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Evaluation of LV Diastolic Function and Heart Failure by Two-dimensional and Doppler Echocardiography
S138 Journal of Cardiac Failure Vol. 15 No. 7S September 2009
Symposium 1 S1-1 Assessment of Cardiac Function and Heart Failure by Cardiac Time Analysis (Tei Index) TOSHINORI YUASA1, MIHOKO KOUNO1, AKIRA KISANUKI2, NAMI UEYA1, KENICHI NAKASHIKI1, EIJI KUWAHARA1, KAYOKO KUBOTA1, NAOKO MIZUKAMI3, KUNITSUGU TAKASAKI1, CHUWA TEI1 1 Department of cardiovascular, respiratory and metabolic medicine, graduate school of medicine, Kagoshima university, Kagoshima, Japan, 2Department of health, Kagoshima university hospital, Kagoshima, Japan, 3Clinical laboratory, Kagoshima university hospital, Kagoshima, Japan Tei index has been proposed as a noninvasive and simple index that enables the assessment of global left ventricular (LV) and right ventricular (RV) function and prediction of patient prognosis. Therefore, the purpose of this presentation is to show the assessments of cardiac function and heart failure using Tei index and cardiac time intervals (isovolumic contraction time, isovolumic relaxation time). Especially, the usability of RV Tei index for assessing severity and improvement of LV systolic heart failure, will be noted. RV Tei index significantly correlates with brain natriuretic peptide (BNP) in patients with LV systolic dysfunction (r 5 0.55, p 5 0.001). Furthermore, the changes of RV Tei index also correlates with changes of BNP after Waon therapy (r 5 0.41, p 5 0.04).
In this lecture, the following issues will be discussed: (1) Grading the degree of diastolic dysfunction by transmitral flow (TMF) and pulmonary venous flow (PVF), (2) Estimation of LVEDP by TMF and PVF, (3) Estimation of filling pressures by TMF and PVF, and their limitations, and (4) Estimation of filling pressures using newer indices of relaxation (‘‘flow propagation velocity’’ and ‘‘early annular diastolic velocity’’).
S1-3 Detection of Pre-ejection Septal Flash and Systolic Shuffle by Curved Color M-mode can Predict Favorable Outcome After Cardiac Resynchronization Therapy KAZUYA MURATA1, CHIKAGE KIHARA2, TAKEO TANAKA2, YASUAKI WADA2, MASUNORI MATSUZAKI2 1 Division of Laboratory, Yamaguchi University Hospital, Yamaguchi, Japan, 2 Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan Background: Left ventricular (LV) systolic shuffle (SS) motion and pre-ejection septal flash (SF) are indices of LV dyssynchrony. However, both SS and SF are evaluated by visual estimations and so can lack objectivity. Methods: Twenty-nine patients with severe heart failure who received cardiac resynchronization therapy (CRT) were studied. Apical 3- and 4-chamber views were obtained before CRT. Curved color M-mode (CCM) images were obtained by velocity profiles measured by a two-dimensional speckle tracking technique at both the interventricular septal and lateral (or posterior) walls. We defined SF as the septum coded ‘‘blue’’ during the pre-ejection period, and shuffle as lateral (or posterior) wall coded ‘‘blue’’ during systole. If each motion was confirmed by CCM, we scored one for each, and the sum of scores was calculated. Results: Eighteen of the 29 patients showed more than 10% reduction in end-systolic volume at 3 months after CRT (responders). If the sum of scores O 2, the sensitivity and specificity of predicting responders were 83 and 63%, respectively. Conclusion: Systolic Shuffle motion and septal flash, as demonstrated by CCM, have the potential to be simple indices for evaluating LV dyssynchrony and to predict favorable effects after CRT.
