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Systolic time interval (STI) estimation is an established noninvasive method for the quantifiable assessment of left ventricular (LV) performance in well-being and disease states; it stays valuable for clinical application and forms no burden to the subjects. This manuscript reviews the potential clinical applications and prognostic value of STI for the assessment of LV systolic function in cardiovascular disease (CVD). STIs could be obtained by several noninvasive imaging modalities such as transthoracic echocardiography, tissue Doppler imaging M-mode echocardiography, conventional echocardiography, and so on. In view of that, a literature review for studies reporting the clinical applications of STI in assessing LV systolic function among CVD patients was carried out using PubMed search. Accordingly, the current review describes how STI can be measured; reliability of cardiac time interval measurement in patients with CVD and its role in a clinical setting. With the advent of modern techniques, STI could be easily measured in a clinical setting. Likewise, STI parameter, particularly preejection period and LV ejection time ratio (PEP/LVET), has got the highest degree of correlation with LV ejection fraction (LVEF) in assessing LV performance. Furthermore, reproducibility of systolic ejection time (SET) achieved by the TDI M-mode method is outstanding and better when compared with the reproducibility of SET obtained by the conventional pulsed Doppler method. Furthermore, prolonged SET is independently related with enhanced outcomes among heart failure with reduced EF (HFrEF, i.e., EF ≤40%) but not HF with preserved EF (HFpEF, i.e., EF >40%) patients, indicating that stabilizing SET would be helpful in the case of systolic dysfunction. Clinically, tissue Doppler-derived time intervals could be beneficial to analyze abnormal cases in comparison with other invasive and noninvasive methods of ventricular function examination. Furthermore, phonoelectrocardiography-derived STI parameters, particularly electromechanical activation time-to-LVET ratio, may have a significant role in the diagnostic approach of heart failure (HF) in patients with undifferentiated dyspnea. In addition, in HF patients, PEP/LVET of >0.43 helps to detect LVEF

Systolic time interval (STI) estimation is an established noninvasive method for the quantifiable assessment of left ventricular (LV) performance in well-being and disease states; it stays valuable for clinical application and forms no burden to the subjects. This manuscript reviews the potential clinical applications and prognostic value of STI for the assessment of LV systolic function in cardiovascular disease (CVD). STIs could be obtained by several noninvasive imaging modalities such as transthoracic echocardiography, tissue Doppler imaging M-mode echocardiography, conventional echocardiography, and so on. In view of that, a literature review for studies reporting the clinical applications of STI in assessing LV systolic function among CVD patients was carried out using PubMed search. Accordingly, the current review describes how STI can be measured; reliability of cardiac time interval measurement in patients with CVD and its role in a clinical setting. With the advent of modern techniques, STI could be easily measured in a clinical setting. Likewise, STI parameter, particularly preejection period and LV ejection time ratio (PEP/LVET), has got the highest degree of correlation with LV ejection fraction (LVEF) in assessing LV performance. Furthermore, reproducibility of systolic ejection time (SET) achieved by the TDI M-mode method is outstanding and better when compared with the reproducibility of SET obtained by the conventional pulsed Doppler method. Furthermore, prolonged SET is independently related with enhanced outcomes among heart failure with reduced EF (HFrEF, i.e., EF =40%) but not HF with preserved EF (HFpEF, i.e., EF >40%) patients, indicating that stabilizing SET would be helpful in the case of systolic dysfunction. Clinically, tissue Doppler-derived time intervals could be beneficial to analyze abnormal cases in comparison with other invasive and noninvasive methods of ventricular function examination. Furthermore, phonoelectrocardiography-derived STI parameters, particularly electromechanical activation time-to-LVET ratio, may have a significant role in the diagnostic approach of heart failure (HF) in patients with undifferentiated dyspnea. In addition, in HF patients, PEP/LVET of >0.43 helps to detect LVEF <35% by pulsed Doppler echocardiography. Moreover, LVET continues to be an independent predictor of incident HF and provides incremental prognostic value on the future HF risk and death but not myocardial infarction. In conclusion, STI measurement could be useful, particularly in identifying LVEF <35% in the case of refractory HF patients. This could be beneficial in the selection of patients requiring cardiac resynchronization, specifically when accurate LVEF evaluation by echocardiography proves challenging in atrial fibrillation or if the evaluation is done by a trainee echocardiographer. Furthermore, the cardiac time intervals including SET can be acquired irrespective of rhythm. Good image quality is required for the assessment of LVEF. In contrast, evaluation of SET could be useful in the case of echocardiograms with poor quality images. As a final point, the present review suggests using an echocardiographic parameter like STIs to procure additional information regarding the risk of mortality in patients with HFrEF along with LVEF measurement. [ABSTRACT FROM AUTHOR]

