Synchronous motion assessment of left ventricular myocardium and pericardium in normal adult using dual pulse wave Doppler echocardiography / 中华医学超声杂志（电子版）

Objective To investigate the clinical value , the motive regularity, the temporal and spatial correlation between myocardium and adjacent pericardium of left ventricular short -axis in normal adsults by using dual pulse wave Doppler echocardiography .Methods Tissue dual pulse spectral Doppler images about segmental myocardium and adjacent pericardial of three complete cardiac cycles in 99 normal adults were collected synchronously by using dual pulse wave Doppler techenology ,6 segments were enrolled in this study, including the anterior and posterior wall at mitral valve , papillary muscles, and apex level of left ventricular short-axis view.The motive regularity of myocardium and adjacent pericardium at different levels and segments were observed .Peak speed, onset time and peak time between myocardium and adjacent pericardium in anterior and posterior wall of three valves were measured online in systolic , early diastolic, and late diastolic, and the correlation between segmental myocardium and adjacent pericardium in speed and time were analyzed.Results Dual pulse wave Doppler echocardiography showed that in left ventricular short-axis view, motion between myocardium and adjacent pericardium in the same segment had consistent direction, motions between myocardium and adjacent pericardium in anterior and posterior wall at the same level had opposite directions .Comparison of peak velocity, in anterior wall, the peak velocities of myocardium in systolic and late diastolic at mitral valve level , and the peak velocity of myocardium in systolic at papillary muscle level were lower than that of adjacent pericardium .In posterior wall, the peak velocities of myocardium in early diastolic and late diastolic at mitral valve level , the peak velocities of myocardium in systolic and early diastolic at papillary muscle level , and the peak velocity of myocardium in early diastolic at apex level were higher than that of adjacent pericardium , with statistical significance (t=-4.207, -2.078, 4.575, -2.277, -2.440, -2.292, 5.980, 2.604, all P<0.05).Comparison of onset time, the onset time of myocardium in systolic at papillary muscle level in anterior wall , and the onset time of myocardium in early diastolic at mitral valve level in posterior wall were lower than that of adjacent pericardium, with statistical significance (t =-2.447, -2.020, both P<0.05).Comparison of peak time, except the peak time of myocardium in systolic and early diastolic at mitral valve level in posterior wall was lower than that of adjacent pericardium , the remaining differences were statistically significant ( t =-3.530, -2.411, both P<0.05).Peak velocity, onset times and peak times of each segment measured between myocardium and adjacent pericardium were well correlated (r =0.407 -0.933, all P <0.01). Conclusions Dual pulse wave Doppler echocardiography can provide relativity and accordance between motive velocity and direction of left ventricular myocardium and adjacent pericardium in normal adults .It is a promising new method for the clinical diagnosis of constrictive pericarditis and differentiation with restrictive cardiomyopathy.

Assessment of left ventricular diastolic function by brain natriuretic peptide and tissue doppler imaging in the elderly patients with diabetes mellitus and hypertension / 中华老年医学杂志

Objective To investigate the correlation between brain natriuretic peptide(BNP)and left ventricular diastolic function in the elderly patients with diabetes mellitus and hypertension.Methods 128 elderly patients with diabetes mellitus were divided into diabetes without hypertension (n=63)and with hypertension(n=65),and other 62 normal subjects were selected as control group.Plasma BNP levels and indexes of echocardiography,including left ventricular mass index(LVMI),the mitral peak flow velocity during early(E)and late diastole(A),ratio of E/A,average peak velocities at mitral annuluses of six sites in left ventricular wall during early(MEm)and late diastole (MAm),and relative E/MEm were measured in all patients.Results LVMI,E/MEm and the levels of BNP were significantly higher in groups of diabetes without and with hypertension[(91.6 ±17.3)g/m2 and(116.7±20.5)g/m2,(10.3±1.8)and(12.5±1.4),(47.7±29.4)ng/L and(105.7±32.5)ng/L]than in control group[(78.7±19.5)g/m2,(8.9± 1.6)and(20.8±11.63)ng/L,respectively](F=11.54,13.83 and 9.75,all P＜0.05),while MEm in two diabetes groups[(6.8±1.0)and(5.4±0.9)cm/s]were decreased as compared with control group[(8.0± 1.1)cm/s,F=11.26,P＜0.05].The BNP levels were negatively correlated with E/A and MEm(r =-0.42 and -0.51,all P＜0.01),and positively correlated with LVMI and E/MEm(r=0.48 and 0.58,all P＜0.01).Conclusions Left ventricular diastolic function is impaired in diabetes mellitus and more severely impaired in diabetic patients with hypertension.A combination of plasma BNP and echocardiography parameter may be helpful to accurately evaluate left ventricular diastolic function in the elderly patients with diabetes mellitus and hypertension.

