Reference values of tissue Doppler imaging and pulsed Doppler echocardiography for analysis of left ventricular diastolic function in healthy adults.

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 Vitória, Espírito 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.

Anthropometric measures of increased central and overall adiposity in association with echocardiographic left ventricular hypertrophy.

Left ventricular hypertrophy is an important predictor of cardiovascular risk and sudden death. This study explored the ability of four obesity indexes (body mass index, waist circumference, waist-hip ratio and waist-stature ratio) to identify left ventricular hypertrophy. A sample of the general population (n=682; 43.5% men) was surveyed to assess cardiovascular risk factors. Biochemical, anthropometric and blood pressure values were obtained in a clinic visit according to standard methods. Left ventricular mass was obtained from transthoracic echocardiogram. Left ventricular hypertrophy was defined using population-specific cutoff values for left ventricular mass indexed to height. The waist-stature ratio showed the strongest positive association with left ventricular mass. This correlation was stronger in women, even after controlling for age and systolic blood pressure. By multivariate analysis, the main predictors of left ventricular hypertrophy were waist-stature ratio (23%), systolic blood pressure (9%) and age (2%) in men, and waist-stature ratio (40%), age (6%) and systolic blood pressure (2%) in women. Receiver-operating characteristic curves showed the optimal cutoff values of the different anthropometric indexes associated with left ventricular hypertrophy. The waist-stature ratio was a significantly better predictor than the other indexes (except for the waist-hip ratio), independent of gender. It is noteworthy that a waist-stature ratio cutoff of 0.56 showed the highest combined sensitivity and specificity to detect left ventricular hypertrophy. Abdominal obesity identified by waist-stature ratio instead of overall obesity identified by body mass index is the simplest and best obesity index for assessing the risk of left ventricular hypertrophy, is a better predictor in women and has an optimal cutoff ratio of 0.56.

Determinants of left ventricular mass and presence of metabolic risk factors in normotensive individuals.

BACKGROUND: Insulin resistance and obesity are recognized as left ventricular (LV) mass determinants independent of blood pressure (BP). Prevalence of LV hypertrophy (LVH) and the relationship between LV mass to body composition and metabolic variables were evaluated in normotensive individuals as participants of a population-based study. METHODS: LV mass was measured using the second harmonic image by M-mode 2D guided echocardiography in 326 normotensive subjects (mean 47+/-9.4 years). Fasting serum lipids and glucose, BP, body composition and waist circumference (WC) were recorded during a clinic visit. RESULTS: Applying a normalization criterion not related to body weight (g/height raised to the power 2.7) and the cut-off points of 47.7 (men) and 46.6 g/m(2.7) (women), LVH was found in 7.9% of the sample. Univariate analysis showed LV mass (g/m(2.7)) related to age, body mass index (BMI), WC, fat and lean body mass, systolic and diastolic BP, and metabolic variables (cholesterol, HDL-c, triglycerides and glucose). In multivariate analysis only BMI and age-adjusted systolic BP remained as independent predictors of LV mass, explaining 31% and 5% of its variability. Removing BMI from the model, WC, age-adjusted systolic BP and lean mass remained independent predictors, explaining 25.0%, 4.0% and 1.5% of LV mass variability, respectively. After sex stratification, LV mass predictors were WC (8%) and systolic BP (5%) in men and WC (36%) and systolic BP (3%) in women. CONCLUSION: BMI in general and particularly increased abdominal adiposity (WC as surrogate) seems to account for most of LV mass increase in normotensive individuals, mainly in women.

Medidas ecocardiográficas de referência em amostra da população brasileira adulta sem doença cardio-vascular / Echocardiography reference measurements in sample of the Brazilian adult population without cardiovascular disease

Objetivo: Determinar as medidas ecocardiográficas de referência das cavidades cardíacas, da massa e dos índices de massa do ventrículoesquerdo (VE), em amostra da população brasileira adulta sem doença cardiovascular.Métodos: Estudo observacional realizado em amostra randômica da população da cidade de Vitória -Espírito Santo, Brasil.Foi realizado ecocardiograma transtorácico em 295 indivíduos voluntários, assintomáticos, sendo 61,7 por cento de mulheres, sem históriapregressa de doença cardiovascular. Os diâmetros dos ventrículos, a espessura do septo interventricular e da parede posterior do VE, amassa e os índices do VE e os diâmetros da aorta e do átrio esquerdo foram avaliados por ecocardiograma unidimensional. As medidasforam descritas por média e desvio padrão, por percentis, com intervalo de confiança de 95 por cento.Resultados: Sexo e idade influenciaram discretamente os valores ecocardiográficos. A espessura da parede posterior, os índices de massacorrigidos pela altura e o diâmetro diastólico foram influenciados pela idade. Os valores de percentil de 95 por cento do septo interventriculare parede posterior do VE, para homens, foram 9,9 mm e 9,6 mm, respectivamente, e 9,3 cm para septo e parede posterior paramulheres.Conclusões: Os valores do percentil de 95 por cento do septo interventricular e parede posterior e, conseqüentemente, de massa ventricularesquerda absoluta e indexada, encontrados neste estudo, são inferiores aos valores encontrados em estudos prévios. Neste aspecto,os resultados serão úteis como referência, pois estão de acordo com os novos limites sugeridos na literatura para o diagnósticoecocardiográfico de hipertrofia ventricular esquerda.