Background: Respiratory variation in Inferior Vena Cava (IVC) diameter is validated for estimation of Right Atrial Pressure (RAP) by echocardiogram. Although IVC flow into the Right Atrium (RA) can be appreciated in parasternal views, it is not routinely evaluated. We have observed an uninterrupted continuous wave (CW) Doppler flow signal from the IVC during sampling of the Tricuspid Regurgitation (TR) jet. Objectives: The present study aimed to show that this uninterrupted signal was a surrogate for normal/low RAP. Methods: This retrospective study was conducted on 500 consecutive echocardiograms and sought continuous flow from IVC into the RA in the subcostal view. RAP was then measured using IVC dynamics like size and respirophasic variation. Analysis was performed by comparison of the percentages. Results: Out of the 500 echocardiograms, 60 (12%) had Doppler evidence of continuous IVC flow into the RA. Among these 60 echocardiograms, RAP was calculated in 57 patients. Accordingly, RAP was 3 mmHg in 54 (95%) and 8 mmHg in 3 (5%) patients. RAP could not be estimated in three patients due to lack of visualization of IVC. Furthermore, RA volume index was normal in 51 patients (85%), but increased in 9 ones (15%). Right Ventricular (RV) function was also normal in 48 (96%) and low in 2 (4%) patients. Conclusion: The study findings supported the hypothesis that continuous flow from IVC into RA on CW Doppler is a surrogate for IVC dynamics in normal/low RAP and is particularly useful when subcostal views are suboptimal or inaccessible due to poor acoustic windows. [ABSTRACT FROM AUTHOR]

Background Pulmonary 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. Methods The prevalence of PH was estimated by Doppler echocardiography in a cohort of 100 patients aged 49.3 ± 13.9 years 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. Results The 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 ± 0.2 cm, 126.5 ± 24.6 g/m 2 , and 16.9 ± 4.4, respectively, p < 0.001 for all). Pulmonary artery systolic pressure was positively correlated to duration of dialysis and negatively correlated to glomerular filtration rate ( p < 0.001 and r = −0.991). Pulmonary vascular resistance was significantly increased in dialysis patients (1.9 ± 0.2 Wood units vs. 1.2 Wood units in controls, p < 0.001). Endothelial dysfunction, defined as brachial artery flow mediated dilatation <6%, was found in 46% of dialysis group. Conclusion Increased pulmonary artery systolic pressure in the HD population could be attributed to left atrium dilatation and left ventricle diastolic dysfunction. Pulmonary vascular resistance was significantly increased in dialysis group. This might be explained by impaired endothelial nitric oxide synthesis that not only caused systemic vasoconstriction but also affected the pulmonary vasculature. [ABSTRACT FROM AUTHOR]

The mitral early to late diastolic flow velocity ratio ( E/ A ratio) is age-dependent. It has been considered that its age dependency reflects the age-related lengthening of left ventricular (LV) relaxation; however, the change in E/ A ratio is far larger than that expected from those in LV relaxation. We hypothesized that an age-related reduction of the parasympathetic activity increases left atrial (LA) contractility, and that this accounts for the age-related change in E/ A ratio. (1) Exercise stress test was performed in 61 normal subjects (age range, 8-80 years, mean, 40 years) to assess heart rate (HR) recovery because slowed HR recovery indicates lowered parasympathetic activity. There were good interrelations among age, E/ A ratio, and HR recovery. Among those aged ≤30 years, the age no longer correlated with E/ A ratio or HR recovery, but there was a significant correlation between HR recovery and E/ A ratio ( r = 0.44, p < 0.05). (2) Pulsed Doppler and two-dimensional speckle tracking echocardiography (2DSTE) were performed before and after administration of parasympathetic blockade (atropine) in ten young healthy subjects. LA booster pump function was assessed with LA emptying index calculated by 2DSTE. LA emptying index was calculated from ([LA volume before the atrial contraction − minimal LA volume]/LA volume before the atrial contraction) × 100. Atropine increased mitral A velocity ( p < 0.001) and LA emptying index ( p < 0.05) along with a decrease in E/ A ratio ( p < 0.001). Parasympathetic withdrawal enhances LA contraction and increases mitral A velocity, which likely cause a reciprocal decrease in mitral E velocity and E/ A ratio. Thus, parasympathetic deactivation with aging should be closely involved in the age-related change in mitral E/ A ratio. [ABSTRACT FROM AUTHOR]

