Echocardiographic and Doppler Assessment of Cardiac Functions in Patients of Non-Insulin Dependent Diabetes Mellitus
|
|
- Kerrie Burns
- 5 years ago
- Views:
Transcription
1 ORIGINAL ARTICLE JIACM 2002; 3(2): Echocardiographic and Doppler Assessment of Cardiac Functions in Patients of Non-Insulin Dependent Diabetes Mellitus Rajesh Rajput*, Jagdish**, SB Siwach***, A Rattan**** Abstract Diabetes mellitus is a chronic progressive metabolic disease. It involves myocardium at a relatively early stage even before clinical manifestation(s) become obvious. The present study was undertaken to assess cardiac functions by echocardiography and doppler in patients of NIDDM before and after control of hyperglycaemia. This study included thirty patients of uncomplicated type-2 diabetes mellitus (duration > 1 year) and thirty, age and sex matched, healthy subjects. Pre-treatment blood sugar, fasting ( ± mg%) and post-prandial ( ± mg%), was significantly higher than the post-treatment values ( ± mg% and ± mg% respectively). Systolic functions of LV were within normal range in all patients. Diastolic dysfunction of LV was very common and was detected in 63% of patients (A/E > 1.0). None of the control subjects had systolic or diastolic dysfunction. Diastolic dysfunction persisted even after control of hyperglycaemia over three-month duration. It is suggested that all patients of NIDDM should be routinely and repeatedly subjected to 2D-echocardiography and doppler assessment of cardiac functions in long term management of this metabolic disease. Long-term glycaemic control may result in decrease/ reversal of diastolic dysfunction or development of overt cardiomyopathy. Key words Diabetes, Diastolic dysfunction. Introduction * Lecturer ** Professor *** Professor and Head **** Senior Resident Department of Medicine, Pt. BD Sharma PGIMS, Rohtak (Haryana). Diabetes mellitus is associated with a multitude of cardiovascular complications, e.g., increased incidence of atherosclerotic coronary artery disease, myocardial infarction, congestive heart failure, coronary microangiopathy, and systemic arterial hypertension. In addition, structural myocardial involvement termed as diabetic cardiomyopathy may be there which is suggested by clinical, epidemiological, and histological studies done till date in large number of diabetics 1,2. Myocardial involvement in diabetics may occur relatively early in the course of disease, initially impairing early diastolic relaxation and when more extensive, it causes decreased myocardial contraction. Prior to the development of symptomatic congestive heart failure, subclinical left ventricular dysfunction (systolic or diastolic) exists for sometime 3-5. However, frequency of progression from pre-clinical to clinically evident myocardial dysfunction is not established. Further, role of metabolic control in primary prevention or reversal of myocardial dysfunction had not been much studied. With the availability of echocardiography and doppler, it is now possible to fully elucidate the natural history of cardiac involvement from pre-clinical to clinical stage in patients with diabetes 6,7. The present study intends to assess diabetic patients by echocardiographic and doppler parameters, specifically excluding diabetes mellitus with neurological, cardiovascular, pulmonary, and renal complications. Material and methods The study material comprised of sixty subjects. 1. Uncontrolled diabetes mellitus type2 30 subjects duration 1 year (Group A). 2. Normal healthy controls 30 subjects, age and sex matched (Group B).
2 The patients with history of diabetes mellitus, hypertension, valvular dysfunction, coronary artery disease, significant pulmonary or renal disease, and neurological disease were excluded from the study. Each had normal ECG, chest X-ray, and exercise treadmill test negative for myocardial ischaemia. 24 hours urinary albumin excretion was < 500 mg. Echocardiographic assessment was done in 2 dimensional mode, M-mode, and doppler mode using colour flow mapping. Each patient was examined in left lateral recumbent position using standard parasternal, short axis, and apical views. From the pulsed doppler spectrum of mitral flow, the following measurements were made: (figure 1). 1. Peak velocity of early filling (E) 2. Peak velocity of atrial filling (A) 3. Ratio of A/E 4. Deceleration time-dt (msec) 5. Acceleration time-at (msec) 6. Isovolumetric relaxation time (IVRT) 7. Isovolumetric contraction time (IVCT) From the 2-D echo using apical 4-chamber view, the ejection fraction was calculated using the area-length method. Aortic, pulmonary, and tricuspid valves were studied in detail. Echo and doppler parameters were repeated in patients of diabetes mellitus after control of diabetes. Data so obtained was analysed using student s paired t test, while difference between various Fig. 1 : Showing Doppler Velocites baseline parameters in diabetics and controls was analysed using student s unpaired t test. The p value of > 0.05 was taken as nonsignificant, < 0.05 as probable significant, < 0.01 as definitely significant and < as highly significant. Results Baseline characteristics of the study population were comparable. Group-A (Patients) had an average age of 42 ± 4.78 years. Group-B (Control) had an average of 39.6 ± 6.27 years. Male and female ratio was comparable in both the groups (Table I). Blood sugar levels were elevated in all patients, both in fasting samples ( ± mg%) as well as in post-prandial samples ( ± mg%) at the start of study. After three months of treatment these levels were near normal (fasting ± mg% and postprandial ± mg% respectively). The difference in both fasting and post-prandial levels was statistically significant (P < 0.001). Blood sugar levels were