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Over the past six decades, echocardiography has evolved into an important technique for not only imaging cardiac structures, but also, by employing the Doppler equation, for assessing cardiac blood flow and tissue velocities. This review focuses on pulsed Doppler echocardiography: its principles, early development, and clinical applications. Important clinical applications include: (1) measurement of flow velocities, stroke volumes, and regurgitant and shunt volumes; (2) assessment of time intervals, e.g., pulmonary artery acceleration time as a measure of pulmonary artery pressure and resistance or the timing of mitral regurgitation in hypertrophic cardiomyopathy; (3) detection of turbulent flow in regurgitation, stenoses, and shunts, enhanced by the implementation of color Doppler; and (4) evaluation of left ventricular diastolic function in conjunction with pulsed tissue Doppler and deformation (strain) measurements.

BackgroundPulmonary hypertension (PH) is one of the most important comorbidities in patients undergoing hemodialysis (HD). The goal of the present work is to determine the possible etiologic factors for its occurrence.MethodsThe prevalence of PH was estimated by Doppler echocardiography in a cohort of 100 patients aged 49.3±13.9years on regular HD. Mean pulmonary artery pressure was estimated from pulmonary acceleration time by Mahan’s regression equation. Pulmonary vascular resistance and pulmonary capillary wedge pressure were calculated. We focused on the effect of HD on left and right ventricle diastolic and systolic function. Right ventricle systolic function was assessed by tricuspid annular systolic excursion and pulsed Doppler myocardial performance index. Since impaired endothelial function was postulated as an underlying cause of PH, we studied the effects of HD on brachial artery endothelial function.ResultsThe current study found that pulmonary hypertension was prevalent in 70% of patients on dialysis. Left atrium diameter, left ventricle mass indexed to body surface area, and mitral E/E′ were increased in the dialysis group (4.4±0.2cm, 126.5±24.6g/m2, and 16.9±4.4, respectively, p

Hossein Karami,1 Hadi Darvishi-Khezri,2 Mehrnoush Kosaryan,1 Rosetta Akbarzadeh,2 Mojdeh Dabirian3 1Department of Pediatrics, Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran; 2Student Research Committee, Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran; 3Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran Introduction: Pulmonary arterial hypertension (PAH) is relatively prevalent in patients with thalassemia. PAH treatment is necessary as the prevalence of Doppler-estimated PAH and the resultant mortality is high in such patients. Materials and methods: This study aimed at evaluating the effect of bosentan therapy on patients with thalassemia suspected of PAH. Based on pulsed Doppler echocardiography, all the cases were suspected of severe PAH. Consequently, bosentan was initiated at a dose of 62.5 mg twice a day for 4 weeks, which was increased to 62.5–125 mg twice a day, if no adverse side effects were observed. Results: The results of this study showed that pulmonary artery pressure (PAP) decreased after the administration of bosentan in three cases, from 160 to 120, 110 to 65, and 60 to 25 mmHg; in other words, the PAP reduced in the mentioned cases by 25%, 36.4%, and 58.4%, respectively. Conclusion: In this study, PAP improved after bosentan therapy in patients with β-thalassemia suspected of PAH; however, further studies are required to confirm the findings. Keywords: β-thalassemia major, pulmonary arterial hypertension, pulsed Doppler echocardiography, bosentan, tricuspid regurgitation jet velocity, right ventricular pressure

Aims Transesophageal echocardiographic (TEE) findings of left atrial appendage (LAA) thrombus, spontaneous echo contrast (SEC), and LAA dysfunction are established risk factors of cardioembolic stroke. The semi-invasive nature of TEE limits its utility as a routine risk stratification tool. We aim to correlate TEE and transthoracic echocardiography (TTE) pulsed Doppler measurements of LAA flow velocities and use TTE measurements to predict TEE findings. Methods and Results We prospectively measured pulsed Doppler LAA flow velocities in 103 consecutive patients on TEE and TTE. There was a strong correlation between TEE and TTE LAA emptying velocity (LAA E) (r = .88, P

Cetin, Mustafa/0000-0001-6342-436X; Durakoglugil, Emre/0000-0001-5268-4262; Erdogan, Turan/0000-0003-2986-5457; duman, hakan/0000-0002-1441-7320 WOS: 000397578400002 PubMed: 28932490 Background: Prolonged QRS duration is associated with decreased left ventricular (LV) systolic function. However, the relation between LV restrictive filling pattern (RFP) and QRS duration has not been investigated yet. the purpose of our study was to assess this relationship. Methods: We analyzed standard 12-lead surface electrocardiogram (ECG) of 155 consecutive patients. Mitral inflow and septal tissue velocities were obtained using the apical 4-chamber view with pulsed Doppler echocardiography. Patients were divided into 2 groups according to measured deceleration time (DT): restrictive (with DT 130 ms). Results: QRS duration was significantly longer in the restrictive group than in the non-restrictive group (0.101 vs. 0.090 s, p < 0.0001). QRS duration of > 0.10 s was highly specific (82.6%), but modestly sensitive (64.7%), for the prediction of LV RFP. Multivariate analyses demonstrated that E/A ratio, peak E, peak A, septal e', and a' velocities were significantly associated with RFP. Conclusions: Prolonged QRS duration (>0.10 s) obtained from a standard resting 12-lead ECG is associated with LV RFP. However, the relationship of QRS duration with RFP was not independent of echocardiographic parameters.

Background and Objectives Irregular RR intervals in atrial fibrillation (AF) make beat-to-beat changes in left ventricular (LV) systolic performance. Early diastolic mitral annular velocity (E') is one of the well-established parameters for evaluating LV diastolic function. The relation between RR intervals and E's is unknown. The aim of this study was to observe the influence of continuous changes in RR interval on the parameter for diastolic function in AF. Subjects and Methods Echocardiography was performed in 117 patients with AF. E' was adjusted for the effect of pre-preceding RR interval (RR-2) using the logarithmic equation between RR-2 and E'. The logarithmic equation between adjusted E' and preceding RR interval (RR-1) was calculated. Results The slope in the relation between RR-1 and E' varied from -2.5 to 2.6. The slope was lower (more likely negative) in patients with higher ratio of early diastolic mitral flow velocity (E) to E' (r=-0.21, p=0.023), ischemic heart disease (IHD, r=0.21, p=0.026), and higher systolic blood pressure (r=-0.19, p=0.046). When patients were divided into these 3 groups on the basis of slope, the lowest slope group (0.57, n=39). The slope with regards to the relationship between RR-2 and E' also varied from -3.4 to 3.1. Conclusion Changes in RR intervals had variable effects on E's according to clinical variables in AF.