Introduction Some complications of obstructive sleep-disordered breathing ( OSDB), such as heart failure including right ventricular ( RV) overload, are more serious than an increase of the apnea-hypopnea index ( AHI) or respiratory disturbance index ( RDI). These serious complications may contribute to the worsening of OSDB. Objective To explore the relationship between RV function in OSDB patients while awake and the severity of OSDB. Methods Fifty-eight patients were evaluated to determine the cause of OSDB and were subjected to various examinations, including cardiac ultrasonography. Of them, 54 were included in this analysis. Results Isovolumetric relaxation time decreased as AHI increased to about 40 events/h and increased when AHI increased beyond 40 events/h. The total ejection isovolume index increased as AHI increased to approximately 35 events/h and decreased when AHI increased beyond 35 events/h. Conclusions RV function gradually deteriorated from the early stages of obstructive sleep apnea syndrome, even though there was no apparent increase in pulmonary artery pressure. The results of this study indicated that the progression of OSDB correlated with RV function determined in patients while awake. Further studies are required to clarify this relationship, including assessment of components of RV function. [ABSTRACT FROM AUTHOR]

Background: It is known that patients with chronic renal failure are at increased risk for morbidity and mortality. We aimed to assess the effects of hemodialysis on certain parameters used to evaluate left and right ventricular systolic and diastolic functions using conventional and tissue Doppler echocardiography in patients with end-stage renal insufficiency. Methods: In this prospective observational study, 41 uremic patients were evaluated via echocardiography before and 60 minutes after hemodialysis. Systolic and diastolic functions of left ventricle (LV) and right ventricle (RV) were measured by two dimensional, M-Mode, conventional and tissue Doppler echocardiography. Results: While a significant increase was observed in the mean heart rate after hemodialysis, the mean body weight, systolic and diastolic blood pressure values were significantly decreased (all p values< 0.01). Compared to before hemodialysis, mitral E/ mitral annulus septal E' and mitral E/ mitral annulus lateral E' did not change (p= 0.105 and p= 0.165), but significant alterations were determined in many of M-Mode, conventional and other tissue Doppler echocardiographic parameters after hemodialysis (all p values< 0.05 and < 0.01). Conclusions: Mitral E/ septal E' and mitral E/ lateral E' did not change following hemodialysis and therefore are the best parameters to use to assess diastolic function in hemodialysis patients. Since the other conventional and traditional Doppler parameters vary with hemodialysis, these are not accurate measurements in these patients. [ABSTRACT FROM AUTHOR]

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. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims: We evaluated the relationship between the mitral inflow velocities by pulsed Doppler echocardiography and mitral annular motion velocities by pulsed Doppler tissue imaging in patients with mitral annular calcification.Methods and Results: Fifty-three patients with mitral annular calcification were divided into two groups: severe mitral annular calcification (n=15, mitral annular calcification ≧5 mm in width) and mild mitral annular calcification (n=38, mitral annular calcification <5 mm in width). In addition, 20 patients with hypertensive heart disease (HHD group) and mild left ventricular hypertrophy but no mitral annular calcification and 30 normal individuals (normal group) were studied. The early diastolic mitral inflow velocity (E) was higher in the severe mitral annular calcification group (0·75±0·26 m/s) than in the HHD and normal groups (mild mitral annular calcification, 0·65±0·21; HHD, 0·57±0·24; normal, 0·55±0·15 m/s), and the late diastolic mitral inflow velocity (A) was higher in the severe mitral annular calcification group (1·24±0·23 m/s) than in the other three groups (mild mitral annular calcification, 0·96±0·20; HHD, 0·84±0·23; normal, 0·75±0·13 m/s). In contrast, the early and late diastolic annular velocities (Ea, Aa) were lower in the severe mitral annular calcification group (Ea: 5·7±2·2; Aa: 11·9±4·4 cm/s) than in the other three groups (Ea: mild mitral annular calcification, 8·3±2·5; HHD, 7·7±2·2; normal, 9·0±1·8 cm/s; Aa: mild mitral annular calcification, 14·2±4·1; HHD, 14·3±2·8; normal, 14·2±2·1 cm/s). Mitral valve area was smaller in the severe mitral annular calcification group (2·6±1·0 cm2) than in the other three groups (mild mitral annular calcification, 3·1±0·7; HHD, 4·1±0·7; normal, 4·2±0·9 cm2). In the mitral annular calcification and normal groups, the A correlated inversely with mitral valve area (r=−0·67, P<0·01) and directly with severity of mitral annular calcification (r=0·65, P<0·01), and the Ea correlated inversely with left ventricular wall thickness (r=−0·37, P<0·01) and severity of mitral annular calcification (r=−0·45, P<0·01).Conclusion: Patients with severe mitral annular calcification have higher mitral inflow velocities due to mitral annular restriction and lower mitral annular velocities caused by decreased mitral annular motion and abnormal left ventricular relaxation. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved. [ABSTRACT FROM AUTHOR]

