- Email: [email protected]
Physiologic correlates of pulmonary valve motion in diastole
ABSTRACTS
SENSITIVITY AND SPECIFICITY CF THE PULMONIC VALVE ECHOGRAM IN THE DETECTION OF PULMONARY HYPERTENSION Roy Kaku, MD; Alexander Neumann, BS; William Bommer, MD; Lynn Weinert, BS; Dean T. Mason, MD, FACC; Anthony N. DeMaria, MD, FACC, University of California, Davis, Calif. Little data are available regarding the sensitivity and specificity of the pulmonic valve echogram in the detection of pulmonary hypertension (PHT). Thus simultaneous pulmonic echograms were evaluated in 52 patients with normal pulmonary artery pressure and 46 patients with PHT (mean pressure >20 mm Hg). Maximum A wave depth (Amax) bore a general correlation with pulmonary pressure (r = .70) and was >2 mm in all normals (mean 3.4). Amax was less in PHT (1.1 pc.01) and was absent in 7 of 27 PHT patients with sinus rhythm. A mid-systolic notch was recorded in 15 of 22 PHT patients, but no normals, in whom pulmonic echograms were recorded throughout systole. The ratio of right ventricular pre-ejection period to ejection time (PEP/RVET) correlated with pulmonary artery pressure (r = .70) and was greater than 6.3 in all but 2 PHT patients (mean .43). PEP/RVET was less in normals (.26, pc.001) and was greater than 0.3 in only 3. The opening velocity (OV) of the pulmonic echogram did not correlate with pulmonary artery pressure nor was OV different in normals as compared to PHT: (369 vs 363 mm/set). Diastolic slope (EF) of the pulmonic echogram also did not correlate with pulmonary pressure, but EF was less in PHT than normals: 34 vs 26 mm/set (pc.05). Thus, considerable overlap exists in all measurements of the pulmonic echogram between normals and patients with pulmonary hypertension. However, no normals exhibited an Amax ~2 mm if in normal sinus rhythm or a mid-systolic notch, and thereby these criteria may be utilized to indicate the presence of pulmonary hypertension.
ECHOCARDIOGRAPHIC DETERMINATION OF MITRAL VALVE FLOW IN NORMAL SUaTECTS AND IN PATIENTS WITH CORONARY ARTERY DISEASE, CARDIOMYOPATHY OR MITRAL REGURGITATION Susan Rasmussen RN, Betty C. Corya MD, Mary Jo Black BA, John F. Phillips MD, FACC, Harvey Feigenbaum MD, FACC Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana The purpose of this study was to derive and test a clinically applicable method for calculating flow across the mitral valve(m). Based on data derived from Mv echograms which were manually traced on a digital tabloid and entered into a graphic terminal for computer analysis, a formula was derived for calculating Mv stroke volume (SV-MV) using mitral EE(vertica1 distance between leaflets in mm at the E point) and DE slope(mm/sec), electrocardiographic PR interval(sec), and heart rate (HR). sv-Mv = '% + PR) x lOO+= HR This formula was tested prospectively on 80 consecutive patients from whom 95 simultaneous MV echograms and either thermodilution(TD) [45] or Fick(F1) cardiac outputs (CO) [50] were performed. Of the 80 patients, 16 were normal; 54 had coronary artery disease; 3 had cardiomyopathy;and 7 had nonrheumatic mitral regurgitation(MR). For the 73 patients without MR, there was no statistical difference in SV-MV vs SV-TD or SV-FI nor in CO-MV YS CO-TD or CO-F1 when data were compared using either the Student t test; Mann-Whitney U test; or the Kolmogorov-Smirnov test.SV-TD ranged from 24-83 cc (mean 56 cc) and SV-FI ranged from 35-139 cc (mean 78 cc). Linear regression(r) for stroke volume was .90 f 6 cc and for cardiac output was .83 i .5 liter. The presence or absence of ventricular asynergy did not alter statistical findings. For the 7 patients with MR, SV-Mv consistently overestimated forward stroke volume. This study shows that, for these 80 patients, the Mv echogram reflects mitral valve flow.