S1-4 Assessment of Left Ventricular Dyssynchrony Using 3D Speckle Tracking Imaging YOSHIHIRO SEO, TOMOKO ISHIZU, YUKIO SEKIGUCHI, HIROSHI TADA, KAZUTAKA AONUMA Cardiovascular Division, University of Tsukuba, Ibaraki, Japan
S1-2 Evaluation of LV Diastolic Function and Heart Failure by Two-dimensional and Doppler Echocardiography SATOSHI YAMADA Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine The filling of the ventricle to provide an adequate cardiac output while maintaining normal diastolic pressure at rest and during exercise occurs through the interaction of multiple intracardiac and extracardiac factors. Failure of these factors results in the elevation of LV filling pressures. Several pressure measurements are referred to as filling pressures: mean left atrial pressure (LAP), mean pulmonary artery wedge pressure (PAWP), LV end diastolic pressure (LVEDP), and diastolic LV pressure prior to atrial contraction (LV pre-A). Understanding that LVEDP can be elevated before mean LAP is increased is essential to interpretation of diastolic function. Although the high LVEDP reflects increased LV stiffness at end diastole, LV pre-A pressure is often preserved normal, and consequently mean LAP remains normal. Therefore, LVEDP should be used to evaluate LV stiffness, whereas, in order to evaluate patients with dyspnea, it is preferable to utilize indices that provide an estimate of mean LAP rather than LVEDP.
Background: Left ventricular (LV) dyssynchrony has been focused in the cardiac resynchronization therapy (CRT) era. In the clinical electrophysiology, 3D imaging has been used in assessing of intraventricular electrical propagation. For 3D mechanical imaging, a robust 3D speckle tracking imaging (3D-STI) system has been developed and introduced on a commercially available ultrasound system. Methods: First, we compared 3D mechanical dyssynchrony images by 3D-STI with 3D intraventricular electrical propagation imaging (EnSite) in patients with CRT. Second, we assessed intraventricular dyssynchrony in consecutive patients with LBBB or pacemaker rhythm. Result: 3D-STI provided intraventricular dyssynchrony clearly (Figure). In addition, we found similar mechanical and electrical dyssynchrony pattern. Conclusion: 3D-STI may be reliable in assessing LV dyssynchrony, and have a potential to provide novel aspect of mechanical dyssynchrony.
Symposium 1 S1-1 Assessment of Cardiac Function and Heart Failure by Cardiac Time Analysis (Tei Index) TOSHINORI YUASA1, MIHOKO KOUNO1, AKIRA KISANUKI2, NAMI UEYA1, KENICHI NAKASHIKI1, EIJI KUWAHARA1, KAYOKO KUBOTA1, NAOKO MIZUKAMI3, KUNITSUGU TAKASAKI1, CHUWA TEI1 1 Department of cardiovascular, respiratory and metabolic medicine, graduate school of medicine, Kagoshima university, Kagoshima, Japan, 2Department of health, Kagoshima university hospital, Kagoshima, Japan, 3Clinical laboratory, Kagoshima university hospital, Kagoshima, Japan Tei index has been proposed as a noninvasive and simple index that enables the assessment of global left ventricular (LV) and right ventricular (RV) function and prediction of patient prognosis. Therefore, the purpose of this presentation is to show the assessments of cardiac function and heart failure using Tei index and cardiac time intervals (isovolumic contraction time, isovolumic relaxation time). Especially, the usability of RV Tei index for assessing severity and improvement of LV systolic heart failure, will be noted. RV Tei index significantly correlates with brain natriuretic peptide (BNP) in patients with LV systolic dysfunction (r 5 0.55, p 5 0.001). Furthermore, the changes of RV Tei index also correlates with changes of BNP after Waon therapy (r 5 0.41, p 5 0.04).
In this lecture, the following issues will be discussed: (1) Grading the degree of diastolic dysfunction by transmitral flow (TMF) and pulmonary venous flow (PVF), (2) Estimation of LVEDP by TMF and PVF, (3) Estimation of filling pressures by TMF and PVF, and their limitations, and (4) Estimation of filling pressures using newer indices of relaxation (‘‘flow propagation velocity’’ and ‘‘early annular diastolic velocity’’).
