Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic [corrected] study.

It was hypothesised that, apart from right ventricular (RV) dysfunction, patients with idiopathic pulmonary fibrosis (IPF) also exhibit left ventricular (LV) impairment, which may affect disease progression and prognosis. The aim of the present study was to evaluate LV performance in a cohort of IPF patients using conventional and tissue Doppler ECG. IPF patients exhibiting mild-to-moderate pulmonary arterial hypertension (mean age 65+/-9 yrs; n = 22) and healthy individuals (mean age 61+/-6 yrs; n = 22) were studied. Conventional and tissue Doppler ECG were used for the evaluation of RV and LV systolic and diastolic function. In addition to the expected impairment in RV function, all patients showed a characteristic reversal of LV diastolic filling to late diastole compared with controls (early diastolic peak filling velocity (E)/late diastolic peak filling velocity 0.7+/-0.2 versus 1.5+/-0.1, respectively). Patients with IPF also exhibited lower peak myocardial velocities in early diastole (E(m); 5.7+/-1.1 versus 10.3+/-1.6 cm x s(-1), respectively), higher in late diastole (A(m); 8.9+/-1.3 versus 5.5+/-0.8 cm x s(-1), respectively), lower E(m)/A(m) ratio (0.6+/-0.1 versus 1.9+/-0.5, respectively) and higher E/E(m) ratio (10.8+/-3 versus 6+/-0.6, respectively), all indicative of LV diastolic dysfunction. Moreover, LV propagation velocity was significantly lower in IPF patients (46+/-13 versus 83+/-21 cm x s(-1), respectively). Physicians should be aware that patients with idiopathic pulmonary fibrosis exhibit early impairment of left ventricular diastolic function.

Usefulness of colour tissue Doppler imaging in assessing aortic elastic properties in Type 1 diabetic patients.

AIMS: Diabetes mellitus (DM) is associated with macrovascular disease and impaired aortic function. We hypothesized that the change in aortic elastic properties could be investigated with colour tissue Doppler imaging (CTDI) in Type 1 diabetic patients and that these findings could be related to the aortic stiffness index. METHODS: We examined by echocardiography 66 patients with Type 1 DM (mean age 35 +/- 10 years, mean duration of disease 20 +/- 9 years) without a history of arterial hypertension or coronary artery disease (negative thallium-201 stress test) and 66 age- and sex-matched normal subjects. Arterial pressure was measured before echocardiography was performed. Internal aortic systolic and diastolic diameters by M-mode echocardiography and aortic systolic upper wall tissue velocity (Sao, cm/s) by CTDI were measured 3 cm above the aortic valve. Aortic distensibility and aortic stiffness index were calculated using accepted formulae. RESULTS: Aortic stiffness, distensibility and Sao velocity differed significantly between the studied groups. In the diabetic group, duration of diabetes correlated with aortic stiffness (r = 0.53, P < 0.001), distensibility (r = -0.61, P < 0.001) and Sao velocity (r = -0.48, P < 0.001). There was a negative correlation between aortic stiffness and Sao velocity (r = -0.49, P < 0.001). Multiple stepwise linear regression analysis in the diabetic group revealed that aortic S velocity (beta = 0.30, P = 0.005) and duration of diabetes (beta = -0.49, P = 0.001) were the main predictors of aortic distensibility (overall R(2) = 0.48). CONCLUSIONS: Aortic elastic properties can be directly assessed by measuring the movements in the upper aortic wall. Reduced aortic S velocity is associated with increased aortic stiffness in Type 1 diabetic patients.

Evaluation of a hand carried cardiac ultrasound device in an outpatient cardiology clinic.