Dual Pulsed-Wave Doppler Tracing of Right Ventricular Inflow and Outflow: Single Cardiac Cycle Right Ventricular Tei Index and Evaluation of Right Ventricular Function

BACKGROUND AND OBJECTIVES: The reliability and usefulness of the right ventricular (RV) Tei index (RTX) remains controversial because it has not been possible to simultaneously measure RV inflow and outflow. However, dual pulsed-wave Doppler (DPD) enables flow velocities to be obtained at different sampling sites simultaneously. In this study we evaluated the feasibility and reliability of RTX values obtained by DPD (RTX(DPD)). SUBJECTS AND METHODS: Forty-one patients who underwent cardiac catheterization and echocardiography for RV volume or pressure overloading conditions were evaluated. Symptom-limited exercise treadmill testing with expired gas analysis was performed and maximal exercise capacity was measured. RESULTS: RTX by conventional flow Doppler (RTX(CFD), 0.262+/-0.164) was similar to RTX(DPD) (0.253+/-0.117, p=NS), whereas RTX by tissue Doppler echocardiography (RTX(TDE), 0.447+/-0.125) was significantly larger than RTX(DPD) (p<0.001). Based on multiple regression analysis, maximal exercise capacity was independently related to RTX(DPD) (beta=-0.60, p<0.001), mid-RV dimension (beta=-0.26, p=0.012), left ventricular ejection fraction (beta=0.22, p=0.023), and early diastolic tricuspid annular velocity (beta=0.21, p=0.048). CONCLUSION: It is feasible and reliable to evaluate RV function using RTX(DPD) values. However, to evaluate the clinical usefulness of RTX(DPD), additional studies are required with a large number of patients and long-term follow-up.

New Parameters for Left Ventricular Function in Atrial Fibrillation: Based on the Relationship between RR Interval and Performance

This study was designed to obtain new parameters representing left ventricular (LV) function independent of irregular RR intervals in atrial fibrillation (AF). AF patients were divided into Normal (n=9) and LV Dysfunction (n=9) groups. The relations between LV outflow peak ejection velocity (Vpe) and preceding (RR-1) or prepreceding RR intervals (RR-2) were obtained using logarithmic equations, from which the squared correlation coefficient (r2), slope, Vpe at RR-1 or RR-2=1 sec (Vpe-1), and the ratio of slope to Vpe-1 (Slope/Vpe-1) were calculated. Among the parameters between RR-1 and Vpe, Slope/Vpe-1 was higher in LV Dysfunction group than in Normal group (p=0.05). When only coordinates with RR-1 from 0.6 to 1 sec were included, Slope/Vpe-1 (p=0.001) was higher in LV Dysfunction group than in Normal group. Among the parameters between RR-2 and Vpe, Slope/Vpe-1, slope, and r2 were different between the two groups. In multivariate analysis, Slope/Vpe-1 between RR-2 and Vpe was only independent parameter. However, Slope/Vpe-1 between RR-1 and Vpe in the coordinates with RR-1 from 0.6 to 1 sec had the highest discriminating power. New parameters derived from the relations between RR intervals and LV performance might be useful to evaluate LV function quantitatively in AF.

The Relationship between Preceding RR Intervals and Peak Ejection Velocity of Left Ventricular Outflow in Atrial Fibrillation without Organic Heart Diseases

BACKGROUND AND OBJECTIVES: Cardiac performance is dependent on both the preceding RR interval (RR-1) and the prepreceding RR interval (RR-2) in atrial fibrillation (AF). We reported a new method for improving the relation between the two RR intervals and cardiac performance in AF of various causes. The aim of this study was to re-evaluate the method and its relationship in AF without organic heart disease. SUBJECTS AND METHODS: The beat to beat variation in the left ventricular outflow peak ejection velocity (Vpe) was measured by pulsed Doppler ultrasound in 28 consecutive patients with lone AF. The relations between the RR-2 and the Vpe were obtained before and after the exclusion of coordinates with the RR-1<0.5 second. The association of the Vpe with the RR-1 was adjusted by the RR-2 using an equation obtained from the relation between the RR-2 and the Vpe. RESULTS: The RR-2 was found to have a weak, negative, association with the Vpe. The mean squared correlation coefficient (r2) between the RR-2 and the Vpe was 0.14+/-0.13, which was improved to 0.23+/-0.21 (p=0.007) following the exclusion of coordinates with a RR-1<0.5 second. The RR-1 was positively associated with the Vpe. The mean r2 between the RR-1 and the Vpe was 0.55+/-0.15, which became stronger, at 0.68+/-0.12 (p<0.001), following adjustment with the RR-2. A multiple stepwise regression analysis revealed that the mean and standard deviation of the RR interval, and the duration of AF were independently associated with the modified r2 between the RR-2 and the Vpe. CONCLUSION: Simple modification could improve the relationship of both the RR-1 and the RR-2 with the cardiac performance in AF without organic heart disease, as with AF of various causes.

A Case of Multiple Coronary Artery-Left Ventricular Microfistulae Demonstrated by Transthoracic Doppler Echocardiography

Of the congenital coronary artery fistulae, the multiple coronary artery microfistulae, arising from the left and right coronary artery emptying into the left ventricle, are very rare. Little is known about their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. The clinical findings are heterogeneous, but include, in most cases, a history of typical or atypical angina pectoris. A 67 year old woman was referred for evaluation of chest pain on exertion, and a shortness of breath. The electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic Doppler echocardiography, using a high frequency transducer, with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.