Impact of Chronic Left Ventricular Preload and Afterload on Doppler Tissue Imaging Velocities: A Study in Congenital Heart Disease

Eidem, Benjamin W.; McMahon, Colin J.; Ayres, Nancy A.; Kovalchin, John P.; Denfield, Susan W.; Altman, Carolyn A.; Bezold, Louis I.; Pignatelli, Ricardo H.

doi:10.1016/j.echo.2004.09.011

Cited by 72 publications

(24 citation statements)

References 45 publications

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“…Recent studies have reported promising results, with upwards of 35–40% of patients achieving a biventricular circulation 2,4 . In children with other left heart obstructive lesions, including congenital AS and aortic coarctation, LV diastolic dysfunction (DD) is well described 5–10 . Our previous work has shown DD in infants and children with biventricular circulation after FAV is common, more severe than isolated congenital AS and persists over medium term follow-up 11 .…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Diastolic Function and Characteristics in Fetal Aortic Stenosis

Friedman

Schidlow

Freud

et al. 2014

The American Journal of Cardiology

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Fetal aortic valvuloplasty (FAV) has shown promise in averting progression of mid-gestation aortic stenosis (AS) to hypoplastic left heart syndrome in a subset of patients. Patients who achieve biventricular circulation after FAV frequently have left ventricular (LV) diastolic dysfunction (DD). This study evaluates DD in fetuses with AS by comparing echocardiographic indices of LV diastolic function in fetuses undergoing FAV (n=20) to controls (n=40) and evaluates for LV factors associated with DD in FAV patients. We also compared pre- and post-FAV DD variables (n=16). Median gestational age (24 weeks, range 18–29 weeks) and fetal heart rate were similar between FAV and controls. Compared to controls, FAV patients had universally abnormal LV diastolic parameters including fused mitral inflow E and A waves (p=0.008), higher E velocity(p<0.001), shorter mitral inflow time (p=0.001), lower LV lateral annulus E′ (p<0.001), septal E′ (p=0.003) and higher E/E′ (p<0.001) than controls. FAV patients had abnormal right ventricular mechanics with higher tricuspid inflow E velocity (p<0.001), and shorter tricuspid inflow time (p=0.03). Worse LV diastolic function (lower LV E′) was associated with higher endocardial fibroelastosis (EFE) grade (r=0.74, p<0.001), large LV volume (r=0.55, p=0.013) and sphericity (r=0.58, P=0.009) and with lower LV pressure by mitral regurgitation jet (r=−0.68, p<0.001). Post-FAV, fewer patients had fused mitral inflow E and A than pre-FAV (p=0.05) and septal E′ was higher (=0.04). In conclusion, fetuses with mid-gestation AS have evidence of marked DD. Worse DD is associated with larger, more spherical LV, with more extensive EFE and lower LV pressure.

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Section: Introductionmentioning

confidence: 99%

Left Ventricular Diastolic Function and Characteristics in Fetal Aortic Stenosis

Friedman

Schidlow

Freud

et al. 2014

The American Journal of Cardiology

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“…2,4 In children with other left heart obstructive lesions including congenital AS and aortic coarctation, LV diastolic dysfunction is common. 5–8 However, LV diastolic function in patients who have undergone FAV has not been evaluated. This report describes echocardiographic indexes of LV diastolic function in patients with a biventricular circulation after FAV and compares them to patients with isolated congenital AS and to normal controls.…”