within normal limits in all controls. None, patients and controls, had evidence of other systemic disease, which could have potentially affected the heart. A conventional 12 lead ECG in all patients had no abnormality. All patients were subjected to stress test and were found to have normal responses with ST segment, never exceeding 1.0 mm. None of the patients suffered from arrhythmia/chest pain during or after exercise and none showed any hypertensive blood pressure response. Using the doppler study, the atrial filling (A) wave velocity in msec in diabetic patients (0.71 ± 0.18) was found to be significantly higher (p < 0.01) when compared with normal controls (0.59 ± 0.13). The early filling (E) wave velocity in msec in diabetic patients (0.67 ± 0.17) was found to be significantly lower when compared with normal controls (0.79 ± 0.15). Journal, Indian Academy of Clinical Medicine Vol. 3, No. 2 April-June
3 The comparison of atrial filling (A) and early filling (E) wave ratios, i.e., A/E, suggestive of diastolic dysfunction was seen in 63% of diabetics. Maximum percentage of patients with diastolic dysfunction (43%) was seen in years age group. While no patient had diastolic dysfunction in group B. In diabetics, A/E (1.09 ± 0.26) was found to be statistically significant and higher (p < 0.001) when compared with normal controls (0.74 ± 0.12) and is suggestive of impaired relaxation type of diastolic dysfunction. None of the patients had pseudonormalisation or restrictive filling pattern of diastolic dysfunciton. The mean value of A/E was > 1 in 60% of patients even after correction of hyperglycaemia. Acceleration time (AT) in diabetics (56.66 ± 19.7 msec) was found to be significantly lower when compared with normal controls (69.33 ± msec). (13.20 ± 2.40 mm) and 2D-echo parameters like stroke volume (SV) (60.93 ± ml/m 2 ), ejection fraction (EF) (59.16 ± 8.31%), and fractional shortening (FS) (29.03 ± 10.24%) were not found to be statistically significant when compared with normal controls (Table II). After three months of treatment, all these echodoppler parameters were not found to be statistically different from pre-treatment values. Discussion The importance of diastolic dysfunction as a cause for heart failure in isolation or associated with systolic dysfunction is increasingly recognised. Three patterns of abnormal diastolic function have been recognised, i.e., impaired relaxation, pseudonormalisation, and restrictive filling 8. Impaired relaxation is characterised by A/E > 1, prolonged IVRT, and increased DT. Pseudonormalisation refers to Table I : Baseline characteristic of study population. Characteristics Patients Controls Number of patients Age (years ± SD) 42± ±6.27 Male Female Pre-treatment fasting blood sugar (mg%) ±33.92 Pre-treatment postprandial blood sugar (mg%) ±37.87 Post-treatment fasting blood sugar (mg%) ±10.17 Post-treatment fasting blood sugar (mg%) ±15.42 However, deceleration time (DT) ( ± msec), isovolumetric contraction time (IVCT) (66.0 ± msec), isovolumetric relaxation time (IVRT) (120 ± msec), and other M-mode parameters like left ventricular end-diastolic dimension (LVEEDD) (45.73 ± 4.93 mm), left ventricular end-systolic dimension (LVESD) (32.16 ± 6.02 mm), left ventricular posterior wall thickness in diastole [LVPW (D)] (9.27 ± 1.60 mm), left ventricular posterior wall thickness in systole [LVPW (S)] normal appearance of ventricular inflow (A/E < 1). This pattern is due to combined effects of abnormal relaxation and elevated LV pressure and is considered as intermediate stage between impaired relaxation and restrictive physiology due to natural progression of disease. Reduction of preload by doing Valsalva manoeuvre can convert pseudonormal pattern to impaired relaxation pattern and thus helps in this abnormality. Restrictive filling pattern is characterised by markedly decreased A/E, short 166 Journal, Indian Academy of Clinical Medicine Vol. 3, No. 2 April-June 2002
4 DT, and reduced IVRT. This pattern is associated with greater LV filling pressures and poor prognosis. Thus, impaired relaxation pattern of early disease progresses to increase in ventricular wall thickness, decrease in ejection fraction and poor prognosis. in normal controls (< 1). This abnormality was seen in 63% of diabetics. Other workers have reported similar results as well 6-8. The mean value of A/E ratio was > 1 in 60% patients even after correction of hyperglycaemia. However, improvement in left ventricular function was noted Table II : Results : 2-D echo and doppler parameters in diabetics and controls. Echo./Doppler Patients Patients Normal p-value p-value Pre-treatment Post-treatment subjects a : c b : c Parameter (a) (b) (c) A-velocity (M/sec.) 0.71 ± ± ± 0.13 < 0.01 < 0.01 E-velocity (M/sec.) 0.67 ± ± ± 0.15 < < A : E ratio 1.09 ± ± ± 0.12 < < AT (m sec.) ± ± ± < 0.01 < 0.01 DT (m sec.) ± ± ± NS NS EF (%) ± ± ± 9.22 NS NS FS (%) ± ± ± 8.65 NS NS IVRT (msec) 120 ± ± ± NS NS IVCT (msec) 66 ± ± ± NS NS Left ventricular diastolic function has been shown to be affected at an early stage in several myocardial diseases when systolic functions remain normal 3,5,6. Left ventricular diastolic filling patterns by doppler correlate closely with those obtained by contrast and radio-nuclide angiographic techniques 7. These velocity-derived indices have proved to be a sensitive indicator of impaired left ventricular filling even in early stages of myocardial diseases. Till the recent past, all importance was being given to systolic functions of the heart. But in the last decade clinicians and researchers have discovered that both reversible and irreversible abnormality of left ventricular diastolic functions contribute significantly to symptoms and morbidity in individuals with a