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/A[sub max] 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.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: It has been reported that the most intensely granuled cardiocytes secreting atrial natriuretic peptide (ANP) are located in the atrial appendages.Aims: To evaluate the mechanisms of ANP release in congestive heart failure.Methods and Results: The relationship between ANP and left atrial appendage (LAA) function was evaluated in 36 patients who underwent both transoesophageal echocardiography and cardiac catheterization. ANP level correlated positively with mean pulmonary capillary wedge pressure (mPCWP;r=0·75, P<0·0001), whereas it showed no significant correlation with the mean right atrial pressure. mPCWP correlated positively with the maximal LAA area (LAAa;r=0·79,P <0·0001) and negatively with the LAA ejection fraction during atrial contraction (LAA-EF;r=−0·61, P<0·0001) and peak late diastolic LAA emptying flow velocity (LAAF;r=−0·69, P<0·0001). ANP level correlated negatively with the LAA-EF (r=−0·56, P<0·001) and with LAAF (r=−0·61,P <0·0001). ANP level correlated more closely with the LAAa (r=0·79,P <0·0001) than with maximal LA volume (r=0·34, P<0·05). Multiple stepwise regression analysis selected LAAa as the only factor independently related to the plasma concentration of ANP (ANP=−22·4+28·6 LAAa, r=0·79,P <0·0001).Conclusions: We conclude that the factor most predictive for ANP in patients with left-sided cardiac dysfunction is distension of the LAA wall rather than elevation in the LA pressure or distension of the body of LA. This is consistent with the known distribution of ANP-secreting cardiocytes. [ABSTRACT FROM AUTHOR]

To clarify the factors determining transmitral filling, left ventricular and atrial pressures (LVP and LAP) and Doppler-derived diastolic indices were analysed in six anaesthetized dogs at various right atrial pacing rates during dextran infusion. The relationship of the late to early diastolic peak velocity ratio (A/E ratio) to end-diastolic LVP (LVEDP) showed a quadratic curve concave to the LVEDP axis in five animals (r= 0.320–0.588). An elevation in LVEDP up to 25 mmHg accompanied an increase in A/E ratio (ascending limb), and further LVEDP elevation caused its inverse decline (descending limb). Multiple regression analysis indicated that A/E ratio correlated positively with maximal L VP, a-wave LA P and heart rate, and negatively with v-wave LAP in both limbs. The time constant of isovolumic LVP decline, which was prolonged as LVEDP was elevated, was a positive correlate of A/E ratio in the ascending limb, but lost its influence on A/E ratio in the descending limb. An elevation in v-wave LAP must have masked the expected effect of left ventricular relaxation abnormality on A/E ratio in this limb. Thus, the transmitral filling profile did not alter unidirectionally, but returned to that seen before volume loading, with a simultaneous progressive impairment of cardiac function. [ABSTRACT FROM PUBLISHER]

