Pattern of left ventricular diastolic filling associated with right ventricular enlargement

Lavine, Steven J.; Tami, Luis; Jawad, Ibrahim A.

doi:10.1016/0002-9149(88)90975-7

Cited by 24 publications

(10 citation statements)

References 18 publications

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“…Right ventricular enlargement and or dysfunction can affect the filling property of the left ventricle presumably due to ventricular interdependence. Reversed mitral Doppler flow E / A ratio similar to an impaired relaxation pattern have been observed in conditions that predominantly affect the right heart 24,25 . To the best of our knowledge, however, a restrictive filling pattern due to an isolated structural and/or functional abnormality of the right ventricle has not been reported.…”

Section: Discussionmentioning

confidence: 90%

“…Reversed mitral Doppler flow E ⁄ A ratio similar to an impaired relaxation pattern have been observed in conditions that predominantly affect the right heart. 24,25 To the best of our knowledge, however, a restrictive filling pattern due to an isolated structural and ⁄ or functional abnormality of the right ventricle has not been reported. On the other hand, pulmonary hypertension is common in patients with significant LV dysfunction as a result of associated pulmonary venous hypertension.…”

Section: Discussionmentioning

confidence: 97%

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Plasma Carboxy‐Terminal Peptide of Procollagen Type I Is an Independent Predictor of Diastolic Function in Patients With Advanced Systolic Heart Failure

Roongsritong¹,

Sadhu²,

Pierce³

et al. 2008

Congestive Heart Failure

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Severe diastolic dysfunction has important clinical implications in advanced systolic heart failure. The authors investigated whether a marker of fibrosis, serum carboxy‐terminal peptide of procollagen type I (PICP) is a major determinant of diastolic function in 40 patients with heart failure and ejection fraction <35%. Patients with unstable heart failure or ischemic symptoms were excluded. The authors found PICP to be an independent predictor of diastolic function in addition to age and pulmonary artery systolic pressure. The authors’ findings suggest that studies evaluating whether therapy that improves myocardial fibrosis could have a favorable impact on diastolic function in this population are warranted.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Plasma Carboxy‐Terminal Peptide of Procollagen Type I Is an Independent Predictor of Diastolic Function in Patients With Advanced Systolic Heart Failure

Roongsritong¹,

Sadhu²,

Pierce³

et al. 2008

Congestive Heart Failure

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“…In fact, a shortening of E-wave deceleration time with pulmonary hypertension has been reported. 18 However, others have found a prolongation, 19 and recently, a lack of ventricular interdependence has been reported in chronic severe pulmonary hypertension explained by pericardial adaptation. 20 We therefore believe that low atrial compliance is the dominant factor in most patients with mitral stenosis.…”

Section: Net Av Compliance: a Physiological Modulator Of Papmentioning

confidence: 99%

Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis

et al. 2000

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Background-The decay of the pressure gradient across a stenotic mitral valve is determined by the size of the orifice and net AV compliance (C n ). We have observed a group of symptomatic patients, usually in sinus rhythm, characterized by pulmonary hypertension (particularly during exercise) despite a relatively large mitral valve area by pressure half-time. We speculated that this discrepancy was due to low atrial compliance causing both pulmonary hypertension and a steep decay of the transmitral pressure gradient despite significant stenosis. We therefore tested the hypothesis that C n is an important physiological determinant of pulmonary artery pressure at rest and during exercise in mitral stenosis. Methods and Results-Twenty patients with mitral stenosis were examined by Doppler echocardiography. C n , calculated from the ratio of effective mitral valve area (continuity equation) and the E-wave downslope, ranged from 1.7 to 8.1 mL/mm Hg. Systolic pulmonary artery pressure (PAP) increased from 43Ϯ12 mm Hg at rest to 71Ϯ23 mm Hg (range, 40 to 110 mm Hg) during exercise. There was a particularly close correlation between C n and exercise PAP (rϭϪ0.85).Patients with a low compliance were more symptomatic (PϽ0.025). Catheter-and Doppler-derived values for C n , determined in 10 cases, correlated well (rϭ0.79). Conclusions-C n , which can be noninvasively assessed, is an important physiological determinant of PAP in mitral stenosis. Patients with low C n represent an important clinical entity, with symptoms corresponding to severe increases in PAP during stress echocardiography.