variety of cardiac disorders, including those with normal or near normal systolic function 4-6. It was observed that A/E ratio was significantly abnormal (> 1) in diabetics as compared to value with the correction of hyperglycaemia in 39 percent of patients of type 2 diabetes by Uusitupa et al 9. The difference could primarily be due to the exclusion of patients of myocardial ischaemia by performing exercise treadmill test at the beginning of the present study. Total of 70 percent of patients had deceleration time more than 150 msecs. Left ventricular wall thickness defined as the sum of ventricular septal and posterior wall thickness, relative wall thickness, and LV mass was statistically insignificant both in systole as well as in diastole when compared with normal controls. However, Galderisi et al 1 found an increase in left ventricular wall thickness. This increase could be because of interstitial deposition of para amino-salicylic acid glycoproteins and interstitial fibrosis seen in patients with diabetes mellitus 1. The present study did not show any significant decrease in ejection fraction in diabetics and the Journal, Indian Academy of Clinical Medicine Vol. 3, No. 2 April-June
5 results of study correlated well with the study done by Mathew et al 6 in young diabetics where they found no statistical difference in ejection fraction in diabetics and normal controls. From the foregoing discussion, it can be concluded that diastolic dysfunction in patients of NIDDM is present in 60% of patients even when the DM is present at younger age, is of shorter duration, and has no effects on other body systems. This dysfunction persists even after control of diabetes mellitus over a duration of 3 months and it is suggestive of pre-clinical diabetic cardiomyopathy. However, long-term effect of good control of diabetes may result in decrease of this diastolic dysfunction, deceleration of the development of clinical cardiomyopathy, and decreased morbidity and mortality. It is suggested that all patients of NIDDM should be routinely and repeatedly subjected to 2-D colour doppler echocardiographic assessment of cardiac functions in the long-term management of this metabolic disease. This has important therapeutic implications and helps physicians planning early intervention strategies. Thus, diastolic dysfunction can be used as an early indicator, as it is a precursor to increased LV hypertrophy and clinical left ventricular dysfunction. References 1. Galderisi M, Anderson KM, Wilson PWF, Levy D. Echocardiographic evidence for the existence of a distinct cardiomyopathy. Am J Cardiol 1991; 68: Panja M, Sarkar C, Kumar S et al. Diabetic cardiomyopathy. JAPI 1998; 46 (7): Mittal SR, Bharadwaj A, Gupta VD, Kapoor NC. Noninvasive assessment of pre-clinical left ventricular dysfunction in young diabetics. Ind Heart J 1983; 35 (4): Thanikachalam S, Lakshminathan C, Vishwanathan M et al. Sub clinical diabetic cardiomyopathy - Assessment by systolic time intervals. J Assoc Phy Ind 1981; 29: Ahmed SS, Jaferi GA, Narang RM, Regan TJ. Pre-clinical abnormality of left ventricular function in diabetes mellitus. Am Heart J 1975; 89 (2): Mathew P, John L, Jose J, Krishna Swami S. Assessment of left ventricular diastolic function in young diabetics - A two dimensional echo doppler study. Ind Heart J 1992; 44 (1): Studdard MF, Pearson AC, Kun MJ et al. Left ventricular diastolic dysfunction: comparision of pulsed doppler echocardiography and haemodynamic indexes in subjects with and without coronary artery disease. J Am Coll Cardiol 1989; 13: Gerald Cohen, Joseph Pietroluhgo, James Thomas. A practical guide to assessment of ventricular diastolic function using doppler echocardiography. J Am Coll Cardiol 1996; 27: Uusitupa M, Siitonen O, Aso A et al. Effect of correction of hyperglycaemia on left ventricular function in noninsulin dependent (Type II) diabetics. Acta Med Scand 1983; 213: Journal, Indian Academy of Clinical Medicine Vol. 3, No. 2 April-June 2002
Echocardiographic study of left ventricular diastolic dysfunction in normotensive asymptomatic type II diabetes mellitus
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 14, Issue 7 Ver. VI (July. 2015), PP 39-43 www.iosrjournals.org Echocardiographic study of left ventricular
More informationLeft Ventricular Diastolic Dysfunction in South Indian Essential Hypertensive Patient
Left Ventricular Diastolic Dysfunction in South Indian Essential Hypertensive Patient Dr. Peersab.M. Pinjar 1, Dr Praveenkumar Devarbahvi 1 and Dr Vasudeva Murthy.C.R 2, Dr.S.S.Bhat 1, Dr.Jayaraj S G 1
More informationA study of left ventricular dysfunction and hypertrophy by various diagnostic modalities in normotensive type 2 diabetes mellitus patients
Available online at www.ijmrhs.com ISSN No: 2319-5886 International Journal of Medical Research & Health Sciences, 2016, 5, 8:102-106 A study of left ventricular dysfunction and hypertrophy by various
More informationLeft ventricular systolic and diastolic dysfunction in asymptomatic, normotensive type 2 diabetes mellitus
World Journal of Pharmaceutical Sciences ISSN (Print): 2321-3310; ISSN (Online): 2321-3086 Published by Atom and Cell Publishers All Rights Reserved Available online at: http://www.wjpsonline.org/ Original
More informationDiastology State of The Art Assessment
Diastology State of The Art Assessment Dr. Mohammad AlGhamdi Assistant professor, KSAU-HS Consultant Cardiologist King AbdulAziz Cardiac Center Ministry of National Guard Health Affairs Diagnostic Clinical
More informationBasic Approach to the Echocardiographic Evaluation of Ventricular Diastolic Function
Basic Approach to the Echocardiographic Evaluation of Ventricular Diastolic Function J A F E R A L I, M D U N I V E R S I T Y H O S P I T A L S C A S E M E D I C A L C E N T E R S T A F F C A R D I O T
