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Effect of increasing heart rate on Doppler indices of left ventricular performance in healthy men
T Oniki1, Y Hashimoto, S Shimizu
1Third Department of Internal Medicine, Tokyo Medical and Dental University, School of Medicine, Japan.
Insights
Heart rate significantly impacts Doppler measurements of left ventricular diastolic function. As heart rate increases, the ratio of early to late peak transmitral flow velocity (E/A) and early to late time-velocity integrals of transmitral flow (Ei/Ai) decrease.
Area of Science:
- Cardiology
- Physiology
- Medical Imaging
Background:
- Doppler echocardiography is crucial for assessing left ventricular diastolic function.
- Heart rate variations can influence Doppler-derived measurements, potentially affecting diagnostic accuracy.
- Understanding the normal pattern of heart rate dependency is essential for accurate diastolic function assessment.
Purpose of the Study:
- To investigate the impact of heart rate on Doppler measurements of left ventricular function.
- To establish the normal relationship between heart rate and key diastolic function indices.
- To quantify the rate dependency of specific Doppler parameters.
Main Methods:
- The study involved 10 healthy male volunteers in a university hospital setting.
- Transesophageal atrial pacing was used to control heart rate at 70, 80, and 90 beats per minute (bpm).
- Measurements included transmitral flow velocity (E/A ratio), time-velocity integrals (Ei/Ai), and atrial filling fraction (AFF).
Main Results:
- A significant linear correlation was observed between heart rate and E/A (r²=0.806), Ei/Ai (r²=0.838), and AFF (r²=0.343).
- Specifically, E/A and Ei/Ai decreased with increasing heart rate.
- Peak aortic flow velocity and mean aortic flow acceleration showed no significant changes across paced heart rates (70-100 bpm).
Conclusions:
- For every 10 bpm increase in heart rate, E/A is expected to decrease by approximately 0.5, and Ei/Ai by 0.9.
- These findings quantify the normal rate dependency of key diastolic function Doppler parameters.
- This knowledge can aid in developing algorithms to adjust Doppler measurements for heart rate, improving diastolic function assessment.
Objective:
To investigate the effects of heart rate on the Doppler measurements of left ventricular function and to determine the normal pattern of rate dependency.
Setting:
University hospital specialising in internal medicine.
Participants:
14 healthy male volunteers 10 of whom were studied.
Intervention:
Transoesophageal atrial pacing.
Main Outcome Measures:
At paced rates of 70, 80, and 90 ppm the ratio of early to late peak transmitral flow velocity (E/A) was 1.97 (0.28), 1.49 (0.21), and 0.95 (0.11) respectively; the ratio of early to late time-velocity integrals of transmitral flow (Ei/Ai) was 3.03 (0.51), 2.11 (0.24), and 1.14 (0.30) respectively; and the atrial filling fraction (AFF) was 0.17 (0.03), 0.21, (0.04), and 0.24 (0.04) (mean (SD)).
Results:
Heart rate showed a linear correlation with E/A (r2 = 0.806), Ei/Ai (r2 = 0.838), and AFF (r2 = 0.343). Neither the peak aortic flow velocity or the mean aortic flow acceleration showed significant changes during pacing at rates of 70, 80, 90, and 100 ppm.
Conclusions:
E/A and Ei/Ai can be expected to decrease by 0.5 and 0.9 for each increase of 10 beats/min in heart rate. Knowledge of this relation may be useful for the development of algorithms to correct for heart rate when diastolic function is assessed.
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