PHYSIOLOGIC CORRELATES OF PULMONARY VALVE MOTION IN DIASTOLE David J. Pocoski, MD; Pravin M. Shah, MD, FACC; Linda Sylvester, University of Rochester Medical Center, Rochester, NY
ASSESSMENT OFMITRALVALVE E POINT-SEPTALSEPARATION AS AN INDEX OF LEFT VENTRICULARFUNCTION IN ACUTE
The diastolic pulmonary valve (PV) waveform has been This study correlated with pulmonary hypertension. examined the relationship and further correlated it with changes in left. atria1 (LA) size as reflected by the posterior aortic wall (PAW) motion. Complete diastolic PV waveforms were obtained in 55 patients. The e-f slope of the PV correlated with the O-R slope of the PAW (t-=0.95) and the interval S2-f correlated with AW the S2-R (r=0.94) and neither parameter correlated with pulmonary arterial In all patients with pressure (PAP). Aa & mitral stenosis both the PV e-f and the pAw M PAW O-R slones were flattened irrespective of PAP. In patients with '" a normal left atria1 index (52.0 cm/M2) PCG 1 \ , , ’ 1 stroke volume index (SVI) correlated with e-f slope (t-=0.60) and the slope KG u was flattened in all patients with significantly reduced SVI. The e-f slope was uniformly PAP was normal in 72% of patients flat with a large LA. with pulmonary valve "a dips" > 2 mm and was elevated in 75% of patients with absent "a dips" reflecting the instantaneous pressure differences across the PV in The numerous exceptions suggested other factors. diastole. The A wave PAW correlated with the "a dip" PV (t-=0.85). Conclusion: The early diastolic waveform of the PV, like the PAW, reflects underlying LA events due to anatomical proximity. The e-f slope is not a measure of PAP. The "a dip" is a complex event related to PAP and other factors which'include LA'events.
We compared a new echo index of leftventricular(LV) function, mitral valve E point-septalseparation (EPSS), to the radionuclide
438
February 1978
The American Journal of CARDIOLOGY
AND CHRONICISCHEMICHEART DISEASE Wilbur Lew, MD; Hartmut Henning, MD; Heinz Schelbert, MD; Joel Korliner, MD, FACC, Univenity of California, San Diego
ejection
fraction
(EF) calculated
from the first
pass method in 60
patients (pts) (73 studies)with ischemic heart disease. Thirty-eight pts had acute myocardial infarction(MI)and 22 pts were studied an overage of 24 months after acute Ml. In 30 normals EPSS ronged from 0 to 5.4 mm (average = 1.3 mm). In 57 studies (78%) EPSS correctly identified pts with a normal or reduced EF (< 0.52), but in 13 studies (18%) EPSS was normal and EF depressed. In only 3 studies (4%) was there o normol EF and an abnormal EPSS. Results did not differbetween pts with acute Mland those studied late after Ml. An EPSS of >5.5 mm was highly specific (89%) for a reduced EF, but sensitivitywas only 65%. Abnormal wall motion by echoanti/or videotracking occurred equally among pts with normal and increased EPSS, but EPSS was less accurate in pts with more severe wnll motion abnormalities. EPSS was unrelated to heart rate; an abnormal EPSS was equally distributed among pts with a normol vs an enlarged echo LV end-diastolic dimension. EPSS wws superior to other echo indices of LV function (% of fractional shortening, mean Vcfond EF). Thus, EPSS isa simple noninvasive measure of LV function. We conclude that an abnormal EPSS is useful for identifyingdepressed LV function in patientswith acute Mland chronic ischemic heartdisease;however, o normal EPSS can be associated with normal as well CISreduced LV performance and therefore isnot of value in the ossessment of LV function in such patients.