More informationLV FUNCTION ASSESSMENT: WHAT IS BEYOND EJECTION FRACTION
LV FUNCTION ASSESSMENT: WHAT IS BEYOND EJECTION FRACTION Jamilah S AlRahimi Assistant Professor, KSU-HS Consultant Noninvasive Cardiology KFCC, MNGHA-WR Introduction LV function assessment in Heart Failure:
More informationThe Patient with Atrial Fibrilation
Assessment of Diastolic Function The Patient with Atrial Fibrilation Assoc. Prof. Adriana Ilieşiu, FESC University of Medicine Carol Davila Bucharest, Romania Associated Conditions with Atrial Fibrillation
More informationEvalua&on)of)Le-)Ventricular)Diastolic) Dysfunc&on)by)Echocardiography:) Role)of)Ejec&on)Frac&on)
Evalua&on)of)Le-)Ventricular)Diastolic) Dysfunc&on)by)Echocardiography:) Role)of)Ejec&on)Frac&on) N.Koutsogiannis) Department)of)Cardiology) University)Hospital)of)Patras)! I have no conflicts of interest
More informationImaging in Heart Failure: A Multimodality Approach. Thomas Ryan, MD
Imaging in Heart Failure: A Multimodality Approach Thomas Ryan, MD Heart Failure HFrEF HFpEF EF50% Lifetime risk 20% Prevalence 6M Americans Societal costs - $30B 50% 5-year survival 1 Systolic
More informationLeft atrial function. Aliakbar Arvandi MD
In the clinic Left atrial function Abstract The left atrium (LA) is a left posterior cardiac chamber which is located adjacent to the esophagus. It is separated from the right atrium by the inter-atrial
More informationObjectives. Diastology: What the Radiologist Needs to Know. LV Diastolic Function: Introduction. LV Diastolic Function: Introduction
Objectives Diastology: What the Radiologist Needs to Know. Jacobo Kirsch, MD Cardiopulmonary Imaging, Section Head Division of Radiology Cleveland Clinic Florida Weston, FL To review the physiology and
More informationAn Integrated Approach to Study LV Diastolic Function
An Integrated Approach to Study LV Diastolic Function Assoc. Prof. Adriana Ilieşiu, FESC University of Medicine Carol Davila Bucharest, Romania LV Diastolic Dysfunction impaired relaxation (early diastole)
More informationLeft Ventricular Function In Subclinical Hypothyroidism
Clinical Proceedings. 2016;12(1):13-19 Original Article Left Ventricular Function In Subclinical Hypothyroidism NK Thulaseedharan, P Geetha, TM Padmaraj Department of Internal Medicine, Govt. Medical College
More informationHypertrophic cardiomyopathy (HCM) of cats is the
J Vet Intern Med 2006;20:65 77 Pulsed Tissue Doppler Imaging in Normal Cats and Cats with Hypertrophic Cardiomyopathy H. Koffas, J. Dukes-McEwan, B.M. Corcoran, C.M. Moran, A. French, V. Sboros, K. Simpson,
More informationLeft ventricular diastolic function and filling pressure in patients with dilated cardiomyopathy
Left ventricular diastolic function and filling pressure in patients with dilated cardiomyopathy Bogdan A. Popescu University of Medicine and Pharmacy Bucharest, Romania My conflicts of interest: I have
More informationHeart Failure in Women: Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre
Heart Failure in Women: More than EF? Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre Overview Review pathophysiology as it relates to diagnosis and management Rational approach to workup:
More informationAppendix II: ECHOCARDIOGRAPHY ANALYSIS
Appendix II: ECHOCARDIOGRAPHY ANALYSIS Two-Dimensional (2D) imaging was performed using the Vivid 7 Advantage cardiovascular ultrasound system (GE Medical Systems, Milwaukee) with a frame rate of 400 frames
More informationSegmental Tissue Doppler Image-Derived Tei Index in Patients With Regional Wall Motion Abnormalities
ORIGINAL ARTICLE DOI 10.4070 / kcj.2010.40.3.114 Print ISSN 1738-5520 / On-line ISSN 1738-5555 Copyright c 2010 The Korean Society of Cardiology Open Access Segmental Tissue Doppler Image-Derived Tei Index
More informationDiastolic Function: What the Sonographer Needs to Know. Echocardiographic Assessment of Diastolic Function: Basic Concepts 2/8/2012
Diastolic Function: What the Sonographer Needs to Know Pat Bailey, RDCS, FASE Technical Director Beaumont Health System Echocardiographic Assessment of Diastolic Function: Basic Concepts Practical Hints
More informationEffect of Heart Rate on Tissue Doppler Measures of E/E
Cardiology Department of Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok, Thailand Abstract Background: Our aim was to study the independent effect of heart rate (HR) on
More informationJMSCR Vol 06 Issue 03 Page March 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i3.175 Echocardiographic Evaluation
More informationMyocardial performance index, Tissue Doppler echocardiography
Value of Measuring Myocardial Performance Index by Tissue Doppler Echocardiography in Normal and Diseased Heart Tarkan TEKTEN, 1 MD, Alper O. ONBASILI, 1 MD, Ceyhun CEYHAN, 1 MD, Selim ÜNAL, 1 MD, and
More informationOPTIMIZING ECHO ACQUISTION FOR STRAIN AND DIASTOLOGY
OPTIMIZING ECHO ACQUISTION FOR STRAIN AND DIASTOLOGY October 8, 2017 Deborah Agler, ACS, RDCS, FASE Coordinator of Education and Training Cleveland Clinic General Principles Diastology Clinical Data Heart
More informationLV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital
LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV inflow across MV LV LV outflow across AV LV LV geometric changes Pressure overload
More informationHypertensive heart disease and failure
Hypertensive heart disease and failure Prof. Dr. Alan Fraser Cardiff University The heart in hypertension Pathophysiology of LV adaptation Regional development of hypertrophy Stress testing - inducible
More informationValue of echocardiography in chronic dyspnea
Value of echocardiography in chronic dyspnea Jahrestagung Schweizerische Gesellschaft für /Schweizerische Gesellschaft für Pneumologie B. Kaufmann 16.06.2016 Chronic dyspnea Shortness of breath lasting
