Assessment of left ventricular diastolic filling in arterial hypertension Comparison of pulsed doppler echocardiography and acoustic quantification

Abstract

We compared acoustic quantification (AQ) to Doppler echocardiography (DE) in the evaluation of left ventricular (LV) diastolic filling in 41hypertensives and 42 controls. In hypertensives, DE showed reduced ratios of early to late diastolic velocity, AQ revealed reduced peak to late filling rate ratios, and both techniques found prolonged acceleration times indicating abnormal filling. In 22 patients with mild hypertension and less LV hypertrophy, however, all DE filling parameters were normal. In these patients AQ indicated A nalysis of mitral inflow velocities as determined by pulsed Doppler echocardiography has been used for noninvasive assessment of left ventricular (LV) diastolic function.1-3 Doppler echocardiographic parameters of diastolic filling are functions of temporal pressure differences between left atrium and left ventricle. 4 They are determined not only by myocardial relaxation and compliance, but also by pericardial properties, ventricular interaction, age, heart rate, preload, and afterload. 5,6 Therefore, the Doppler mitral inflow profile is often inconclusive in the assessment of LV diastolic function. A commercially available acoustic quantification system of ultrasonic integrated backscatter has been introduced that provides on-line delineation of borders between blood and endocardium in two-dimensional imaging. 7,8 This novel technique allows on line tracking of the changing LV area over time. Also, a curve of the rate of area change (dA/dt) over time can be displayed. In sinus rhythm this curve shows an early and late diastolic peak corresponding to peak and late diastolic filling rate, which has been reported to permit characterization of LV diastolic filling. 9,10 However, the role of acoustic quantification in the diagnosis of diastolic dysfunction is still unclear. Therefore, we investigated whether acoustic quantification is useful in the investigation of diastolic filling in arterial hypertension and offers additional information in patients with inconclusive Doppler filling profiles.

Real-Time Three-Dimensional Echocardiography for Improved Evaluation of Diastolic Function Using Volume-Time Curves

“…Impaired left ventricular filling in terms of reduced peak filling rate and delayed time to peak filling rate was demonstrated also in arterial hypertension through several studies using RNA, MRI and 2-D echo with automated boundary detection [7,10,12]. In two separate studies it was even suggested to be superior to conventional Doppler echo in detecting early diastolic dysfunction [10,12].…”

Assessment of Global and Regional Left Ventricular Diastolic Function in Hypertensive Heart Disease Using Automated Border Detection Techniques

“…Spencer et al 20 Chenzbraun et al 17 Angomachalelis et al 15 Muscholl et al 9 abnormal 22% to 48% of the time. The most commonly abnormal LA AQ parameters were the LA diastolic one-third time, as well as the rapid and atrial emptying fractions.…”

“…This technique provides LV area or volume versus time waveforms. The diastolic portion of the LV AQ waveform can be used to assess the diastolic properties of the LV 8–18 . We have found that the reliability of AQ for the assessment of LV diastolic function is improved by signal averaging of the continuous data to generate a single averaged waveform 19 .…”

“…Muscholl et al 9 studied 41 patients with systemic hypertension using AQ in the LV parasternal short‐axis view. This report noted that although the peak rates of filling failed to distinguish the hypertensive patients from age‐matched normal patients, the ratio of filling rates was significantly reduced.…”