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“…In humans with ASD, right ventricular dilatation significantly alters left ventricular geometry (e.g., a flattened inter- ventricular septum toward the left ventricle at end systole and early diastole and decreased left ventricular chamber dimension), increases left ventricular chamber stiffness and reduces its compliance, and consequently impairs left ventricular filling (3,6,17). However, all these abnormalities are not associated with significant changes in the mitral flow pattern in patients with normal pulmonary pressure (21,30,34). Human patients with similar right ventricular enlargement but normal to moderately elevated pulmonary pressure do not have mitral flow patterns significantly different from those in normal subjects.…”

Section: Possible Mechanisms For Left Ventricular Diastolic Dysfunctionmentioning

confidence: 99%

Abnormal cardiac inflow patterns during postnatal development in a mouse model of Holt-Oram syndrome

Zhou¹,

Zhu²,

Bishop³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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del/ϩ mice showed significant changes in the mitral flow pattern, including decreased peak velocity of the left ventricular (LV) early filling wave (E wave), increased peak velocity of the late filling wave (A wave), and decreased or even reversed peak E-to-A ratio. The prolongation of LV isovolumic relaxation time was detected in Tbx5 del/ϩ neonates as early as 1 wk of age. In Tbx5 del/ϩ mice, LV wall thickness appeared normal but LV chamber dimension was significantly reduced. LV systolic function did not differ from that in wild-type littermates. In contrast, the Doppler flow spectrum in the enlarged tricuspid orifice of Tbx5 del/ϩ mice demonstrated increased peak velocities of both E and A waves and increased total time-velocity integral but unchanged peak E/A. In another 13 mice ( 7 Tbx5 del/ϩ , 6 wild-type) at 2 wk of age, significant correlation was found between Tbx5 gene expression level in ventricular myocardium and LV filling parameters. In conclusion, the LV diastolic function of Tbx5 del/ϩ mice is significantly deteriorated, whereas the systolic function remains normal. Tbx5 mutation; atrial septal defect; left ventricular diastolic function; right ventricular dilatation; Doppler flow sampling HUMAN HOLT-ORAM SYNDROME is an autosomal dominant disease caused by mutations of the TBX5 gene and is characterized by congenital cardiac and forelimb anomalies (1,4,15,16,22). Similar to Holt-Oram syndrome, Tbx5del/ϩ mice demonstrate cardiac anatomic abnormalities including atrial septal defects (ASDs) and/or ventricular septal defects and limb malformations. Secondary changes in cardiac morphology including dilated atria and right ventricle leading to a bulbous shape of the whole heart are observed. Abnormal cardiac electrophysiology, particularly atrioventricular block, has also been found (5, 23).Although the cardiac structural phenotypes of Tbx5 del/ϩ mice have been well identified ex vivo with histology or MRI, the in vivo cardiac functional phenotypes and their comparison with those of corresponding human cardiac disease have not yet been evaluated. As seen in humans with right ventricular volume and/or pressure overload caused by ASD, left ventricular diastolic filling is impaired because of right heart dilatation and abnormal interaction of both ventricles (3,6,19,30). Because ASD and resultant right heart dilatation are the major structural anomalies in Tbx5 del/ϩ mice, it is of interest to explore the consequent functional abnormalities of this model compared with those in humans. Another question is whether Tbx5 mutation that markedly decreases the expression of downstream targeted genes in the developing murine heart (5) affects ventricular myocardial function.Recently, a methodology has been established for comprehensive in vivo cardiac imaging in mice using a high-frequency (ϳ20 -55 MHz) ultrasound imaging, ultrasound biomicroscopy (UBM) (10 -12, 25, 38, 40). This new technology has been successfully applied to measure cardiac dimensions, function, and hemodynamics with various functional modali...

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Pattern of left ventricular diastolic filling associated with right ventricular enlargement

Cited by 24 publications

References 18 publications

Plasma Carboxy‐Terminal Peptide of Procollagen Type I Is an Independent Predictor of Diastolic Function in Patients With Advanced Systolic Heart Failure

Plasma Carboxy‐Terminal Peptide of Procollagen Type I Is an Independent Predictor of Diastolic Function in Patients With Advanced Systolic Heart Failure

Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis

Abnormal cardiac inflow patterns during postnatal development in a mouse model of Holt-Oram syndrome

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