More informationBritish Society of Echocardiography
British Society of Echocardiography Affiliated to the British Cardiac Society A Minimum Dataset for a Standard Adult Transthoracic Echocardiogram From the British Society of Echocardiography Education
More informationAssessment of LV systolic function
Tutorial 5 - Assessment of LV systolic function Assessment of LV systolic function A knowledge of the LV systolic function is crucial in the undertanding of and management of unstable hemodynamics or a
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationDiastolic Function Assessment Practical Ways to Incorporate into Every Echo
Diastolic Function Assessment Practical Ways to Incorporate into Every Echo Jae K. Oh, MD Echo Hawaii 2018 2018 MFMER 3712003-1 Learning Objectives My presentation will help you to Appreciate the importance
More informationHemodynamic Assessment. Assessment of Systolic Function Doppler Hemodynamics
Hemodynamic Assessment Matt M. Umland, RDCS, FASE Aurora Medical Group Milwaukee, WI Assessment of Systolic Function Doppler Hemodynamics Stroke Volume Cardiac Output Cardiac Index Tei Index/Index of myocardial
More informationi n d i a n h e a r t j o u r n a l 6 8 ( ) Available online at ScienceDirect
i n d i a n h e a r t j o u r n a l 6 8 ( 2 0 1 6 ) 8 3 8 7 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/ihj Original Article Myocardial Performance
More informationAortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants
Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Martin G. Keane, MD, FASE Professor of Medicine Lewis Katz School of Medicine at Temple University Basic root structure Parasternal
More informationA STUDY OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN HYPERTENSION Ravi Keerthy M 1
A STUDY OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN HYPERTENSION Ravi Keerthy M 1 HOW TO CITE THIS ARTICLE: Ravi Keerthy M. A Study of Left Ventricular Diastolic Dysfunction in Hypertension. Journal of
More informationΜαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό
Μαρία Μπόνου Διευθύντρια ΕΣΥ, ΓΝΑ Λαϊκό Diastolic HF DD: Diastolic Dysfunction DHF: Diastolic HF HFpEF: HF with preserved EF DD Pathophysiologic condition: impaired relaxation, LV compliance, LV filling
More informationQuantitation of right ventricular dimensions and function
SCCS Basics of cardiac assessment Quantitation of right ventricular dimensions and function Tomasz Kukulski, MD PhD Dept of Cardiology, Congenital Heart Disease and Electrotherapy Silesian Medical University
More informationReview of Cardiac Imaging Modalities in the Renal Patient. George Youssef
Review of Cardiac Imaging Modalities in the Renal Patient George Youssef ECHO Left ventricular hypertrophy (LVH) assessment Diastolic dysfunction Stress ECHO Cardiac CT angiography Echocardiography - positives
More informationEchocardiography as a diagnostic and management tool in medical emergencies
Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications
More informationDiastolic filling in hypertrophied hearts of elite runners: an Echo-Doppler study
European Review for Medical and Pharmacological Sciences 2001; 5: 65-69 Diastolic filling in hypertrophied hearts of elite runners: an Echo-Doppler study A. PALAZZUOLI, L. PUCCETTI, F. BRUNI, A.L. PASQUI,
More informationDominic Y. Leung, MBBS, PhD; Melissa Leung, MBBS, PhD Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia
Original Article Heart Metab. (2017) 73:18-23 Early detection of left ventricular dysfunction in diabetes Dominic Y. Leung, MBBS, PhD; Melissa Leung, MBBS, PhD Department of Cardiology, Liverpool Hospital,
More informationNancy Goldman Cutler, MD Beaumont Children s Hospital Royal Oak, Mi
Nancy Goldman Cutler, MD Beaumont Children s Hospital Royal Oak, Mi Identify increased LV wall thickness (WT) Understand increased WT in athletes Understand hypertrophic cardiomyopathy (HCM) Enhance understanding
More information2005 Young Investigator s Award Winner: Assessment of Diastolic Function in Newly Diagnosed Hypertensives
684 5 Young Investigator s Award Winner: Assessment of Diastolic Function in Newly Diagnosed Hypertensives M Masliza, 1 MBChB, M Med, MRCP, S Mohd Daud, 2 MD, M Med, Y Khalid, 3 FRCP, FACC, FASc Abstract
More informationGENERAL PRINCIPLES FOR ECHO ASSESSMENT OF DIASTOLIC FUNCTION (For full recommendation refer to the Left Ventricular Diastolic Function Guideline)
1 THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY RECOMMENDATIONS FOR THE EVALUATION OF LEFT VENTRICULAR DIASTOLIC FUNCTION BY ECHOCARDIOGRAPHY: A QUICK REFERENCE GUIDE FROM THE ASE WORKFLOW AND LAB MANAGEMENT
More informationCardiac Cycle MCQ. Professor of Cardiovascular Physiology. Cairo University 2007
Cardiac Cycle MCQ Abdel Moniem Ibrahim Ahmed, MD Professor of Cardiovascular Physiology Cairo University 2007 1- Regarding the length of systole and diastole: a- At heart rate 75 b/min, the duration of
More information좌심실수축기능평가 Cardiac Function
Basic Echo Review Course 좌심실수축기능평가 Cardiac Function Seonghoon Choi Cardiology Hallym university LV systolic function Systolic function 좌심실수축기능 - 심근의수축으로심실에서혈액을대동맥으로박출하는기능 실제임상에서 LV function 의의미 1Diagnosis
More informationStephen Glen ISCHAEMIC HEART DISEASE AND LEFT VENTRICULAR FUNCTION
Stephen Glen ISCHAEMIC HEART DISEASE AND LEFT VENTRICULAR FUNCTION Overview Coronary arteries Terminology to describe contractility Measuring ventricular function Systolic dysfunction Practice cases- LV
More informationDiastology Disclosures: None. Dias2011:1
Diastology 2011 James D. Thomas, M.D., F.A.C.C. Cardiovascular Imaging Center Department of Cardiology Cleveland Clinic Foundation Cleveland, Ohio, USA Disclosures: None Dias2011:1 Is EVERYBODY a member!?!
