Related Experiment Videos
[The pulsed Doppler evaluation of patients with dilated cardiopathy]
Insights
Doppler echocardiography reveals distinct left ventricular filling patterns in patients with dilated cardiomyopathy and varying pulmonary capillary wedge pressures. These patterns differ based on hemodynamic status, aiding in clinical evaluation.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Physiology
Background:
- Dilated cardiomyopathy is characterized by impaired left ventricular systolic function.
- Left ventricular diastolic filling patterns are crucial for assessing cardiac health.
- Pulmonary capillary wedge pressure (PWP) reflects left ventricular filling pressures.
Purpose of the Study:
- To evaluate left ventricular filling patterns using 2D-Doppler echocardiography.
- To compare these patterns in patients with systolic dysfunction and varying PWP.
- To differentiate filling characteristics based on hemodynamic status.
Main Methods:
- A prospective study involving patients with dilated cardiomyopathy undergoing cardiac catheterization.
- 2D-Doppler echocardiography was used to measure diastolic flow indexes: peak protodiastolic velocity (Vel E), peak telediastolic velocity (Vel A), and E/A ratio.
- Patients were categorized into groups based on PWP (<16 mmHg and >=16 mmHg) and compared to a normal control group.
Main Results:
- Patients with lower PWP (group A1) showed decreased Vel E and increased Vel A compared to controls and those with higher PWP (group A2).
- The E/A ratio was lower in group A1 and higher in group A2 compared to controls.
- Increased E-D time was observed in group A1, while group A2 showed a slight reduction; mitral regurgitation was associated with group A2.
Conclusions:
- 2D-Doppler echocardiography effectively evaluates left ventricular filling in dilated cardiomyopathy.
- Distinct diastolic filling patterns are associated with different hemodynamic states (PWP levels).
- These findings support the utility of Doppler echocardiography in managing patients with cardiomyopathy.
Objective:
To evaluate, by 2D-Doppler echocardiography, the patterns of left ventricular filling in groups of patients with left ventricular systolic disfunction and different pulmonary wedge pressures.
Study Design:
perspective study of different indexes of left ventricular diastolic filling measured by Doppler echocardiography and compare them with a normal group.
Setting:
Patients studied in the Cardiology Department of the Santa Marta Hospital with a diagnosis of dilated cardiopathy and submitted to cardiac catheterisation.
Patients:
Twenty-four patients, aged 39 years old, submitted to hemodynamic study (group A) and nineteen subjects, aged 34 years old (group B). Pulmonary capillary wedge pressure (PWP) was determined in group A and the patients were divided in two groups: group A1 (with PWP < 16 mmHg) and group A2 (with PWP > or = 16 mmHg).
Interventions:
Every patient was submitted to cardiac catheterisation. The echocardiographic study showed global decrease of left ventricular systolic function. With pulsated Doppler left ventricular diastolic flow indexes were determined. The following parameters were studied: peak protodiastolic flow velocity (Vel E), peak telediastolic flow velocity (Vel A), E/A ratio, protodiastolic acceleration time (O-E) and diastolic flow time (O-C).
Measurements And Results:
There were no statistical differences between group A as a whole and group B. However in group A1, with a lower PWP there was a decrease of E flow velocity in relation to the control group (54.6 cm/sec +/- 14 vs 66.4 cm/seg +/- 12.8 p < 0.05) or to the group A2 (75.3 cm/sec +/- 29.9 p < 0.05). In the group A1 there was an increase of the flow velocity A in relation to group B (56.1 cm/sec +/- 15.9 vs 36.4 cm/sec +/- 7.3 p < 0.05) and to the group A2 (56.1 cm/sec +/- 15.5 vs 28.2 +/- 9.1 p < 0.05). The relation E/A in group A1 was deceased in relation to group B (1.0 +/- 0.4 m vs 1.8 +/- 0.6 p < 0.05) and in group A2 its increased in relation to B (2.6 +/- 0.9 vs 1.8 +/- 0.6 p < 0.05). The E-D time was increased in group A1 in relation to group B (162.1 +/- 8.7 cm/sec vs 140.5 +/- 42.0 cm/sec p < 0.05) and slightly reduced in group A2 (134.5 +/- 78 msec vs 140.5 +/- 42.0 msec NS). All the patients with mitral regurgitation belonged to group A2. There was only statistical difference in the velocity between the patients in group A with and without mitral regurgitation (29.6 +/- 17.4 cm/sec vs 26.4 +/- 8.5 cm/sec p < 0.05).
Conclusions:
In spite of some limitations, Doppler echocardiography is useful in the evaluation of left ventricular filling of patients with dilated cardiomyopathy. It shows different patterns that vary according to the hemodynamic states of the patient.