To determine reference values for tissue Doppler imaging (TDI) and pulsed Doppler echocardiography for left ventricular diastolic function analysis in a healthy Brazilian adult population. Observations were based on a randomly selected healthy population from the city of Vitoria, Espirito Santo, Brazil. Healthy volunteers (n = 275, 61.7% women) without prior histories of cardiovascular disease underwent transthoracic echocardiography. We analyzed 175 individuals by TDI and evaluated mitral annulus E′- and A′-waves from the septum (S) and lateral wall (L) to calculate E′/A′ ratios. Using pulsed Doppler echocardiography, we further analyzed the mitral E- and A-waves, E/A ratios, isovolumetric relaxation times (IRTs), and deceleration times (DTs) of 275 individuals. Pulsed Doppler mitral inflow mean values for men were as follows: E-wave: 71 ± 16 cm/sec, A-wave: 68 ± 15 cm/sec, IRT: 74.8 ± 9.2 ms, DT: 206 ± 32.3 ms, E/A ratio: 1.1 ± 0.3. Pulsed Doppler mitral inflow mean values for women were as follows: E-wave: 76 ± 17, A-wave: 69 ± 14 cm/sec, IRT: 71.2 ± 10.5 ms, DT: 197 ± 33.3 ms, E/A ratio: 1.1 ± 0.3. IRT and DT values were higher in men than in women (P = 0.04 and P = 0.007, respectively). TDI values in men were as follows: E′S: 11± 3 cm/sec, A′S: 13 ± 2 cm/sec, E′S/A′S: 0.89 ± 0.2, E′L: 14 ± 3 cm/sec, A′L: 14 ± 2 cm/sec, E′L/A′L: 1.1± 0.4. E-wave/ E′S ratio: 6.9 ± 2.2; E-wave / E′L ratio: 4.9 ± 1.7. In this study, we determined pulsed Doppler and TDI derived parameters for left ventricular diastolic function in a large sample of healthy Brazilian adults. (Echocardiography 2010;27:777-782)

Purpose: To predict the optimal atrioventricular (AV) delay using the phonocardiogram (PCG). Methods: We studied 12 recipients of cardiac resynchronization therapy (CRT) system and eight recipients of dual-chamber pacemakers implanted for AV block with normal left ventricular (LV) function. The amplitude of the first heart sound (S1) was recorded by PCG and the LV outflow tract (OT) time-velocity integral (TVI) was measured by pulsed Doppler echocardiography. The AV delay was prolonged in 20-ms increments, from 60 ms to 240 ms. Ishikawa's method was used for the echocardiographic optimization of the AV delay. The relation between S1 amplitude and the AV delay was analyzed. Results: The correlation between the amplitude of S1 and the length of AV delay showed an S-shaped curve. The AV delay at the inflection point of each patient's S-shaped curve (161.2 ± 19.5 ms) was positively correlated with the optimal AV delay determined by echocardiography (148.3 ± 16.9 ms, r = 0.83, P < 0.001). In addition, there was a positive correlation between the AV delay at the maximal TVI of LVOT (150.8 ± 22.7 ms) and the AV delay at the inflection point of the S-shaped curve (159.5 ± 24.9 ms, r = 0.87, P < 0.001). In two CRT system recipients, an optimal AV delay could not be found by echocardiography; however, an optimal AV delay could be determined by PCG. Conclusions: A high correlation was observed between the optimal AV delay determined by phonocardiography versus echocardiography.

The echocardiogram is the preferred procedure in confirming the diagnosis and characterizing PDA. Doppler echocardiography proved more efficient than clinical examination in grading PDA and becomes essential in the evaluation of clinically significant ductal shunting. Four patterns of PDA shunt can be identified using pulsed Doppler echocardiography: pulmonary hypertension, growing pattern, pulsatile pattern, closing pattern. In this review we confirm that echocardiography can provide a reasonable as well as accurate prediction of the development of later clinically significant PDA by a combination of variables that are easy to measure and compare.

Objective: To determine whether the systolic fraction (SF) of the pulmonary venous flow (PVF), measured by transesophageal echocardiography (TEE) could be used to estimate the pulmonary artery occlusion pressure (PAOP). Design: Prospective clinical investigation. Patients: Nineteen intubated patients with ARDS. Interventions: Doppler examinations with measurement of the SF of the PVF (ie, the systolic velocity-time integral expressed as a fraction of the sum of systolic and early diastolic velocity-time integrals) were performed simultaneously with measurements of PAOP via a right heart catheter at 0 cmH2O PEEP (ZEEP), at PEEP = 8 cmH20 and at PEEP = 16 cmH2O. Measurements and Main Results: At ZEEP, PAOP was inversely correlated with the SF of the PVF (r = −.89). The difference of SF between the group with PAOP

Coronary artery stenosis is seen in 10-45% of patients with Takayasu's arteritis (TA) and coronary ostia are most frequently involved. It may cause angina pectoris and sudden death during the early course of the disease. We describe a 14-year-old girl who first presented with exertional angina and syncope and was diagnosed as having left coronary artery ostial stenosis from TA by using transthoracic echocardiography. This is the first report showing the important role of color flow and pulsed Doppler echocardiography to detect coronary artery stenosis caused by TA.

The study investigated the temporal relationship between left ventricular (LV) relaxation and filling during early diastole. The transmitral flow (TMF) velocity by pulsed Doppler echocardiography and LV wall motion velocity by pulsed tissue Doppler imaging (TDI) were evaluated in 57 patients with various heart diseases and 33 normal controls. The patients were classified into 2 groups according to the ratio of the peak early diastolic to atrial systolic TMF velocity (E/A): (1) the high A group included 44 patients with an E/A ≤ 1, and (2) the pseudonormalization group included 13 patients with an E/A > 1. The isovolumic relaxation time (IRT) from the aortic component of the second heart sound (IIA) to the onset of the E wave of the TMF was measured. The peak early diastolic velocity of the LV posterior wall (Ew) and time from the IIA to the onset of the early diastolic wave (IIA-Ewo) were determined from the LV wall motion velocity assessed by pulsed TDI. The Ew was lower in the pseudonormalization and high A groups than in the control group. The IIA-Ewo was significantly longer in the pseudonormalization and high A groups than in the control group. The time constant of the LV pressure decay at isovolumic diastole (tau) correlated negatively with the Ew, and correlated positively with the IIA-Ewo in all groups. The IIA-Ewo was equal to or shorter than the IRT in control subjects, and was longer than the IRT in patients in the pseudonormalization group. In conclusion, the temporal relationship between LV relaxation and filling during early diastole varied according to the subjects' hemodynamic status. Analysis of TMF by pulsed Doppler echocardiography and LV wall motion velocity by pulsed TDI was useful for detailed evaluation of early diastolic LV hemodynamics. (Jpn Circ J 1999; 63: 209 - 215)