More informationEcho-Doppler evaluation of left ventricular diastolic function. Michel Slama Amiens France
Echo-Doppler evaluation of left ventricular diastolic function Michel Slama Amiens France Left ventricular pressure Pressure A wave [ LVEDP LVEDP préa Congestive cardiac failure with preserved systolic
More informationCoronary artery disease (CAD) risk factors
Background Coronary artery disease (CAD) risk factors CAD Risk factors Hypertension Insulin resistance /diabetes Dyslipidemia Smoking /Obesity Male gender/ Old age Atherosclerosis Arterial stiffness precedes
More informationEchocardiographic Changes in Type 2 Diabetes Mellitus with Reference to Body Mass Index and Waist Hip Ratio
Section Medicine Original Article Echocardiographic Changes in Type 2 Diabetes Mellitus with Reference to Body Mass Index and Waist Hip Ratio Saad Bin Saif 1*, M Ghosh 2, P K Agrawal 2, Faiyaz Alam 3,
More informationDiastolic Function Assessment New Guideline Update Practical Approach
Mayo Clinic Department of Cardiovascular Diseases Mayo Clinic Echocardiography Review Course for Boards and Recertification Diastolic Function Assessment New Guideline Update Practical Approach Jae K.
More informationTissue Doppler Imaging in Congenital Heart Disease
Tissue Doppler Imaging in Congenital Heart Disease L. Youngmin Eun, M.D. Department of Pediatrics, Division of Pediatric Cardiology, Kwandong University College of Medicine The potential advantage of ultrasound
More informationPeak Early Diastolic Mitral Annulus Velocity by Tissue Doppler Imaging Adds Independent and Incremental Prognostic Value
Journal of the American College of Cardiology Vol. 41, No. 5, 2003 2003 by the American College of Cardiology Foundation ISSN 0735-1097/03/$30.00 Published by Elsevier Science Inc. doi:10.1016/s0735-1097(02)02921-2
More informationTissue Doppler and Strain Imaging. Steven J. Lester MD, FRCP(C), FACC, FASE
Tissue Doppler and Strain Imaging Steven J. Lester MD, FRCP(C), FACC, FASE Relevant Financial Relationship(s) None Off Label Usage None a. Turn the wall filters on and turn down the receiver gain. b. Turn
More informationDoppler-echocardiographic findings in a patient with persisting right ventricular sinusoids
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 1990 Doppler-echocardiographic findings in a patient with persisting right
More informationEchocardiography: Guidelines for Valve Quantification
Echocardiography: Guidelines for Echocardiography: Guidelines for Chamber Quantification British Society of Echocardiography Education Committee Richard Steeds (Chair), Gill Wharton (Lead Author), Jane
More informationRIGHT VENTRICULAR SIZE AND FUNCTION
RIGHT VENTRICULAR SIZE AND FUNCTION Edwin S. Tucay, MD, FPCC, FPCC, FPSE Philippine Society of Echocardiography Quezon City, Philippines Echo Mission, BRTTH, Legaspi City, July 1-2, 2016 NO DISCLOSURE
More informationMITRAL STENOSIS. Joanne Cusack
MITRAL STENOSIS Joanne Cusack BSE Breakdown Recognition of rheumatic mitral stenosis Qualitative description of valve and sub-valve calcification and fibrosis Measurement of orifice area by planimetry
More informationECHOCARDIOGRAPHY DATA REPORT FORM
Patient ID Patient Study ID AVM - - Date of form completion / / 20 Initials of person completing the form mm dd yyyy Study period Preoperative Postoperative Operative 6-month f/u 1-year f/u 2-year f/u
More informationThe Doppler Examination. Katie Twomley, MD Wake Forest Baptist Health - Lexington
The Doppler Examination Katie Twomley, MD Wake Forest Baptist Health - Lexington OUTLINE Principles/Physics Use in valvular assessment Aortic stenosis (continuity equation) Aortic regurgitation (pressure
More informationEvaluation of Left Ventricular Diastolic Dysfunction by Doppler and 2D Speckle-tracking Imaging in Patients with Primary Pulmonary Hypertension
ESC Congress 2011.No 85975 Evaluation of Left Ventricular Diastolic Dysfunction by Doppler and 2D Speckle-tracking Imaging in Patients with Primary Pulmonary Hypertension Second Department of Internal
More informationAdel Hasanin Ahmed 1
Adel Hasanin Ahmed 1 PERICARDIAL DISEASE The pericardial effusion ends anteriorly to the descending aorta and is best visualised in the PLAX. PSAX is actually very useful sometimes for looking at posterior
More informationPROSTHETIC VALVE BOARD REVIEW
PROSTHETIC VALVE BOARD REVIEW The correct answer D This two chamber view shows a porcine mitral prosthesis with the typical appearance of the struts although the leaflets are not well seen. The valve
More informationDiastolic Heart Function: Applying the New Guidelines Case Studies
Diastolic Heart Function: Applying the New Guidelines Case Studies Mitral Regurgitation The New ASE William Guidelines: A. Zoghbi Role MD, of FASE, 2D/3D MACCand CMR Professor and Chairman, Department
More informationRownak Jahan Tamanna 1, Rowshan Jahan 2, Abduz Zaher 3 and Abdul Kader Akhanda. 3 ORIGINAL ARTICLES
University Heart Journal Vol. 4 No. 2 July 2008 ORIGINAL ARTICLES Correlation of Doppler echocardiography with cardiac catheterization in estimating pulmonary capillary wedge pressure: A tertiary level
More informationAbstract. Introduction. Al- Kindy Col Med J 2007; Vol.4 (1)
Left Ventricular Hypertrophy in Diabetic Patients and Its Relation to Other Diabetic Complications *Hilal B. shawki FRCP, FACC*, Jawad A. kadhim MD, FICMS **, Adil S. Ghafour FRCP,FACC ***, Amal Al Marayati
More informationHISTORY. Question: What category of heart disease is suggested by the fact that a murmur was heard at birth?
