Echokardiografické hodnocení diastolické funkce levé komory prodělává neustálý vývoj, který je podmíněn prohlubujícími se znalostmi o fyziologii a patofyziologii diastoly levé komory a zaváděním nových ultrasonografických modalit do klinické praxe. Komplexností své problematiky představuje analýza plnění levé komory jeden z nejnáročnějších úkolů, před které je echokardiografista postaven. Cílem tohoto přehledového sdělení je proto podat detailní souhrn principů současného echokardiografického hodnocení diastolické funkce levé komory.
Echocardiographic assessment of left ventricular (LV) diastolic function is constantly evolving as a result of our improving understanding of physiology and pathophysiology of LV diastole and introduction of new ultrasound modalities into routine clinical practice. Because of its comprehensive nature, LV filling analysis represents one of the most challenging tasks to be solved by the echocardiographer. Therefore, the aim of this article is to give a detail review of the current principles of echocardiographic evaluation of LV diastolic function.
- MeSH
- Diastole MeSH
- Ventricular Function, Left MeSH
- Echocardiography, Doppler, Pulsed methods MeSH
- Publication type
- Review MeSH
Úvod: Echokardiografie hraje vedoucí roli v diagnostice diastolické funkce levé komory srdeční. Dosud jsme měli k dispozici pouze omezená data o vlivu věku na různé parametry diastolické funkce. Metodika: Retrospektivně jsme analyzovali databázi echokardiografických nálezů pacientů vyšetřených na našem pracovišti. Do studie jsme zahrnuli pouze pacienty se sinusovým rytmem, normální ejekční frakcí levé komory, bez chlopenní vady nebo jakékoliv jiné signifikantní echokardiografické patologie. Manuálním prohledáním lékařských záznamů jsme pacienty rozdělili do tří skupin na základě jejich anamnézy - skupina zdravých pacientů, skupina pacientů s arteriální hypertenzí a skupina s ischemickou chorobou srdeční. Výsledky: Zařazeno bylo celkem 999 pacientů průměrného věku 60,1 ± 14,4 roku, 48,5 % byli muži. Skupina zdravých pacientů zahrnovala 363 subjektů, skupina s arteriální hypertenzí 429 subjektů a skupina s ischemickou chorobou srdeční 207 subjektů. Transmitrální poměr E/A vlivem věku postupně klesal z průměru 1,65 u pacientů mladších 30 let na 0,78 u pacientů starších 80 let. Septální a laterální rychlosti mitrálního anulu v dopplerovském tkáňovém zobrazení (e´ sep a e´ lat) s věkem poklesly, stejně jako septální a laterální e´/a´ poměr. Septální, laterální a průměrný poměr E/e´ s věkem rostly shodně jako decelerační čas vlny E (DtE). S výjimkou deceleračního času vlny E nebyly χ2 testem nalezeny žádné statisticky významné rozdíly v měřených parametrech mezi třemi srovnávanými skupinami. Závěr: Echokardiografické parametry diastolické funkce se s přibývajícím věkem fyziologicky zhoršují. Na základě této studie mohou být určeny přesnější hraniční hodnoty měřených parametrů diastolické funkce pro různé věkové skupiny, než jsou doposud dostupné.
Introduction: Echocardiography plays a pivotal role in the diagnosis of left ventricular diastolic function. There has been only limited data on effects of age on different parameters of left ventricular diastolic function. Methods: We retrospectively searched and analysed a computerised echocardiography database data of subjects investigated at our department. We enrolled only subjects with sinus rhythm, normal left ventricular ejection fraction, without any valvular disease or any other significant echocardiographic pathology. By a subsequent manual search of hospital records we divided subjects into three groups based on their clinical history - group of healthy patients, group of patients with arterial hypertension and a group with coronary artery disease. Results: We enrolled a total of 999 subjects, mean age 60.1 ± 14.4 years, 48.5% were men. There were 363 healthy subjects, 429 subjects with arterial hypertension and 207 subjects with coronary artery disease. Transmitral E/A ratio decreased with age from mean 1.65 in subjects aged under 30 years to 0.78 in subjects over 80 years of age (p < 0.001). Tissue doppler velocities of septal and lateral mitral anulus (Em sep and Em lat) decreased with age, as did the septal and lateral e´/a´ ratio. The septal, lateral and average E/Em ratio increased with age, as did the E wave deceleration time (DtE) (all parameters with p < 0.001). Except for DtE, Chi-square goodness of fit test did not find any statistically significant differences in the measured para- meters between the three compared groups. Conclusions: Echocardiographic parameters of diastolic function physiologically deteriorate with age. Based on this study, more exact cut-off values can be adopted for different age groups and measured diastolic parameters, than are currently available.
- MeSH
- Echocardiography MeSH
- Ventricular Function, Left * MeSH
- Hypertension * diagnosis physiopathology MeSH
- Myocardial Ischemia * diagnosis physiopathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Age Factors MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Echocardiography, Doppler MeSH
- Ventricular Function, Left MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
Diastolic dysfunction might represent an important pathophysiological intermediate between hypertension and heart failure. Our aim was to determine whether inhibitors of the renin-angiotensin-aldosterone system, which can reduce ventricular hypertrophy and myocardial fibrosis, can improve diastolic function to a greater extent than can other antihypertensive agents. METHODS: Patients with hypertension and evidence of diastolic dysfunction were randomly assigned to receive either the angiotensin receptor blocker valsartan (titrated to 320 mg once daily) or matched placebo. Patients in both groups also received concomitant antihypertensive agents that did not inhibit the renin-angiotensin system to reach targets of under 135 mm Hg systolic blood pressure and under 80 mm Hg diastolic blood pressure. The primary endpoint was change in diastolic relaxation velocity between baseline and 38 weeks as determined by tissue doppler imaging. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170924. FINDINGS: 186 patients were randomly assigned to receive valsartan; 198 were randomly assigned to receive placebo. 43 patients were lost to follow-up or discontinued the assigned intervention. Over 38 weeks, there was a 12.8 (SD 17.2)/7.1 (9.9) mm Hg reduction in blood pressure in the valsartan group and a 9.7 (17.0)/5.5 (10.2) mm Hg reduction in the placebo group. The difference in blood pressure reduction between the two groups was not significant. Diastolic relaxation velocity increased by 0.60 (SD 1.4) cm/s from baseline in the valsartan group (p<0.0001) and 0.44 (1.4) cm/s from baseline in the placebo group (p<0.0001) by week 38. However, there was no significant difference in the change in diastolic relaxation velocity between the groups (p=0.29). INTERPRETATION: Lowering blood pressure improves diastolic function irrespective of the type of antihypertensive agent used.
