Assessment of diastolic function in elderly patients with aortic stenosis. Evaluation of flow propagation velocity using color M-mode Doppler technique
Background: The purpose of this study was to assess the left ventricular (LV) diastolic function in elderly patients with aortic stenosis (AS). Methods: The subjects included 11 consecutive elderly patients with AS (AS group), and 17 elderly patients with hypertensive LV hypertrophy (HT group), al...
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| Published in | Geriatrics & gerontology international Vol. 5; no. 4; pp. 242 - 247 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Melbourne, Australia
Blackwell Science Pty
01.12.2005
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1444-1586 1447-0594 |
| DOI | 10.1111/j.1447-0594.2005.00293.x |
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| Abstract | Background: The purpose of this study was to assess the left ventricular (LV) diastolic function in elderly patients with aortic stenosis (AS).
Methods: The subjects included 11 consecutive elderly patients with AS (AS group), and 17 elderly patients with hypertensive LV hypertrophy (HT group), all were more than 70 years of age. Echocardiographic and Doppler examinations were performed, and the data was analyzed to determine the LV end‐diastolic dimension (LVDd), the LV mass index (LVMI), fractional fiber shortening (FS), the aortic valve resistance (AVR), peak aortic flow velocity (peak V), and the maximal early diastolic transmitral flow velocity (E). The flow propagation velocity (FPV) was measured during early LV filling phase using a color M‐mode Doppler method. Then, (i) FPV/E were compared between the two groups; and (ii) correlations between FPV/E and LVMI, LVDd, AVR, and FS/peak V were assessed in the AS group.
Results: FPV/E was significantly lower in the AS group than in the HT group (P < 0.01). There were significant negative correlations between FPV/E and LVMI (r =−0.728, P < 0.001), and FPV/E and LVDd (r =−0.642, P < 0.01) in the AS group. There were no significant correlations between FPV/E and AVR, and FPV/E and FS/peak V.
Conclusion: We considered that in elderly patients with AS, diastolic dysfunction was more severe than that of hypertensive heart disease even if the LV hypertrophy is equivalent, and diastolic dysfunction was more severe in cases having a larger LVDd and a larger LVMI, and could not be related to hemodynamic severity of AS. |
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| AbstractList | Background: The purpose of this study was to assess the left ventricular (LV) diastolic function in elderly patients with aortic stenosis (AS).
Methods: The subjects included 11 consecutive elderly patients with AS (AS group), and 17 elderly patients with hypertensive LV hypertrophy (HT group), all were more than 70 years of age. Echocardiographic and Doppler examinations were performed, and the data was analyzed to determine the LV end‐diastolic dimension (LVDd), the LV mass index (LVMI), fractional fiber shortening (FS), the aortic valve resistance (AVR), peak aortic flow velocity (peak V), and the maximal early diastolic transmitral flow velocity (E). The flow propagation velocity (FPV) was measured during early LV filling phase using a color M‐mode Doppler method. Then, (i) FPV/E were compared between the two groups; and (ii) correlations between FPV/E and LVMI, LVDd, AVR, and FS/peak V were assessed in the AS group.
Results: FPV/E was significantly lower in the AS group than in the HT group (P < 0.01). There were significant negative correlations between FPV/E and LVMI (r =−0.728, P < 0.001), and FPV/E and LVDd (r =−0.642, P < 0.01) in the AS group. There were no significant correlations between FPV/E and AVR, and FPV/E and FS/peak V.