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confidence: 99%

Postnatal Left Ventricular Diastolic Function After Fetal Aortic Valvuloplasty

Friedman

Margossian

Harrild

et al. 2011

The American Journal of Cardiology

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Fetal aortic balloon valvuloplasty (FAV) has shown promise in altering in utero progression of aortic stenosis to hypoplastic left heart syndrome. In patients who achieve a biventricular circulation after FAV, left ventricular (LV) compliance may be impaired. Echocardio-graphic indexes of diastolic function were compared between patients with biventricular circulation after FAV, congenital aortic stenosis (AS), and age-matched controls. In the neonatal period, patients with FAV had similar LV, aortic, and mitral valve dimensions but more evidence of endocardial fibroelastosis than patients with AS. Patients with FAV underwent more postnatal cardiac interventions than patients with AS (p = 0.007). Mitral annular early diastolic tissue velocity (E′) was lower in patients with FAV and those with AS and controls in the neonatal period and over follow-up (p <0.001). Septal E′ was similar among all 3 groups in the neonatal period. In follow-up patients, with FAV had lower septal E′ than patients with AS or controls (p <0.001). Early mitral inflow velocity/E′ was higher in patients with FAV as neonates and at follow-up (p <0.001). Mitral inflow pulse-wave Doppler-derived indexes of diastolic function were similar between groups. In conclusion, echocardiographic evidence of LV diastolic dysfunction is common in patients with biventricular circulation after FAV and persists in short-term follow-up. LV diastolic dysfunction in this unique population may have important implications on long-term risk of left atrial and subsequent pulmonary hypertension.

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“…Eidem et al reported a series of 96 children with various degrees of congenital aortic stenosis and showed a significant decrease in early and late systolic and diastolic tissue velocities at the septal and lateral mitral annulus, the systolic-diastolic function parameters measured by standard methods being within normal limits. The patients with the highest transaortic gradients had the most significant decreases in tissue velocities, suggesting that postload influences to a great extent these tissue velocities [26]. Pauliks et al evaluated 39 children with atrial septal defect both before and after the percutaneous repair of the defect, demonstrating a transient decrease of tissue velocities in all myocardial segments, which returned to normal after 24 hours.…”

Section: Discussionmentioning

confidence: 99%

Systolic and Diastolic Function in Congestive Heart Failure Pediatric Patients

Butnariu

Zamfir

Iancu

et al. 2016

Romanian Journal of Internal Medicine

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Background and Aims. and Doppler echocardiography are the main methods for the non-invasive evaluation of ventricular function in children. Our study monitored the evaluation of systolic and diastolic function in pediatric patients, using classical echocardiographic parameters and pulsed tissue Doppler parameters, as well as the correlation between these.Methods. The study included 18 healthy children and 9 children diagnosed with congestive heart failure secondary to congenital heart malformations. The parameters of systolic and diastolic function were measured by 2D echocardiography, 2D guided M mode, color and pulsed Doppler, as well as by pulsed tissue Doppler at the level of the mitral and tricuspid annulus.Results. A relaxation alteration pattern or a pseudonormal pattern of E diastolic velocity compared to the A wave was found (E = A; E > A) in the group of subjects with heart failure. E wave deceleration time had significantly increased values in the case of patients with CHF, being correlated with diastolic dysfunction. Left ventricular flow propagation velocity Vp was decreased in patients with heart failure, the E/Vp ratio being maintained relatively constant in subjects with congestive heart failure and healthy subjects, most probably on account of the concomitant change in the E wave. Associations between the severity of systolic dysfunction and the diastolic dysfunction were found in pediatric patients diagnosed with congestive heart failure (Student test, p < 0.05).Conclusions. Tissue Doppler measurements proved to be useful for the evaluation of pediatric patients with altered ventricular geometry secondary to congenital heart disease, systolic-diastolic dysfunction and heart failure.

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Impact of Chronic Left Ventricular Preload and Afterload on Doppler Tissue Imaging Velocities: A Study in Congenital Heart Disease

Cited by 72 publications

References 45 publications

Left Ventricular Diastolic Function and Characteristics in Fetal Aortic Stenosis

Left Ventricular Diastolic Function and Characteristics in Fetal Aortic Stenosis

Postnatal Left Ventricular Diastolic Function After Fetal Aortic Valvuloplasty

Systolic and Diastolic Function in Congestive Heart Failure Pediatric Patients

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