We sought to determine the prognostic value of left ventricular (LV) mitral annular velocities measured by tissue Doppler imaging (TDI) in hypertensive patients with echocardiographic evidence of LV hypertrophy.
Echo LV hypertrophy and LV geometry provide additional predictive value of all-cause mortality beyond traditional cardiovascular risk factors. Limited data exist regarding the predictive value of TDI velocities for cardiovascular risk stratification in treated hypertensive patients.
Two-dimensional and Doppler echocardiograms were obtained in 252 consecutive subjects, including 174 subjects with systemic hypertension and 78 age-matched normal subjects. The end point was cardiac death in subsequent median follow-up of 19 months.
Nineteen patients (7.54%) died of cardiac causes. The TDI mitral annulus systolic velocity and the early diastolic mitral annular velocity (Em) were significantly lower in the non-survivors (all P < 0.001). The pseudonormal (PN) or restrictive filling pattern (RFP) was associated with cardiac mortality. The other parameters associated with cardiac mortality were LV ejection fraction, LV mass index, inter-ventricular septal wall thickness in diastole and the ratio of early mitral inflow to early myocardial velocity. In multivariate analysis, Em, inter-ventricular septal wall thickness in diastole and either PN or RFP were the strongest predictors. The addition of Em < 3.5 cm/s significantly improved the outcome of a model that contained clinical risk factors, inter-ventricular septal wall thickness in diastole > 1.4 cm and either PN or RFP (P = 0.043).
Early diastolic mitral annulus velocity measured by TDI provides prognostic information, incremental to clinical data and standard echocardiographic variables, for risk stratification of hypertensive patients under treatment.
"It also appears that diastolic function evaluated by TDI may be impaired in hypertensive subjects in the absence of LV hypertrophy (Müller-Brunotte et al., 2007; Tsilakis et al., 2008; Narayanan et al., 2009). In addition, impaired systolic and diastolic function measured by TDI is a strong individual predictor of adverse clinical outcome in patients with hypertension and preserved LV ejection fraction (Wang et al., 2005; Yu et al., 2007). A healthy lifestyle with regular physical exercise is recommended as part of the non-pharmacological treatment of hypertension (Cornelissen & Fagard, 2005; Fagard & Cornelissen, 2007; Mancia et al., 2007; Cornelissen et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: We investigated the effects of 3 and 6 months of regular football training on cardiac structure and function in hypertensive men. Thirty-one untrained males with mild-to-moderate hypertension were randomized 2:1 to a football training group (n = 20) and a control group receiving traditional recommendations on healthy lifestyle (n = 11). Cardiac measures were evaluated by echocardiography. The football group exhibited significant (P < 0.05) changes in cardiac dimensions and function after just 3 months: Left ventricular (LV) end-diastolic volume increased from 104 ± 25 to 117 ± 29 mL. LV diastolic function improved measured as E/A ratio (1.15 ± 0.32 to 1.54 ± 0.38), early diastolic velocity, E' (11.0 ± 2.5 to 11.9 ± 2.6 cm/s), and isovolumetric relaxation time (74 ± 13 to 62 ± 13 ms). LV systolic function improved measured as longitudinal displacement (10.7 ± 2.1 to 12.1 ± 2.3 mm). Right ventricular function improved with respect to tricuspid annular plane systolic excursion (21.8 ± 3.2 to 24.5 ± 3.7 mm). Arterial blood pressure decreased in both groups, but significantly more in the football training group. No significant changes were observed in the control group. In conclusion, short-term football training improves LV diastolic function in untrained men with mild-to-moderate arterial hypertension. Furthermore, it may improve longitudinal systolic function of both ventricles. The results suggest that football training has favorable effects on cardiac function in hypertensive men.
