We tested the hypothesis that abnormal left ventricular(LV) relaxation is associated with concentric LV geometry. Methods and results: Doppler LV filling properties were studied in 1384 hypertensive participants witho...We tested the hypothesis that abnormal left ventricular(LV) relaxation is associated with concentric LV geometry. Methods and results: Doppler LV filling properties were studied in 1384 hypertensive participants without cardiovascular disease, from the HyperGEN population(731 women, 784 obese, 236 diabetic) and compared in four LV geometry groups; normal, concentric remodelling(3.5% ), eccentric(23% ), and concentric LV hypertrophy(4% ), based on echocardiographic LV mass index(in g/m2.7). Abnormal LV relaxation was identified by European Society of Cardiology criteria in 275 subjects(20% ). After accounting for significant confounders, E/A ratio and isovolumic relaxation time were not related to the presence of LV hypertrophy, but indicated abnormal relaxation when LV geometry was concentric(both P< 0.0001). Deceleration time of E velocity was prolonged with LV hypertrophy(P< 0.03), but the behaviour in relation to concentric LV geometry differed in the presence(prolonged) or absence(reduced) of LV hypertrophy(P=0.05), a difference independently related to the magnitude of both transmitral gradients and stroke volume(all P< 0.05). Logistic regression showed that, compared with normal LV geometry, the odds of abnormal LV relaxation was 2.3- fold greater when LV geometry was concentric and that LV hypertrophy conferred a borderline higher risk than normal LV mass. Conclusions: In hypertensive individuals without prevalent cardiovascular disease from a multi-ethnic population-based sample, delayed LV relaxation is independently associated with concentric LV geometry.展开更多
Objectives and design: An abnormal diastolic filling is common in hypertensive left ventricular(LV) hypertrophy, a condition that may lead to heart failure and death. The renin-angiotensin-aldosterone system has been ...Objectives and design: An abnormal diastolic filling is common in hypertensive left ventricular(LV) hypertrophy, a condition that may lead to heart failure and death. The renin-angiotensin-aldosterone system has been implicated in the development of LV hypertrophy. This study examines the effects of 48 weeks of double-blind treatment with the AT1 receptor blocker irbesartan and the beta-blocker atenolol on diastolic function. Methods: Diastolic function was evaluated in 115 hypertensive patients with LV hypertrophy by Doppler echocardiography mitral in-flow velocities calculated from the peak of early(E) and peak of late(A) diastolic velocities(E/A ratio), the E-wave deceleration time, the isovolumic relaxation time, the pulmonary venous flow velocity, and by the atrioventricular valve plane displacement method. Results: By similar reductions in blood pressure both groups progressively reduced the LV mass index, with a greater reduction in the irbesartan group(P=0.024). Diastolic function was improved similarly by irbesartan and atenolol; for example, the E/A ratio by 12 and 14%(P=0.022 and P< 0.001), and the pulmonary venous flow velocity by 10 and 7%(P=0.036 and P=0.001), respectively. The isovolumic relaxation time was improved by irbesartan(P=0.040) only, and was related to changes in LV geometry(P< 0.001). For atenolol, improvement in diastolic function was associated only with the reduction in blood pressure(P=0.048). An improvement in diastolic function appeared greater in concentric LV hypertrophy than in eccentric LV hypertrophy. Conclusions: Treatment based on atenolol or irbesartan improves diastolic function in patients with hypertensive LV hypertrophy to the same degree, but through different mechanisms.展开更多
