Search

Background: Early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (Ea) ratio has been proposed as the best Doppler predictor for evaluating left ventricular (LV) filling pressure., Purpose: To evaluate the relationship between a novel echocardiographic index, E/(EaxSa), and left ventricular end-diastolic pressure (LVEDP); Sa is the peak systolic mitral annular velocity. We measured this index at different sites of the mitral annulus and compared it with other Tissue Doppler parameters., Methods: Echocardiography was performed simultaneously with left heart catheterization in 110 consecutive patients in sinus rhythm. E, Sa, Ea and Aa (late mitral annular diastolic velocity) were determined at medial and lateral site, and average values obtained. E/Ea and E/(EaxSa) were calculated (medial, lateral, average). LVEDP was measured with invasively fluid-filled catheter., Results: We demonstrated significant correlations between LVEDP and E/(EaxSa)(lateral) (r=0.78, p<0.0001), E/Ea(average) (r=0.70, p<0.0001), E/Ea(lateral) (r=0.66, p<0.0001), E/Ea(medial) (r=0.60, p<0.0001) and E/(EaxSa)(medial) (r=0.60, p<0.0001). E/(EaxSa)(average) had the strongest correlation with LVEDP (r=0.80, p<0.0001). An E/(EaxSa)(average) cut-off of 1.6 had 86% sensitivity and 85% specificity for detecting LVEDP>15 mmHg. Weaker correlations were found for Sa, Ea and Aa. E/(EaxSa)(average) was the best parameter to assess LVEDP in patients with normal LV ejection fraction (LVEF>or=50%) (r=0.83, p<0.0001), depressed LVEF (r=0.76, p<0.0001), regional dysfunction (r=0.81, p<0.0001), or E/Ea(average) between 8 and 15 (r=0.67, p<0.0001)., Conclusions: E/(EaxSa)(average) was the best predictor of LVEDP in sinus rhythm patients, regardless of LVEF, particularly in those with E/Ea(average) between 8 and 15 and in those with regional dysfunction.

Unlabelled: N-terminal pro-brain natriuretic peptide (NTproBNP) correlates with left ventricular (LV) filling pressure. The ratio between early diastolic transmitral velocity and early mitral annular diastolic velocity (E/Ea) reflects LV filling pressure in a variety of cardiac diseases. However this relationship was not validated in some categories of patients. Our aim was to evaluate the correlation between tissue Doppler velocities of the mitral annulus and NTproBNP levels in sinus rhythm patients., Methods: Echocardiography was performed in 111 consecutive patients simultaneously with NTproBNP measurement. E/Ea and E/(Ea x Sa) were calculated (Sa is the maximal systolic velocity of mitral annulus); the average of the velocities of septal and lateral mitral annulus was used., Results: Simple regression analysis demonstrated a significant linear correlation between E/(Ea x Sa) and NTproBNP (r = 0.71, P < 0.0001), superior to E/Ea correlation (r = 0.58, P < 0.0001). Significant but weaker correlations were found between NTproBNP and Sa, pulmonary artery systolic pressure, Ea, mitral E/A (early/late diastolic transmitral velocity), E wave, mitral E deceleration time and LV ejection fraction (LVEF). The optimal E/(Ea x Sa) cut-off for prediction of NTproBNP levels > 900 pg/ml was 1.5 (sensitivity = 81%, specificity = 70%). Among analyzed parameters, E/(Ea x Sa) was best correlated with NTproBNP levels in patients with LVEF >or= 50% (r = 0.80, P < 0.0001), with depressed LVEF (<50%) (r = 0.66, P < 0.0001), with regional wall motion abnormalities (r = 0.75, P < 0.0001), and with E/Ea 8 to 15 (r = 0.58, P < 0.0001)., Conclusions: E/(Ea x Sa) strongly correlates with NTproBNP, regardless of LVEF, and can be a simple and accurate echocardiographic index in patients in sinus rhythm, particularly in those with regional wall motion abnormalities or intermediate E/Ea.

