Diastolic Function Evaluation in Systemic Arterial Hypertension : A Color M-mode Doppler and Doppler Echocardiographic Analysis

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.

Efficacy of 2-dimensional Contrast Echocardiography During Pericardiocentesis

BACKGROUND: Pericardiocentesis is simple procedure in itself but has been associated with serious complicatios. In this study we assess the mortality and morbidity of 2-dimentional contrast echocardiographically directed pericardiocentesis. METHOD: Fourteen patients(8 males and 6 females, mean age : 55 years) with pericardial effusion were included in this study. The 2-dimensional echocardiographic transducer was place at the apex and a 4-chamber view was obtained. When return of fluid was obtained at least 10cc were aspirated and discarded, then 5cc of agitated saline solution were injected through the exploration needle and cloud of echoes indicated the position of the needle. When its position in the pericardial sac was confirmed, the needle was replaced by a catheter, then 5cc of agitated saline solution were injected through the catheter and cloud of echoes confirm the location of the catheter. RESULTS: In all 14 patients a satisfactory apical 4-chamber view was obtained. The echocardiogram showed explorating meedle in all patients but did'nt show exact location. The echocardiographic contrast effect produced by hand-agitated saline was seen in the pericardiac sac in all pateints. The contrast study confirmed the position of the needle and catheter in thepericardial cavity in all patients. The life-threatening complications were not developed. CONCLUSION: 2-dimensional contrast echocardiographically directed pericardiocentesis is simple, safe and effective. It is useful in early detection of locating needle and catheter position, thus it could reduce the mortality and morbidity of pericardiocentesis.