Aims: We have recently shown in the randomized-controlled BOne marrOw transfe r to enhance ST-elevation infarct regeneration(BOOST) trial that intracoronary autologous bone marrow cell(BMC) transfer improves left vent...Aims: We have recently shown in the randomized-controlled BOne marrOw transfe r to enhance ST-elevation infarct regeneration(BOOST) trial that intracoronary autologous bone marrow cell(BMC) transfer improves left ventricular(LV) ejection fraction recovery in patients after acute myocardial infarction(AMI). However, the impact of BMC therapy on LV diastolic function in patients after AMI has rem ained uncertain. Methods and results: Using(tissue) Doppler echocardiography, we evaluated the effects of BMC transfer on LV diastolic function in patients enro lled in the BOOST trial. After successful primary percutaneous coronary interven tion(PCI) for acute ST-elevation myocardial infarction(MI), patients were rando mized to a control(n=29) or BMC transfer group(n=30). Diastolic function was det ermined 4.5±1.5 days after PCI, at 6 months, and at 18 months by measuring tran smitral flow velocities(E/A ratio), diastolic myocardial velocities(Ea/Aa ratio) , isovolumic relaxation time(IVRT), and deceleration time(DT). All analyses were performed in a blinded fashion. There was an overall effect of BMC transfer on E/A [0.33±0.12; 95%confidence interval(CI): 0.09-0.57; P=0.008] and Ea/Aa rat ios(0.29±0.14; 95%CI: 0.01-0.57;P=0.04). In contrast, we found no effect of B MC transfer on DT(-5±14 ms; 95%CI: -33 to 22; P=0.70), IVRT(-7±7 ms; 95%C I: -20 to 6; P=0.29), and E/Ea ratio(0.35±0.14; 95%CI: -0.92 to 1.62; P=0.57 ). Conclusion: Intracoronary autologous BMC transfer improves echocardiographic parameters of diastolic function in patients after AMI.展开更多
Aim: To evaluate left ventricular (LV) diastolic function in children with end-stage renal disease (ESRD) using conventional pulsed-Doppler echocardiography and Doppler tissue imaging (DTI), and to compare the finding...Aim: To evaluate left ventricular (LV) diastolic function in children with end-stage renal disease (ESRD) using conventional pulsed-Doppler echocardiography and Doppler tissue imaging (DTI), and to compare the findings with these two modalities. Methods: Twenty-four children with ESRD and 22 healthy age-and sex-matched control subjects were assessed with conventional Doppler echocardiography and DTI. The scans of the renal disease patients were done after a dialysis session. Parameters related to LV systolic and diastolic function were compared in the ESRDand control groups. Results: The ESRD patients had lower mean mitral E/A ratio both according to conventional Doppler echocardiography and TDI than the control subjects. The ESRD group also had significantly longer isovolumetric relaxation time (116 ±31 ms vs 97 ±3.1 ms, respectively; p < 0.001), and significantly longer deceleration time (235 ±44 ms vs 202 ±35 ms, respectively; p < 0.01) than the control group. Conclusion: DTI findings correlate well with conventional Doppler echocardiography findings. Children with ESRD show, after dialysis, echocardiographic signs of LV diastolic dysfunction.展开更多
文摘We tested the hypothesis that abnormal left ventricular(LV) relaxation is associated with concentric LV geometry. Methods and results: Doppler LV filling properties were studied in 1384 hypertensive participants without cardiovascular disease, from the HyperGEN population(731 women, 784 obese, 236 diabetic) and compared in four LV geometry groups; normal, concentric remodelling(3.5% ), eccentric(23% ), and concentric LV hypertrophy(4% ), based on echocardiographic LV mass index(in g/m2.7). Abnormal LV relaxation was identified by European Society of Cardiology criteria in 275 subjects(20% ). After accounting for significant confounders, E/A ratio and isovolumic relaxation time were not related to the presence of LV hypertrophy, but indicated abnormal relaxation when LV geometry was concentric(both P< 0.0001). Deceleration time of E velocity was prolonged with LV hypertrophy(P< 0.03), but the behaviour in relation to concentric LV geometry differed in the presence(prolonged) or absence(reduced) of LV hypertrophy(P=0.05), a difference independently related to the magnitude of both transmitral gradients and stroke volume(all P< 0.05). Logistic regression showed that, compared with normal LV geometry, the odds of abnormal LV relaxation was 2.3- fold greater when LV geometry was concentric and that LV hypertrophy conferred a borderline higher risk than normal LV mass. Conclusions: In hypertensive individuals without prevalent cardiovascular disease from a multi-ethnic population-based sample, delayed LV relaxation is independently associated with concentric LV geometry.
