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Comparison of simultaneous Doppler echo and apexcardiogram in detecting left ventricular diastolic dysfunction in
J Manolas1, Y Melanidis, J D Steriotis
1Dopplerechocardiographic Laboratory, Medical Center of Athens, Greece.
Insights
Apexcardiogram (ACG) is a more accurate noninvasive method than pulsed Doppler echocardiography (PDE) for evaluating left ventricular diastolic dysfunction in hypertensive patients. ACG indices showed abnormalities where PDE did not, highlighting its diagnostic potential.
Area of Science:
- Cardiology
- Noninvasive diagnostic methods
- Diastolic function assessment
Background:
- Systemic hypertension frequently causes left ventricular (LV) diastolic dysfunction.
- Pulsed Doppler echocardiography (PDE) is a common noninvasive method for assessing LV diastolic function.
- Left ventricular apexcardiogram (ACG) may also reflect LV diastolic events.
Purpose of the Study:
- To compare the diagnostic accuracy of PDE and ACG in assessing LV diastolic dysfunction.
- To evaluate the utility of ACG in identifying diastolic abnormalities in hypertensive patients.
Main Methods:
- Simultaneous acquisition of PDE and ACG in 29 patients with chronic systemic hypertension and 61 controls.
- Assessed PDE indices: peak early (E) and late atrial (A) diastolic transmitral flow velocities, A/E ratio, deceleration time.
- Assessed ACG indices: A-wave to total height ratio (A/H), total relaxation time (TART), heart rate-corrected TART, diastolic amplitude time index (DATI).
Main Results:
- In hypertensive patients, only PDE's A and A/E ratio differed significantly from controls.
- All evaluated ACG indices demonstrated abnormal mean values in hypertensive patients compared to controls.
- ACG showed greater sensitivity in detecting diastolic abnormalities than PDE.
Conclusions:
- ACG appears to be a more accurate noninvasive method for evaluating diastolic mechanical events than routine PDE in chronic hypertension.
- ACG may offer superior diagnostic value for identifying LV diastolic dysfunction in hypertensive individuals.
Abstract:
Patient with systemic hypertension have often abnormalities of left ventricular (LV) diastolic function. Although pulsed Doppler echocardiography (PDE) is at present time the only simple widely used noninvasive method for evaluating such LV diastolic dysfunction, LV apexcardiogram (ACG) reflecting LV pressure curve changes can also be useful for evaluating LV diastolic events. In order to compare the validity of these two methods in assessing LV diastolic dysfunction, PDE and ACG were simultaneously obtained in 29 patients with chronic systemic hypertension and in 61 controls. As diastolic indices of PDE served the peak early (E) and late atrial (A) diastolic transmitral flow velocities, the A/E ratio and the deceleration time; and of the ACG the relative A-wave to total height (A/H), the total relaxation time (TART), the heart rate corrected TART and the combined index DATI (= diastolic amplitude time index). In patients with hypertension, from the PDE only A and A/E ratio were significantly different from the controls, whereas all mentioned ACG indices showed an abnormal mean value. Thus, the less widely used ACG appears to be a more accurate method in the noninvasive evaluation of diastolic mechanical events than the routinely used PDE in patients with chronic hypertension.