HISTORY 23-year-old man. CHIEF COMPLAINT: Decreasing exercise tolerance of several years duration. PRESENT ILLNESS: The patient is the product of an uncomplicated term pregnancy. A heart murmur was discovered
More informationE/Ea is NOT an essential estimator of LV filling pressures
Euroecho Kopenhagen Echo in Resynchronization in 2010 E/Ea is NOT an essential estimator of LV filling pressures Wilfried Mullens, MD, PhD December 10, 2010 Ziekenhuis Oost Limburg Genk University Hasselt
More informationAortic stenosis (AS) is common with the aging population.
New Insights Into the Progression of Aortic Stenosis Implications for Secondary Prevention Sanjeev Palta, MD; Anita M. Pai, MD; Kanwaljit S. Gill, MD; Ramdas G. Pai, MD Background The risk factors affecting
More informationIndex of subjects. effect on ventricular tachycardia 30 treatment with 101, 116 boosterpump 80 Brockenbrough phenomenon 55, 125
145 Index of subjects A accessory pathways 3 amiodarone 4, 5, 6, 23, 30, 97, 102 angina pectoris 4, 24, 1l0, 137, 139, 140 angulation, of cavity 73, 74 aorta aortic flow velocity 2 aortic insufficiency
More informationJong-Won Ha*, Jeong-Ah Ahn, Jae-Yun Moon, Hye-Sun Suh, Seok-Min Kang, Se-Joong Rim, Yangsoo Jang, Namsik Chung, Won-Heum Shim, Seung-Yun Cho
Eur J Echocardiography (2006) 7, 16e21 CLINICAL/ORIGINAL PAPERS Triphasic mitral inflow velocity with mid-diastolic flow: The presence of mid-diastolic mitral annular velocity indicates advanced diastolic
More informationIndex. K Knobology, TTE artifact, image resolution, ultrasound, 14
A Acute aortic regurgitation (AR), 124 128 Acute aortic syndrome (AAS) classic aortic dissection diagnosis, 251 263 evolutive patterns, 253 255 pathology, 250 251 classifications, 247 248 incomplete aortic
More informationPART II ECHOCARDIOGRAPHY LABORATORY OPERATIONS ADULT TRANSTHORACIC ECHOCARDIOGRAPHY TESTING
PART II ECHOCARDIOGRAPHY LABORATORY OPERATIONS ADULT TRANSTHORACIC ECHOCARDIOGRAPHY TESTING STANDARD - Primary Instrumentation 1.1 Cardiac Ultrasound Systems SECTION 1 Instrumentation Ultrasound instruments
More informationIntroduction. In Jeong Cho, MD, Wook Bum Pyun, MD and Gil Ja Shin, MD ABSTRACT
ORIGINAL ARTICLE DOI 10.4070 / kcj.2009.39.4.145 Print ISSN 1738-5520 / On-line ISSN 1738-5555 Copyright c 2009 The Korean Society of Cardiology The Influence of the Left Ventricular Geometry on the Left
More informationThe Use of Left Ventricular Myocardial Stiffness Index as a Predictor of Myocardial Performance in Patients with Systemic Hypertension
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 2014, 3, 167-175 Published Online August 2014 in SciRes. http://www.scirp.org/journal/ijmpcero http://dx.doi.org/10.4236/ijmpcero.2014.33022
More informationClinical Investigations
Clinical Investigations The Effect of Pulmonary Hypertension on Left Ventricular Diastolic Function in Chronic Obstructive Lung Disease: A Tissue Doppler Imaging and Right Cardiac Catheterization Study
More informationQuestions on Chamber Quantitation
Questions on Chamber Quantitation @RobertoMLang Which of the following statements is true? 1. The aortic annulus should be measured in midsystole. 2. The aortic annulus should be measured in enddiastole.
More informationMechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling. What is the pathophysiology at presentation?
Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling What is the pathophysiology at presentation? Ventricular-arterial coupling elastance Central arterial pressure
More informationThe new Guidelines: Focus on Chronic Heart Failure
The new Guidelines: Focus on Chronic Heart Failure Petros Nihoyannopoulos MD, FRCP, FESC Professor of Cardiology Imperial College London and National & Kapodistrian University of Athens 2 3 4 The principal
More informationThe Impact of Autonomic Neuropathy on Left Ventricular Function in Normotensive Type 1 Diabetic Patients: a Tissue Doppler Echocardiographic Study
Diabetes Care Publish Ahead of Print, published online November 13, 2007 The Impact of Autonomic Neuropathy on Left Ventricular Function in Normotensive Type 1 Diabetic Patients: a Tissue Doppler Echocardiographic
More informationIncorporating the New Echo Guidelines Into Everyday Practice
Incorporating the New Echo Guidelines Into Everyday Practice Clinical Case RIGHT VENTRICULAR FAILURE Gustavo Restrepo MD President Elect Interamerican Society of Cardiology Director Fellowship Training
More informationEchocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016
Echocardiographic Evaluation of the Cardiomyopathies Stephanie Coulter, MD, FACC, FASE April, 2016 Cardiomyopathies (CMP) primary disease intrinsic to cardiac muscle Dilated CMP Hypertrophic CMP Infiltrative
More informationCharacteristics of Left Ventricular Diastolic Function in Patients with Systolic Heart Failure: A Doppler Tissue Imaging Study
Characteristics of Left Ventricular Diastolic Function in Patients with Systolic Heart Failure: A Doppler Tissue Imaging Study Bassem A. Samad, MD, PhD, Jens M. Olson, MD, and Mahbubul Alam, MD, PhD, FESC,
More informationNoninvasive assessment of left ventricular (LV)
Comparative Value of Tissue Doppler Imaging and M-Mode Color Doppler Mitral Flow Propagation Velocity for the Evaluation of Left Ventricular Filling Pressure* Michal Kidawa, MD; Lisa Coignard, MD; Gérard
More information3/27/2014. Introduction.
