Assessment of Left Ventricular Diastolic functions in Elderly Patients with Pulmonary congestion and in Asymptomatic Elders

BACKGROUND: The recent studies shows that LV relaxation abnormalities are the important factors of heart failure in elders. To determine the association between LV diastolic functions and heart failure, we assessed LV diastolic functions in elderly patients with pulmonary congestion and in asymptomatic elders by using pulsed doppler echocardiography. METHODS: In order to assess LV diastolic function, we performed pulsed doppler echocardiography to elderly patients with pulmonary congestion and asymptomatic elders from Mar.2001 to Sep.2001. The following parameters were used as indices of LV diastolic function; Mitral E wave(E), Mitral A wave(A), Deceleration time(DT), Isovolumic relaxation time(IVRT), Systolic pulmonary venous flow(PVs), Diastolic pulmonary venous flow(PVd). RESULTS: In elderly patients groups, there was significant increase in deceleration time compared with asymptomatic elders(255.83+/-54.41 vs 210.80+/-48.53, p<0.05). There was significant increase in isovolumic relaxation time in elderly patient group compared with asymptomatic elders(123.06+/-25.07 vs 98.78+/-15.12, p<0.01). Although there was no significant difference, decreased E/A ratio and increased PVs/PVd were noted in both groups. CONCLUSIONS: The results shows that the impairments of LV diastolic function were noted in both groups. Especially DT and JVRT were significant increase in elderly patient group with pulmonary congestion. Therefore these parameters, such as DT, IVRT, can be helpful as predictive indices of diastolic heart failure in elders.

The Effect of Hemodialysis on the Echocardiographic Indexes of Left Ventricular Diastolic Function in Chronic Renal Failure

BACKGROUND AND OBJECTIVES: The assessment of left ventricular (LV) diastolic function is important in chronic renal failure because abnormal LV diastolic function has been frequently described in patients on maintenance hemodialysis both during the dialysis and in the dialysis-free interval despite the normal LV systolic function. But the echocardiographic indexes of LV diastolic function is known to be affected by several factors such as loading condition, LV compliance and heart rate. The purpose of this study is to investigate the effect of hemodialysis on the echocardiographic indexes of left ventricular diastolic function in chronic renal failure. Materials AND METHODS: We examined transmitral flow velocity, pulmonary venous flow velocity, and mitral annulus velocity in 20 patients (15 men and 5 women, average 50+/-14, range 19-69 years) of chronic renal failure with normal LV systolic function by echocardiography before and after hemodialysis. RESULTS: 1)According to the body weight change (from 59.5+/-8.3 to 57.2+/-8.1 kg, p=0.0001), after hemodialysis, inferior vena cava dimension (from 18+/-4 to 13+/-5 cm, p=0.0001), left ventricular end-diastolic dimension (from 57+/-6 to 53+/-7 cm, p=0.0001), and left ventricular outflow tract (LVOT)-time velocity integral (TVI, from 26+/-5 to 23+/-5 cm, p=0.004), which reflect intravascular blood volume, decreased significantly. 2)The peak velocity of early transmitral flow (E, from 0.79+/-0.14 to 0.64+/-0.11 m/s, p=0.0001), the peak velocity of late transmitral flow (A, from 0.84+/-0.21 to 0.78+/-0.21 m/s, p=0.011), and E/A ratio (from 0.99+/-0.25 to 0.87+/-0.27, p=0.007) decreased significantly, and deceleration time (DT, from 241+/-48 to 267+/-59 ms, p=0.055) showed tendency of prolongation after hemodialysis. 3)Peak systolic velocity of pulmonary venous flow decreased significantly after hemodialysis (from 0.65+/-0.11 to 0.59+/-0.12 m/s, p=0.042). 4)The difference between duration of reversal flow of pulmonary vein and duration of transmitral flow during atrial contraction (ADD) did not change significantly after hemodialysis (from 5+/-31 to 1+/-29 ms, p=0.502), and did not correlate with the change of peak velocity of early transmitral flow during hemodialysis (DMVE, r=0.390, p=0.089). 5)The peak early diastolic velocity (Ean, from 0.07+/-0.02 to 0.06+/-0.02 m/s, p=0.002) and Ean/the peak late diastolic velocity (Aan) ratio (from 0.78+/-0.27 to 0.62+/-0.19, p=0.003) of medial annulus of mitral valve decreased significantly after hemodialysis. CONCLUSION: Hemodialysis, which reduces LV preload by fluid removal, changes the echocardiographic indexes of left ventricular diastolic function in chronic renal failure. Preload condition need to be accounted for when we evaluate the LV diastolic function with echocardiography.

Effect of Enalpril on LVH and LV Performance in Essential Hypertension

BACKGROUND: Left ventricular hypertrophy(LVH) is the independent poor prognostic factor in hypertensives. But, it is uncertain that the reduction of LVH by antihypertensives therapy will improve the prognosis of hypertensive patioents. THe effect of reduction of LVH on LV function(espacially diastolic function) and the mechanism of reduction of LVH are not clarified also. The aim of this study was to ascertain whether reduction in LV mass with enalapril has a beneficial effect ofn LV diastolic filling in hypertensive patients with diastolic dysfunction. METHODS: Mild to moderate hypertensive patients were treated with enalapril(10-20mg once daily) for 4 months. Their blood pressure and pulse rate were regularly measured devery 2 weeks. Using M mode echocardiograms, LV dimensions at end-diastole and end-systole, thicknesses of ventricular septum and LV free wall were measured. LV ejection fraction(EF), LV mass index(LVMI) and total peripheral resistance(TPR) were calculated. Pulsed ddoppler examination of transmitranl flow for assessment of LV diastolic function was performend from apical four chamber viw. The peak flow velocities of the early and late waves and their ratio(PFVE, PFVA, PFVE/PFVA) were measured from consecutive 3 cardiac cycles. In addition, the time velocity integral of the early and late waves and their ratio(EA, AA, EA/AA) were measured. Echocardiographic evaluations were performed at baseline and at the end of treatment. RESULTS: Average systolic and diastolic blood pressure decreased after treatment with enalapril. But there was no significant difference of pulse rate between basal and after treatment. The LV dimensions at end-diastole and end-systole and the thickness of LV free wall didn't change significantly. The thickness of interventricular septum, LVMI and TPR reduced significantly after treatment. The ejection fraction of LV didn't change significantly after treatment. There was no significant change in PFVE, EA, AA and EA/AA. But PFVA was significantly decreased after treatment with enalapril for 4 months. PFVE/PFVA was significantly increased also. CONCLUSION: In conclusion, antihypertensive treatment with enalapril led to a significant reduction of LVH partially associated with improvement in LV diastolic performance and no deterioration of LV systolic function.