Influence of Aging, Tidal Volume, and Respiratory Rate on Doppler Echocardiographic Indices of Diastolic Function in Normal Male Subjects: A Quantitative Evaluation

Division of Cardiology, Department of Internal Medicine, University Hospital, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
Echocardiography (Impact Factor: 1.25). 02/2008; 25(1):40-6. DOI: 10.1111/j.1540-8175.2007.00562.x
Source: PubMed


Although the influence of respiration on ventricular filling, as evaluated by Doppler technique, and the evaluation of diastolic velocities of mitral valve annulus (MVA), as measured by Doppler tissue imaging (DTI), can provide valuable information for the study of left ventricular (LV) diastolic function, the concomitant effects of aging, tidal volume (TV), and respiratory rate (RR) on these velocities have not been quantitatively investigated.
We evaluated 12 normal male volunteers (Group I) aged 20-26 years (mean: 22.8) and 8 normal subjects aged 41 to 54 years old (mean: 45.9) (Group II). Using DTI we measured peak early (E(a)) and late (A(a)) velocities of longitudinal axis expansion at lateral and medial MVA. Doppler mitral and tricuspid flow velocities were measured: peak early (E) and late (A) inflow velocity, early (E(i)) and late (A(i)) flow integral, and deceleration time of peak early mitral flow velocity (DT). Respiratory cycles were simultaneously recorded at RR of 9, 12, 15, and 18 cycles/min and TV of 600 and 900 mL during respiration (RESP).
(1) E, A, and A(i) in MV had negligible change during respiration, but E(i) was significantly reduced during inspiration; (2) DT reduced slightly with inspiration, but the change was significant only with TV of 900 mL; (3) an important increase of E in right ventricular flow was observed during inspiration; (4) variations of RR and TV did not significantly influence right and left ventricular inflow in normal subjects, in the conditions of this investigation; (5) a significant increase of E(a) at medial MVA was documented during inspiration only in young subjects; (6) a significant decrease of A(a) at medial MVA was observed during inspiration in both groups of volunteers; (7) RR and TV did not influence MVA velocities in young and adult subjects; (8) a consistent reduction in E(a) and a significant increase in A(a) were observed with increasing age; (9) these changes were more conspicuous and consistent than those documented in ventricular filling when young and middle-age men are compared, suggesting that the DTI is more sensitive to detect changes in diastolic function; and (10) in addition, these data suggest that, for evaluation of diastolic function, in clinical context, it is not necessary to control rigorously RR or TV.

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    ABSTRACT: The authors assessed the capability of quantitative tissue velocity imaging (QTVI) to detect left ventricular (LV) early diastolic dysfunction (LVEDDY) in a canine model. Rapid ventricular pacing (RVP) at 240 beats/min was maintained in 14 dogs for 2 weeks. Echocardiography, cardiac catheterization, and endomyocardial biopsies were performed at baseline, during pacing, and at 2 weeks. QTVI, conventional echocardiographic, and LV pressure and pathologic indices were measured, and correlations were analyzed during the progressive development of diastolic dysfunction produced by RVP. Receiver operating characteristic (ROC) curves of QTVI parameters were analyzed to identify predictors of LVEDDY. The onset of LVEDDY occurred 24 hours after RVP initiation. Most of the QTVI indices were altered at 12 or 24 hours after RVP onset. New parameters were identified, including time-R and time-E', which are the times from aortic valve closure to peak isovolumetric relaxation (R) and peak early diastolic velocity (E'), respectively, as well as the ratios of peak myocardial systolic velocity (S') and peak E' to R (S'/R and E'/R, respectively), which significantly changed during RVP. These parameters were correlated with LV -dp/dt(max) or LV end-diastolic pressure, but time-R, time-E', and S'/R were not correlated with heart rate. In addition, using ROC analysis, time-R had the largest area under the curve to predict LVEDDY after RVP. QTVI is a sensitive and specific quantitative method that can be used for the early detection of LVEDDY under tachycardic conditions. The novel indices described here, including time-R, time-E', and S'/R, can serve as effective, noninvasive, possibly heart rate independent LVEDDY markers.
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    ABSTRACT: Background The left ventricular filling pattern may show changes during respiration, which are generally used in the diagnosis of diastolic dysfunction. The clinical importance of the respiratory E/A wave pattern change has been investigated in a limited number of studies. The aim of the present study was to assess the diastolic function of hypertensive patients with respiratory changes in mitral flow over a long-term follow-up period. Material/Methods Our study included 107 newly diagnosed and untreated hypertensive patients (49 males; mean age, 46±10 years) with respiratory changes during transthoracic echocardiography (TTE). In addition, the patient group was classified into 2 groups according to the change in E/A pattern by the Valsalva maneuver. After a mean follow-up period of 44±7 month, 90% of the hypertensive patients and the entire control group were re-examined. Results Relaxation abnormalities developed in 84% of the patients (58/80) in the Valsalva-positive group after the follow-up period. The frequency of relaxation abnormalities was 60% in the Valsalva-negative group and 3.1% in the control group (p<0.001). Based on multivariate regression analysis, the echocardiographic predictors of the development of relaxation impairment were mitral E velocity, A velocity, deceleration time, isovolumetric contraction time, E/E′ ratio, and the presence of respiratory change. The most important parameter for the development of an abnormal relaxation pattern was the presence of respiratory change after adjustment according to the changes with the Valsalva maneuver. Conclusions Respiratory change in mitral flow can be evaluated as an early sign of diastolic dysfunction in patients with hypertension.
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