The use of transesophageal pulsed Doppler echocardiography provides an ideal approach for determining both pulmonary venous flow and transmitral flow. This approach thus provides information about the flow of blood into and out of the left atrium. We designed a new method for separately evaluating left atrial functions on the basis of the time-velocity integrals of pulmonary venous flow and transmitral flow using transesophageal pulsed Doppler echocardiography, assuming that the cross-sectional areas of the mitral ring during the left ventricular diastolic phase and of the four pulmonary venous orifices throughout a cardiac cycle were constant and that the blood flows of the four pulmonary veins exhibited identical velocity profiles. Good correlation was observed between the indices of left atrial function (i.e. left atrial reservoir, conduit and forward contractile volume) using this new method of analysis of Doppler echocardiographic data and those of a conventional method using contrast angiography. In conclusion, transesophageal pulsed Doppler echocardiography provided satisfactory information about left atrial function, and our new method may be one of the most practical techniques for estimating individual left atrial functions.

We evaluated right ventricular (RV) diastolic performance in 12 healthy subjects (control), 25 patients with chronic pulmonary diseases (CPD) and 6 patients with chronic pulmonary thromboembolism (PTE). Flow velocity patterns were determined by the pulsed Doppler technique. The values determined included acceleration time (AT), deceleration time (DT), and the ratio of the atrial contraction wave (A) to the rapid filling wave (R) (A/R ratio) from flow velocity patterns in the RV inflow tract. DT was significantly prolonged in the CPD and PTE groups compared with the control group, indicating dysfunction during the early (middle) filling period. The prolongation was marked in those patients with pulmonary hypertension. The A/R ratio was significantly higher in the CPD and PTE groups than in the control group, indicating a decrease in RV compliance. The A/R ratio increased slightly with the increase in the end-diastolic volume index. These results suggested that the pressure overload plays an important role in RV diastolic dysfunction in patients with pulmonary disease, and that preload contributes to the dysfunction.

Introduction: Previous reports have suggested that the use of continuous-wave Doppler for nonimaging heart rate monitoring or in utero Doppler imaging increased fetal activity. In this study, 11 fetuses (EGA 20–28 weeks) underwent a cardiac 2-D ultrasound and pulsed Doppler examination (since pulsed Doppler is more often used for fetal cardiac diagnosis) with 2-D and Doppler performed in a randomized order and with 10-minute ultrasound observation periods with as little transducer movement as possible before, during, and after 2-D only, and Doppler evaluation. Methods: All studies were performed with informed consent at the lowest available Doppler power < 90 mW/cm2 spatial peak temporal average. Fetal heart rate, the number of fetal gross movements / min, and the percent time occupied by fetal movements were evaluated by two blinded observers from video taped records. Patients had been referred to rule out fetal heart disorders but all echoes showed normal cardiac anatomy. Results: Fetal heart rate after pulsed Doppler study was statistically higher by analysis of variance (mean 127 beats/min) than in the pre-Doppler evaluation period (mean 120) and was highest during the Doppler exam period (mean 136; P < 0.05) in 10 of 11 fetuses. The percent time of fetal movements was highest during the Doppler exam period and in 9 of 11 fetuses movement increased. The raw number of gross movements / min, however, was highest after the Doppler. No such changes occurred during or after 2-D alone. Conclusion: Whether associated with slightly higher energy output, minimal thermal changes, or audible switching or electronic output sounds transmitted from the instrumentation through the uterus, fetal heart rate and activity increased in our study both during and after pulsed Doppler examination.

Ten patients with severe aortic regurgitation (AR) and early diastolic mitral closure demonstrated by M-mode echocardiography (group I) were compared to 10 age-matched patients with severe AR and normal timing of mitral closure to quantify the accompanying alterations in transmitral flow dynamics assessed by pulsed Doppler echocardiography. Transmitral filling period expressed as a fraction of the time available for diastolic filling was significantly shortened in group I patients relative to group II patients (0.50 +/- 0.10 vs 1.04 +/- 0.09, p0.001) because early mitral closure truncated transmitral filling and obliterated the atrial contribution to left ventricular filling. The rapid diastolic filling period normalized for the time available for diastolic filling was also shortened for group I patients relative to group II patients (0.49 +/- 0.11 vs 0.64 +/- 0.19; p0.05). Early mitral closure in group I patients was functionally incomplete because 9 of the 10 patients had diastolic mitral regurgitation, which was not detected in any patients in group II (p0.001). Thus the group I patients with early mitral closure and severe aortic regurgitation had truncated transmitral inflow and diastolic mitral regurgitation. These patients had higher pulmonary capillary wedge pressures (32 +/- 6 vs 11 +/- 9 mm Hg; p0.001) and more severe functional limitation (p0.001) than group II patients.

We describe the echocardiographic findings of extrinsic compression of the left atrium by a large aneurysm of the descending aorta. Pulsed Doppler echocardiography demonstrated increased velocity at the junction of left atrium and pulmonary vein suggesting obstruction of left atrial filling.

