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[Left ventricular diastolic function in heart failure--a Doppler echocardiography study]
1Medizinische Klinik der Ruhruniversität im Knappschaftskrankenhaus Bochum.
Insights
Doppler echocardiography reveals altered transmitral flow patterns in heart failure. Overt heart failure shows increased early diastolic flow and decreased late diastolic flow, suggesting elevated filling pressures mask underlying cardiac disease.
Area of Science:
- Cardiology
- Physiology
Context:
- Doppler echocardiography is used to assess left ventricular filling patterns.
- Cardiac diseases often present with altered transmitral flow velocities.
Purpose:
- To evaluate the impact of overt heart failure on transmitral velocity profiles.
- To compare flow patterns in decompensated heart failure, compensated heart failure, and healthy controls.
Summary:
- Patients in overt heart failure (group II) exhibited higher early diastolic flow (E) and lower late diastolic flow (A) compared to compensated patients (group III) and controls (group I).
- The early/late diastolic flow velocity ratio (E/A) was significantly higher in decompensated heart failure (2.58) versus compensated (0.87) and controls (1.06).
- Shorter deceleration halftime in decompensated heart failure suggests elevated left atrial pressure may mask underlying disease-specific flow patterns.
Impact:
- Findings suggest elevated left atrial pressure in overt heart failure can invert typical transmitral velocity profiles.
- These results may offer practical value for managing congestive heart failure patients if follow-up studies confirm treatment-induced flow pattern normalization.
Abstract:
Assessment of transmitral flow by Doppler echocardiography allows measurement of changes in left ventricular filling patterns in patients with cardiac disease. Typically a decrease in early diastolic flow velocity and increase in late diastolic flow velocity is found in various cardiac diseases. In order to assess the influence of overt heart failure on transmitral velocity profiles these were measured in 20 patients with a history of myocardial infarction and in 10 normal controls (group I). Of those patients with coronary heart disease 10 patients were in overt heart failure according to clinical and radiological criteria (group II); another 10 patients were compensated after treatment for heart failure (group III). In decompensated group II early diastolic flow velocity (E) was 91.2 cm/s and higher than 67.9 cm/s in group III (p less than 0.05) compared to 68.8 cm/s in the control group. In contrast late diastolic flow (A) at the time of atrial contraction was 41.2 cm/s in group II, 81.3 cm/s in group III, and 65.0 cm/s in group I (p less than 0.05). The ratio between early and late diastolic flow velocities (E/A) was 2.58 in group II, 0.87 in group III, and 1.06 in group I (p less than 0.05). Deceleration halftime was significantly shorter in group II as compared to the other two groups (p less than 0.05). These results can be interpreted as masking of the pathological flow patterns of the underlying heart disease (E/A ratio) by elevated left atrial filling pressure that leads to inversion of the pathologically altered velocity profiles of the underlying heart disease. These results might gain practical value for the care of patients in congestive heart failure if follow-up studies should demonstrate conversion of the flow pattern of group II to that of group III under treatment.