Scandinavian Journal of Medicine and Science in Sports 06/2014; 24(S1). DOI:10.1111/sms.12237 · 2.90 Impact Factor
"Reduced mitral annular plane systolic excursion (MAPSE), measured by M-mode echocardiography, provides a sensitive, early marker of systolic dysfunction in hypertensive patients with preserved EF, and can diagnose heart failure with preserved EF . Mitral annular velocity (E’), measured in early diastole by tissue Doppler echocardiography, incrementally predicts cardiac mortality beyond clinical data and standard echocardiographic measures [3,4]. At the present time, however, there is still no simple, validated cardiovascular magnetic resonance (CMR) technique to measure mitral annular excursion and recoil. "
[Show abstract][Hide abstract] ABSTRACT: Background
We have developed a novel and practical cardiovascular magnetic resonance (CMR) technique to evaluate left ventricular (LV) mitral annular motion by tracking the atrioventricular junction (AVJ). To test AVJ motion analysis as a metric for LV function, we compared AVJ motion variables between patients with hypertrophic cardiomyopathy (HCM), a group with recognized systolic and diastolic dysfunction, and healthy volunteers.
We retrospectively evaluated 24 HCM patients with normal ejection fractions (EF) and 14 healthy volunteers. Using the 4-chamber view cine images, we tracked the longitudinal motion of the lateral and septal AVJ at 25 time points during the cardiac cycle. Based on AVJ displacement versus time, we calculated maximum AVJ displacement (MD) and velocity in early diastole (MVED), velocity in diastasis (VDS) and the composite index VDS/MVED.
Patients with HCM showed significantly slower median lateral and septal AVJ recoil velocities during early diastole, but faster velocities in diastasis. We observed a 16-fold difference in VDS/MVED at the lateral AVJ [median 0.141, interquartile range (IQR) 0.073, 0.166 versus 0.009 IQR -0.006, 0.037, P < 0.001]. Patients with HCM also demonstrated significantly less mitral annular excursion at both the septal and lateral AVJ. Performed offline, AVJ motion analysis took approximately 10 minutes per subject.
Atrioventricular junction motion analysis provides a practical and novel CMR method to assess mitral annular motion. In this proof of concept study we found highly statistically significant differences in mitral annular excursion and recoil between HCM patients and healthy volunteers.
Journal of Cardiovascular Magnetic Resonance 05/2014; 16(1):35. DOI:10.1186/1532-429X-16-35 · 4.56 Impact Factor
"A variety of indexes derived using echocardiography have been used to
predict cardiac outcome of patients with HF, including left cavity dimensions, LV
ejection fraction (LVEF), and transmitral flow patterns1-4. Some studies
demonstrated that tissue Doppler imaging (TDI) parameters were capable of adding
prognostic information to predict cardiac death in major cardiac diseases, such as
HF3,5-7, acute coronary
syndrome8,9, acute myocardial infarction10, and hypertension11. "
[Show abstract][Hide abstract] ABSTRACT: It has been shown that a new tissue Doppler index, E/(E'×S'), including the ratio between early diastolic transmitral and mitral annular velocity (E/E'), and the systolic mitral annular velocity (S'), has a good accuracy to predict left ventricular filling pressure.
We investigated the value of E/(E'×S') to predict cardiac death in patients with heart failure.
Echocardiography was performed in 339 consecutive hospitalized patients with heart failure, in sinus rhythm, after appropriate medical treatment, at discharge and after one month. Worsening of E/(E'×S') was defined as any increase of baseline value. The end point was cardiac death.
During the follow-up period (35.2 ± 8.8 months), cardiac death occurred in 51 patients (15%). The optimal cut-off value for the initial E/(E'×S') to predict cardiac death was 2.83 (76% sensitivity, 85% specificity). At discharge, 252 patients (74.3%) presented E/(E'×S') < 2.83 (group I) and 87 (25.7%) presented E/(E'×S') > 2.83 (group II), respectively. Cardiac death was significantly higher in group II than in group I (38 deaths, 43.7% vs 13 deaths, 5.15%, p < 0.001). By multivariate Cox regression analysis, including variables that affected outcome in univariate analysis, E/(E'×S') at discharge was the best independent predictor of cardiac death (hazard ratio = 3.09, 95% confidence interval = 1.81-5.31, p = 0.001). Patients with E/(E'×S') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05).
In patients with heart failure, the E/(E'×S') ratio is a powerful predictor of cardiac death, particularly if it is associated with its worsening.
Dike B Ojji, Elena Libhaber, John J Atherton, Bolaji Abdullahi, Ada Nwankwo, Karen Sliwa
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