In 31 patients who had undergone cardiac orthotopic transplantation, valvular regurgitation was studied by echocardiographic and pulsed Doppler over 2 years. The first week after cardiac transplantation, transplant recipients had an increase in the severity of tricuspid, mitral (group II), and aortic regurgitation, as well as a greater number of simultaneously regurgitating valves when compared with those in a group of 60 normal subjects of similar age to heart donors: transplant recipients, trivalvular regurgitation 48% (95% confidence interval [CI] 30 to 66) vs control group, 5% (CI 1 to 13; p0.001). Moderate-severe tricuspid regurgitation (TR) was the most frequent occurrence (55%, CI 36 to 73) followed by pulmonary (PR) (42%, CI 25 to 61), moderate mitral (MR) (32%, CI 15 to 51), and mild aortic (AR) (23%, CI 10 to 43) regurgitation. These regurgitations were asymptomatic at rest except for TR. TR was associated with right-sided heart failure in 76% of patients in the early postoperative period and controlled with diuretic drugs. This regurgitation correlated with persistence of post-transplant pulmonary hypertension (r = 0.6) and was not related to pulmonary hypertension before cardiac transplant. There was also no relation found between donor ischemia time or episodes of cardiac rejection.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac output (CO) measurements by the three methods of dye dilution, pulsed Doppler echocardiography and thermodilution in horses under anesthetized conditions were compared. Although CO determined by the thermodilution method was slightly higher than those obtained by the other two methods, the measurements by all methods showed almost similar results. The coefficients of correlation between the dye dilution and thermodilution methods, the dye dilution and pulsed Doppler echocardiography methods, and the thermodilution and pulsed Doppler echocardiography methods were 0.87, 0.89, and 0.88, respectively (P

This paper presents a comparison study between two non invasive approaches for the estimation of Pulmonary Artery Pressure (PAP). The first method relies on the Pulsed Doppler echocardiography which has been used in this case for the measurement of maximum tricuspid transvalvular pressure gradient. The second method is based on the elaboration of heart acoustic sounds and particularly of the second heart sound. In the present works results relevant to the first experimental campaign are reported and relevant to PAP measurements on 40 athletes of different kinds of sport. Results show encouraging matching between two methods.

Objectives To examine if the fetal main pulmonary artery diastolic forward flows (MPADFs) are detected consistently, if the waves from fetal MPADFs coincide with those from atrial contractions, and the reproducibility of the cardiac cycle measurements using this technique. Methods Two examiners performed a fetal pulsed Doppler echocardiography of the four chamber (4CV), ductal arch (DA) and short axis (SA) views on 44 women with singleton pregnancies. Time intervals between atrial contraction peaks and those between MPADF peaks were compared. Atrioventricular (AV) and ventriculoatrial (VA) intervals were measured from MPADF waves in DA and SA views and compared between observers. Intraclass correlation coefficients (ICCs) were calculated as a measure of inter-observer reproducibility. Results In all observations, MPADFs were demonstrated. The mean time intervals between atrial contraction peaks from 4CV and those between MPADF peaks from DA and SA views were not significantly different. The mean AV and VA intervals were not significantly different between observers. Comparison of measurements of two observers had substantial agreements. Conclusions Our data show that MPADFs can be found consistently and coincide with atrial contractions. As cardiac cycle measurements can be done with considerable reproducibility, this technique may be useful in assessing fetal cardiac cycle.

Objective: In clinical practice, measurement of mechanical PR interval (mPR) with pulsed Doppler echocardiography is a standard method used to estimate the atrioventricular conduction time in the fetus. However, fetal echocardiography does not directly reflect the electrical properties of the heart. Technological advances in fetal magnetocardiography (fMCG) have allowed recording of the electrical PR interval (ePR) with high time resolution. The aim of this study was to clarify the differences between ePR and mPR. Methods: The study subjects were 295 normal human fetuses (gestational age, range 20.4–41.4 weeks) who underwent fMCG, and 135 of them underwent fetal echocardiography 15–90 min before or after fMCG. The ePR was measured using the fMCG, and the mPR was determined by two pulsed Doppler methods, simultaneous recording of the left ventricular inward and outward flow (LV in/out) (n = 135) and superior vena cava and ascending aorta (SVC/aAo) (n = 84). Results: The ePR showed a significant, but weak, positive correlation with gestational age (r = 0.162, p = 0.0053). The mPR was significantly longer than the ePR (p < 0.0001), with mean differences of 14.6% (95% limits of agreement –10.7, 39.9) for the LV in/out method and 14.7% (95% limits of agreement –8.6, 38.0) for the SVC/aAo method. Conclusion: Our results point to the risk of overestimation of the atrioventricular conduction time when the mPR is used, and the need for careful interpretation of PR prolongation determined by mPR.

This study assessed the flow velocity profiles of the left anterior descending coronary artery (LAD) in 7 patients with nonobstructive hypertrophic cardiomyopathy (HC) and in 6 normal subjects by transesophageal pulsed Doppler echocardiography, and evaluated their characteristics and the hemodynamic determinants. Systolic peak flow velocity of the LAD (7 +/- 30 cm/sec) was significantly lower in patients with HC than in normal subjects (34 +/- 11 cm/s, p0.05), and there was a significant inverse correlation between systolic peak flow velocity and the thickness of the ventricular septum (r = 0.81, p0.01). In 2 cases of HC with ventricular septal thickness of20 mm, a remarkable systolic reverse flow was observed in the LAD. However, there was no significant difference in diastolic peak flow velocity between HC and normal subjects. During early diastole, the acceleration time of LAD flow velocity was significantly prolonged (210 +/- 67 vs 95 +/- 15 ms, p0.01) and the acceleration rate was significantly decreased (3.6 +/- 2.0 vs 6.6 +/- 1.8 m/s2, p0.02) in patients with HC. The time constant of the left ventricular pressure decay was significantly prolonged in patients with HC (55 +/- 6 ms) compared with normal subjects (39 +/- 2 ms, p0.001). In HC, increased intramural perivascular pressure of the thickened ventricular septum during systole may be attributed to systolic LAD flow pattern. However, the early and mid-diastolic LAD flow pattern may be affected by impaired left ventricular relaxation.

This study aimed to assess the left ventricular diastolic function of borderline hypertensive patients (BHT) and to determine the effect of long-term blood pressure control by an angiotensin converting enzyme inhibitor on the left ventricular filling profile. Pulsed Doppler echocardiograms were obtained from 18 BHT (14 men, 4 women; mean age: 55 years) and 20 age-sex matched normotensive controls. Studies were done at rest and immediately after exercise on a supine ergometer bicycle. Of the 18 patients, 11 were treated with delapril (30 mg/day) and followed up with longitudinal studies for 24 weeks. At baseline, BHT had a normal left ventricular structure. They showed a decreased peak velocity of early filling (E) (43 +/- 7 v 56 +/- 13 cm/sec, P < .01) and E/A ratio (0.83 +/- 0.2 v 1.08 +/- 0.3, P < .01), whereas peak velocity of late filling (A) and deceleration time (Dec T) were similar in the two groups. Exercise-enhanced filling indices were observed in both groups. Following blood pressure control, no change was observed in the left ventricular morphology. In contrast, progressive improvement of resting and after exercise peak velocity of early filling and E/A ratio were achieved. This indicates that long-term angiotensin converting enzyme inhibition ameliorates cardiac function in borderline hypertension.

