Reversal E/A Value at End‐Inspiration Might Be More Sensitive and Accurate for Diagnosing Abnormal Left Ventricular Diastolic Function

Yuan, Lijun; Cao, Tun; Zang, Yi-Min; Pei, Jianming; Duan, Yun-you; Gao, Feng

doi:10.1111/j.1540-8175.2007.00433.x

Cited by 9 publications

(10 citation statements)

References 16 publications

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“…This hypothesis may provide a new insight into the respiration-related hemodynamics and help for seeking methods for noninvasive quantification of the intracardiac pressure [27], [32].…”

Section: Discussionmentioning

confidence: 97%

Mechanism Study of Pulsus Paradoxus Using Mechanical Models

et al. 2013

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Pulsus paradoxus is an exaggeration of the normal inspiratory decrease in systolic blood pressure. Despite a century of attempts to explain this sign consensus is still lacking. To solve the controversy and reveal the exact mechanism, we reexamined the characteristic anatomic arrangement of the circulation system in the chest and designed these mechanical models based on related hydromechanic principles. Model 1 was designed to observe the primary influence of respiratory intrathoracic pressure change (RIPC) on systemic and pulmonary venous return systems (SVR and PVR) respectively. Model 2, as an equivalent mechanical model of septal swing, was to study the secondary influence of RIPC on the motion of the interventriclar septum (IVS), which might be the direct cause for pulsus paradoxus. Model 1 demonstrated that the simulated RIPC had different influence on the simulated SVR and PVR. It increased the volume of the simulated right ventricle (SRV) when the internal pressure was kept constant (8.16 cmH2O), while it had the opposite effect on PVR. Model 2 revealed the three major factors determining the respiratory displacement of IVS in normal and different pathophysiological conditions: the magnitude of RIPC, the pressure difference between the two ventricles and the intrapericardial pressure. Our models demonstrate that the different anatomical arrangement of the two venous return systems leads to a different effect of RIPC on right and left ventricles, and thus a pressure gradient across IVS that tends to shift IVS left- and rightwards. When the leftward displacement of IVS reaches a considerable amplitude in some pathologic condition such as cardiac tamponade, the pulsus paradoxus occurs.

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“…This hypothesis may provide a new insight into the respiration-related hemodynamics and help for seeking methods for noninvasive quantification of the intracardiac pressure [27], [32].…”

Section: Discussionmentioning

confidence: 97%

Mechanism Study of Pulsus Paradoxus Using Mechanical Models

et al. 2013

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“…Performing the Valsalva maneuver as a preload reduction method during Doppler echocardiographic evaluation may facilitate the detection of LVDD through unmasking in patients who appear normal [35]. In their study involving 51 patients with hypertension, Yuan et al [36] reported that they observed this characteristic phenomenon in 19.6% of the patients and stated that considering this phenomenon within the normal or abnormal group of pattern classification was controversial. They also suggested that because E/A <1 is usually thought to represent abnormal left ventricular filling and 1<E/A<2 with E/A<1 is thought to be pseudonormal left ventricular filling, the phenomenon of E/A<1 on inspiration E/A>1 on expiration appears to be in between the abnormal relaxation and pseudonormal patterns.…”

Section: Discussionmentioning

confidence: 99%

“…DT has been used as a measure of chamber stiffness [37]. Yuan et al [36] found that DT on expiration was significantly shortened compared to inspiration. Hsu et al [38] showed that DT did not exhibit significant variation with respiration in hypertensive patients.…”

Section: Discussionmentioning

confidence: 99%

Respiratory changes in the E/A wave pattern can be an early sign of diastolic dysfunction: An echocardiographic long-term follow-up study

et al. 2012

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SummaryBackgroundThe left ventricular filling pattern may show changes during respiration, which are generally used in the diagnosis of diastolic dysfunction. The clinical importance of the respiratory E/A wave pattern change has been investigated in a limited number of studies. The aim of the present study was to assess the diastolic function of hypertensive patients with respiratory changes in mitral flow over a long-term follow-up period.Material/MethodsOur study included 107 newly diagnosed and untreated hypertensive patients (49 males; mean age, 46±10 years) with respiratory changes during transthoracic echocardiography (TTE). In addition, the patient group was classified into 2 groups according to the change in E/A pattern by the Valsalva maneuver. After a mean follow-up period of 44±7 month, 90% of the hypertensive patients and the entire control group were re-examined.ResultsRelaxation abnormalities developed in 84% of the patients (58/80) in the Valsalva-positive group after the follow-up period. The frequency of relaxation abnormalities was 60% in the Valsalva-negative group and 3.1% in the control group (p<0.001). Based on multivariate regression analysis, the echocardiographic predictors of the development of relaxation impairment were mitral E velocity, A velocity, deceleration time, isovolumetric contraction time, E/E′ ratio, and the presence of respiratory change. The most important parameter for the development of an abnormal relaxation pattern was the presence of respiratory change after adjustment according to the changes with the Valsalva maneuver.ConclusionsRespiratory change in mitral flow can be evaluated as an early sign of diastolic dysfunction in patients with hypertension.

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“…There are small changes (<15%) in transmitral peak flow velocities that occur with spontaneous respiration. Valsalva maneuver was found to be effectively unloading the heart and unmask an impaired relaxation pattern and high filling pressures in patients with a baseline pseudonormal flow pattern (Yuan et al 2007).…”

Section: Valsalva Maneuvermentioning

confidence: 99%