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Resumen El ultrasonido es una técnica portátil y repetible, que permite evaluar de forma dinámica los movimientos del diafragma. Existen muchas causas que pueden generar disfunción diafragmática y parálisis diafragmática como anestésicos, injuria del nervio frénico, postoperatorio de cirugía cardíaca, torácica o abdominal, enfermedades neuromusculares, metabólicas e infecciosas y causas relacionadas al paciente crítico como sepsis y ventilación mecánica prolongada. Se tuvieron en cuenta cuarenta y ocho perros, entre internados y programados para cirugía electiva, sin signos clínicos cardiorrespiratorios a los cuales se les realizó ultrasonido Global FAST, se evaluó el movimiento del diafragma en modo M en tres posiciones y se registró la medida del índice de excursión diafragmática. Tres de los perros internados fueron excluidos, debido a hallazgos en el ultrasonido, los perros programados para cirugía electiva fueron sometidos al mismo protocolo preanestésico en los mismos tiempos. No se presentaron diferencias estadísticas entre las posiciones. Al comparar la medida del índice de excursión diafragmática entre los perros internados y anestesiados en la posición DLD (decúbito lateral derecho) y DD (decúbito dorsal), se observaron diferencias significativas (p<0,01). El ultrasonido en modo M es una buena herramienta para medir el índice de excursión diafragmática, proporciona información cuantitativa para la evaluación de la función dinámica diafragmática, la anestesia puede llegar a causar una disminucion significativa en el índice de excursión diafragmático, el cual puede permanecer oculto y generar complicaciones anestésicas.
Abstract The ultrasonographic examination is a portable, non-invasive, repeatable technique that can assess the dynamic movements of the diaphragm. There are several causes for diaphragmatic dysfunction or paralysis, including anesthetic drugs, phrenic nerve injury, postoperative cardiac, thoracic or abdominal surgery; neuromuscular, infectious or metabolic diseases, critical patient comorbidities such as sepsis or prolonged mechanical ventilation complications. The study included forty-eight dogs that where either hospitalized or admitted for elective surgery without cardiorespiratory disease signs. They were evaluated following Global FAST protocol. The diaphragmatic movement was evaluated in M mode and the excursion diaphragmatic index was measured in three different positions. Three dogs were excluded due to their ultrasonographic findings. The same anesthetic protocol was used for the dogs admitted for elective surgery. There was no statistical difference between the dogs evaluated in the three different positions. The excursion diaphragmatic index of the hospitalized dogs compared to anesthetized dogs in right lateral recumbency (RLR) and dorsal recumbency (DR) was significantly different (p <0,01). Mode M ultrasonographic examination is a useful tool to measure the excursion diaphragmatic index in dogs because it provides quantitative information for the evaluation of the dynamic function of the diaphragm. Anesthetic drugs can cause a significant reduction of the excursion diaphragmatic index which, if not evaluated and detected promptly, can cause complications anesthetic.
Resumo O ultra-som é uma técnica portátil e repetível, que permite avaliar de forma dinâmica os movimentos do diafragma. Muitas causas podem gerar disfunção do diafragma e paralisia diafragmática como anestésicos, lesão do nervo frénico, cirurgia cardíaca, torácica ou abdominal, doenças neuromusculares, e infecciosa e metabólica relacionados para paciente crítico como sepsia e faz com que a ventilação mecânica prolongada. Quarenta e oito cães foram tidos em conta, incluindo estágios e agendada para cirurgia electiva sem sinais clínicos cardio-respiratórias que foram submetidos a ultrasons RÁPIDO global, o movimento do diafragma no modo-M foi avaliada em três posições e medição do índice foi gravado de excursão diafragmática. Três dos cães de embarque foram excluídos porque os resultados de ultrasom, cães agendados para cirurgia eletiva foram submetidos ao mesmo protocolo pré-anestésica, ao mesmo tempo. Não houve diferenças estatísticas entre as posições para a medição. Ao comparar a medida do índice de excursão diafragmática entre os cães admitidos e anestesiados na posição DLD (decúbito lateral direito) e DD (decúbito dorsal), foram observadas diferenças significativas (p <0,01), sendo este valor menor em cães anestesiado. A ultrassonografia modo-M para medir o índice de excursão diafragmática é uma boa ferramenta, pois fornece informações quantitativas para a avaliação da função dinâmica diafragmática. A anestesia pode causar uma diminuição significativa no índice de excursão diafragmática, que pode permanecem escondidos e geram complicações anestésicas.
