Congestive heart failure. Correlation between functional class and systolic and diastolic functions assessed by Doppler echocardiography.

OBJECTIVE: To evaluate the influence of systolic or diastolic dysfunction, or both on congestive heart failure functional class. METHODS: Thirty-six consecutive patients with a clinical diagnosis of congestive heart failure with sinus rhythm, who were seen between September and November of 1998 answered an adapted questionnaire about tolerance to physical activity for the determination of NYHA functional class. The patients were studied with transthoracic Doppler echocardiography. Two groups were compared: group 1 (19 patients in functional classes I and II) and group 2 (17 patients in functional classes III and IV). RESULTS: The average ejection fraction was significantly higher in group 1 (44.84 % +/- 8.04 % vs. 32.59 % +/- 11.48 % with p = 0.0007). The mean ratio of the initial/final maximum diastolic filling velocity (E/A) of the left ventricle was significantly smaller in group 1 (1.07 +/- 0.72 vs. 1.98 +/- 1.49 with p = 0.03). The average maximum systolic pulmonary venous velocity (S) was significantly higher in group 1 (53.53 cm/s +/- 12.02 cm/s vs. 43.41 cm/s +/- 13.55 cm/s with p = 0.02). The mean ratio of maximum systolic/diastolic pulmonary venous velocity was significantly higher in group 1 (1.52 +/- 0.48 vs. 1.08 +/- 0.48 with p = 0.01). A predominance of pseudo-normal and restrictive diastolic patterns existed in group 2 (58.83 % in group 2 vs. 21.06 % in group 1 with p = 0.03). CONCLUSION: Both the systolic dysfunction index and the patterns of diastolic dysfunction evaluated by Doppler echocardiography worsened with the evolution of congestive heart failure.

[Morpho-functional cardiac evaluation in young normotensive children of hypertensive patients. A prospective Doppler-echocardiographic study]. / Avaliação morfo-funcional cardíaca em jovens normotensos, filhos de hipertensos. Estudo Doppler-ecocardiográfico prospectivo.

PURPOSE: Evaluate functional and/or structural cardiac changes in young normotensive subjects with a family history of hypertension. METHODS: Prospective study was performed with 62 normotensive persons, ages 15 to 30 years, divided in 32 children of hypertensive patients (group 1) and 30 children of normotensive persons (group 2) comparable in blood pressure, body surface area, heart rate, age and sex. After clinical examination, all underwent Doppler-echocardiogram to evaluate cardiac structure and left ventricular (LV) systolic and diastolic function. RESULTS: Systolic LV fractional shortening was increased in group 1 when compared with group 2 (38.03 +/- 4.95% and 34.7 +/- 4.48%, respectively--p < 0.01). Mitral deceleration time (DT) ranged from 85 to 160 ms--mean values 116.47 +/- 16.99 ms--in group 1 and from 100 to 220 ms--mean values 126.73 +/- 26.66 ms--in group 2 (p < 0.05). A correlation between LV mass and left atrium (LA) diameter was noted in group 1 (r-0.514, p < 0.01). CONCLUSION: Children of hypertensive patients show increased LV function, similar to what occurs in early hypertension and in borderline hypertension, even when there is no evidence of LV hypertrophy or high blood pressure. Mitral DT (shorten in group 1) was the only diastolic parameter that differed in the groups. The correlation between LV mass and LA dimension suggests that LA size could be related to functional and hemodynamic LV changes.