The pulmonary artery blood flow was determined in 40 dogs by pulsed Doppler echocardiography as a non-invasive means for estimating pulmonary artery pressure. Most of these dogs had become infected with heartworm disease which has been known to often cause pulmonary artery hypertension. From the flow velocity profile, four parameters, i.e., the Doppler tracing pattern, right ventricular ejection acceleration time (AT), and the ratios of AT to heart rate (AT/HR) and right ventricular ejection time (AT/ET), were obtained and their correlations with the pulmonary artery pressure determined invasively were investigated. Although the morphological pattern of flow velocity hardly allowed quantitative estimation of the pulmonary artery pressure, a relatively good negative correlation (P < 0.01) was obtained between the systolic pulmonary artery pressure and AT (r = 0.71), AT/HR (r = -0.67) or AT/ET (r = -0.84). The present results indicate that pulsed Doppler echocardiography is applicable to the estimation of pulmonary artery pressure and that AT/ET has the closest correlation with directly measured pulmonary artery pressure.

We have previously shown that the systolic and diastolic pulmonary venous flow (PVF) distribution is predictive of left atrial pressure. This study was designed to define the confounding influences of left atrial expansion, descent of the mitral anulus, and left ventricular contractile function on that relationship; to define normal PVF patterns; and to document the interaction of PVF with mitral inflow. Therefore we studied 27 consecutive intraoperative patients with coronary artery disease (22 men and 5 women, ages 35 to 78 years) using transesophageal echocardiography. A group of 12 normal subjects served as a control. Doppler and two-dimensional echocardiographic parameters were obtained simultaneously with monitoring pulmonary capillary wedge pressure (PCWP). We found that neither left atrial expansion nor the descent of the mitral anulus influenced the relationship between PVF and PCWP, but that left ventricular fractional shortening confounded this relationship. In normal subjects PVF was dominant in systole, whereas PVF in patients with elevated PCWP was dominant in diastole (systolic fraction of 68 +/- 6% [SD] in normals versus 42 +/- 15% in patients with PCWP greater than or equal to 15 mm Hg). PVF velocities interacted with transmitral flow velocities. Peak early diastolic mitral inflow velocities increased linearly with peak early diastolic PVF velocities (r = 0.62). We conclude that systolic and diastolic PVF distribution is mainly determined by the level of PCWP and to a lesser extent by left ventricular contraction, but not by left atrial expansion or by mitral anulus descent. Transesophageal pulsed Doppler echocardiography of PVF provides useful clinical information about the level of PCWP in intraoperative patients with coronary artery disease.

Two cases of patients with quadricuspid aortic valve diagnosed by Doppler echocardiography are presented. Aortic regurgitation was detected by pulsed Doppler echocardiography in both patients. Because they were young patients, this aortic regurgitation indicated that aortic regurgitation is not necessarily a late-developing event, as has been thought previously.

慢性血液透析患者の心不全の成因として, 収縮不全のみならず, 心室壁の肥厚や心筋間質の線維化による左室コンプライアンスの低下など, 種々の要因に基づく拡張不全も関与する可能性がある. そこで慢性血液透析患者の左室流入動態を超音波パルス・ドップラー法を用いて解析し, さらに前負荷の左室流入動態に及ぼす影響について, 右室駆出率/心拍出量測定装置 (REF-1) を用いて検討した.慢性血液透析患者 (HD群) 13例 (男5例, 女8例, 年齢55±9歳) および健康成人 (control群) 6例を対象とし, 超音波パルス・ドップラー法を施行し, 左室流入パターンを急速流入最大速度 (R), 心房収縮流入最大速度 (A), A/R比などを指標として検討した. なおHD群では血液透析前後でも同様の検査を行い比較検討し, うち5例にREF-1を用い透析中の血行動態を測定した. Control群に比しHD群ではA/R比の上昇 (0.90±0.09 vs 1.21±0.30, p

Pericardial effect on left ventricular early filling was studied in six dogs by use of pulsed Doppler echocardiography. Rapid dextran infusion was used to manipulate left atrial pressure. Left ventricular peak early filling velocities before and after pericardiectomy were measured at different levels of left atrial pressure with right atrial and left ventricular pressures. Peak early filling velocity correlated with mean left atrial pressure before and after pericardiectomy. Before pericardiectomy, when mean right atrial pressure exceeded 12 mm Hg, further increase of the velocity was not observed in spite of volume loading. After pericardiectomy, peak early filling velocity became higher and the slope of the relation line between mean left atrial pressure and the velocity became steeper than before pericardiectomy. When the filling pressure was denoted by the transmural mean left atrial pressure, the points on the relation line before pericardiectomy fell along the relation line after pericardiectomy. We conclude the pericardium exerts an external constraint on left ventricular early filling. Therefore we should not consider the absolute but the transmural filling pressure when estimating left ventricular early diastolic function with use of Doppler-derived left ventricular early filling velocity.

Abnormalities in left ventricular diastolic function or filling are considered to be responsible for some of the symptoms in patients with hypertrophic cardiomyopathy. To clarify whether the abnormalities in left ventricular diastolic filling are improved by septal myectomy, 13 patients with hypertrophic cardiomyopathy and intracavitary pressure gradient were studied preoperatively and postoperatively by use of pulsed Doppler echocardiography. Peak early diastolic filling velocity (E), the ratio of peak early diastolic filling to peak atrial filling velocities (E/A ratio), and deceleration time were measured from the transmitral flow velocity pattern before and after septal myectomy. Although E and E/A ratio did not change after septal myectomy, deceleration time significantly shortened from 314 +/- 72 to 271 +/- 53 milliseconds (n = 10; p less than 0.05). Further, if seven patients with significant changes in heart rate (greater than 30%) or in the Doppler-determined severity of mitral regurgitation (more than one degree) were excluded (because these parameters may effect E and E/A ratio), there were also significant changes in E (81 +/- 21 versus 98 +/- 25 cm/sec, p less than 0.05) and in E/A ratio (0.84 +/- 0.17 versus 1.14 +/- 0.33, p less than 0.05). Because left ventricular systolic function has been demonstrated to remain constant or to decrease by most measures after septal myectomy, relief of some symptoms may be largely the result of the improvement in diastolic filling suggested by these criteria.