Introduction. Myocardial perfusion & contractility becomes abnormal immediately after the onset of ischaemia, even before the development of the symptoms & ST segment changes. 1 Myocardial Wall Motion
More informationGilles HANTON, BVSc, DVM, DABT, ERT GH Toxconsulting Brussels, Belgium
Gilles HANTON, BVSc, DVM, DABT, ERT GH Toxconsulting Brussels, Belgium What is echocardiography (EC) Ultrasounds (US) are emitted by a transducer Reflection of US on tissues depends on their physical properties
More informationHow to Assess Diastolic Dysfunction?
How to Assess Diastolic Dysfunction? Fausto J Pinto, MD, PhD, FESC, FACC, FASE Lisbon University Dyastolic Dysfunction Impaired relaxation Elevated filling pressures Ischemic heart disease Cardiomyopathies
More informationCardiac ultrasound protocols
Cardiac ultrasound protocols IDEXX Telemedicine Consultants Two-dimensional and M-mode imaging planes Right parasternal long axis four chamber Obtained from the right side Displays the relative proportions
More informationEVALUATION OF LEFT VENTRICLE DIASTOLIC FUNCTION IN NATIVE HYPERTENSIVE PATIENTS.
EVALUATION OF LEFT VENTRICLE DIASTOLIC FUNCTION IN NATIVE HYPERTENSIVE PATIENTS. Cardiovascular Medicine Department, Cairo University ABSTRACT Background: Systemic hypertension is a common cause of left
More informationHISTORY. Question: How do you interpret the patient s history? CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: 45-year-old man.
HISTORY 45-year-old man. CHIEF COMPLAINT: Dyspnea of two days duration. PRESENT ILLNESS: His dyspnea began suddenly and has been associated with orthopnea, but no chest pain. For two months he has felt
More informationPRELIMINARY STUDIES OF LEFT VENTRICULAR WALL THICKNESS AND MASS OF NORMOTENSIVE AND HYPERTENSIVE SUBJECTS USING M-MODE ECHOCARDIOGRAPHY
Malaysian Journal of Medical Sciences, Vol. 9, No. 1, January 22 (28-33) ORIGINAL ARTICLE PRELIMINARY STUDIES OF LEFT VENTRICULAR WALL THICKNESS AND MASS OF NORMOTENSIVE AND HYPERTENSIVE SUBJECTS USING
More informationMechanisms of False Positive Exercise Electrocardiography: Is False Positive Test Truly False?
Mechanisms of False Positive Exercise Electrocardiography: Is False Positive Test Truly False? Masaki Izumo a, Kengo Suzuki b, Hidekazu Kikuchi b, Seisyo Kou b, Keisuke Kida b, Yu Eguchi b, Nobuyuki Azuma
More informationGlobal left ventricular circumferential strain is a marker for both systolic and diastolic myocardial function
Global left ventricular circumferential strain is a marker for both systolic and diastolic myocardial function Toshinari Onishi 1, Samir K. Saha 2, Daniel Ludwig 1, Erik B. Schelbert 1, David Schwartzman
More information22 nd Annual Conference of the Saudi Heart Association Riyadh, Saudi Arabia
22 nd Annual Conference of the Saudi Heart Association Riyadh, Saudi Arabia New Echocardiographic Modalities to Evaluate Ventricular Function in Congenital Heart Disease: Tissue Doppler & Strain Rate Imaging
More informationTHE PHARMA INNOVATION - JOURNAL Tei Index: Assessment of the Myocardial Function of the Left Ventricle in Case of Acute Myocardial Infarction
Received: 16-06-2013 Accepted: 13-07-2013 ISSN: 2277-7695 CODEN Code: PIHNBQ ZDB-Number: 2663038-2 IC Journal No: 7725 Vol. 2 No. 6 2013 Online Available at www.thepharmajournal.com THE PHARMA INNOVATION
More informationProspect Cardiac Packages. S-Sharp
Prospect Cardiac Packages S-Sharp B mode: Teichholz: Teichholz formula LV Volume 2D: modified Simpson's rule method ALM: area length method LV Volume (Intg.): integral method M mode: Long axis: Teichholz
More informationStrain/Untwisting/Diastolic Suction
What Is Diastole and How to Assess It? Strain/Untwisting/Diastolic Suction James D. Thomas, M.D., F.A.C.C. Cardiovascular Imaging Center Department of Cardiology Cleveland Clinic Foundation Cleveland,
More informationThe Cardiac Cycle Clive M. Baumgarten, Ph.D.
The Cardiac Cycle Clive M. Baumgarten, Ph.D. OBJECTIVES: 1. Describe periods comprising cardiac cycle and events within each period 2. Describe the temporal relationships between pressure, blood flow,
More informationAtrial dyssynchrony syndrome: An overlooked cause of heart failure with normal ejection fraction
Atrial dyssynchrony syndrome: An overlooked cause of heart failure with normal ejection fraction JC Eicher, G Laurent, O Barthez, A Mathé, G Bertaux, JE Wolf Heart Failure Treatment Unit, Rhythmology and
More information