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M-mode echocardiography is a non- invasive tool for the quantitative study of heart. Rajapalayam is a guard dog and Chippiparai is a sight hound breed which both originated from the southern districts of Tamil Nadu, India. Diagnosis of cardiac diseases in our indigenous breeds has been challenging due to less or no work done regarding cardiac anatomy and physiology in native breeds. Hence, this study was undertaken to establish basic reference data in these indigenous dog breeds which will help in diagnosing cardiac diseases. Various normal cardiac parameters were documented between young and adult age groups. The results indicated that a high significant difference (P<0.01) was observed in LVDd and LVDs and only a significant difference (P<0.05) in AO and RVD values between the age groups in Rajapalayam dogs,whereas, in Chippparai dogs, a significant difference was observed in CO (P<0.05) and in LVPWs, IVSd, IVSd (P<0.0) between the young and adult age groups
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Objective@#To assess the longitudinal mitral annular plane systolic excursion (MAPSE) of different directions in normal fetuses during mid-late pregnancy based on two-dimensional speckle tracking imaging (STI).@*Methods@#Seventy-six normal fetuses during middle and late pregnancy were selected at 26-32 weeks of gestation. The peak MAPSE was measured by free angle M-mode echocardiography (FAM) perpendicular to the lateral annulus in the mitral annular plane. The time-displacement curves of interventricular septal mitral annulus in three different directions including points A, B and C through transverse level of apex were recorded by STI. The peak MAPSE of interventricular septal mitral annulus (SEPT-MAPSE-A, SEPT-MAPSE-B, SEPT-MAPSE-C) in three different directions including points A, B and C and the time to peak (TTP: SEPT-TTP-A, SEPT-TTP-B, SEPT-TTP-C) were recorded respectively. The time-displacement curves of lateral mitral annulus in three different directions including points A, B and C through transverse level of apex were recorded by STI. The peak MAPSE of lateral mitral annulus (LAT-MAPSE-A, LAT-MAPSE-B, LAT-MAPSE-C) in three different directions including points A, B and C, the time to peak(LAT-TTP-A, LAT-TTP-B, LAT-TTP-C) were recorded respectively. Finally, the data were analyzed statistically.@*Results@#The peak MAPSE of the lateral mitral annulus in 3 different directions including points A, B and C[LAT-MAPSE-A (3.62±1.01)mm, LAT-MAPSE-B (3.95±1.04)mm, LAT-MAPSE-C (4.45±1.05)mm] were greater than those of the interventricular septum mitral annulus[SEPT-MAPSE-A (3.41±0.63)mm, SEPT-MAPSE-B (3.07±0.50)mm, SEPT-MAPSE-C (2.82±0.51)mm]. LAT-MAPSE-C and SEPT-MAPSE-A were the largest longitudinal excursions of mitral annulus. The differences were statistically significant in points B and C (P<0.05). There was no significant difference in point A (P>0.05). LAT-MAPSE-C was less than FAM-MAPSE[(6.06±1.35)mm]. There was a significant difference between them(P<0.05). Strong correlation was found between them(r=0.896, P<0.05). There were no significant differences in the time to peak of interventricular septal mitral annulus [SEPT-TTP-A (0.210±0.008)s, SEPT-TTP-B (0.213±0.008)s, SEPT-TTP-C (0.210±0.005)s] in directions including points A, B, C(P>0.05). There were no significant differences in time to peak of lateral mitral annulus[LAT-TTP-A(0.210±0.008)s, LAT-TTP-B(0.213±0.006)s, LAT-TTP-C(0.210±0.007)s] in directions inclucling points A, B, C(P>0.05).@*Conclusions@#Longitudinal systolic motion of fetal left ventricular wall during mid-late pregnancy has good synchronization. Longitudinal motion of fetal mitral annulus is a comprehensive movement of multiple directions and different degrees of displacement, with the movement perpendicular to the annulus as the maximum displacement direction. The displacement parameters of mitral annulus measured by STI can reflect the left ventricular longitudinal systolic function and have clinical application value in evaluating the left ventricular longitudinal systolic function of fetuses.
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Objective To assess the longitudinal mitral annular plane systolic excursion ( M APSE) of different directions in normal fetuses during mid‐late pregnancy based on two‐dimensional speckle tracking imaging ( ST I) . Methods Seventy‐six normal fetuses during middle and late pregnancy were selected at 26－32 weeks of gestation . T he peak M APSE was measured by free angle M‐mode echocardiography ( FAM ) perpendicular to the lateral annulus in the mitral annular plane . The time‐displacement curves of interventricular septal mitral annulus in three different directions including points A ,B and C through transverse level of apex were recorded by STI . T he peak M APSE of interventricular septal mitral annulus ( SEPT‐M APSE‐A ,SEPT‐M APSE‐B ,SEPT‐M APSE‐C) in three different directions including points A ,B and C and the time to peak ( T T P :SEPT‐T T P‐A ,SEPT‐T T P‐B ,SEPT‐T T P‐C) were recorded respectively . T he time‐displacement curves of lateral mitral annulus in three different directions including points A ,B and C through transverse level of apex were recorded by STI . T he peak M APSE of lateral mitral annulus ( LAT‐M APSE‐A ,LAT‐MAPSE‐B ,LAT‐MAPSE‐C) in three different directions including points A ,B and C ,the time to peak( LA T‐T T P‐A ,LA T‐T T P‐B ,LA T‐T T P‐C) were recorded respectively . Finally ,the data were analyzed