Objective—To investigate the relationship between the myocardial performance index (MPI) determined by use of pulsed Doppler (PD) echocardiography and tissue Doppler imaging (TDI) in the response to volume overload–related changes in left ventricle (LV) performance. Animals—7 male Beagles. Procedures—Dogs were anesthetized and intubated. A 6-F fluid-filled catheter was placed in the LV to measure LV peak systolic (LVPs) and LV end-diastolic (LVED) pressures. Preload was increased by IV infusion of lactated Ringer's solution (rate of 200 mL/kg/h for 60 minutes) into a cephalic vein. Transmitral flow velocities and aortic outflow were measured, and TDI velocities were obtained from the 4-chamber view. Results—Acute volume overload induced a significant increase in heart rate, LVPs pressure, and LVED pressure, compared with baseline values. A significant decrease in the PD-MPI and TDI-MPI values and a significant correlation (r = 0.70) between PD-MPI and TDI-MPI were detected. The PD-derived A-wave velocity, ejection time, and isovolumic relaxation time (IRT) and the TDI-derived IRT, MPI, and ratio of the velocity of the E wave to the velocity of the ventricular portion of the E wave during early diastole had equal ability to predict LVED pressure (r2 = 0.63). Conclusions and Clinical Relevance—The TDI-MPI was closely correlated with LV filling pressure and may be helpful in evaluating global cardiac function in dogs.

Purpose. We studied the relationship between minute distance calculated from pulmonary venous flow (PVF) velocity tracing and cardiac output (CO)measured with thermodilution method in patients undergoing cardiovascular surgery. Methods. In 32 patients undergoing cardiovascular surgery, simultaneous measurements of hemodynamics including CO and transesophageal pulsed Doppler signals of PVF velocity were performed before and after surgical repair. Minute distance was calculated as the product of the heart rate and the sum of time-velocity integrals of PVF. Results. The minute distance after surgical intervention increased from 1121 ± 347 cm・sec-1to 1764 ± 538 cm・sec-1 (plt0.001 mean ± SD), while CO increased after surgical intervention from3.5 ± 0.9 L・min-1 to 5.3 ± 1.1 L・min-1. Simple linear regression analysis showed that minute distance was related with CO before and after surgical intervention (r=0.81 and r=0.76, respectively). The changes in minute distance were also related with those in CO (r=0.80). Conclusion. The present study demonstrated that minute distance obtained from the pulsed Doppler tracings of PVF velocity was related with CO during cardiovascular surgery in adults. These results suggest that the changes in CO could be estimated from minute distance in pulmonary vein.

In this paper we examine the pattern of left ventricular filling dynamics in normal subjects and cardiac patients studied by pulsed Doppler interrogation of the left ventricular inflow tract and pulmonary veins.Four patterns are identified, (1 )normal, (2)"abnormal relaxation", (3)"normalized" and (4)restrictive. The hemodynamics significance of these different patterns are discussed and the major role of ].eft atrial driving pressure in characterizing left ventricular filling dynamics is underlined. It is stressed that despite some overlap of Doppler parameters in different conditions the pathophysiological analysis of left ventricular filling can give us a rational understanding of the various flow patterns and useful

Objective: Alterations in thyroid status may lead to changes in both systolic and diastolic function of the heart. Pulsed Doppler echocardiography is a reliable non-invasive means of assessing left-ventricular (LV) diastolic function. The aim of the present study was to evaluate LV diastolic function in patients with primary hypothyroidism receiving thyroxine therapy. Methods: Twelve patients (all females, mean age 47 ± 17, range 16–69 years) with primary hypothyroidism were studied by pulsed Doppler echocardiography. The first examination was made before the start of thyroxine substitution and the second at 37–68 (mean 53 ± 10) days after commencing thyroxine treatment (mean dose 136 ± 22 µg/day). Results: During thyroxine substitution therapy, the hypothyroid patients became clinically euthyroid and serum T4 increased from 51 ± 21 to 119 ± 24 nmol/l; TSH decreased from 50.4 ± 55.3 to 1.2 ± 1.5 mU/l. During therapy, heart rate increased from 61 ± 8 to 68 ± 10 (p = 0.05). The LV posterior wall (7.8 ± 1.0 mm) and interventricular septum thickness (8.0 ± 1.4 mm) were significantly greater in hypothyroid patients than in the control subjects (6.4 ± 1.0 mm, p = 0.007 and 6.8 ± 1.0 mm, p = 0.04, respectively). There was no significant change in LV dimensions and wall thickness during follow-up. E/Amax increased significantly during treatment (from 1.679 ± 0.432 to 1.947 ± 0.335, p = 0.006). The isovolumic relaxation time shortened significantly (from 88 ± 23 ms to 75 ± 24 ms, p = 0.005). Conclusions: The present study shows that LV diastolic function as assessed by pulsed Doppler echocardiography in hypothyroid patients is enhanced by thyroxine therapy during a rather short follow-up period.

We examined whether pulmonary arterial pressure can be estimated on the basis of pulmonary arterial flow velocity determined via intraoperative pulsed Doppler transesophageal echocardiography (TEE) in 20 patients undergoing cardiac surgery. Standard pulmonary artery measurements were taken as well. Measurements were taken before sternotomy, after pericardiotomy, after cardiopulmonary bypass, and after sternum closure. The variables obtained by TEE included preejection period (PEP), acceleration time (AT), right ventricular ejection time (RVET), and R-R interval (RR). Five ratios were calculated as indices of pulmonary arterial pressure--PEP/AT, PEP/RVET, AT/RVET, PEP/ square root of RR, and AT/ square root of RR--and were compared with pulmonary artery catheterization findings, i.e., systolic pulmonary arterial pressure (sPAP), log sPAP, mean PAP (mPAP), and log mPAP. Before sternotomy, PEP/AT, PEP/ square root of RR, and AT/ square root of RR showed significant correlation with all pulmonary artery catheterization values. AT/RVET showed correlation with all pulmonary artery values except log mPAP. PEP/AT showed the closest correlation with sPAP (r = 0.771) and log sPAP (r = 0.789). PEP/AT also showed close correlation with mPAP (r = 0.764) and log mPAP (r = 0.777). Significant agreement between sPAP and mPAP values calculated from a regression equation and values measured via pulmonary artery catheter was observed by plotting the differences against the mean values of the two measurements. We therefore conclude that noninvasive estimation of pulmonary arterial pressure is feasible via intraoperative TEE when sternotomy is not involved.