Conclusion: We considered that in elderly patients with AS, diastolic dysfunction was more severe than that of hypertensive heart disease even if the LV hypertrophy is equivalent, and diastolic dysfunction was more severe in cases having a larger LVDd and a larger LVMI, and could not be related to hemodynamic severity of AS. Background: The purpose of this study was to assess the left ventricular (LV) diastolic function in elderly patients with aortic stenosis (AS). Methods: The subjects included 11 consecutive elderly patients with AS (AS group), and 17 elderly patients with hypertensive LV hypertrophy (HT group), all were more than 70 years of age. Echocardiographic and Doppler examinations were performed, and the data was analyzed to determine the LV end‐diastolic dimension (LVDd), the LV mass index (LVMI), fractional fiber shortening (FS), the aortic valve resistance (AVR), peak aortic flow velocity (peak V), and the maximal early diastolic transmitral flow velocity (E). The flow propagation velocity (FPV) was measured during early LV filling phase using a color M‐mode Doppler method. Then, (i) FPV/E were compared between the two groups; and (ii) correlations between FPV/E and LVMI, LVDd, AVR, and FS/peak V were assessed in the AS group. Results: FPV/E was significantly lower in the AS group than in the HT group ( P < 0.01). There were significant negative correlations between FPV/E and LVMI ( r =−0.728, P < 0.001), and FPV/E and LVDd ( r =−0.642, P < 0.01) in the AS group. There were no significant correlations between FPV/E and AVR, and FPV/E and FS/peak V. Conclusion: We considered that in elderly patients with AS, diastolic dysfunction was more severe than that of hypertensive heart disease even if the LV hypertrophy is equivalent, and diastolic dysfunction was more severe in cases having a larger LVDd and a larger LVMI, and could not be related to hemodynamic severity of AS. |
| Author | Suzuki, Kengo Imai, Yukiko Yoshida, Akihiro Miyake, Fumihiko Nakamura, Toshio Nobuoka, Sachihiko Adachi, Hisanobu Shibamoto, Masaaki |
| Author_xml | – sequence: 1 givenname: Sachihiko surname: Nobuoka fullname: Nobuoka, Sachihiko email: s.-nobuoka@marianna-u.ac.jp organization: Division of General Internal Medicine, Department of Internal, Medicine, and – sequence: 2 givenname: Kengo surname: Suzuki fullname: Suzuki, Kengo organization: Division of Cardiology, Department of Internal Medicine, St. Marianna University, School of Medicine, Yokohama City, Japan – sequence: 3 givenname: Yukiko surname: Imai fullname: Imai, Yukiko organization: Division of Cardiology, Department of Internal Medicine, St. Marianna University, School of Medicine, Yokohama City, Japan – sequence: 4 givenname: Hisanobu surname: Adachi fullname: Adachi, Hisanobu organization: Division of Cardiology, Department of Internal Medicine, St. Marianna University, School of Medicine, Yokohama City, Japan – sequence: 5 givenname: Masaaki surname: Shibamoto fullname: Shibamoto, Masaaki organization: Division of Cardiology, Department of Internal Medicine, St. Marianna University, School of Medicine, Yokohama City, Japan – sequence: 6 givenname: Akihiro surname: Yoshida fullname: Yoshida, Akihiro organization: Division of Cardiology, Department of Internal Medicine, St. Marianna University, School of Medicine, Yokohama City, Japan – sequence: 7 givenname: Fumihiko surname: Miyake fullname: Miyake, Fumihiko organization: Division of Cardiology, Department of Internal Medicine, St. Marianna University, School of Medicine, Yokohama City, Japan – sequence: 8 givenname: Toshio surname: Nakamura fullname: Nakamura, Toshio organization: Division of General Internal Medicine, Department of Internal, Medicine, and |
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| References | Shahi M, Thom S, Poulter N, Sever PS, Foale RA. Regression of hypertensive left ventricular hypertrophy and left ventricular diastolic function. Lancet 1990; 336: 458-461. Mann DL, Usher BW, Hammerman S, Bell A, Gillam LD. The fractional shortening-velocity ratio: validation of a new echocardiographic Doppler method for identifying patients with significant aortic stenosis. J Am Coll Cariol 1990; 15: 1578-1584. Palta S, Pai AM, Gill KS, Pai RG. New insights into the progression of aortic stenosis: implications for secondary prevention. Circulation 2000; 101: 2497-2502. Garcia MJ, Ares MA, Asher C, Rodriguez VP, Thomas JD. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol 1997; 29: 448-454. Brun P, Tribouilloy C, Duval A et al. Left ventricular flow propagation during early filling is related to wall relaxation. J Am Coll Cardiol 1992; 20: 420-432. Vanoverschelde JLJ, Essamri B, Michel X et al. Hemodynamic and volume correlates of left ventricular diastolic relaxation and filling in patients with aortic stenosis. J Am Coll Cardiol 1992; 20: 813-821. Little WC, Downers TR. Clinical evaluation of left ventricular diastolic performance. Prog Cardiovasc Dis 1990; 32: 273-290. Aronow WS, Ahn C, Shirani J, Kronzon I. Comparison of frequency of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis. AM J Cardiol 1998; 81: 647-649. Rokey R, Kuo LC, Zoghbi WA. Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography. Circulation 1985; 71: 543-550. Hess OM, Villari B, Krayenbuehl HP. Diastolic dysfunction in aortic stenosis. Circulation 1993; 87 (Suppl. IV): IV73-IV76. Otto CM, Pearlman AS, Amsler LC. Doppler echocardiographic evaluation of left ventricular diastolic filling in isolated valvular aortic stenosis. Am J Cardiol 1989; 63: 313-316. Louie EK, Mason TJ, Shah R, Bienarz T, Moore AM. Determinants of anterior mitral leaflet fluttering in pure aortic regurgitation from pulsed Doppler study of the early interaction between the regurgitant jet and mitral flow. Am J Cardiol 1988; 61: 1085-1091. Stugaard M, Smiseth OA, Ris EC, Ihlen H. Intra ventricular early diastolic filling during acute myocardial ischemia. Assessment by multigated color M-mode Doppler echocardiography. Circulation 1993; 88: 2705-2713. Moller JE, Sondergaard E, Seward JB, Appleton CP, Egstrup K. Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction. J Am Coll Cardiol 2000; 35: 363-370. Mautner GC, Mautner SL, Cannon RO III, Hunsberger SA, Roberts WC. Clinical factors useful in predicting aortic valve structure in patients > 40 years of age with isolated valvular aortic stenosis. Am J Cardiol 1993; 72: 194-198. Cannon JD, Zile MR, Crawford FA, Carabello BA. Aortic valve resistance as an adjunct to the Gorlin formula in assessing the severity of aortic stenosis in symptomatic patients. J Am Coll Cardiol 1992; 20: 1517-1523. Nagueh SF, Kopelen HA, Quinones MA. Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. Circulation 1996; 94: 2138-2145. Ganau A, Devereux RB, Roman MJ et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19: 1550-1558. Deverux RB, Reichek N. Echocardiographic determination of leftventricular mass in man. Anatomic validation of the method. Circulation 1977; 55: 613-618. Hatle L, Angelsen BA, Tromsdal A. Noninvasive assessment of aortic stenosis by Doppler ultrasound. Br Heart J 1980; 43: 284-292. Takatsuji H, Mikami T, Urasawa K et al. A new approach for evaluation of left ventricular diastolic function: spatial and temporal analysis of left filling flow propagation by color M-mode Doppler echocardiography. J Am Coll Cardiol 1996; 27: 365-371. Rapp AH, Hillis LD, Lange RA, Cigarroa JE. Prevalence of coronary artery disease in patients with aortic stenosis with and without angina pectoris. Am J Cardiol 2001; 87: 1216-1217. Villari B, Hess OM, Kaufmann P, Krogmann ON, Grimm J, Krayenbuehl HP. Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic diastolic function. Am J Cardiol 1992; 69: 927-934. 1989; 63 1990; 32 1990; 336 1990; 15 1993; 72 2000; 35 1993; 88 1993; 87 1980; 43 1996; 94 1997; 29 1992; 19 1977; 55 1998; 81 1988; 61 1992; 69 1985; 71 2000; 101 1992; 20 1996; 27 2001; 87 Deverux RB (e_1_2_5_8_2) 1977; 55 e_1_2_5_14_2 e_1_2_5_13_2 Hess OM (e_1_2_5_19_2) 1993; 87 e_1_2_5_9_2 e_1_2_5_16_2 e_1_2_5_24_2 e_1_2_5_15_2 e_1_2_5_7_2 e_1_2_5_10_2 e_1_2_5_22_2 e_1_2_5_6_2 e_1_2_5_23_2 e_1_2_5_5_2 e_1_2_5_12_2 e_1_2_5_20_2 e_1_2_5_4_2 e_1_2_5_11_2 e_1_2_5_21_2 e_1_2_5_3_2 e_1_2_5_2_2 e_1_2_5_18_2 e_1_2_5_17_2 |
| References_xml | – reference: Deverux RB, Reichek N. Echocardiographic determination of leftventricular mass in man. Anatomic validation of the method. Circulation 1977; 55: 613-618. – reference: Cannon JD, Zile MR, Crawford FA, Carabello BA. Aortic valve resistance as an adjunct to the Gorlin formula in assessing the severity of aortic stenosis in symptomatic patients. J Am Coll Cardiol 1992; 20: 1517-1523. – reference: Palta S, Pai AM, Gill KS, Pai RG. New insights into the progression of aortic stenosis: implications for secondary prevention. Circulation 2000; 101: 2497-2502. – reference: Brun P, Tribouilloy C, Duval A et al. Left ventricular flow propagation during early filling is related to wall relaxation. J Am Coll Cardiol 1992; 20: 420-432. – reference: Mautner GC, Mautner SL, Cannon RO III, Hunsberger SA, Roberts WC. Clinical factors useful in predicting aortic valve structure in patients > 40 years of age with isolated valvular aortic stenosis. Am J Cardiol 1993; 72: 194-198. – reference: Rokey R, Kuo LC, Zoghbi WA. Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography. Circulation 1985; 71: 543-550. – reference: Aronow WS, Ahn C, Shirani J, Kronzon I. Comparison of frequency of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis. AM J Cardiol 1998; 81: 647-649. – reference: Shahi M, Thom S, Poulter N, Sever PS, Foale RA. Regression of hypertensive left ventricular hypertrophy and left ventricular diastolic function. Lancet 1990; 336: 458-461. – reference: Stugaard M, Smiseth OA, Ris EC, Ihlen H. Intra ventricular early diastolic filling during acute myocardial ischemia. Assessment by multigated color M-mode Doppler echocardiography. Circulation 1993; 88: 2705-2713. – reference: Otto CM, Pearlman AS, Amsler LC. Doppler echocardiographic evaluation of left ventricular diastolic filling in isolated valvular aortic stenosis. Am J Cardiol 1989; 63: 313-316. – reference: Vanoverschelde JLJ, Essamri B, Michel X et al. Hemodynamic and volume correlates of left ventricular diastolic relaxation and filling in patients with aortic stenosis. J Am Coll Cardiol 1992; 20: 813-821. – reference: Hatle L, Angelsen BA, Tromsdal A. Noninvasive assessment of aortic stenosis by Doppler ultrasound. Br Heart J 1980; 43: 284-292. – reference: Hess OM, Villari B, Krayenbuehl HP. Diastolic dysfunction in aortic stenosis. Circulation 1993; 87 (Suppl. IV): IV73-IV76. – reference: Villari B, Hess OM, Kaufmann P, Krogmann ON, Grimm J, Krayenbuehl HP. Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic diastolic function. Am J Cardiol 1992; 69: 927-934. – reference: Takatsuji H, Mikami T, Urasawa K et al. A new approach for evaluation of left ventricular diastolic function: spatial and temporal analysis of left filling flow propagation by color M-mode Doppler echocardiography. J Am Coll Cardiol 1996; 27: 365-371. – reference: Garcia MJ, Ares MA, Asher C, Rodriguez VP, Thomas JD. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol 1997; 29: 448-454. – reference: Little WC, Downers TR. Clinical evaluation of left ventricular diastolic performance. Prog Cardiovasc Dis 1990; 32: 273-290. – reference: Moller JE, Sondergaard E, Seward JB, Appleton CP, Egstrup K. Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction. J Am Coll Cardiol 2000; 35: 363-370. – reference: Louie EK, Mason TJ, Shah R, Bienarz T, Moore AM. Determinants of anterior mitral leaflet fluttering in pure aortic regurgitation from pulsed Doppler study of the early interaction between the regurgitant jet and mitral flow. Am J Cardiol 1988; 61: 1085-1091. – reference: Ganau A, Devereux RB, Roman MJ et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19: 1550-1558. – reference: Rapp AH, Hillis LD, Lange RA, Cigarroa JE. Prevalence of coronary artery disease in patients with aortic stenosis with and without angina pectoris. Am J Cardiol 2001; 87: 1216-1217. – reference: Nagueh SF, Kopelen HA, Quinones MA. Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. Circulation 1996; 94: 2138-2145. – reference: Mann DL, Usher BW, Hammerman S, Bell A, Gillam LD. The fractional shortening-velocity ratio: validation of a new echocardiographic Doppler method for identifying patients with significant aortic stenosis. 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IV year: 1993 end-page: IV76 article-title: Diastolic dysfunction in aortic stenosis publication-title: Circulation – volume: 81 start-page: 647 year: 1998 end-page: 649 article-title: Comparison of frequency of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis publication-title: AM J Cardiol – volume: 63 start-page: 313 year: 1989 end-page: 316 article-title: Doppler echocardiographic evaluation of left ventricular diastolic filling in isolated valvular aortic stenosis publication-title: Am J Cardiol – volume: 61 start-page: 1085 year: 1988 end-page: 1091 article-title: Determinants of anterior mitral leaflet fluttering in pure aortic regurgitation from pulsed Doppler study of the early interaction between the regurgitant jet and mitral flow publication-title: Am J Cardiol – volume: 71 start-page: 543 year: 1985 end-page: 550 article-title: Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography publication-title: Circulation – volume: 55 start-page: 613 year: 1977 end-page: 618 article-title: Echocardiographic determination of leftventricular mass in man. 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| Snippet | Background: The purpose of this study was to assess the left ventricular (LV) diastolic function in elderly patients with aortic stenosis (AS).
Methods: The... Background: The purpose of this study was to assess the left ventricular (LV) diastolic function in elderly patients with aortic stenosis (AS). Methods: The... |
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| SubjectTerms | aortic stenosis color M-mode Doppler method diastolic function elderly patient flow propagation velocity |
| Title | Assessment of diastolic function in elderly patients with aortic stenosis. Evaluation of flow propagation velocity using color M-mode Doppler technique |
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