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Background Although Doppler left ventricular (LV) filling abnormalities have been extensively analyzed in patients with systolic heart failure (SHF), they have not yet been well characterized in patients with acute to chronic diastolic heart failure (DHF) in the light of plasma brain natriuretic peptide (BNP) levels. Methods and ResultsIn 25 patients presenting with acute DHF and 25 with acute SHF, echo Doppler parameters and plasma BNP levels were obtained on admission and in the chronic stage. The mitral E/A ratio was lower in DHF patients than in SHF patients in the acute stage (1.3±0.4 vs 1.8±0.9, p<0.05), and in the chronic stage of DHF the ratio decreased with plasma BNP level, but plasma BNP level was still greater than 100 pg/ml in 15 patients (60%). Among patients with DHF the plasma BNP level did not correlate with the mitral E/A ratio or deceleration time (r=0,25, p=NS; r=0,23, p=NS), but did with estimated pulmonary artery systolic pressure (r=0.64, p<0.01). Conclusions A restrictive mitral flow velocity pattern is observed in only 25% of patients with DHF, so it is particularly important to recognize pseudonormalization in those with possible DHF. Persistently elevated plasma BNP level is not primarily caused by LV diastolic dysfunction, but by secondary alteration for hemodynamic adjustment (elevated LV end-diastolic pressure) in patients with DHF. (Circ J 2007; 71: 1412 -1417

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LVMI and E velocity were independent determinants of plasma BNP level in patients with untreated hypertension. Plasma BNP level is substantially useful for the screening of abnormalities of LV geometry and/or function in patients with untreated hypertension. Additional echocardiography is useful to assess the mechanism of the elevation of plasma BNP level in untreated hypertensive patients.

Background. Restrictive or pseudonormalized mitral flow velocity pattern (MFVP) is observed not only in patients with heart failure but also in patients with severe mitral regurgitation (MR). It is important to assess the restrictive MFVP which is primarily due to functional deterioration of the left ventricle or due to MR in individual patients. We hypothesized that left atrial (LA) geometry may be used to estimate restrictive MFVP due to heart failure or MR.Methods. In addition to MFVP and LA chamber size, LA eccentricity index was determined as LA superior-inferior dimension x2/(LA antero-posterior dimension + LA medio-lateral dimension) using 2-dimensional echocardiography in 61 sinus rhythm patients with LA volume of 35 ml or greater. Ten patients had congestive heart failure (CHF group), and 9, severe organic MR (MR group). LV diastolic dysfunction was the most likely explanation for the LA enlargement in the remaining 42 patients (DDF group).Results. There was no difference in mitral E/A ratio (peak early diastolic flow velocity/peak flow velocity at atrial contraction) or in LA chamber size between the MR and CHF groups, but the LA eccentric index was greater in the CHF and DDF groups than in the MR group indicating that LA geometry was spherical in the MR group and elongated in the CHF and DDF groups.Conclusions. Two-dimensional echocardiographic assessment of the LA geometry is useful to determine whether the pseudonormalized or restrictive MFVP is due to functional deterioration of the left ventricle or due to MR. (J Echocardiogr 2005; 3: 109-117)