We compared acoustic quantification (AQ) to Doppler echocardiography (DE) in the evaluation of left ventricular (LV) diastolic filling in 41 hypertensives and 42 controls. In hypertensives, DE showed reduced ratios of early to late diastolic velocity, AQ revealed reduced peak to late filling rate ratios, and both techniques found prolonged acceleration times indicating abnormal filling. In 22 patients with mild hypertension and less LV hypertrophy, however, all DE filling parameters were normal. In these patients AQ indicated prolonged acceleration times and early filling times. In conclusion, AQ is useful for the identification of abnormal LV filling in arterial hypertension and might be superior to DE in detection of early diastolic dysfunction.

To define the change in plasma natriuretic peptides in newborns, we prospectively studied 10 premature infants. They were followed sequentially during the first week of extrauterine life by two-dimensional and pulsed Doppler echocardiography, and studied for atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). We estimated mean pulmonary arterial pressure (MPAP) and measured blood pressure on days 1, 2, 3, 5, 7, respectively. Plasma ANP levels were 81.7 +/- 11.4 pg/ml on day 1 and 67.9 +/- 6.0 pg/ml on day 7, respectively. Between day 2 and day 7, there was a fall in MPAP, i.e. from 37 +/- 4 mmHg to 22 +/- 2 mmHg (P0.01), which was associated with a significant decrease in plasma BNP (41.8 +/- 10.1 pg/ml on day 2 vs. 10.4 +/- 0.9 pg/ml on day 7, P0.01). There was a positive correlation between MPAP and plasma BNP level (r = 0.643, P0.0001), but there was no correlation between MPAP and plasma ANP level. These data suggest that the pattern of secretion of BNP is different from that of ANP and that BNP levels reflect the changes of pulmonary arterial pressure in the neonatal period in premature infants.

Pulsed Doppler echocardiographic indices of mitral valve filling were measured in 20 healthy children, between 3 and 125 years old, in order to evaluate the effects of spontaneous respiration on left ventricular diastolic filling patterns. There were significant respiratory variations in four parameters of left ventricular diastolic function: The peak early filling velocity, the ratio of early to late peak filling velocity, and the ratio of early to late diastolic velocity-time integral decreased significantly during inspiration (mean decrease 7%, P

Although left ventricular (LV) inflow and pulmonary venous (PV) flow variables estimated by transesophageal Doppler echocardiography (TEE) reflect pulmonary capillary wedge pressure (PCWP), they are also affected by changes in cardiac function. The purpose of the present study was to detect the most appropriate variable for the estimation of PCWP by TEE in patients (pts) with ischemic heart disease. Several variables of LV inflow and left upper PV flow were compared with PCWP in 36 pts (six with angina pectoris and 30 with old myocardial infarction). Early diastolic flow (E) and atrial contraction flow (A) were used as LV inflow, while systolic forward flow (X), diastolic forward flow (Y) and atrial contractile reversal flow (z) were used as PV flow. The peak velocity of each flow wave (Ep, Ap, Xp, Yp, and Zp) and the time-velocity integral (Ei, Ai, Xi, Yi, and Zi) were measured. The ratio of Ep to Ap (Ep/Ap), Ei to Ai (Ei/Ai), Xp to Yp (Xp/Yp), Xi to Yi (Xi/Yi), Zp to Ap (Zp/Ap), Zi to Ai (Zi/Ai) and the systolic fraction of PV forward flow were calculated. Among these variables, the Zi/Ai ratio was most strongly correlated with PCWP (R=0.80). The Zi/Ai ratio may not be influeced by atrial function because the augmentation of atrial pump function increases Zi as well as Ai, and this may be one reason why the ratio correlated well with PCWP.Conclusion: The Zi/Ai ratio is a new useful variable for estimating PCWP by TEE.

The stroke volume of the left ventricle (SV) was calculated from noninvasive recordings of the arterial pressure using a finger photoplethysmograph and compared to the values obtained by pulsed Doppler echocardiography (PDE). A group of 19 healthy men and 12 women [mean ages: 20.8 (SD 1.6) and 22.2 (SD 1.6) years respectively] were studied at rest in the supine position. The ratio of the area below the ejection phase of the arterial pressure wave (A(s)) to SV, as obtained by PDE, yielded a "calibration factor" dimensionally equal to the hydraulic impedance of the system (Zao = A(s).SV-1). The Zao amounted on average to 0.062 (SD 0.018) mmHg.s.cm-3 for the men and to 0.104 (SD 0.024) mmHg.s.cm-3 for the women. The Zao was also estimated from the equation: Zao = a.(d + b.HR + c.PP + e.MAP)-1, where HR was the heart rate, PP the pulse pressure, MAP the mean arterial pressure and the coefficients of the equation were obtained by an iterating statistical package. The value of Zao thus obtained allowed the calculation of SV from measurements derived from the photoplethysmograph only. The mean percentage error between the SV thus obtained and those experimentally determined by PDE amounted to 14.8 and 15.6 for the men and the women, respectively. The error of the estimate was reduced to 12.3 and to 11.1, respectively, if the factor Zao, experimentally obtained from a given heart beat, was subsequently applied to other beats to obtain SV from the A(s) measurement in the same subject.

A case report where the diagnosis of pacemaker syndrome was made using simply suprahepatic vein, pulsed Doppler echocardiography. To the knowledge of the authors, this method is currently unpublished.

The impact of valvular, myocardial and pericardial abnormalities on cardiac haemodynamics in patients treated for Hodgkin's disease with COPP/ABVD with and without mediastinal irradiation was determined in 49 patients 2-10 years after induction therapy. Diagnostic procedures to evaluate cardiac function consisted of history, physical examination, exercise bicycle stress test, M-mode two-dimensional and pulsed Doppler echocardiography. No patient reported symptoms related to cardiomyopathy, and only one of the 49 had evidence of coronary heart disease. Pericardial thickening was seen on echocardiograms in 19/49 patients (38.8%), valvular thickening in 21/49 (42.9%), and reduced fractional shortening in 9/49 (18.4%). The Doppler-derived mean E and A (+/- SD) of transmitral flow were 0.75 +/- 0.14 m/s and 0.56 +/- 0.09 m/s, respectively, in patients receiving chemotherapy and 0.81 +/- 0.19 m/s and 0.63 +/- 0.20 m/s in those with additional mediastinal irradiation. There was no statistically significant difference between mean E and A in transmitral flow in patients treated for Hodgkin's disease and control subjects. Furthermore, the transtricuspid and hepatic vein flow velocities did not differ significantly. Although the present study demonstrates high frequencies of pericardial and valvular thickening in patients treated for Hodgkin's disease with the COPP/ABVD regimen with or without mediastinal irradiation, it showed no impact on cardiac flow velocities. The abnormalities might thus be of minor clinical relevance in these patients.

