Left Atrial Deformation Predicts Pulmonary Capillary Wedge Pressure in Pediatric Heart Transplant Recipients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110826/1/echo12679.pd

Estimation of LV End‐Diastolic Pressure Using Color‐TDI and Its Application to Noninvasive Quantification of Myocardial Wall Stress

Background: This study was undertaken to evaluate early-diastolic annular velocity (Ea) by color-TDI, combined with the early transmitral filling velocity (E) by pulsed Doppler echocardiographyfor estimation of left ventricular end diastolic pressure (LVEDP). We applied LVEDP to noninvasivequantification of myocardial wall stress in end-diastole. Forty-one coronary artery disease (CAD)patients with sinus rhythm underwent echocardiography and cardiac catheterization evaluated inthe study. Methods: First linear regression analysis was performed to assess the relationships betweenE/Ea and LVEDP. Second LVEDP estimation with these two methods was tested prospectively in 59additional CAD patients, and average end-diastolic wall stress was calculated at rest by measuringthe principal radii, the thickness of the LV segments, and the estimated LVEDP. The results werecompared to the wall stress that was calculated using catheter-measured LVEDP. Linear regressionanalysis was performed to assess the relationships between calculated wall stress using Doppler-estimated LVEDP (WSEP) and calculated wall stress using catheter-measured LVEDP (WSMP).Results: The results showed that LVEDP had a strong correlation to the lateral E/Ea (r = 0.85; P <0.001) and medial E/Ea ratios (r = 0.73; P < 0.001). No significant differences were found between theWSEP and WSMP. There were highly significant correlations (at least r = 0.85, P < 0.001) betweenthe WSMP and WSEP at all the myocardial sites. Conclusions: The current data demonstrate thatthe lateral E/Ea ratio obtained by Doppler echocardiography and color-TDI is a powerful estimator ofLVEDP in CAD patients and provides pressure information required for noninvasive quantificationof LV myocardial wall stress with reasonable accuracy in diastole. (ECHOCARDIOGRAPHY, Volume26, April 2009

CMR for Assessment of Diastolic Function

Prevalence of heart failure with preserved left ventricular ejection fraction amounts to 50% of all cases with heart failure. Diagnosis assessment requires evidence of left ventricular diastolic dysfunction. Currently, echocardiography is the method of choice for diastolic function testing in clinical practice. Various applications are in use and recommended criteria are followed for classifying the severity of dysfunction. Cardiovascular magnetic resonance (CMR) offers a variety of alternative applications for evaluation of diastolic function, some superior to echocardiography in accuracy and reproducibility, some being complementary. In this article, the role of the available CMR applications for diastolic function testing in clinical practice and research is reviewed and compared to echocardiography

Unlocking the Mysteries of Diastolic Function Deciphering the Rosetta Stone 10 Years Later

It has now been a quarter of a century since the first description by Kitabatake and his associates of the use of echo-Doppler to characterize the transmitral flow velocity curves in various disease states. A decade ago we described the role of echocardiography in the “Evaluation of Diastolic Filling of Left Ventricle in Health and Disease: Doppler Echocardiography Is the Clinician’s Rosetta Stone.” Over the ensuing decade, advances in echo-Doppler have helped to further decipher the morphologic and physiological expression of cardiovascular disease and unlock additional mysteries of diastology. The purpose of this review is to highlight the developments in echo-Doppler and refinements in our knowledge that have occurred over the past decade that enhance our understanding of diastology

Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function

Congestive heart failure with preserved left ventricular systolic function has emerged as a growing epidemic medical syndrome in developed countries, which is characterized by high morbidity and mortality rates. Rapid and accurate diagnosis of this condition is essential for optimizing the therapeutic management. The diagnosis of congestive heart failure is challenging in patients presenting without obvious left ventricular systolic dysfunction and additional diagnostic information is most commonly required in this setting. Comprehensive Doppler echocardiography is the single most useful diagnostic test recommended by the ESC and ACC/AHA guidelines for assessing left ventricular ejection fraction and cardiac abnormalities in patients with suspected congestive heart failure, and non-invasively determined basal or exercise-induced pulmonary capillary hypertension is likely to become a hallmark of congestive heart failure in symptomatic patients with preserved left ventricular systolic function. The present review will focus on the current clinical applications of spectral tissue Doppler echocardiography used as a reliable noninvasive surrogate for left ventricular diastolic pressures at rest as well as during exercise in the diagnosis of heart failure with preserved left ventricular systolic function. Chronic congestive heart failure, a disease of exercise, and acute heart failure syndromes are characterized by specific pathophysiologic and diagnostic issues, and these two clinical presentations will be discussed separately