Pulsed Doppler measurements on both sides of the mitral valve and M-mode left ventricular echocardiograms were performed in 215 healthy subjects, 120 males and 95 females, between one and 65 years old, in order to evaluate normal diastolic filling patterns of the left ventricle. The relation between the maximum blood velocity during early passive filling (Ewave) and during atrial contraction (A wave) was computed from the Doppler spectra obtained proximal and distal to the mitral valve, resulting in the EA ratio. The influence on the EA ratio of age, gender, body surface area, blood pressure, heart rate, PR interval, respiration, wall thickness and basal wall mass of the left ventricle was investigated. The study showed that the EA ratio measured proximal to the mitral valve (in the left atrium) was significantly smaller than the EA ratio measured distal (in the left ventricle) and that the only prominent relations with the EA ratio were those with age and heart rate. The EA ratio declines with age: proximal to the mitral valve from approximately (medians) 2.5 to 1 and distal to it from 3.5 to 1.5. All other physiological variables are weakly related or unrelated to the EA ratio in this group of healthy subjects. [ABSTRACT FROM PUBLISHER]

Pulsed Doppler signals were recorded in 215 healthy subjects, 120 males and 95 females, between 1 and 65 years of age. The measurements were performed in the left ventricular outflow tract (LVOT) and in the ascending aorta (AAO). Amplitude spectra from the Doppler signals were stored in digital form together with adjustment data for the instrument, the simultaneously registered ECG and respiration signal. The maximum velocity (Vmax, the maximum acceleration (Amax) and the width of the velocity distribution around Vmax (width) were derived from these spectra and used for the characterization of the signals. These parameters were computed without observer interaction using a computer program. Effects of age, sex, body surface area, heart rate and respiration were studied. Reference ranges were calculated. The following conclusions can be drawn: Vmax and Amax in the AAO decrease clearly with increasing age from approximately 100 to 60 cm s-1 and from 2000 to 1000 cm s-2 (medians), respectively. The variation of the width in the AAO is greater for people over 45 years. Vmax, Amaxand width in the LVOT increase slightly with advancing age from approximately 60 to 80 cm s-1, 800 to 1000 cm s-2 and 12 to 15 cm s-1 (medians), respectively. These parameters of flow were either unrelated or only weakly related to other physiological variables in this study group. [ABSTRACT FROM PUBLISHER]

To test the ability of pulsed Doppler echocardiography (PDE) to detect and quantify aortic regurgitation (AR), 55 consecutive patients {14–74 years) with aortic and mitral valve disease were examined clinically and by echocardiography before cardiac catheterisation. The severity of AR was determined angiographically (I–IV) and compared to the extent of the regurgitant jet in the left ventricle measured by PDE. In 13 of 55 patients (3 with mitral stenosis, 3 with mitral incompetence, 3 with combined mitral lesions, 3 with aortic stenosis, one with aortic and mitral stenosis) neither angiography nor PDE showed AR (specificity 100%). Apart from 3 patients with poor echo quality PDE correctly detected AR in 39 of 42 patients (sensitivity 93%). Clinical examination (62%), mode M-mode (62%) and both methods combined (81%) were significantly less sensitive than PDE, especially in mild AR (P < 0.008). The PDE degree of AR closely correlated with angiography (corrected contingency coefficient 0.91). Differentiation between AR III and IV was not possible. Mitral valve disease did not affect quantification of AR (n = 20 patients).Conclusions: Pulsed Doppler echocardiography is better than auscultation and M-mode echocardiography in the diagnosis of aortic regurgitation, especially in grades I and II. PDE can reliably discriminate between three degrees of aortic regurgitation (I–III). Mitral valve disease does not affect quantification of aortic regurgitation by PDE. [ABSTRACT FROM PUBLISHER]

In order to assess the value of pulsed Doppler echocardiography in detection of valvular regurgitation, 63 patients were evaluated for aortic and/or mitral regurgitation using pulsed Doppler echocardiography and selective cineangiography. The Doppler study was considered as positive when a turbulent flow was detected below the aortic valve for aortic insufficiency and behind the mitral valve for mitral insufficiency on a graphic display (time interval histogram) when technically adequate and⊘or on an audiosignal. These results were compared with standard angiographic evaluation of the regurgitation: pulsed Doppler echocardiography had 94% sensitivity and the specificity rate was very high (87.5%) even for mild regurgitation. Thus, Doppler technique is highly specific and sensitive in detection of aortic and mitral regurgitation when both audiosignal and time interval histogram are simultaneously performed. [ABSTRACT FROM PUBLISHER]

