[Practical assessment using transmitral Doppler echocardiography for the evaluation of left ventricular filling pressure in patients with systolic ventricular dysfunction]. / Praktische Anwendung der transmitralen Dopplerechokardiographie zur Beurteilung der linksventrikulären Füllungsdrücke bei eingeschränkter systolischer Ventrikelfunktion.

Transmitral flow velocity profiles by Doppler echocardiography are strongly related to left ventricular diastolic properties. The aim of this study was to address the assessment of left ventricular filling pressures by transmitral flow velocity curves in patients with impaired systolic function. 90 patients (23 female, 67 men, age 60.0 +/- 9,9 a) with an ejection fraction < or = 45% either due to coronary artery disease (n = 67) or dilated cardiomyopathy (n = 23) were investigated by Doppler echocardiography prior to left heart catheterization. Early diastolic deceleration time (DT) and ratio of early to late diastolic peak velocities (VE/VA) were measured. Both, DT and VE/VA showed a significant correlation to left ventricular enddiastolic pressures (r = -0.79 respectively r = 0.73, p < 0.001 for all). According to DT three different transmitral flow patterns were identified. All patients with restrictive filling patterns (DT < 160) had elevated left ventricular filling pressures, whereas impaired relaxation (DT > 210) was a strong predictor of normal filling pressures. In patients with pseudonormal transmitral flow patterns (DT 160 to 210) filling pressures could not be predicted. Furthermore DT was strongly related to clinical signs of left heart failure. Doppler echocardiography gives useful additional information on left ventricular filling pressures in patients with systolic dysfunction.

[The Doppler echocardiographic assessment of left ventricular diastolic function in coronary heart disease]. / Dopplerechokardiographische Beurteilung der diastolischen linksventrikulären Funktion bei koronarer Herzkrankheit.

BACKGROUND AND OBJECTIVE: Changes in left ventricular (LV) diastolic function lead to characteristic changes in the transmitral flow profile as determined by Doppler echocardiography (DEC). Although DEC cannot provide direct quantitative measurement of LV filling pressures and is influenced by several factors, transmitral flow correlates well with LV haemodynamics. In this prospective study the results of transthoracic DEC were compared with haemodynamic parameters in patients with coronary heart disease (CHD) and their clinical value assessed. PATIENTS AND METHODS: 254 consecutive patients with CHD (67 women, 187 men, aged 62.5 +/- 8.5 years) underwent transthoracic DEC. The ratio of early to late diastolic velocity (VE/VA) and early diastolic deceleration time (DT) of the transmitral flow were measured as an indication of diastolic LV function. RESULTS: Patients with reduced LV compliance and increased filling pressure (LV end-diastolic pressure [LVEDP] > 15 mm hg) had a restrictive transmitral flow profile with a significantly higher than normal VE/VA and a shorter DT (1.35 +/- 0.84 vs. 0.86 +/- 0.26, P < 0.001; and 158 +/- 45 vs. 213 +/- 35, P < 0.001, respectively). VE/VA and DT also significantly correlated with LVEDP (r = 0.65, P < 0.001 and r = -0.60, P < 0.001 respectively). Sensitivity and specificity of an LVEDP of > 15 mm Hg were 67% and 84%, respectively, for a VE/VA of more than 1, and 65% and 91% for a DT of less than 170. The combination of the two parameters increased specificity to 97%. CONCLUSION: Determining the transmitral flow profile makes it possible noninvasively to obtain an indication of LV end-diastolic function. Patients with severe diastolic dysfunction and increased filling pressures are recognized with a high degree of specificity.

[Echocardiographic grading of cor pulmonale in chronic lung diseases]. / Echokardiographische Schweregradbeurteilung des Cor pulmonale bei chronischen Lungenerkrankungen.

The extent of right heart strain determines the prognosis of chronic lung disease. The value of a simple semiquantitative echocardiographic grading system for cor pulmonale was assessed in 69 patients (24 females, 45 males, age 61 +/- 12 years, ranging from 28-82 years) suffering from chronic lung disease. The patients were classified by echocardiography into four groups, Grade 0 consisting of those without evidence of right heart strain and three groups showing increasing severity of change (Grade I: right ventricular hypertrophy; Grade II: I + right ventricular dilation; Grade III: II + Dilation of the inferior vena cava). Echocardiographic investigation, at least from the subcostal view, and grading was possible in all patients. A correlation was found between the echocardiographic grading and the mean pulmonary artery pressure (PAP)-normal echo study 15.7 +/- 4.8; grade I 21.1 +/- 5.6; grade II 28.8 +/- 10.2; grade III 39.4 +/- 9.4 mmHg. In addition, patients with stress-induced pulmonary hypertension (PHT) were detected by Doppler echocardiography. 6 of 11 patients with latent PHT already showed evidence of cor pulmonale (4 Grade I and 2 Grade II). In 42 patients (61%) the systolic PAP was estimated by measuring the velocity of the tricuspid insufficiency jet with Doppler, and these data correlated closely with the invasive data (p < 0.001; r = 0.81). Doppler echocardiography for evaluation of cor pulmonale is feasible even in patients with chronic lung disease and limited acoustic windows. Semiquantitative grading correlates well with invasive data. Here, this technique is useful as a baseline study as well as for the follow-up of patients with chronic lung disease.

[Doppler echocardiography in chronic right ventricular pressure load]. / Dopplerechokardiographie bei chronischer rechtsventrikulärer Druckbelastung.

Doppler-echocardiography (DEC) was performed before cardiac catheterization in 61 consecutive patients (25 women, 36 men; aged 59 +/- 10.6 years) with pulmonary hypertension. Chronic obstructive lung disease was its cause in 32, mitral valve disease in 16 and dilated cardiomyopathy in 13 patients. The subcostal approach was possible in all patients and a semiquantitative assessment into three degrees of severity determined from right ventricular wall thickness and size, as well as the diameter of the inferior vena cava. The severity grade was closely correlated with the level of pulmonary hypertension. In the absence of all signs of increased right ventricular load (grade 0) the mean pulmonary arterial pressure was 18.7 +/- 6.2 mm Hg, in grade I it was 15 and 22 mm Hg (only two patients), in grade II 29.9 +/- 11.9 and in grade III 41.1 +/- 8.6 mm Hg. 13 of the 21 patients in grade 0 or I had no manifest signs of pulmonary hypertension, but this was the case in only 6 of 22 in grade II and none in grade III. In 42 patients (69%) the systolic pulmonary artery pressure could be measured by DEC and it correlated well with the values obtained by cardiac catheterization (P < 0.001, r = 0.92). These findings show that DEC can provide semiquantitative and, in most cases, even exact evidence of chronic right ventricular overload.

[Current status and indications for contrast echocardiography]. / Stellenwert und Indikationen der Kontrastechokardiographie.

Due to newly developed techniques contrast echocardiography (CE) is less often applied today. As to reevaluate the usefulness and the indications for CE 7823 consecutive echocardiographic studies were analysed. In 638 (8%) of these studies CE was used. 379 patients showed signs of right ventricular overload, 58 due to a left-to-right shunt. Pressure overload due to pulmonary hypertension was found in 321 cases. CE enhanced doppler flow signals in tricuspid regurgitation and facilitated quantification of right heart dimensions. 259 patients were screened for patent foramen ovale (PFO), 94 after embolic events, and 165 because neurosurgical intervention in a sitting position was planned. So CE proved to be still indicated in the era of color flow doppler, especially for the detection of PFO.