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[The Doppler echocardiographic assessment of left ventricular diastolic function in coronary heart disease]
W Weihs1, B Anelli-Monti, H Schuchlenz
1II. Medizinische Abteilung, Kardiopulmonales Departement, Landeskrankenhaus und Universitätsklinikum Graz.
Insights
Doppler echocardiography (DEC) can noninvasively assess left ventricular (LV) diastolic function by analyzing transmitral flow patterns. Specific transmitral flow parameters accurately identify patients with severe diastolic dysfunction and elevated LV filling pressures.
Area of Science:
- Cardiology
- Echocardiography
- Physiology
Background:
- Left ventricular (LV) diastolic dysfunction alters transmitral flow patterns detectable by Doppler echocardiography (DEC).
- While DEC is not a direct measure of LV filling pressures, transmitral flow correlates with LV hemodynamics.
- Assessing these changes is crucial for managing patients with coronary heart disease (CHD).
Purpose of the Study:
- To compare transthoracic DEC findings with hemodynamic parameters in patients with CHD.
- To evaluate the clinical utility of DEC in assessing LV diastolic function and filling pressures.
- To determine the accuracy of transmitral flow parameters in identifying elevated LV end-diastolic pressure (LVEDP).
Main Methods:
- Prospective study involving 254 consecutive patients with CHD.
- Transthoracic Doppler echocardiography (DEC) was performed to measure transmitral flow parameters.
- Key parameters analyzed included the ratio of early to late diastolic velocity (VE/VA) and early diastolic deceleration time (DT).
Main Results:
- Patients with reduced LV compliance and elevated LVEDP (>15 mm Hg) exhibited a restrictive transmitral flow profile (higher VE/VA, shorter DT).
- VE/VA and DT showed significant correlations with LVEDP (r=0.65 and r=-0.60, respectively, P<0.001).
- The combination of VE/VA > 1 and DT < 170 achieved 97% specificity for detecting LVEDP > 15 mm Hg.
Conclusions:
- Transmitral flow profiling via DEC provides a noninvasive indication of LV end-diastolic function.
- DEC effectively identifies patients with severe diastolic dysfunction and increased filling pressures with high specificity.
- This noninvasive method aids in the clinical assessment of cardiac function in CHD patients.
Background And Objective:
Changes in left ventricular (LV) diastolic function lead to characteristic changes in the transmitral flow profile as determined by Doppler echocardiography (DEC). Although DEC cannot provide direct quantitative measurement of LV filling pressures and is influenced by several factors, transmitral flow correlates well with LV haemodynamics. In this prospective study the results of transthoracic DEC were compared with haemodynamic parameters in patients with coronary heart disease (CHD) and their clinical value assessed.
Patients And Methods:
254 consecutive patients with CHD (67 women, 187 men, aged 62.5 +/- 8.5 years) underwent transthoracic DEC. The ratio of early to late diastolic velocity (VE/VA) and early diastolic deceleration time (DT) of the transmitral flow were measured as an indication of diastolic LV function.
Results:
Patients with reduced LV compliance and increased filling pressure (LV end-diastolic pressure [LVEDP] > 15 mm hg) had a restrictive transmitral flow profile with a significantly higher than normal VE/VA and a shorter DT (1.35 +/- 0.84 vs. 0.86 +/- 0.26, P < 0.001; and 158 +/- 45 vs. 213 +/- 35, P < 0.001, respectively). VE/VA and DT also significantly correlated with LVEDP (r = 0.65, P < 0.001 and r = -0.60, P < 0.001 respectively). Sensitivity and specificity of an LVEDP of > 15 mm Hg were 67% and 84%, respectively, for a VE/VA of more than 1, and 65% and 91% for a DT of less than 170. The combination of the two parameters increased specificity to 97%.
Conclusion:
Determining the transmitral flow profile makes it possible noninvasively to obtain an indication of LV end-diastolic function. Patients with severe diastolic dysfunction and increased filling pressures are recognized with a high degree of specificity.