statistically . Results T he peak M APSE of the lateral mitral annulus in 3 different directions including points A ,B and C[ LA T‐M APSE‐A ( 3 .62 ± 1 .01) mm ,LA T‐M APSE‐B ( 3 .95 ± 1 .04) mm ,LAT‐M APSE‐C ( 4 .45 ± 1 .05) mm ] were greater than those of the interventricular septum mitral annulus[ SEPT‐MAPSE‐A (3 .41 ± 0 .63)mm ,SEPT‐MAPSE‐B (3 .07 ± 0 .50) mm ,SEPT‐MAPSE‐C (2 .82 ± 0 .51) mm] . LAT‐M APSE‐C and SEPT‐M APSE‐A were the largest longitudinal excursions of mitral annulus . T he differences were statistically significant in points B and C ( P ＜0 .05) . T here was no significant difference in point A ( P ＞0 .05) . LA T‐M APSE‐C was less than FAM‐M APSE [ ( 6 .06 ± 1 .35 ) mm ] . T here was a significant difference between them ( P ＜0 .05 ) . Strong correlation was found between them ( r ＝0 .896 , P＜0 .05) . T here were no significant differences in the time to peak of interventricular septal mitral annulus [ SEPT‐T T P‐A ( 0 .210 ± 0 .008 ) s ,SEPT‐T T P‐B ( 0 .213 ± 0 .008 ) s ,SEPT‐T T P‐C ( 0 .210 ± 0 .005 ) s] in directions including points A ,B ,C ( P＞ 0 .05 ) . T here were no significant differences in time to peak of lateral mitral annulus [ LAT‐T T P‐A ( 0 .210 ± 0 .008 ) s , LAT‐T T P‐B ( 0 .213 ± 0 .006 ) s , LAT‐T T P‐C ( 0 .210 ± 0 .007) s] in directions inclucling points A ,B ,C ( P ＞0 .05) . Conclusions Longitudinal systolic motion of fetal left ventricular wall during mid‐late pregnancy has good synchronization . Longitudinal motion of fetal mitral annulus is a comprehensive movement of multiple directions and different degrees of displacement ,with the movement perpendicular to the annulus as the maximum displacement direction . T he displacement parameters of mitral annulus measured by ST I can reflect the left ventricular longitudinal systolic function and have clinical application value in evaluating the left ventricular longitudinal systolic function of fetuses .
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Background The mitral annulus (MA) is a crucial structure that is in constant motion throughout the cardiac cycle. The main purpose of this study was to determine if M-mode evaluation of the longitudinal motion of the MA could be useful to examine atrio-ventricular interactions. Methods Echocardiographic data obtained from 150 patients (mean age 56 ± 16; 82 males) from the University of Cincinnati College of Medicine was evaluated to examine if any relationship exists between MA motion and measures of atrio-ventricular interactions. Results Even though left atrial size, left ventricular (LV) mass index, LV ejection fraction (LVEF) and degree of LV diastolic dysfunction (LVDD) were significant echocardiographic variables affecting MA motion; LVEF and the degree of LVDD were the main determinants of MA excursion during systole (MAPSE) and after atrial contraction (MAa). Our results confirm the surrogate value of MAPSE with regards to LVEF and also show that the extent of MA excursion during systole is the main determinant of MAa. The effect of LV diastolic function applies more strongly to MAPSE than to MAa. However, the maximal MAa amplitude varies in accordance to the type of LVDD. Conclusions We have shown for the first time that M-mode interrogation of the MA longitudinal motion appears useful to assess atrio-ventricular interactions. Since LV systolic and diastolic functions are so closely related; additional studies are now required to examine how this longitudinal measure correlates with known circumferential rotational data obtained with other imaging modalities.
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In this retrospective study 420 echocardiograms from a single center were reviewed showing that TAPSE was acquired in 66% while TA TDI s’ signals were recorded in 98% of all echocardiograms. Based on these results greater efforts are required to standardize acquisition and reporting of objective measurements of RV function.
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Objective To evaluate the usefulness of free angle M-mode echocardiography (FAM) in obtaining tricuspid annular plane systolic excursion (TAPSE) for assessing the fetal right ventricular function,and to compare the results of measurements of TAPSE by conventional M-mode(CM) and FAM.Methods Two hundred and forty-three normal fetuses in second and late trimester were divided into 5 groups by gestational age(GA):20-24 weeks,24+1-28 weeks,28+1-32 weeks,32+1-36 weeks,36+1-40 weeks.The TAPSE were measured by CM and FAM echocardiography,meanwhile multiple parameters for evaluating right ventricular function were obtained by using myocardial tissue Doppler imaging (TDI),and the correlation between TAPSE and other parameters were analyzed by linear correlation.ANOVA was used to compare CM-TAPSE,FAM-TAPSE,Em,Sm and right ventricular fractional shortening(RVFS)with different GA.Regression equation estimate was used to compare the relationship of FAM-TAPSE with GA.Independent sample t test was used to compare CM TAPSE with FAM TAPSE.Results There were significant differences in CM-TAPSE,FAM-TAPSE,Em,and Sm among 5 groups (P =0.000),the measured value of FAM-TAPSE was higher than that of CM TAPSE (P =0.000).Both FAM-TPASE and CM-TAPSE showed significant positive correlations with GA,Em and Sm,but FAM TAPSE demonstrated better correlation than CM-TAPSE.Conclusions By adjusting sample line of FAM,measuring the maximum displacement of tricuspid annular plane is feasible,and FAM may evaluate fetal right ventricular function more accurately and effectively.
