Changes in left ventricular inflow and pulmonary venous flow velocities during preload alteration in dilated heart

Kiyoshige, Koichi; Oki, Takashi; Fukuda, Nobuo; Iuchi, Arata; Tabata, Tomotsugu; Fujimoto, Takashi; Manabe, Kazuyo; Kageji, Yoshimi; Sasaki, Miwa; Ito, Susumu

doi:10.1002/clc.4960190108

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…In patients with an Aw value of the mitral annulus 5 cm/s, the prognosis is poor [54] ( Figure 16). Because this parameter can be easily recorded by the transthoracic approach and is not influenced by preload, unlike TMF or PVF velocity pattern [56,57], it may be applied to clinical practice in the future.…”

Section: Implication In Pulmonary Congestion With Reduced LV Ejectionmentioning

confidence: 99%

Renewed Interest in Left Atrial Function: What do we Need to Evaluate Clinically?

et al. 2005

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The use of a Swan-Ganz catheter has resulted in the accurate evaluation of the severity of acute left heart failure, making it possible to establish appropriate therapeutic strategies for this disorder using Forrester s classification. The routine use of clinical echocardiography has facilitated the noninvasive diagnosis of hemodynamic abnormalities related to various disease conditions. In particular, transmitral flow (TMF) and pulmonary venous flow (PVF) velocity patterns, acquired by the pulsed Doppler method, have led to the establishment of a new clinical field, diastology [1].Previously, the left ventricle (LV) was the focus of investigation when evaluating left heart function, and the left atrium (LA) was considered to have a minor supporting role. However, recent studies have focused on the role of the LA, because it has been recognized that a thorough understanding of LA performance is essential to evaluate more accurately left heart diseases [2]. When evaluating LV function clinically, hemodynamic abnormalities in the pulmonary vein-LA-LV relationship should always be considered, and echocardiography may be an indispensable tool for obtaining important information concerning the relationship between the pulmonary veins and LV with the LA playing a central role.In this review, we summarize how to evaluate LA function using echocardiography with the role of LA function in patients with left-side heart failure. Basic UnderstandingLeft atrial function is classified into 3 categories based on hemodynamic characteristics [3-6]: 1) reservoir function for blood returning from the pulmonary veins due to active relaxation and passive expansion of the LA during ventricular systole; 2) conduit function promoting direct blood inflow from the pulmonary veins to the LV during ventricular diastole; and 3) booster pump function that is responsible for active ejection of blood into the LV during atrial systole.The blood inflow from the pulmonary veins to the LA and that from the LA to the LV can be evaluated by pulsed Doppler echocardiography based on the PVF velocity pattern (Figure 1, PVF) and the TMF velocity pattern (Figure 1, TMF). Because LA filling and emptying are involved in the hemodynamic relationship between the pulmonary veins, LA and LV, the LA appendage flow velocity pattern (Figure 1, LAAF), recorded by pulsed Doppler echocardiography, and the mitral annular motion velocity pattern (Figure 1, MAMV), recorded by tissue Doppler imaging, also may be important indices for assessing LA function in addition to the LA size determined by M-mode and 2-and 3-dimensional echocardiography, which assess

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Section: Implication In Pulmonary Congestion With Reduced LV Ejectionmentioning

confidence: 99%

Renewed Interest in Left Atrial Function: What do we Need to Evaluate Clinically?

et al. 2005

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“…In particular, many studies emphasized that TMF velocity changes easily from the pseudonormalized (E/A>1) pattern to the relaxation failure (E/A<1) pattern during preload reduction in the presence of elevated LV end-diastolic pressure, and PVF decreases peak early diastolic and atrial systolic velocities [5-7, 12, 13]. Some studies indicated that preload reduction decreases the peak velocity and time-velocity integral of the E wave in TMF velocity, but there is no significant change in peak velocity and time-velocity integral of the A wave in normal hearts [5,7,10,12]. In the present study, preload reduction decreased the timevelocity integral of the E wave in TMF velocity, and its decreasing rate depended on that in IEa.…”