To non-invasively determine abdominal aortic properties, a five-element lumped circuit model was adopted. The model consists of resistance due to blood viscosity (R1), inertia of blood flow, compliances of the vessel (C1, C2), resistance of the peripheral arteries (R2) and the impedance of the of the femoral arteries (termination). Patterns of the central velocity of the upper abdominal aorta and the femoral artery are measured by pulsed Doppler echocardiography, and contours of flow volume rates are calculated. The pressure pattern of the lower limb is recorded by a pulse wave transducer and corrected according to sphygmomanometer values. Contours are transformed into respective Fourier transform components. The current transfer function is described theoretically and calculated from the acquired Fourier components. Values of every element are evaluated by the nonlinear least squares method. In 94 subjects (17-92 years), the values of each element are estimated. R2 values are greater in the elderly group than in the young group and r1 (R1/cm) increased with age. This model demonstrates that vessel compliance (C1 + C2 (C1 + C2/cm)) decreases with age, and it is suggested that this may be a useful marker of arteriosclerosis. [ABSTRACT FROM AUTHOR]

Diastolic mitral regurgitation has been observed in .patients with DDD pacemakers when the atrioventricular (AV) delay was prolonged. However, diastolic mitral regurgitation associated with first-degree AV block has not been fully studied. We examined transmitral blood flow in 24 patients with first-degree AV block and normal cardiac function (ages 35.3 ± 17.4 years), and in nine patients with DDD pacemakers and normal cardiac /unction (ages 73.1 ± 8.1 years), using pulsed Doppler echocardiography. Diastolic mitral regurgitation was observed in 19 of 24 patients with first-degree AV block. Although PQ interval was shortened from 0.32 ± 0.06 to 0.20 ± 0.05 seconds (P < 0.01) after 1 mg atropine sulfate IV, the interval between P wave (ECG) and the beginning of diastolic mitral regurgitation did not change, while the duration of diastolic mitral regurgitation was shortened from 0.15 ± 0.03 to 0.05 ± 0.03 seconds (P < 0.01). There was a significant correlation between changes in PQ interval and changes in the duration of diastolic mitral regurgitation (r = 0.92, P < 0.001). Although cardiac output (3.9 ± 0.05 L/min) and pulmonary capillary wedge pressure (5.1 ± 1.5 mmHg) were normal in all patients with pacemakers, diastolic mitral regurgitation was observed when the AV delay was prolonged. The critical PQ interval for the appearance of diastolic mitral regurgitation was 0.23 ± 0.01 seconds. In patients with prolonged PQ intervals, delayed ventricular contraction following atrial contraction may be associated with mitral regurgitation in the presence of a reversed AV pressure gradient. The results of this study suggest that diastolic mitral regurgitation occurs not only in patients with DDD pacemakers, but also with AAIR pacemakers when the PQ interval is prolonged. The occurrence of diastolic mitral regurgitation is associated with the pacing mode or the setting of AV delay. [ABSTRACT FROM AUTHOR]

Diastolic mitral regurgitation (MR) is known to be induced by prolonging atrioventricular (AV) delay in patients implanted with a DDD pacemaker. We studied the relationship between diastolic MR and PQ intervals on cardiac function in 50 patients (71.3 ± 11.3 years old: mean ± SD), who had been implanted with DDD pacemakers. In 19 patients, prior to pacemaker implantation, pulmonary capillary wedge pressure (PCWP) was measured using a Swan-Ganz catheter during AV sequential pacing with an AV delay of 0.165 seconds. Transmitral blood flow was measured with pulsed Doppler echocardiography, while prolonging AV delay stepwise by 0.025 seconds from 0.065 seconds for about 5 minutes each. In nine patients, AV delay could not be prolonged enough due to occurrence of intrinsic AV conduction. In the other 41 patients, diastolic MR was induced by prolonging AV delay. The critical PQ intervals that induced diastolic MR ranged from 0.14 to 0.26 (0.23 ± 0.03) seconds. Four of five patients whose critical PQ intervals were 0.20 seconds or shorter had heart failure, while 36 patients whose critical PQ intervals were >0.20 seconds were free from signs and symptoms of heart failure. Their PCWPs were 2-27 (7.5 ± 5.1) mmHg. There was a significant negative correlation between the critical PQ intervals for the appearance of diastolic MR and PCWP during AV sequential pacing, which was performed prior to pacemaker implantation (r = -0.85, P < 0.001). It is suggested that the appearance of diastolic MR is determined mainly by PQ intervals and cardiac function. Measurement of the critical PQ intervals that induce diastolic MR may be useful in assessing cardiac function in patients implanted with DDD pacemakers. [ABSTRACT FROM AUTHOR]

