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[Stress pulsed Doppler echocardiography in the evaluation of diastolic left ventricular function]
Insights
Sublingual nifedipine improved left ventricular (LV) filling in hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD). Pulsed Doppler echocardiography and radioisotope angiography effectively evaluated LV diastolic function during nifedipine treatment.
Area of Science:
- Cardiology
- Pharmacology
- Diagnostic Imaging
Context:
- Left ventricular (LV) diastolic dysfunction is a hallmark of various heart conditions, including hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD), and ischemic heart disease (IHD).
- Sublingual nifedipine is a calcium channel blocker used to manage cardiovascular conditions, but its specific effects on LV diastolic function across different heart diseases require detailed investigation.
- Assessing LV diastolic function is crucial for guiding therapeutic strategies and predicting patient outcomes.
Purpose:
- To evaluate the impact of sublingual nifedipine on left ventricular (LV) diastolic function in patients with HCM, HHD, and IHD.
- To compare the efficacy of pulsed Doppler echocardiography (PDE) and radioisotope (RI) angiography in assessing these functional changes.
- To determine the differential effects of nifedipine on LV inflow velocity patterns and filling rates across the studied patient groups.
Summary:
- Sublingual nifedipine administration led to a shortened deceleration time (DT) in HCM and HHD patients, indicating improved diastolic relaxation.
- Mean LV rapid filling rate (V1) increased in HCM and HHD groups, suggesting enhanced early diastolic filling.
- Nifedipine improved LV filling in most HCM and HHD cases, and some IHD cases, with PDE and RI angiography proving useful for evaluating these diastolic function changes.
Impact:
- The findings suggest that sublingual nifedipine can be beneficial for improving LV diastolic function, particularly in HCM and HHD.
- Pulsed Doppler echocardiography and radioisotope angiography are validated as valuable non-invasive tools for monitoring nifedipine's effects on diastolic function in diverse cardiac pathologies.
- This study provides insights into the utility of nifedipine in managing diastolic dysfunction, potentially guiding clinical practice for these patient populations.
Abstract:
The effect of sublingual nifedipine on left ventricular (LV) function was assessed by analyzing LV inflow velocity patterns using pulsed Doppler echocardiography (PDE) and radioisotope (RI) angiography in 23 patients with hypertrophic cardiomyopathy (HCM), 13 with hypertensive heart disease (HHD) and 24 with ischemic heart disease (IHD). The results were as follows: LV inflow velocity pattern and M-mode echocardiography after the administration of nifedipine (Study-I). The deceleration time (DT) of the diastolic rapid filling wave was shortened after nifedipine in HCM and HHD, but not in IHD. The acceleration time (AT) of the diastolic rapid filling wave and the A/D ratio (amplitude of an atrial contraction wave/amplitude of a diastolic rapid filling wave) were not significantly changed in all groups. Peak negative Vcf was significantly improved after nifedipine in HCM, but unchanged in the other groups. Fractional shortening and peak Vcf did not change in all groups. LV inflow velocity pattern and RI angiography after nifedipine (Study-II). The mean LV rapid filling rate (V1) based on the LV volume curve by multi-gated blood pool scans increased during nifedipine in HCM and HHD, but other diastolic indices, such as the peak filling rate and 1/3 filling fraction, were unchanged. The DT-V1 relationship during nifedipine shifted toward the right and downward in HCM and HHD. In IHD, however, this relationship shifted toward the left and downward in cases with reduced LV function (V1 less than 1.0 EDC/sec), but toward the right and downward in patients whose LV function was maintained (V1 greater than or equal to 1.0 EDC/sec). Nifedipine therapy was associated with an improved LV filling in nearly all cases of HCM and HHD, and in some cases of IHD. PDE and RI angiography are useful for evaluating LV diastolic function during sublingual nifedipine in various heart diseases.