inflow velocity on Doppler echocardiography (4), and increased atrial filling fraction (5). Because the S 4 has been associated with conditions that cause left ventricular (LV) diastolic stiffness such as aortic stenosis, ischemia, and left ventricular hypertrophy (6,7), many believe that the S 4 is due to decreased compliance, although this has never been proven.…”

Section: Introductionmentioning

confidence: 99%

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Association of the Fourth Heart Sound With Increased Left Ventricular End-Diastolic Stiffness

Shah

Nakamura

Marcus

et al. 2008

Journal of Cardiac Failure

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Background-Although the fourth heart sound (S 4 ) is thought to be associated with a stiff left ventricle (LV), this association has never been proven. Recently, single-beat estimation of the enddiastolic pressure volume relationship (EDPVR) has been characterized (P = αV β ), allowing the estimation of EDPVR in larger groups of patients. We hypothesized that the S 4 is associated with an upward-and leftward-shifted EDPVR, indicative of elevated end-diastolic stiffness.

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“…Some investigators have applied left atrial wall motion, left atrial volume or systolic time interval by M-mode echocardiography. [11][12][13][14] Flow velocity at the left atrial appendage recorded by pulsed-Doppler using transesophageal echocardiography has emerged as a useful method. 15) Manning, et al 7) introduced LAEF, which is easily calculated from transthoracic echocardiography and can be compared among individuals over time.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Systolic Function Assessed by Left Atrial Ejection Force in Patients with Sick Sinus Syndrome and Paroxysmal Atrial Fibrillation

et al. 2000

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SUMMARYWe evaluated left atrial systolic function using left atrial ejection force (LAEF) in 19 patients with sick sinus syndrome (SSS) and in 20 with paroxysmal atrial fibrillation (Paf) whose ages ranged from 48 to 80 years. We also evaluated 35 normal individuals for comparison. The LAEF was calculated as 1 / 3 × mitral valve area × (peak velocity of A wave) 2 using two-dimensional and pulsed-Doppler echocardiography according to Newton's law of motion and hydrodynamics. In normal individuals, LAEF positively correlated with age (r = 0.82, p < 0.01). Normal LAEF was calculated as 0.098 × age -0.74 (kdynes) from the regression line. Because of this correlation, we used age-corrected LAEF (%LAEF) that was calculated as (measured LAEF / normal LAEF) × 100. The results showed that this value was 53 ± 26% in patients with SSS and 54 ± 26% in patients with Paf. Both were significantly lower than normal individuals (p < 0.001). Among SSS subtypes, %LAEF was lower in types II and III than in type I (51 ± 14%, 37 ± 19%, and 81 ± 35%, respectively). In conclusion, left atrial systolic function is depressed in patients with Paf and SSS, in particular, types II and III. These results suggest that the pathological abnormalities extend not only to the sinus node but also to the left atrial muscle in patients with SSS and Paf. (Jpn Heart J 2000; 41: 723-732)

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Measurement of left atrial systolic time intervals in hypertensive patients using Doppler echocardiography: Relation to fourth heart sound and left ventricular wall thickness

Cited by 19 publications

References 17 publications

Acute depressor effect of alcohol in patients with essential hypertension.

Acute depressor effect of alcohol in patients with essential hypertension.

Association of the Fourth Heart Sound With Increased Left Ventricular End-Diastolic Stiffness

Left Atrial Systolic Function Assessed by Left Atrial Ejection Force in Patients with Sick Sinus Syndrome and Paroxysmal Atrial Fibrillation

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