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Determinaram-se os parâmetros ecocardiográficos em modo-M normais de cães da raça Yorkshire Terrier. Foram utilizados 30 cães clinicamente sadios, com peso médio de 2,42±0,64kg e idades entre um e seis anos. O diâmetro do átrio esquerdo e da aorta, a dimensão interna do ventrículo esquerdo na diástole e na sístole, a espessura do septo interventricular na diástole e na sístole, e a espessura da parede posterior do ventrículo esquerdo na diástole e na sístole correlacionaram-se com o peso corporal. As demais variáveis do modo-M não se correlacionaram com peso corporal, sexo ou idade. Os valores ecocardiográficos obtidos neste estudo podem ser utilizados como referência para cães dessa raça.
The aim of this study was to establish the normal echocardiographic parameters in M-mode for Yorkshire Terrier dogs. Thirty clinically normal dogs with mean weight of 2.42±0.64kg and ages varying from one to six years old were studied. The left atrial diameter, the aortic diameter, the left ventricular internal dimension at end - diastole and end - systole, end - diastolic and end - systolic interventricular septal thickness, and end - diastolic and end - systolic left ventricular posterior wall thickness had correlation with body weight. The other M - mode variables showed no linear correlations with body weight, sex or age. The echocardiographic values found in this study can be used as reference for this breed.
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Animals , Dogs , Heart/anatomy & histology , Dogs , Reference Standards , Ultrasonography/veterinary , Heart Diseases/veterinary , Radiography, Thoracic/veterinary , Thorax/anatomy & histologyABSTRACT
Objective To assess left ventricular radial systolic synchronicity with omnidirectional M-mode echocardiography (OME). Methods OME examination was performed in 21 patients with dilated cardiomyopathy (DCM) and 27 healthy controls. The time to peak radial systolic movement were measured and adjusted by R-R interval. The standard deviation (Tc-SD)and the maximal temporal difference (Tc-dif) of the time to peak radial systolic movement of left ventricular short-axis segments at basal and mid-levels, the septal-to-posterior wall motion delay (SPWMD), septal-to-anterior wall motion delay (SAWMD), septal-to-laterior wall motion delay (SLWMD), septal-to-inferior wall motion delay (SIWMD) and anterior-to-inferior wall motion delay (AIWMD) were used as indicators of systolic dyssynchrony.Results Compared with the controls, Tc-dif, Tc-SD, SLWMD, SPWMD and SIWMD in basal level were significantly higher in the DCM group (P<0.05), while Tc-dif, Tc-SD, SAWMD, SPWMD, SIWMD and AIWMD in mid-level were significantly higher in the DCM group (P<0.05).Conclusion Omnidirectional M-mode echocardiography is useful to evaluate the radial systolic synchrony of the left ventricular in patients with dilated cardiomyopathy.
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Foram avaliados os principais índices diastólicos, inclusive a velocidade de propagação mitral (Vp), em 36 cães sadios da raça Boxer, 18 de cada sexo, de idade entre um ano e meio e seis anos. A relação raiz aórtica e átrio esquerdo medida no modo B foi de 1,17±0,11. Os picos de velocidades das ondas de enchimento atrial esquerdo foram: sistólica 31,41±6,87cm/s, diastólica (D) 73,85±17,04cm/s e de reversão atrial 28,90±8,33cm/s. A relação das ondas de enchimento ventricular inicial (E) e atrial (A) foi 1,58±0,19 na valva mitral e de 1,62±0,29 na valva tricúspide. Entre os índices avaliados, a Vp só se correlacionou fracamente (r=0,39) com as ondas E e A mitrais e com a onda D, mostrando-se um índice, relativamente, independente. A Vp não apresentou diferença significativa entre os sexos nem entre examinadores. A Vp diminuiu com o aumento da idade e exibiu valor médio, neste estudo, de 99,73±16,06cm/s
Major diastolics indexes, including the mitral propagation velocity (Vp), were evaluated in 36 healthy Boxer dogs, 18 males and 18 females, aging from 1.5 to 6-years-old. The aortic root and left atrium ratio, measured in B mode, was 1.17±0.11. The peaks of velocity of waves of the left atrium filling were: systolic 31.41±6.87cm/s, diastolic 73.85±17.04cm/s and atrial reversal 28.90±8.33cm/s. The ratios of the waves of initial ventricular filling were 1.58±0.19 to mitral valve and 1.62±0.29 to tricuspid valve. From the evaluated indexes, the Vp was only weakly correlated (r=0.39) with E and A waves of mitral valve and with D, showing itself, relativity, as an independence index. Regarding to the Vp, no significant differences were seen between the gender of the animals and among the observers. The Vp decreased as the age increased, showing mean values of 99.73±16.06cm/s
Subject(s)