Volume 41
SENSITIVITY AND SPECIFICITY CF THE PULMONIC VALVE ECHOGRAM IN THE DETECTION OF PULMONARY HYPERTENSION Roy Kaku, MD; Alexander Neumann, BS; William Bommer, MD; Lynn Weinert, BS; Dean T. Mason, MD, FACC; Anthony N. DeMaria, MD, FACC, University of California, Davis, Calif. Little data are available regarding the sensitivity and specificity of the pulmonic valve echogram in the detection of pulmonary hypertension (PHT). Thus simultaneous pulmonic echograms were evaluated in 52 patients with normal pulmonary artery pressure and 46 patients with PHT (mean pressure >20 mm Hg). Maximum A wave depth (Amax) bore a general correlation with pulmonary pressure (r = .70) and was >2 mm in all normals (mean 3.4). Amax was less in PHT (1.1 pc.01) and was absent in 7 of 27 PHT patients with sinus rhythm. A mid-systolic notch was recorded in 15 of 22 PHT patients, but no normals, in whom pulmonic echograms were recorded throughout systole. The ratio of right ventricular pre-ejection period to ejection time (PEP/RVET) correlated with pulmonary artery pressure (r = .70) and was greater than 6.3 in all but 2 PHT patients (mean .43). PEP/RVET was less in normals (.26, pc.001) and was greater than 0.3 in only 3. The opening velocity (OV) of the pulmonic echogram did not correlate with pulmonary artery pressure nor was OV different in normals as compared to PHT: (369 vs 363 mm/set). Diastolic slope (EF) of the pulmonic echogram also did not correlate with pulmonary pressure, but EF was less in PHT than normals: 34 vs 26 mm/set (pc.05). Thus, considerable overlap exists in all measurements of the pulmonic echogram between normals and patients with pulmonary hypertension. However, no normals exhibited an Amax ~2 mm if in normal sinus rhythm or a mid-systolic notch, and thereby these criteria may be utilized to indicate the presence of pulmonary hypertension.
ECHOCARDIOGRAPHIC DETERMINATION OF MITRAL VALVE FLOW IN NORMAL SUaTECTS AND IN PATIENTS WITH CORONARY ARTERY DISEASE, CARDIOMYOPATHY OR MITRAL REGURGITATION Susan Rasmussen RN, Betty C. Corya MD, Mary Jo Black BA, John F. Phillips MD, FACC, Harvey Feigenbaum MD, FACC Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana The purpose of this study was to derive and test a clinically applicable method for calculating flow across the mitral valve(m). Based on data derived from Mv echograms which were manually traced on a digital tabloid and entered into a graphic terminal for computer analysis, a formula was derived for calculating Mv stroke volume (SV-MV) using mitral EE(vertica1 distance between leaflets in mm at the E point) and DE slope(mm/sec), electrocardiographic PR interval(sec), and heart rate (HR). sv-Mv = '% + PR) x lOO+= HR This formula was tested prospectively on 80 consecutive patients from whom 95 simultaneous MV echograms and either thermodilution(TD) [45] or Fick(F1) cardiac outputs (CO) [50] were performed. Of the 80 patients, 16 were normal; 54 had coronary artery disease; 3 had cardiomyopathy;and 7 had nonrheumatic mitral regurgitation(MR). For the 73 patients without MR, there was no statistical difference in SV-MV vs SV-TD or SV-FI nor in CO-MV YS CO-TD or CO-F1 when data were compared using either the Student t test; Mann-Whitney U test; or the Kolmogorov-Smirnov test.SV-TD ranged from 24-83 cc (mean 56 cc) and SV-FI ranged from 35-139 cc (mean 78 cc). Linear regression(r) for stroke volume was .90 f 6 cc and for cardiac output was .83 i .5 liter. The presence or absence of ventricular asynergy did not alter statistical findings. For the 7 patients with MR, SV-Mv consistently overestimated forward stroke volume. This study shows that, for these 80 patients, the Mv echogram reflects mitral valve flow.