OBJECTIVE: To determine the diagnostic potential of a hand carried cardiac ultrasound (HCU) device (OptiGo, Philips Medical Systems) in a cardiology outpatient clinic and to compare the HCU diagnosis with the clinical diagnosis and diagnosis with a full featured standard echocardiography (SE) system. METHODS: 300 consecutive patients took part in the study. The HCU examination was performed by an experienced echocardiographer before patients visited the cardiologist. The echocardiographer noted whether the HCU device was able to confirm or reject the referral diagnosis, which abnormality was detected, and whether SE investigation was necessary. Physical examination by a cardiologist followed and thereafter, whenever required, a complete study with an SE was carried out. The HCU data were compared with the clinical diagnosis of the cardiologist and the SE diagnosis in a blinded manner. RESULTS: The cardiologist referred 203 of 300 patients for an SE study and 13 patients for transoesophageal echocardiography. In 84 patients no further examination was considered necessary. HCU echocardiography was able to confirm or reject the suspected clinical diagnosis in 159 of 203 (78%) patients. In 44 of 203 (22%) patients SE Doppler was needed. Agreement between the HCU device and the SE system for the detection of major abnormalities was excellent (98%). The HCU device missed 4% of the major findings. Among the 84 patients not referred for an SE, the HCU device detected unsuspected major abnormalities missed with the physical examination in 14 (17%). CONCLUSION: Integration of an HCU device with the physical examination augments the yield of information.

Left ventricular hypertrophy screening using a hand-held ultrasound device.

AIMS: To test the diagnostic potential of a hand-held ultrasound device for screening for left ventricular hypertrophy in a hypertensive population using a standard echocardiographic system as a reference. METHODS: One hundred consecutive hypertensive patients were enrolled. An experienced investigator performed measurements of the thickness of the anterior septum and posterior wall using the parasternal 2D-long axis view and the end-diastolic dimension of the left ventricle with both imaging devices. Left ventricular hypertrophy was defined as an increase in left ventricular mass > or = 134 g x m(-2) for men and > or = 110 g x m(-2) for women, when indexed for body surface area and > or = 143 g x m(-1) for men and > or = 102 g x m(-1) for women, when indexed for height. RESULTS: Sixty-five men and 35 women were studied (age 60 +/- 11 years); mean duration of hypertension: 13 +/- 11 years; mean blood pressures: systolic 150 +/- 20 mmHg and diastolic 89 +/- 11 mmHg. The anterior septum and posterior wall were visualized in all patients with both imaging devices. The standard echocardiographic system identified left ventricular hypertrophy by body surface area in 18 (18%) patients and by height in 26 (26%) patients. The agreement between the standard echocardiographic system and the hand-held device for the assessment of left ventricular hypertrophy was 93%, kappa: 0.77 (left ventricular mass/body surface area) and 90%, kappa: 0.76 (left ventricular mass/height). CONCLUSIONS: We conclude that hand-held devices can be effectively applied for screening for left ventricular hypertrophy in hypertensive patients.

Doppler echocardiographic evaluation of right ventricular diastolic function in hypertrophic cardiomyopathy.

AIMS: Left ventricular diastolic function in patients with hypertrophic cardiomyopathy has been adequately studied. In contrast there are few studies concerning right ventricular diastolic function in hypertrophic cardiomyopathy. We studied right ventricular diastolic function in patients with hypertrophic cardiomyopathy using Doppler echocardiography. METHODS AND RESULTS: We studied 20 patients with hypertrophic cardiomyopathy (mean age 43.6+/-13.8 years) and 20 healthy volunteers (control group, mean age 43+/-13.8 years). We calculated left ventricular and right ventricular diastolic indices using pulsed Doppler echocardiography. Hypertrophic cardiomyopathy patients compared with controls had significantly lower right ventricular-E/A ratio (1.01+/-0.40 vs 1.30+/-0.28, P<0.04), significantly prolonged right ventricular isovolumic relaxation time (170+/-72 vs 32+/-23 ms, P<0.001), and also significantly prolonged right ventricular deceleration time (160+/-58 vs 118+/-35 ms, P<0.01). There was also strong significant correlation between right ventricular deceleration time and left ventricular deceleration time (r=0.78), right ventricular-E/A ratio and left atrial filling fraction (r=-0.55) and between right atrial filling fraction and left atrial filling fraction (r=0.75). CONCLUSIONS: Right ventricular diastolic function in patients with hypertrophic cardiomyopathy is impaired, reflecting abnormal relaxation. Right ventricular diastolic indices correlate well with those of left ventricle.