In 94 subjects with normally functioning heart valve prostheses (51 aortic and 43 mitral valve prostheses) and in 35 patients with intact aortic and mitral valves, blood flow velocity within the heart and the aortic root have been recorded using pulsed Doppler velocity studies in patients with diseased valves of the left heart. In addition, a further 7 patients were investigated using invasive catheter tip velocitometry, pre- and postoperatively. The preversus postoperative changes of maximum velocity and acceleration is characterized as follows: postoperative flow velocity tracings show approximately normal profiles comparable to normal valve function. Turbulence formation is diminished and the steep uptroke of the normal flow pattern is restituted. Differencies in transprosthetic blood flow patterns dependent on the implanted prosthesis model can be defined. Bioprostheses, in particular the Carpentier-Edwards device, reliably approximate normal amplitude-time characteristics. This is also true for the St. Jude Medical prosthesis with central flow properties. Velocitometric signs of valve dysfunction were detected in 9 patients: sensitivity was 100%; specificity ranged from 76% in aortic to 96% in mitral prostheses. Pulsed Doppler echocardiography therefore is a useful complement in the non-invasive haemodynamic tools and can be repeatedly applied to a patient with prosthetic cardiac valve replacement. [ABSTRACT FROM AUTHOR]

The diagnostic value of pulsed Doppler echocardiography (PDE) had not been sufficiently assessed up until now. Invasive catheter velocitometric measurements in the central vessels give quantitative information on the blood movement across the aortic and pulmonary valves. It is particularly useful in the quantification of aortic regurgitation. We successfully investigated 52 patients by means of PDE (ATL 500 A); 20 were suffering pure aortic incompetence, 11 pure stenosis and 21 had combined stenosis and regurgitation. Fifteen patients without aortic valvular disease served as controls. Our findings were compared with the results of cardiac catheterization and angiography in each case. In addition, 14 patients with aortic regurgitation were studied invasively by catheter velocitometry. The obtained regurgitation values were compared to the PDE method. In the PDE the underlying criteria for the assessment of the recordings were as follows: formal analysis of the analog signal and of the turbulence content during systole and diastole; in the flow velocity tracings aortic incompetence showed a steep increase with high peak to peak aortic velocities and scant turbulence formation; the reverse flow during regurgitation was accompanied by a high grade turbulent velocity pattern. The area under the diastolic (regurgitant) flow velocity curve (the time-amplitude integral) corresponded significantly with the angiographic severity of aortic insufficiency ( r=0.87). In aortic stenosis, turbulence formation leads to an approximately flat velocity profile across the ascending aorta, if the region in the vicinity of the valve is omitted. The flow velocity analog signals are considerably disturbed. However, the turbulence content which can be qualitatively estimated from the recordings, correlates well with the calculated valve area. In combined aortic valve stenosis and incompetence, the prevailing turbulent pattern does not always permit one to assess sufficiently the severity of the stenotic component, whereas the grade of incompetence can be, in general, evaluated. PDE complements the existing non-invasive techniques and probably essentially enriches non-invasive diagnostics. [ABSTRACT FROM AUTHOR]

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<0·05; 16%, P<0·01; and 12%, P<0·05, respectively). On the other hand there was a significant increase in late peak filling velocity with inspiration (10% increase, P<0·05). Other variables of left ventricular diastolic filling were unchanged with inspiration. These results suggest that assessment of left ventricular diastolic function in children should be standardized with regard to respiratory phases in any clinical application.(Eur Heart J 1996; 17: 453%456) [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

We report a case of double aortic arch in which the biphasic flow velocity pattern in the descending aorta changed to a monophasic flow velocity pattern after corrective surgery. The hypoplasia of left aortic arch might prolong the acceleration time of the flow velocity in the left aortic arch. [ABSTRACT FROM AUTHOR]

In a study of 25 children with left-to-right intracardiac shunt we found a good correlation ( r>0.92; p<0.001) between right ventricular pre-ejection period/acceleration time, derived from pulsed Doppler echocardiography, and pulmonary artery systolic, diastolic, and mean pressures, measured at cardiac catheterization. This may enhance the noninvasive estimation of pulmonary artery pressure. [ABSTRACT FROM AUTHOR]