Animals , Male , Female , Dogs , Dogs , Diastole/physiology , Echocardiography, Doppler, Color/methods , Echocardiography, Doppler, Color/veterinary , Echocardiography/methods , Echocardiography/veterinary , Mitral Valve/physiology , Pulmonary Veins/physiologyABSTRACT
PURPOSE: We accidentally found out the decrease of color M-mode propagation velocity of LV inflow(Vp) in several Atrial septal defect(ASD) infants. The aim of this study was to identify it in more number of patients, and to find out the relationship of it to clinical characteristics and other cardiac function study results. METHODS: The present study was conducted on 16 isolated secundum ASD infants with defect diameter greater than 3 mm(L group), 10 infants with a defect diameter less than 3 mm(S group) and 11 infants with no structural abnormal findings(N group), among infants who visited the Pediatric Department of Soonchunhyang University Hospital and underwent a echocardiographic examination from April 2001 through June 2003. The systolic function tests via parasternal long axis, and other diastolic function tests were done at the same time. RESULTS: The mean ages of these three groups(L group, S group and N group) were 0.35+/-0.34 years, 0.22+/-0.22 years and 0.45+/-0.27 years, respectively. The Vp values were 48.42+/-10.84 cm/sec, 65.26+/-16.25 cm/sec, 65.28+/-13.36 cm/sec in groups, and significant difference between L group and other 2 groups(P=0.001). The only affecting variable to Vp values is defect area. There was significant causal relationship between them(P= 0.000). CONCLUSION: We identified the decrease of Vp in ASD infants, and it was linearly related to defect area size. It may be result of early diastolic ventricular interdependence in ASD.
Subject(s)
Humans , Infant , Axis, Cervical Vertebra , Echocardiography , Heart Septal Defects, AtrialABSTRACT
BACKGROUND: Color M-mode doppler echocardiography has been suggested as a new noninvasive technique for assessing left ventricular diastolic function. The present study was performed to define the feasibility and value of color M-mode echocardiography for the assessment of left ventricular diastolic function in patients with acute coronary syndrome. METHODS: Thirty six patients with acute myocardial infarcion and twenty three patients with unstable angina were included (M/F=41/18, 61+/-12.2 years). Doppler study was performed using ATL HDI-3000 within 24 hours after the attack. In color M-mode study, ROP was measured with 'Front wave method' and 'Baseline shift method'. The patients were grouped into three groups based on E/A ratio and deceleration time (DT) in transmitral flow and S/D ratio in pulmonary venous flow; Group I=Normal pattern (E/A>1, S/D>1, DT>140 ms), Group II=Impaired relaxation pattern (E/A140 ms) and Group III=Pseudonormal/Restrictive pattern (E/A>1.5, S/D0.05). CONCLUSION: The ROP seems not to reflect the diastolic function in acute coronary syndrome, although it is measurable with the 'Front wave method' in most cases. The measurement of the ROP with 'Baseline shift method' is not feasible in the patients with acute coronary syndrome.
Subject(s)
Humans , Acute Coronary Syndrome , Angina, Unstable , Deceleration , Echocardiography , Echocardiography, Doppler , RelaxationABSTRACT
PURPOSE: The aims of this study were to evaluate the usefulness of the propagation velocity (Vp) measured by transthoracic color M-mode Doppler in patients with coronary artery disease and compare Vp with conventional diastolic function index using transmitral and pulmonary vein flow. METHODS: Study subjects were classified into two groups according to the presence of coronary artery disease (CAD): 44 subjects (M:F=22:22, mean age 63+/-12 yrs) with CAD (AMI; n=13 , unstable angina; n=5, stable angina; n=26); 31 normal subjects (M:F=13:18, mean age 43+/-15 yrs). Vp of early flow into left ventricular cavity measured by color M-mode Doppler was proposed as an index of left ventricular diastolic function. Vp was compared with conventional diastolic function index. RESULTS: 1. Vp in CAD patients (32.8+/-9.1 cm/sec) was lower than control (63.6+/-14.1 cm/sec)(p>0.01). Among CAD patients, Vp in CAD patients (30.1+/-8.6 cm/sec) with left ventricular hypertrophy (LVH) was lower than Vp in CAD patients without LVH (35.9+/-8.9 cm/sec)(p>0.01). 2. Vp was correlated with left ventricular ejection fraction (r=0.602, p>0.01), with D wave of pulmonary vein flow (r=0.540, p>0.01) and with E/A velocity ratio of mitral inflow (r=0.517, p>0.01) and negatively correlated with left ventricular mass index (r=-0.576, p>0.01). CONCLUSION: The propagation velocity measured by color M-mode Doppler is a useful index for evaluation of diastolic function of left ventricle in the patients with coronary artery disease.
