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PVF velocity pattern in patients with heart failure: transesophageal echocardiographic assessment
A Vitarelli1, M F Luzzi, M Penco
1Cardiac Department, La Sapienza University, Rome, Italy. A.Vitarelli@agora.stm.it
Insights
Pulmonary venous flow (PVF) velocity patterns, assessed via transesophageal echocardiography (TEE), effectively differentiate congestive heart failure (CHF) patients with systolic dysfunction from those with diastolic impairment. This method aids in evaluating heart failure severity and type.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Congestive heart failure (CHF) diagnosis and management rely on accurate assessment of cardiac function.
- Pulmonary venous flow (PVF) velocity patterns offer insights into left atrial and ventricular pressures.
- Distinguishing between systolic and diastolic dysfunction is crucial for targeted CHF therapy.
Purpose of the Study:
- To evaluate the role of pulmonary venous flow (PVF) velocity patterns in assessing patients with congestive heart failure (CHF).
- To correlate PVF patterns with left ventricular ejection fraction (LVEF) and diastolic parameters.
- To determine if PVF patterns can differentiate between systolic and diastolic heart failure.
Main Methods:
- 41 CHF patients and 16 controls underwent transthoracic echocardiography (TTE) and multiplane transesophageal echocardiography (TEE).
- PVF peak systolic and diastolic velocities were measured, calculating systolic fraction (SF).
- Mitral flow velocity patterns (E/VTI, DT, LVIRT) and LVEF were also assessed.
Main Results:
- CHF patients exhibited lower SF and higher E/VTI ratios, with shorter DT and LVIRT compared to controls.
- A significant correlation was found between SF and LVEF (r = 0.76, p < 0.001).
- Two PVF patterns (Type A: low LVEF, Type B: normal/near-normal LVEF) were identified, correlating with systolic and diastolic dysfunction respectively.
Conclusions:
- Transesophageal echocardiography (TEE) assessment of PVF velocity patterns is valuable in CHF evaluation.
- PVF patterns, particularly SF, effectively distinguish systolic dysfunction (low LVEF) from predominant diastolic impairment.
- This technique aids in classifying CHF patients, guiding therapeutic strategies.
Abstract:
In order to assess the role of the pulmonary venous flow (PVF) velocity pattern in the evaluation of patients with congestive heart failure (CHF), we studied 41 CHF patients by means of transthoracic echocardiography (TTE) and multiplane transesophageal echocardiography (TEE). The etiology of CHF was idiopathic or ischemic dilated cardiomyopathy in 19 patients and hypertensive heart disease in 22. Sixteen subjects without cardiovascular disease were selected as normal controls. PVF peak systolic and peak early diastolic (D) velocities were recorded by TEE and TTE and the systolic fraction (SF) was measured (i.e., the systolic velocity-time integral-VTI-expressed as a fraction of the sum of systolic and early diastolic (VTI). TEE tracings were obtained in all patients and had more laminar-appearing spectral signals, thus were used for analysis. By TEE the mitral flow velocity patterns were also evaluated: peak early diastolic velocity (E), peak velocity at atrial contraction, E velocity normalized for VTI (E/VTI), deceleration time (DT), and left ventricular isovolumic relaxation time (LVIRT). The left ventricular ejection fraction (LVEF) was calculated by two-dimensional echocardiographic images using the modified Simpson method. The SF was lower in CHF patients as compared with normal controls (p < 0.0001). The E/VTI ratio was higher, and DT and LVIRT were shorter (p < 0.0001) in CHF patients. A significant correlation was observed between SF and LVEF in CHF patients (r = 0.76, p < 0.001). Two different PVF velocity patterns (type A:SF << 50%, D > 50 cm/s; type B:SF approximately 50%, D > 50 cm/s) were recognized in patients with a low LVEF (type A) and a nearly normal or normal LVEF (type B). Patients with LVEF < 40% showed mean SF values significantly lower than patients with LVEF > 40% (33.26 +/- 10.84 vs. 51.00 +/- 4.00%, p < 0.0001). Mean DT and LVIRT values were not significantly different in patients with LVEF < 40% and > 40%. Thus in CHF patients TEE PVF velocity patterns help in distinguishing patients with systolic dysfunction (low LVEF and SF) from patients with predominant diastolic impairment (normal or nearly normal LVEF, high D velocities).