An angiotensin-converting enzyme inhibitor improves left ventricular systolic and diastolic function in transfusion-dependent patients with beta-thalassemia major.

BACKGROUND: Cardiac complications are the major cause of death in patients with beta-thalassemia major. The purpose of this study was to assess the impact of long-term treatment with the angiotensin-converting enzyme inhibitor enalapril on left ventricular (LV) performance, with an emphasis on diastolic LV function because diastolic dysfunction has been found to be an early event in an asymptomatic thalassemic population with only mild impairment of LV systolic function. METHODS: We used echocardiography to study the impact of treatment with oral enalapril on the evolution of standard M-mode and Doppler indices, along with a recently introduced Doppler index of combined systolic and diastolic LV performance. RESULTS: Patients were found to have significantly increased LV end-diastolic dimensions (LVEDD), LV end-systolic dimensions (LVESD), and left atrial dimensions and decreased LV fractional shortening (LVFS) compared with controls. After treatment with enalapril, LVESD decreased from 3.58 +/- 0.3 cm to 3.23 +/- 0.4 cm (P <.01) and LVFS increased from 32.6% +/- 4.0% to 38.0% +/- 3.1% (P <.001). Patients at baseline were found to have a significantly higher E-wave velocity, E/A ratio, and Doppler index compared with controls. The E-wave deceleration time was significantly shorter compared with that of controls. After treatment with enalapril, the E/A ratio decreased from 2.10 +/- 0.42 to 1.50 +/- 0.30 (P <.05), E-wave deceleration time increased from 0.12 +/- 0.02 seconds to 0.15 +/- 0.03 seconds (P <.01), and the Doppler index decreased from 0.46 +/- 0.10 to 0.37 +/- 0.14 (P <.05). CONCLUSIONS: Enalapril was well tolerated in asymptomatic or minimally symptomatic patients with LV dysfunction resulting from beta-thalassemia major. Echocardiographically we demonstrated significant improvement in LV systolic and diastolic function. Whether this translates to improved long-term prognosis and survival remains to be further evaluated.

Doppler echocardiographic evaluation of right ventricular diastolic function in isolated valvular aortic stenosis.

BACKGROUND AND AIM OF THE STUDY: Left ventricular diastolic function (LVDF) in patients with aortic stenosis (AS) has been adequately studied, in contrast to right ventricular diastolic function (RVDF). In this study, RVDF in patients with AS was evaluated using pulsed-wave Doppler echocardiography. METHODS: The study population comprised 20 patients with isolated AS (mean age 53.7 +/- 6.5 years) and 20 healthy volunteers (control group, mean age 52.6 +/- 8.8 years). The diastolic indices of right ventricular (RV) function were calculated using transtricuspid and transpulmonary Doppler flow velocities. Statistical analysis was performed using Student's t-test. There was no statistically significant difference between patients and controls with regard to age, height, bodyweight, heart rate, systolic and diastolic blood pressures, end-diastolic and end-systolic left ventricular (LV) diameter, LV fractional shortening and RV end-diastolic diameter. RESULTS: RV diastolic indices in patients (versus controls) were as follows: E/A ratio of transtricuspid flow waves was significantly lower (0.88 +/- 0.20 versus 1.25 +/- 0.33, p < 0.001); deceleration time of E wave was significantly longer (184 +/- 3 versus 127 +/- 3 ms, p < 0.001); atrial filling fraction was significantly augmented (43.1 +/- 7.7 versus 33.6 +/- 7.6%, p < 0.001); and isovolumic relaxation time was significantly prolonged (116 +/- 73 versus 31 +/- 15 ms, p < 0.001). There was no statistically significant correlation between diastolic indices and interventricular septum thickness and LV mass index. CONCLUSIONS: RVDF in AS patients is impaired, reflecting abnormal relaxation.