Section: Discussionmentioning

confidence: 99%

“…7 18 years) in normal sinus rhythm and without physiological valvular regurgitation. The purpose of this study was fully explained to all subjects, and informed consent was obtained.…”

Section: Methodsmentioning

confidence: 99%

“…When evaluating LV function clinically, the role of the LA with reservoir, conduit, and booster pump functions is very important [4]. It is well known that TMF and PVF velocities in the diseased hearts depend on loading conditions, especially preload [5][6][7]. Therefore, evaluation of changes in venous and atrioventricular flow velocity patterns during preload alteration may provide valuable information for clarifying the contribution of the venous return system to right ventricular or LV filling.…”

Section: Introductionmentioning

confidence: 99%

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Relation of Atrial Function to Ventricular Filling During Preload Reduction in Normal Subjects: Combined Analysis of Atrioventricular and Venous Flow Velocities

et al. 2007

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Background. Although pulsed Doppler echocardiography, particularly recordings of the transmitral and pulmonary venous flow (TMF and PVF, respectively) velocities, could recently serve as a useful tool in the evaluation of left ventricular (LV) diastolic function, the mechanisms underlying the relation of atrial function to ventricular filling are incompletely understood.Methods. We performed transthoracic and transesophageal pulsed Doppler echocardiography during lower body negative pressure (LBNP, -20 and -40 mm Hg) in 14 healthy volunteers, and assessed the changes in superior vena cava (SVC) flow, transtricuspid flow (TTF), TMF, and PVF velocity patterns during preload reduction.Results. During LBNP, there were no significant changes in heart rate and mean blood pressure. The LV end-diastolic and maximal left atrial dimensions were decreased, whereas there were no significant changes in percent LV fractional shortening. The peak early diastolic velocity (E) and the initial time-velocity integral between the onset and the time of peak flow velocity of the early diastolic filling (IEa) of the TTF and TMF velocities were decreased. The peak second systolic velocity (S 2 ) of the SVC flow and PVF velocities, and time-velocity integral of the second systolic wave (IS 2 ) of the PVF velocity were decreased. There was a positive correlation between the changing IEa ( IEa) of the TMF velocity and the changing IS 2 ( IS 2 ) of the PVF velocity during preload reduction. There were no significant changes in atrial systolic parameters of the TTF and TMF velocities.Conclusions. Atrial passive emptying contributes to the former-part of the early diastolic ventricular filling, particularly in the left heart side, in normal subjects. (J Echocardiogr 2007; 5: 48-54)

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“…In this regard, the echocardiographic Doppler technique represents an ideal noninvasive method for assessing ventricular interaction and filling. [7][8][9][10][11][12][13][14][15][16] It was the purpose of the present study to investigate whether in dilated heart (1) preload reduction by a physiologic stimulus (tilting test) or by acute ACE inhibition (captopril) may cause similar changes in RV and LV dimensions, geometry, and filling; and (2) ACE inhibition may produce an additional effect on ventricular interaction during head-up tilting.…”

Section: Introductionmentioning

confidence: 99%

Effects of acute angiotensin‐converting enzyme inhibition on diastolic ventricular interaction in the dilated heart

Pepi

Tamborini

Maltagliati

et al. 2003

Clinical Cardiology

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SummaryBackground: The normal and dilated heart behaves as a single functional unit during preload reduction; volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling.Hypothesis: We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin-converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction.Methods: Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position (B) and after 40˚ of head-up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mg s.l.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study.Results: In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal-lateral diameter and anterior-posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior-posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic for-

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Changes in left ventricular inflow and pulmonary venous flow velocities during preload alteration in dilated heart

Cited by 8 publications

References 15 publications

Renewed Interest in Left Atrial Function: What do we Need to Evaluate Clinically?

Renewed Interest in Left Atrial Function: What do we Need to Evaluate Clinically?

Relation of Atrial Function to Ventricular Filling During Preload Reduction in Normal Subjects: Combined Analysis of Atrioventricular and Venous Flow Velocities

Effects of acute angiotensin‐converting enzyme inhibition on diastolic ventricular interaction in the dilated heart

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