S1-3 Detection of Pre-ejection Septal Flash and Systolic Shuffle by Curved Color M-mode can Predict Favorable Outcome After Cardiac Resynchronization Therapy KAZUYA MURATA1, CHIKAGE KIHARA2, TAKEO TANAKA2, YASUAKI WADA2, MASUNORI MATSUZAKI2 1 Division of Laboratory, Yamaguchi University Hospital, Yamaguchi, Japan, 2 Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan Background: Left ventricular (LV) systolic shuffle (SS) motion and pre-ejection septal flash (SF) are indices of LV dyssynchrony. However, both SS and SF are evaluated by visual estimations and so can lack objectivity. Methods: Twenty-nine patients with severe heart failure who received cardiac resynchronization therapy (CRT) were studied. Apical 3- and 4-chamber views were obtained before CRT. Curved color M-mode (CCM) images were obtained by velocity profiles measured by a two-dimensional speckle tracking technique at both the interventricular septal and lateral (or posterior) walls. We defined SF as the septum coded ‘‘blue’’ during the pre-ejection period, and shuffle as lateral (or posterior) wall coded ‘‘blue’’ during systole. If each motion was confirmed by CCM, we scored one for each, and the sum of scores was calculated. Results: Eighteen of the 29 patients showed more than 10% reduction in end-systolic volume at 3 months after CRT (responders). If the sum of scores O 2, the sensitivity and specificity of predicting responders were 83 and 63%, respectively. Conclusion: Systolic Shuffle motion and septal flash, as demonstrated by CCM, have the potential to be simple indices for evaluating LV dyssynchrony and to predict favorable effects after CRT.
S1-4 Assessment of Left Ventricular Dyssynchrony Using 3D Speckle Tracking Imaging YOSHIHIRO SEO, TOMOKO ISHIZU, YUKIO SEKIGUCHI, HIROSHI TADA, KAZUTAKA AONUMA Cardiovascular Division, University of Tsukuba, Ibaraki, Japan
S1-2 Evaluation of LV Diastolic Function and Heart Failure by Two-dimensional and Doppler Echocardiography SATOSHI YAMADA Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine The filling of the ventricle to provide an adequate cardiac output while maintaining normal diastolic pressure at rest and during exercise occurs through the interaction of multiple intracardiac and extracardiac factors. Failure of these factors results in the elevation of LV filling pressures. Several pressure measurements are referred to as filling pressures: mean left atrial pressure (LAP), mean pulmonary artery wedge pressure (PAWP), LV end diastolic pressure (LVEDP), and diastolic LV pressure prior to atrial contraction (LV pre-A). Understanding that LVEDP can be elevated before mean LAP is increased is essential to interpretation of diastolic function. Although the high LVEDP reflects increased LV stiffness at end diastole, LV pre-A pressure is often preserved normal, and consequently mean LAP remains normal. Therefore, LVEDP should be used to evaluate LV stiffness, whereas, in order to evaluate patients with dyspnea, it is preferable to utilize indices that provide an estimate of mean LAP rather than LVEDP.
Background: Left ventricular (LV) dyssynchrony has been focused in the cardiac resynchronization therapy (CRT) era. In the clinical electrophysiology, 3D imaging has been used in assessing of intraventricular electrical propagation. For 3D mechanical imaging, a robust 3D speckle tracking imaging (3D-STI) system has been developed and introduced on a commercially available ultrasound system. Methods: First, we compared 3D mechanical dyssynchrony images by 3D-STI with 3D intraventricular electrical propagation imaging (EnSite) in patients with CRT. Second, we assessed intraventricular dyssynchrony in consecutive patients with LBBB or pacemaker rhythm. Result: 3D-STI provided intraventricular dyssynchrony clearly (Figure). In addition, we found similar mechanical and electrical dyssynchrony pattern. Conclusion: 3D-STI may be reliable in assessing LV dyssynchrony, and have a potential to provide novel aspect of mechanical dyssynchrony.