Assessment of the Temporal Relationship Between Left Ventricular Relaxation and Filling During Early Diastole Using Pulsed Doppler Echocardiography and Tissue Doppler Imaging

Onose, Yukiko; Oki, Takashi; Tabata, Tomotsugu; Yamada, Hirotsugu; Ito, Susumu

doi:10.1253/jcj.63.209

Cited by 22 publications

(16 citation statements)

References 35 publications

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“…26 Moreover, using simultaneous recording of LV wall motion velocity by pulsed TDI and transmitral flow velocity, it has been clarified that elastic recoil of the myocardium promotes LV filling in normal subjects, and LV filling begins during active relaxation of the LV myocardium in patients with elevated LV end-diastolic pressure. 27 In the present study, it was most interesting that the E and E/A obtained from the transmitral flow velocity pattern improved first during treatment with cilnidipine, and then the Ew and Ew/Aw obtained from pulsed TDI subsequently improved. These results suggest that LV early diastolic filling initially improved due to the decrease in blood pressure (afterload) induced by cilnidipine and, thereafter, active relaxation of the LV myocardium gradually improved.…”

Section: Left Ventricular Diastolic Functionsupporting

confidence: 49%

Effect of Cilnidipine on Left Ventricular Diastolic Function in Hypertensive Patients as Assessed by Pulsed Doppler Echocardiography and Pulsed Tissue Doppler Imaging

et al. 2001

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eft ventricular (LV) systolic 1 and diastolic 2,3 functions are frequently impaired in hypertensive patients with LV hypertrophy. Because LV hypertrophy may become an important risk factor increasing the morbidity or mortality in ischemic heart disease, 4,5 many clinical studies have been conducted to evaluate morphological and functional improvements of the LV after administering various antihypertensive drugs. [6][7][8][9] Conversely, a number of studies on LV diastolic function in hypertensive patients show that diastolic dysfunction occurs before LV hypertrophy or systolic dysfunction. 2,3,10 Parameters obtained from the transmitral flow velocity pattern correlated closely with parameters obtained by left ventriculography 11 and radionuclide angiography. 12 Therefore, the transmitral flow velocity pattern is widely used to evaluate LV diastolic function in clinical settings. However, because the transmitral flow velocity pattern is influenced strongly by loading condition, such as left atrial pressure or aortic pressure, there is a limitation when this index is used to evaluate LV diastolic Japanese Circulation Journal Vol. 65, April 2001 function in patients with elevated LV end-diastolic pressure. 13,14 Recently, a tissue Doppler imaging (TDI) method has been developed in which large Doppler signals obtained from the ventricular wall can be selectively displayed as a color or pulsed Doppler image by eliminating small Doppler signals produced by the blood flow. This new technique is expected to provide valuable information on LV wall motion abnormalities in patients with heart disease. [15][16][17] Cilnidipine is a novel and unique 1,4-dihydropyridine derivative calcium antagonist that has a hypotensive action of slow-onset and prolonged duration, and has potent inhibitory action on L-and N-type voltage-dependent calcium channels. Clinical usefulness of this calcium antagonist is expected as a result from its heart-protecting action in addition to its antihypertensive effect. 18,19 The present study was designed to evaluate the effect of cilnidipine on LV diastolic dysfunction in hypertensive patients, and to confirm the presence or absence of its beneficial effect. Methods Study PopulationThe study comprised 35 Japanese outpatients (19 men and 16 women aged 65±10 years (mean ± SD)) with essential hypertension who had not been treated previously with antihypertensive drugs. All the patients had a systolic blood The purpose of the present study was to examine the mechanisms of improvement in left ventricular (LV) diastolic function in hypertensive patients treated with cilnidipine, a new and unique calcium antagonist that has both L-type and N-type voltage-dependent calcium channel blocking actions, using pulsed Doppler echocardiography and pulsed tissue Doppler imaging. The study comprised 35 untreated patients with essential hypertension (19 men and 16 women; mean age 65±10 years). The peak early diastolic and atrial systolic transmitral flow velocities (E and A, respectively) and their ratio (E/A), and...