Subject(s)
Humans , Angina, Stable , Angina, Unstable , Coronary Artery Disease , Coronary Vessels , Echocardiography, Doppler , Heart Ventricles , Hypertrophy, Left Ventricular , Pulmonary Veins , Stroke VolumeABSTRACT
BACKGROUND AND PURPOSE OF THE RESEARCH: It is believed that a long-term drinking will be one of the causes of congestive cardiomyopathy (CM). It is also possible for diagnosis of alcoholic cardiomyopathy in the majority of the patients diagnosed as idiopathic dilated cardiomyopathy if the history of mass alcoholic drinking is taken into consideration or proper blood test is conducted. This study is to confirm whether there is an improvement in the clinical result and cardiac function as has so far been known the case in the patients suspected of alcoholic. METHODS: Among 39 patients with dilated CM who were diagnosed by echocardiographic criteria and clinical evaluation, 11 patients who drank more than 77 g of alcoholic everyday for more than 10 years were defined as alcoholic CM. The changes of their clinical manifestations and m-mode echocardiographic findings in the patients with alcoholic CM were compared before and after treatment. RESULTS: All studied patients were male with the mean age of 52.6+8.0 and the mean follow up period was 38.6 months. Of the 11 patients, 3 patients could not completely free themselves from drinking. Their symptoms on first visit ranged in such order as dyspnea (63.6%), tachycardia (54.5%), and generalized edema (27.3%). Following the treatment, dyspnea and tachycardia showed a statistically significant improvement. Echocardio-graphic parameters, ie, LV diastolic dimension (6.7+/-0.6 cm before treatment and 6.3+/-1.2 cm after treatment), LV systolic dimension (5.6+/-0.7 cm before treatment and 5.2+/-1.4 cm after treatment) and E point septal separation (13.6+/-9.6 mm before treatment and 10.9+/-6.6 mm after treatment) decreased after treatment without a significant meanings in a statistical view point. Their ejection fraction (29.6+/-6% before treatment and 34.5+/-11.1% after treatment) increased after treatment. CONCLUSION: Cardiac symptoms of congestive heart failure and echo-cardiographic parameters in patients with alcoholic CM were improved after abstinence from alcoholic ingestion and medical treatment.
Subject(s)
Humans , Male , Alcoholics , Cardiomyopathy, Alcoholic , Cardiomyopathy, Dilated , Diagnosis , Drinking , Dyspnea , Eating , Echocardiography , Edema , Follow-Up Studies , Heart Failure , Hematologic Tests , TachycardiaABSTRACT
BACKGROUND: Abnormalities of the left ventricular diastolic function can be classified by pulsed Doppler echocardiography, but sometimes it may be difficult to differentiate normal diastolic function from pseudonormalization. Heart failure caused by increased left ventricular filling pressure is rather associated with pseudonormalization or restrictive pattern than normal pattem or relaxation abnormality. We investigated the usefulness of color M-mode Doppler echocardiographic indexes in differentiating normal relaxation from pseudonormalization after acute myocardial infarction. METHOD: Echocardiographic examination including color M-mode Doppler was performed in 44 patients with acute myocardial infarction between 10 and 14 days after attack. 34 patients without in-hospital congestive heart failure(CHF) were assigned as group I, and 10 patients with in-hospital CHF as group II. Flow propagation slope(FPS), time difference(TD) between the occurrence of peak flow velocity in the apical region and at the mitral tip, and normalized time difference(nTD) by mitral and apical distance were measured with color M-mode Doppler echocardiography. RESULTS: FPS was lower in group II(group I, 42.0+/-20.6cm/sec vs group II, 27.8+/-8.0cm/ sec , p=0.065). Both groups had similar TD and nTD. FPS was compared in patients with E/ A ratio of mitral inflow greater than 1(22 patients of group I and 7 patients of group II). Patients with E/A) 1 in group II had significantly lower FPS(group I, 52.1+/-17.5cm/sec vs group II, 31.0+/-7.4cm/sec ; p(0.01). CONCLUSION: FPS was significantly decreased after acute myocardial infarction in patients with in-hospital CHF compared with patients without in-hospital CHF, even when E/A ratio of mitral inflow was greater than 1. Therefore, FPS was an useful index in differentiating normal relaxation from pseudonormalization.
Subject(s)
Humans , Echocardiography , Echocardiography, Doppler , Echocardiography, Doppler, Pulsed , Estrogens, Conjugated (USP) , Heart , Heart Failure , Myocardial Infarction , RelaxationABSTRACT
BACKGROUND: Methods for evaluating left ventricular diastolic function have been used exclusively in cardiac patients in sinus rhythm and have not been applied to atrial fibrillation because of large cycle variation in flow velocities and absence of atrial contraction. The utility of these rnethods in atrial fibrillation is unknown, especially M-rnode Doppler echocardiography and automatic border detection method. METHODS: Left Ventricular Normal group(LVN group, Ejection fraction> 40%) of 21 patients(mean age 67 years old, 12 men, 9 women) and Left Ventricular Dysfunction group (LVD group, EF ( 40%) of 15 patients(mean age 64 years old, 11 men, 4 women) were studied. We measured parameters in pulsed Doppler recordings of rnitral flow velocity and the flow propagation velocity in color M-mode recording of mitral flow, and peak filling rate from automatic border detection system. Measurements were averaged over 10 cardiac cycles. RESULTS: Mean heart rates were not different in both population(LVN 79+/-18/min, LVD 83+/-16/min). Left ventricular diastolic dimension were more dilated LVD group than LVN group(5.7+/-1.0crn, 4.6+/-0.7cm p < 0.05) but left atrial dimension were similar(4.4+/-0.8cm, 4.3+/-0.7cm). Deceleration time was significantly shortened in LVD group(158.4+/-24.4ms vs. 180.4+37.6ms, p < 0.05) but other parameters of mitral pulsed Doppler recording such as IVRT, acceleration time, acceleration rate and deceleration rate were not different. Flow propagation velocities were significantly decreased in LVD group(41.7+/-14.9cm/s vs. 53.0+/-11. 9cm/s, p < 0.05). Peak filling rates of automatic border detection system were significantly decreased in LVD group(3.4+/-1.2 EDV/s vs 5.4+/-1.1 EDV/s, p< 0.001). CONCLUSION: Echocardiographic measurements of diastolic function via color M-mode Doppler and autornatic border detection may be useful in presence of atrial fibrillation as sinvs rhythm.