Left ventricular diastolic filling properties during isometric handgrip exercise were measured by pulsed Doppler echocardiography in 33 noninsulin-dependent diabetic patients with a normal ejection fraction and 15 control subjects. Diabetic patients were subdivided into two groups according to their resting left ventricular filling pattern (A/E): 18 patients were in group DM-1 (A/Eor = 1.1) and 15 patients were in group DM-2 (A/E1.1). At rest, A/E ratio and A wave were higher, and deceleration half-time was longer in group DM-2 than in normal subjects and group DM-1, but there was no significant difference between normal subjects and group DM-1. The A/E ratio increased significantly in all three groups during isometric handgrip exercise. However, the change in A/E from rest to peak exercise in group DM-1 (0.29 +/- 0.20) was significantly greater than in normal subjects (0.09 +/- 0.07). These results suggest that diabetes mellitus patients with normal resting left ventricular (LV) filling pattern (group DM-1) had LV diastolic filling abnormalities with isometric handgrip exercise. Doppler echocardiography with isometric handgrip exercise is useful in identifying underlying left ventricular diastolic dysfunction in diabetic patients.

Twenty-seven subjects without apparent cardiac abnormalities underwent transesophageal echocardiography to evaluate normal Doppler characteristics of pulmonary venous flow. In particular, the effects of normal respiration and straining during the Valsalva maneuver were analyzed. Pulmonary venous flow during systole consisted of one forward flow wave in 15 cases (56%) and of two forward flow waves in 12 cases (44%). In all instances one forward flow wave was seen during early diastole and in 23 subjects (85%) a retrograde wave related to atrial contraction was present. Maximal velocity during systole was 57 +/- 13 cm/sec (mean +/- SD), during early diastole was 58 +/- 19 cm/sec, and during late diastole was 16 +/- 9 cm/sec. Velocity time integral during systole was significantly higher than during early diastole (11.8 +/- 4.9 vs 9.5 +/- 3.9 cm, p0.05), while velocity time integral during late diastole was 1.1 +/- 0.7 cm. During normal inspiration both early diastolic velocity and velocity time integral significantly decreased from 59 +/- 15 to 54 +/- 15 cm/sec (p0.01) and from 9.5 +/- 3.9 to 8.5 +/- 4.2 cm (p0.05), respectively. During normal expiration, systolic and early diastolic velocity time integral significantly increased, from 11.0 +/- 4.1 to 11.8 +/- 4.5 cm (p0.001) and from 9.5 +/- 3.9 to 10.1 +/- 4.3 cm (p0.05), respectively. Although statistically significant, the differences were small and do not seem of clinical importance. Straining during the Valsalva maneuver, however, obviously decreased pulmonary venous flow velocities. Systolic and early diastolic velocity decreased from 57 +/- 15 to 32 +/- 10 cm/sec and from 59 +/- 18 to 34 +/- 15 cm/sec, respectively, while velocity time integral during systole, early, and late diastole decreased from 12.0 +/- 5.6 to 4.3 +/- 2.6 cm, from 9.9 +/- 4.4 to 5.2 +/- 3.7 cm, and from 1.3 +/- 0.8 to 0.8 +/- 0.7 cm, respectively. In conclusion, pulmonary venous Doppler characteristics can adequately be analyzed with transesophageal echocardiography. Normal respiration only minimally influences pulmonary venous flow velocities in contrast to straining during the Valsalva maneuver; this should be considered when these variables are applied for clinical purposes.

Pulsed Doppler echocardiography is widely used to evaluate left ventricular diastolic function. Limited data are available regarding the use of this technique in the noninvasive assessment of left ventricular filling pressure. Recent Doppler studies indicated a direct relation between the ratio of early-to-late transmitral diastolic filling velocity ( E A ratio) and left ventricular filling pressure. 1–4 In addition, earlier work showed that left ventricular isovolumic relaxation time is inversely related to pulmonary capillary wedge pressure. 5 The aims of this study were to further examine these relations, and to determine if E A ratio and isovolumic relaxation time could be used to predict pulmonary arterial wedge pressure noninvasively.

OBJECTIVE To seek possible correlations between plasma atrial natriuretic factor (ANF) and left ventricular diastolic function (LVDF) in hypertensive patients. DESIGN Since LVDF abnormalities can be detected in patients with normal left ventricular mass, we studied a group of hypertensive patients without left ventricular hypertrophy. METHODS Untreated hypertensive patients (n = 23) and normotensive control subjects (n = 19) were studied. LVDF indices were obtained by M-mode and pulsed Doppler echocardiography. Blood samples for plasma ANF were taken in the recumbent position from subjects on normal-sodium intake. RESULTS Plasma ANF levels were significantly higher in hypertensive patients than in normotensive subjects. All indices for systolic function were normal in both normotensive subjects and hypertensive patients. Left atrial diameter was significantly higher for hypertensive patients than for normotensive subjects. Considering LVDF, all indices for ventricular filling were found to be altered, on average, in hypertensive patients, the only exception being peak early velocity. In addition, significant correlations were found between plasma ANF and the pulsed Doppler parameters of left ventricular filling, peak atrial velocity and the peak early:peak atrial velocity ratio. Overall correlations between plasma ANF and left atrial diameter, and between left atrial diameter and left ventricular mass index were also observed. CONCLUSIONS The high levels of plasma ANF observed in our hypertensive patients and their correlation with the LVDF indices (which mainly reflect the atrial contribution to ventricular filling) could be the result of an increased atrial stretch due to diastolic ventricular dysfunction. This may exist in hypertensive patients before the development of ventricular hypertrophy.

Reversal of flow in the pulmonary veins during atrial contraction was detected by transthoracic pulsed Doppler echocardiography in a patient with bicuspid aortic valve and heart failure. The flow reversal disappeared after his recovery from heart failure. Flow reversal during atrial contraction detected by transthoracic Doppler may be a sign of congestive heart failure.