Objective of the Study: to evaluate the relation between global myocardial index (GMI) and the pattern of left ventricular (LV) volume curves variation, using automatic border detection (ABD), and their role in assessing LV asynchrony., Methods: We studied 52 patients (mean age = 55 +/- 17 years) with dilated cardiomyopathy. QRS duration (QRSd) and GMI were measured. Currently accepted TDI and M-mode parameters were used to indicate LV dyssynchrony. On-line continuous LV volume changes were recorded using ABD. Ejection time (ET ABD) was measured from the ABD wave-forms as time interval between maximal and minimal volume variation during LV electromechanical systole. We derived the ejection time index (ETiABD) as the ratio between ET ABD and RR interval (ETiABD = ET/RR)., Results: 31 patients had a QRSd > 120 ms and 21 patients had a QRSd < 120 ms. Ventricular dyssynchrony was observed in 39 patients (29 patients had a QRSd > 120 ms). GMI was significantly higher in patients with, than in patients without ventricular dyssynchrony (1.06 +/- 0.18 vs 0.73 +/- 0.13, P = 0.0001), while ETABD was significantly smaller (233 +/- 39 ms vs 321 +/- 28 ms, P = 0.0001). The corresponding difference for ETiABD was 26.9 +/- 6.8% vs 6.3 +/- 4%, P < 0.0001. By simple regression analysis an inverse linear correlation was observed between GMI and ETiABD (r(2) = -0.51, P < 0.0001). The pattern of ABD waveforms showed increased isovolumic contraction and relaxation times in patients with LV asynchrony, similar to the GMI pattern., Conclusions: Regional delays in ventricular activation cause uncoordinated and prolonged ventricular contractions, with lengthening of the isovolumic contraction and relaxation times and shortening of the time available for filling and ejection. GMI explores these parameters and together with ABD might be useful to identify patients with ventricular asynchrony.

Background: The electroanatomical substrate of dilated atria is characterised by increased non-uniform anisotropy and macroscopic slowing of conduction, which promote reentrant circuits., Aim: To analyse the relationship between electrophysiological properties of atria and echocardiographic markers of dilatation and increased filling pressure., Methods: The study group consisted of 79 patients without structural heart disease, aged 53+/-22 years, who were referred for electrophysiological study. In order to examine the atrial electrophysiological characteristics we studied interatrial conduction time (iaCT), double potentials and fragmented atrial activity during premature stimulation of the high right atrium (HRA). The analysed parameters included: duration of atrial activity, baseline iaCT (iaCTb) between HRA and distal coronary sinus (CS), iaCT during HRA pacing S1S1 600 ms (iaCTS1), maximum prolongation of iaCT during S2 and S3 delivery (iaCTS2, iaCTS3). We also calculated the decremental index (DI)=iaCT S3- iaCTS1/iaCTS1%. The following echocardiographic parameters were assessed: left atrial (LA) dimensions, surface (LAs), volume using ellipse formula (LAv), right surface (RAs), total atrial surface (TAs=LAs+RAs), and global myocardial index (GMI)., Results: Patients were divided into two groups. Group 1 consisted of 37 patients with evidence of slow atrial conduction (atrial fragmentation/iaCTb>80 ms/DI>50%/double atrial potentials), whereas group 2 was composed of 42 patients without slow conduction properties. There were no significant differences concerning age, body mass index or LA parasternal dimensions between the groups. Thirty-seven patients, of whom 32 were from group 1, had documented episodes of paroxysmal atrial fibrillation. GMI, LAs, LAv and TAs values were significantly higher in patients from group 1 than in group 2 subjects. A statistically significant linear correlation between iaCTb and TAs (r=0.52 p <0.0001)/LAv (r=0.38 p <0.0001) was found. There was also a trend toward a correlation between DI and TAs., Conclusion: This study supports the role of stretch and dilated atria in electrophysiological changes which occur in structurally normal hearts. The iaCT value may be indirectly and non-invasively evaluated using echocardiographic measurements.

Unlabelled: Prolongation of the interatrial conduction time (ia-CT) is considered an important factor in the pathophysiology of atrial fibrillation (AF) and as a criterion to perform multisite atrial pacing. Measurement of ia-CT requires an electrophysiologic study. The aim of this study was to compare echocardiographic with electrophysiologic measurements to determine if they are correlated., Methods and Results: The study included 32 consecutive patients who underwent electrophysiologic studies. We measured ia-CT between the high right atrium and the distal coronary sinus. In all patients we measured P wave duration, left atrial diameter and area, and ia-CT by Doppler echocardiography was measured as the difference in time intervals between the QRS onset and the tricuspid A wave, and the QRS onset and the mitral A wave (DT). Ia-CT was statistically correlated with DT (r = 0.79, P < 0.0001), but not with P wave duration or left atrial dimensions., Conclusions: Measurement DT may be reliable to estimate ia-CT without invasive procedure. Accordingly, DT could be used as a simple selection criterion when considering patients for atrial resynchronization therapy.