Subject(s)
Aged , Humans , Male , Middle Aged , Acceleration , Atrial Fibrillation , Deceleration , Echocardiography , Echocardiography, Doppler , Heart Rate , Ventricular Dysfunction, LeftABSTRACT
BACKGROUND: Left ventricular diastolic dysfunction may precede systolic dysfunction and play a major role in producing the signs and symptoms of congestive heart failure. Ischemic heart disease can cause impairment of left ventricular filling without any alteration in systolic function so it is very important to evaluate relationship of left ventricular diastolic dysfunction and ischemic heart disease. The purpose of this study is to investigate left ventricular diastolic dysfunction during transient myocardial ischemia caused by balloon occlusion. METHODS: We prospectively studied 20 patients(11 males and 9 females, mean age : 58.5+/-5.9 years) who had been undergone coronary angiography and confirmed significant luminal stenosis(> or =75%)in proximal or middle portion of left anterior descending artery. After coronary angiography, percutaneous transluminal coronary angioplasty were performed all patients. We measured early propagation slope of left ventricular inflow, time difference(TD) between occurrence of peak velocity in the apical region and at the mitral tip and normalized TD(nTD) which dividing TD by the distance of mitral opening to apical region using color M-mode Doppler echocardiography, peak earaly diastolic transmitral inflow velocity(E), peak velocity during atrial contraction(A), E to A ratio, acceleration time of E wave and deceleration time of E wave using pulsed wave Doppler echocardiography, left ventricular end diastolic pressure using left heart catheterization. A color M-mode Doppler echocardiography, pulsed wave Doppler echocardiography and left ventricular end diastolic pressure were recorded before, during 30sec, 60sec & 90sec and after 60sec & 180sec balloon occlusion. RESULTS: Early propagation slope of left ventricular inflow was significantly decreased during 30sec & 60sec balloon occlusion and significantly increased after 60sec & 180sec balloon occlusion, respectively (64.45+/-28.23cm/sec, 39.37+/-11.77cm/sec, 32.78+/-11.77cm/sec, 51.86+/-19.78cm/sec, 65.05+/-29.99cm/sec, p0.05). CONCLUSIONS: These data suggest that transient myocardial ischemia can cause left ventricular diastolic dysfunction and color M-mode Doppler echocardiography is very sensitive diagnostic method to detect early diastolic dysfunction compare to other echocardiographic diastolic indices.
Subject(s)
Female , Humans , Male , Acceleration , Angioplasty, Balloon, Coronary , Arteries , Balloon Occlusion , Blood Pressure , Cardiac Catheterization , Cardiac Catheters , Coronary Angiography , Deceleration , Echocardiography , Echocardiography, Doppler , Echocardiography, Doppler, Pulsed , Heart Failure , Heart Ventricles , Myocardial Ischemia , Phenobarbital , Prospective StudiesABSTRACT
BACKGROUND: Pulsed Doppler measurement of transmitral flow has been widely used to assess the left ventricular relaxation abnormality noninvasively in patients with failing heart. However pulsed Doppler-derived indices are affected by multiple factors, including active relaxation and distensibility of the left ventricle, the pressure gradient between the left ventricle and atrium, and altered loading condition. The purpose of this study is to assess the role of new index, the rate of propagation of left ventricular peak filling flow in early diastole using color M-mode Doppler for the evaluation of left ventricular diastolic function. METHOD: The study group comprised 41 patients(24 males, 17 felames, mean age: 56+/-12). The clinical diagnosis were angina pectoris 32, acute myocardial infarction 3, peripheral arterial obstructive disease 2 and atypical chest pain 4. We measured rate of propagation(ROP) and propagation ratio of peak early filling flow by color M-mode Doppler echocardiography using baseline shifted first aliasing limit technique and compared with pulsed Doppler measurements of transmitral flow. RESULTS: 1) Pulsed Doppler-derived indices of mitral flows were as below. The maximal velocity of E wave was 65.4+/-21.3cm/sec in control group, 54.3+/-7.9cm/sec in group I patients(p<0.05 versus control group) and 70.9+/-15.2cm/sec in group II patients(p<0.01 versus group I). The maximal velocity of A wave was 70.0+/-20.9cm/sec in control group, 78.6+/-3.8cm/sec in group I patients and 60.0+/-14.1cm/sec in group II patients(p<0.01 versus group I). The E/A ratio was 1.01+/-0.42 in control group, 0.69+/-0.10 in group I patients(p<0.05 versus control group) and 1.19+/-0.16 in group II patients(p<0.01 versus group I). The deceleration time was 166.7+/-36.3msec in control group, 202.9+/-17.0msec in group I patients(p<0.01 versus control group) and 160.0+/-10.0msec in group II patients(p<0.01) versus group I). 2) The rate of propagation was 145.0+/-83.4cm/sec in control group, 50.0+/-13.2cm/sec in group I patients(p<0.01 versus control group) and 59.9+/-26.0cm/sec in group II patients(p<0.01 versus control group). 3) The propagation ratio was 2.27+/-1.29cm/sec in control group, 0.93+/-0.25cm/sec in group I patients(p<0.05 versus control group) and 0.86+/-0.36cm/sec in group II patients(p<0.01 versus control group). CONCLUSION: Analysis of filling flow propagation by color M-mode Doppler is an easy and noninvasive method for evaluation of left ventricular diastolic function and may be an additional tool to pulsed Doppler measurement of transmitral flow, especially in differentiation between normal and pseudonormal, but care must be taken in interpretation because of overlapping of values.
