Influence of alterations in loading on mitral annular velocity by tissue Doppler echocardiography and its associated ability to predict filling pressures.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read Online Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print Cited Medium: Print ISSN: 0012-3692 (Print) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE
    • Publication Information:
      Publication: 2016- : New York : Elsevier
      Original Publication: Chicago : American College of Chest Physicians
    • Subject Terms:
      Echocardiography, Doppler* ; Ventricular Function, Left*; Mitral Valve/*physiology; Animals ; Aorta/physiology ; Blood Flow Velocity ; Blood Pressure ; Diastole ; Dobutamine/pharmacology ; Dogs ; Hemodynamics ; Male ; Mitral Valve/diagnostic imaging ; Myocardial Contraction/drug effects ; Propanolamines/pharmacology ; Stroke Volume ; Vena Cava, Inferior/physiology ; Ventricular Pressure
    • Abstract:
      Study Objectives: Early diastolic mitral annular velocity (E') by tissue Doppler echocardiography (TD) has been reported to be a load-independent index of left ventricular (LV) diastolic function, allowing the early diastolic mitral inflow velocity (E)/E' ratio to be used clinically to predict LV filling pressures. However, preload independence of E' has remained controversial, and E/E' may not consistently be predictive of LV filling pressures. Our objectives were to test the hypotheses that E' is affected by preload, and that alterations of preload, afterload, and contractility also affect E/E'. DESIGN, INTERVENTIONS, AND MEASUREMENTS: An open-chest dog model was used (n = 8). High-fidelity pressure and conductance catheters were used for pressure-volume relations, and E' was obtained by pulsed TD from the apical four-chamber view. Changes in preload and afterload were induced by vena caval and partial aortic occlusions, respectively. Data were collected during control phase and during infusions of dobutamine and esmolol to alter contractility.
      Results: E' was consistently and significantly associated with acute decreases in LV end-diastolic pressure in each dog (n = 200 beats; r = 0.93 +/- 0.06 [mean +/- SD]). Similar results occurred with dobutamine and esmolol infusions. This preload sensitivity was reflected in E/E', which was inversely (rather than directly) correlated with LV diastolic pressure (r = - 0.67). E/E' was less affected by preload when diastolic dysfunction was induced by sustained partial aortic occlusion (time constant of relaxation increased from 46 +/- 19 to 53 +/- 21 ms, p < 0.001).
      Conclusions: E' was significantly influenced by preload with preserved LV function and low filling pressures (< 12 mm Hg); accordingly, E/E' was less predictive of LV filling pressures in this scenario. E/E' was more predictive of LV filling pressures in the presence of diastolic dysfunction.
    • Grant Information:
      K24 HL 04503-01 United States HL NHLBI NIH HHS
    • Accession Number:
      0 (Propanolamines)
      3S12J47372 (Dobutamine)
      MDY902UXSR (esmolol)
    • Publication Date:
      Date Created: 20041215 Date Completed: 20050118 Latest Revision: 20161124
    • Publication Date:
      20221213
    • Accession Number:
      10.1378/chest.126.6.1910
    • Accession Number:
      15596692