文摘Objectives and design: An abnormal diastolic filling is common in hypertensive left ventricular(LV) hypertrophy, a condition that may lead to heart failure and death. The renin-angiotensin-aldosterone system has been implicated in the development of LV hypertrophy. This study examines the effects of 48 weeks of double-blind treatment with the AT1 receptor blocker irbesartan and the beta-blocker atenolol on diastolic function. Methods: Diastolic function was evaluated in 115 hypertensive patients with LV hypertrophy by Doppler echocardiography mitral in-flow velocities calculated from the peak of early(E) and peak of late(A) diastolic velocities(E/A ratio), the E-wave deceleration time, the isovolumic relaxation time, the pulmonary venous flow velocity, and by the atrioventricular valve plane displacement method. Results: By similar reductions in blood pressure both groups progressively reduced the LV mass index, with a greater reduction in the irbesartan group(P=0.024). Diastolic function was improved similarly by irbesartan and atenolol; for example, the E/A ratio by 12 and 14%(P=0.022 and P< 0.001), and the pulmonary venous flow velocity by 10 and 7%(P=0.036 and P=0.001), respectively. The isovolumic relaxation time was improved by irbesartan(P=0.040) only, and was related to changes in LV geometry(P< 0.001). For atenolol, improvement in diastolic function was associated only with the reduction in blood pressure(P=0.048). An improvement in diastolic function appeared greater in concentric LV hypertrophy than in eccentric LV hypertrophy. Conclusions: Treatment based on atenolol or irbesartan improves diastolic function in patients with hypertensive LV hypertrophy to the same degree, but through different mechanisms.
文摘Aims: We have recently shown in the randomized-controlled BOne marrOw transfe r to enhance ST-elevation infarct regeneration(BOOST) trial that intracoronary autologous bone marrow cell(BMC) transfer improves left ventricular(LV) ejection fraction recovery in patients after acute myocardial infarction(AMI). However, the impact of BMC therapy on LV diastolic function in patients after AMI has rem ained uncertain. Methods and results: Using(tissue) Doppler echocardiography, we evaluated the effects of BMC transfer on LV diastolic function in patients enro lled in the BOOST trial. After successful primary percutaneous coronary interven tion(PCI) for acute ST-elevation myocardial infarction(MI), patients were rando mized to a control(n=29) or BMC transfer group(n=30). Diastolic function was det ermined 4.5±1.5 days after PCI, at 6 months, and at 18 months by measuring tran smitral flow velocities(E/A ratio), diastolic myocardial velocities(Ea/Aa ratio) , isovolumic relaxation time(IVRT), and deceleration time(DT). All analyses were performed in a blinded fashion. There was an overall effect of BMC transfer on E/A [0.33±0.12; 95%confidence interval(CI): 0.09-0.57; P=0.008] and Ea/Aa rat ios(0.29±0.14; 95%CI: 0.01-0.57;P=0.04). In contrast, we found no effect of B MC transfer on DT(-5±14 ms; 95%CI: -33 to 22; P=0.70), IVRT(-7±7 ms; 95%C I: -20 to 6; P=0.29), and E/Ea ratio(0.35±0.14; 95%CI: -0.92 to 1.62; P=0.57 ). Conclusion: Intracoronary autologous BMC transfer improves echocardiographic parameters of diastolic function in patients after AMI.
文摘Aim: To evaluate left ventricular (LV) diastolic function in children with end-stage renal disease (ESRD) using conventional pulsed-Doppler echocardiography and Doppler tissue imaging (DTI), and to compare the findings with these two modalities. Methods: Twenty-four children with ESRD and 22 healthy age-and sex-matched control subjects were assessed with conventional Doppler echocardiography and DTI. The scans of the renal disease patients were done after a dialysis session. Parameters related to LV systolic and diastolic function were compared in the ESRDand control groups. Results: The ESRD patients had lower mean mitral E/A ratio both according to conventional Doppler echocardiography and TDI than the control subjects. The ESRD group also had significantly longer isovolumetric relaxation time (116 ±31 ms vs 97 ±3.1 ms, respectively; p < 0.001), and significantly longer deceleration time (235 ±44 ms vs 202 ±35 ms, respectively; p < 0.01) than the control group. Conclusion: DTI findings correlate well with conventional Doppler echocardiography findings. Children with ESRD show, after dialysis, echocardiographic signs of LV diastolic dysfunction.