Subject(s)
Humans , Male , Angina Pectoris , Arterial Occlusive Diseases , Chest Pain , Deceleration , Diagnosis , Diastole , Echocardiography, Doppler , Heart , Heart Ventricles , Myocardial Infarction , RelaxationABSTRACT
BACKGROUND: Several recent studies have demonstrated that left ventricular diastolic dysfunction is major cause of congestive heart failure and may precede systolic dysfunction or without left ventricular hypertrophy in most patients with systemic arterial hypertension. The purpose of this study is to evaluate left ventricular diastolic function in patients with systemic arterial hypertension compared with normal control group using color M-mode Doppler and Doppler echocardiographic studies. METHODS: From October 1994 to August 1995. 53 patients(18 men and 35 women, mean age : 56.1±12.6 years) with essential hypertension and 30 subjects age-matched nomal controls(13 men and 17 women, mean age 55.9±12.3 years) were included in this study. We measured the early propagation slope of LV inflow by color M-mode Doppler Echocadiography and the peak velocities of E and A wave, E/A tatio, deceleration time of E wave, isovolumic relaxation time by Doppler echocardiography. We also studied left ventricular diastolic function in patients with hypertension who were divided two group(Group I : hypertension with left ventricular hypertrophy, Group II : hypertension without left vetricular hypertrophy). RESULTS: 1) Early propagation slope of LV inflow was significantly decreased in patients with hypertension compared with normal control group(57.43±17.15m/secs vs 69.87±12.71m/secs, p 0.05), whereas deceleration time of E wave was showed increasing tendency in patients with hypertension empared with normal control group(196.57±37.07m/secs vs 189.33±41.35m/secs, p>0.05). 3) Early propagation slope of LV inflow was not significantly different between Group I and Group II, but showing decreasing tendency in Group I compared with Group II(54.72±14.65m/sec vs 60.16±18.96m/sec, p>0.05). Peak velocity of E wave and peak velocity of A wave and E/A ratio and deceleration time were not significantly different between Group I and Group II but peak velocity of E wave and E/A ratio were showed decreasing tendency in Group I(0.65±0.19m/sec vs 0.73±0.22m/sec, 0.86±040 vs 1.04±0.44, p>0.05), whereas peak velocity of A wave and deceleration time of E wave were showed increasing tendency in Group I(0.80±0.20m/sec vs 0.74±0.18m/sec, 199.38±46.45m/secs vs 196.89±24.76m/secs, p>0.05). Only isovolumic relaxation time was significatly increased in Group I compared with Group II(150.63±44.75m/secs vs 120.34±19.77m/secs, p < 0.05). CONCLUSION: Left ventricular diastolic dysfunction may precrede systolic or without left ventricular hypertrophy in patients with systemic arterial hypertension. An early diagnosis of left ventricular diastolic dysfunction, color M-mode Doppler echocardiography and Doppler echocardiography were useful diagnostic stools.
Subject(s)
Female , Humans , Male , Deceleration , Early Diagnosis , Echocardiography , Echocardiography, Doppler , Heart Failure , Hypertension , Hypertrophy, Left Ventricular , RelaxationABSTRACT
Objective:To know the value of Anatomic M-mode echocardiography(AMM) in detecting ventricular wall motion in coronary artery disease.Methods: The ventricular wall motion in 31patients with coronary heart disease and 25 normal people(17 normal people undergoing coronary arteriongraphy)was detected by AMM and 2DE.The results were compared with coronary arteriongraph.Results:23 out of 31 patients with coronary heart disease were defined correctly by 2DE.14 normal people among 17people were detected by 2DE.The detecting sensibility of coronary heart disease was 74.19% and the detecting specificity was 82.35%.The thickening(