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Section: Left Ventricular Diastolic Functionsupporting

confidence: 49%

Effect of Cilnidipine on Left Ventricular Diastolic Function in Hypertensive Patients as Assessed by Pulsed Doppler Echocardiography and Pulsed Tissue Doppler Imaging

et al. 2001

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“…They reported that LV fi lling started before wall expansion in patients with a pseudonormalized pattern. 13 This indicates that pseudonormalization following the progression of diastolic dysfunction leads to delayed relaxation, and that LV wall expansion commences later than LV fi lling, supporting our results obtained by CK analysis.…”

Section: Comparison Of Early Diastolic Mitral Annular Velocity (E′) Isupporting

confidence: 87%

Assessment of left ventricular diastolic function using color kinesis: differentiation between normal and pseudonormalized patterns

et al. 2009

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“…In addition, simultaneous recording of the transmitral flow velocity and LV posterior wall motion velocity patterns demonstrated that the time from the aortic component of the second heart sound to the onset of Ew is equal to or shorter than the isovolumic relaxation time in normal individuals [69] (Figure 5). This finding suggests that LV wall expansion starts at the same time as, or earlier than, LV filling during early diastole, and that elastic recoil of the LV myocardium Transmitral flow (TMF, top) and left ventricular posterior wall motion (PWV, bottom) velocities recorded from a transthoracic approach in a normal subject (left) and a patient with a markedly increased left ventricular enddiastolic pressure (right).…”

Section: Diastolic Functionmentioning

confidence: 99%

The Role of Tissue Doppler Imaging as a New Diagnostic Option in Evaluating Left Ventricular Function

Oki

2003

J Echocardiogr

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In general, pump function and myocardial contractility should be assessed when evaluating left ventricular (LV) systolic function. Ejection fraction obtained from left ventriculography is routinely used as an index of pump function, and the maximum value of the first derivative of LV pressure curve (peak dP/dt) has been used as an index of myocardial contractility. On the other hand, active relaxation of the LV myocardium during early diastole and LV passive filling or compliance during mid-to late diastole are important factors in evaluating LV diastolic function. To obtain this information, the time constant of the LV pressure decay during isovolumic diastole (tau) and LV end-diastolic pressure, which are calculated from the LV pressure curve recorded during cardiac catheterization, is used. However, invasive hemodynamic measurements cannot be performed in all patients, nor are they appropriate for follow-up evaluation involving repeated examinations.Recently, routine echocardiography has facilitated the noninvasive evaluation of LV systolic and diastolic function. The percent fractional shortening of the LV based on M-mode echocardiography and the LV ejection fraction determined by two-dimensional echocardiography are indices of LV pump function, and therefore cannot accurately evaluate LV myocardial contractility. On the other hand, "diastology" has become an important clinical topic [1]. There are several reasons why assessment of diastolic function is important: 1) 30 to 40% of patients evaluated for congestive heart failure have normal LV pump function [2,3]; 2) the transmitral flow velocity pattern, which is recorded using the pulsed Doppler method, may be an index for noninvasive evaluation of LV diastolic function [4]; and 3) the prognosis is poor in patients with LV systolic dysfunction and pseudonormalization or restrictive pattern of the transmitral flow velocity [5,6]. However, it has been shown that the diastolic indices obtained from transmitral and pulmonary venous flow velocities are influenced by loading conditions, especially by the pre- The Role of Tissue Doppler Imaging as a New Diagnostic Option in Evaluating Left AbstractThe widespread use of the pulsed Doppler echocardiography has facilitated the noninvasive evaluation of hemodynamic abnormalities of the left atrium and left ventricle (LV) based on transmitral and pulmonary venous flow velocity patterns. However, it has been shown that loading conditions, especially preload, influence the indices obtained from these velocity patterns. Recently, tissue Doppler imaging (TDI) has been applied to the clinical setting to assess LV myocardial function. In particular, this procedure has the following characteristics: 1) it can provide circumferential and longitudinal information for the LV myocardium; 2) the early diastolic LV myocardial parameters determined by TDI are not influenced by preload; 3) LV myocardial contractility can be evaluated from the early systolic parameters; 4) LV systolic and diastolic asynchrony can be detected; 5) myoca...

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Assessment of the Temporal Relationship Between Left Ventricular Relaxation and Filling During Early Diastole Using Pulsed Doppler Echocardiography and Tissue Doppler Imaging

Cited by 22 publications

References 35 publications

Effect of Cilnidipine on Left Ventricular Diastolic Function in Hypertensive Patients as Assessed by Pulsed Doppler Echocardiography and Pulsed Tissue Doppler Imaging

Effect of Cilnidipine on Left Ventricular Diastolic Function in Hypertensive Patients as Assessed by Pulsed Doppler Echocardiography and Pulsed Tissue Doppler Imaging

Assessment of left ventricular diastolic function using color kinesis: differentiation between normal and pseudonormalized patterns

The Role of Tissue Doppler Imaging as a New Diagnostic Option in Evaluating Left Ventricular Function

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