- MeSH
- Antihypertensive Agents pharmacology adverse effects therapeutic use MeSH
- Angiotensin II Type 1 Receptor Blockers pharmacology adverse effects therapeutic use MeSH
- Double-Blind Method MeSH
- Echocardiography MeSH
- Hypertension drug therapy complications MeSH
- Hypertrophy, Left Ventricular etiology prevention & control MeSH
- Blood Pressure radiation effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Renin-Angiotensin System drug effects MeSH
- Aged MeSH
- Heart Rate drug effects MeSH
- Stroke Volume drug effects MeSH
- Tetrazoles pharmacology adverse effects therapeutic use MeSH
- Valine analogs & derivatives pharmacology therapeutic use drug effects MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
This study assessed the impact of tissue Doppler derived myocardial early diastolic relaxation velocity (E(m)) on the other parameters of diastolic function (preload dependent transmitral early diastolic velocity [E], tissue Doppler derived myocardial late diastolic velocity [A(m)], preload dependent transmitral late diastolic velocity [A]) and evaluated the correlation of these parameters with selected clinical variables in type 2 diabetic patients. Using tissue Doppler echocardiography, 82 type 2 diabetic patients were evaluated, divided into two equal groups of E(m) < 7.5 cm/s or > or = 7.5 cm/s. Patients with E(m) < 7.5 cm/s had significantly lower E/A and E(m)/A(m), and higher E/E(m) values. Multilinear regression showed a negative correlation between E(m) and glycated haemoglobin (Hb(A1c)) and duration of diabetes, a negative correlation of E(m)/A(m) with age, duration of diabetes and Hb(A1c), and a positive correlation of E/E(m) with age, duration of diabetes and use of diuretics. The E/A ratio only correlated negatively with age. It is concluded that E(m) is a reliable parameter of diastolic function, and that the tissue Doppler parameters of diastolic function are associated with diabetes compensation and diabetes duration.
- MeSH
- Time Factors MeSH
- Diabetes Mellitus, Type 2 physiopathology ultrasonography MeSH
- Diagnostic Techniques, Cardiovascular MeSH
- Diastole physiology MeSH
- Echocardiography, Doppler MeSH
- Ventricular Dysfunction, Left physiopathology ultrasonography MeSH
- Middle Aged MeSH
- Humans MeSH
- Myocardium metabolism pathology MeSH
- Blood Flow Velocity MeSH
- Aged MeSH
- Stroke Volume MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
The objective of this study was to evaluate the effects of Valsartan (Valsacor®) on arterial pressure (AP) and indices of myocardial diastolic and global function in patients with uncontrolled arterial hypertension (AH). Material and methods: 60 patients (39 men and 21 women, mean age 63.9 ± 10.8 years, P > 140/90 mmHg with a background of combined antihypertensive therapy) were involved in the study. Valsartan (Valsacor®) was added to the standard therapy. The follow-up continued for three months, with clinical visits at initiation and completion of the study. The echocardiographic (EchoCG) evaluation included measurements of left ventricular and left atrial dimensions and function via longitudinal strain and Doppler-analysis of the transmitral blood flow. Results: The administration of Valsartan (Valsacor®) ) resulted in a significant improvement in the antihypertensive control in the studied patients. The mean values of the baseline systolic blood (SBP) and diastolic blood (DBP) pressure in the studied group of patients were 174.9 ± 17.9 (range 150–230) mmHg and 97.5 ± 6.4 (range 85–110) mmHg, respectively. The mean SBP and DBP values at the end of the third month of the follow-up period were 139.1 ± 10.9 (range 120–180) mmHg and 84.9 ± 6.2 mmHg, respectively, at p < 0.05, compared to the baseline. The results of the echocardiographic analysis revealed significant differences in the dynamic performance of the indices: telesystolic dimension of the left ventricle, deceleration time (DT), E‘, E/E‘ ratio and values of longitudinal strain. The observed dynamic performance reflects favourable responses of the indices for diastolic function and longitudinal strain in the studied patients. Conclusion: Valsartan (Valsacor®), used as an adjunct to the standard antihypertensive therapy in patients with insufficiently controlled AH, leads to optimisation of the AP values and improvement of the indices of diastolic and global myocardial function, with a very good safety profile.
- MeSH
- Antihypertensive Agents MeSH
- Angiotensin II Type 1 Receptor Blockers administration & dosage pharmacology therapeutic use MeSH
- Adult MeSH
- Echocardiography MeSH
- Hemodynamics MeSH
- Drug Evaluation MeSH
- Hypertension * drug therapy pathology MeSH
- Blood Pressure * drug effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Echocardiography, Doppler, Pulsed statistics & numerical data MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Tetrazoles MeSH
- Valine * analogs & derivatives therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