PHYSIOLOGIC CORRELATES OF PULMONARY VALVE MOTION IN DIASTOLE David J. Pocoski, MD; Pravin M. Shah, MD, FACC; Linda Sylvester, University of Rochester Medical Center, Rochester, NY
ASSESSMENT OFMITRALVALVE E POINT-SEPTALSEPARATION AS AN INDEX OF LEFT VENTRICULARFUNCTION IN ACUTE
The diastolic pulmonary valve (PV) waveform has been This study correlated with pulmonary hypertension. examined the relationship and further correlated it with changes in left. atria1 (LA) size as reflected by the posterior aortic wall (PAW) motion. Complete diastolic PV waveforms were obtained in 55 patients. The e-f slope of the PV correlated with the O-R slope of the PAW (t-=0.95) and the interval S2-f correlated with AW the S2-R (r=0.94) and neither parameter correlated with pulmonary arterial In all patients with pressure (PAP). Aa & mitral stenosis both the PV e-f and the pAw M PAW O-R slones were flattened irrespective of PAP. In patients with '" a normal left atria1 index (52.0 cm/M2) PCG 1 \ , , ’ 1 stroke volume index (SVI) correlated with e-f slope (t-=0.60) and the slope KG u was flattened in all patients with significantly reduced SVI. The e-f slope was uniformly PAP was normal in 72% of patients flat with a large LA. with pulmonary valve "a dips" > 2 mm and was elevated in 75% of patients with absent "a dips" reflecting the instantaneous pressure differences across the PV in The numerous exceptions suggested other factors. diastole. The A wave PAW correlated with the "a dip" PV (t-=0.85). Conclusion: The early diastolic waveform of the PV, like the PAW, reflects underlying LA events due to anatomical proximity. The e-f slope is not a measure of PAP. The "a dip" is a complex event related to PAP and other factors which'include LA'events.
We compared a new echo index of leftventricular(LV) function, mitral valve E point-septalseparation (EPSS), to the radionuclide
438
February 1978
The American Journal of CARDIOLOGY
AND CHRONICISCHEMICHEART DISEASE Wilbur Lew, MD; Hartmut Henning, MD; Heinz Schelbert, MD; Joel Korliner, MD, FACC, Univenity of California, San Diego
ejection
fraction
(EF) calculated
from the first
pass method in 60
patients (pts) (73 studies)with ischemic heart disease. Thirty-eight pts had acute myocardial infarction(MI)and 22 pts were studied an overage of 24 months after acute Ml. In 30 normals EPSS ronged from 0 to 5.4 mm (average = 1.3 mm). In 57 studies (78%) EPSS correctly identified pts with a normal or reduced EF (< 0.52), but in 13 studies (18%) EPSS was normal and EF depressed. In only 3 studies (4%) was there o normol EF and an abnormal EPSS. Results did not differbetween pts with acute Mland those studied late after Ml. An EPSS of >5.5 mm was highly specific (89%) for a reduced EF, but sensitivitywas only 65%. Abnormal wall motion by echoanti/or videotracking occurred equally among pts with normal and increased EPSS, but EPSS was less accurate in pts with more severe wnll motion abnormalities. EPSS was unrelated to heart rate; an abnormal EPSS was equally distributed among pts with a normol vs an enlarged echo LV end-diastolic dimension. EPSS wws superior to other echo indices of LV function (% of fractional shortening, mean Vcfond EF). Thus, EPSS isa simple noninvasive measure of LV function. We conclude that an abnormal EPSS is useful for identifyingdepressed LV function in patientswith acute Mland chronic ischemic heartdisease;however, o normal EPSS can be associated with normal as well CISreduced LV performance and therefore isnot of value in the ossessment of LV function in such patients.
Volume 41