Background:
The ratio of peak transmitral pulsed Doppler early velocity to early diastolic tissue Doppler velocity of the lateral or septal mitral annulus (E/Ea) is considered a reliable estimation of diastolic dysfunction, and their average has been incorporated as clinical determinant of diastolic heart failure. Their relative relaibility in the setting pf left ventricular volumes has not been established.
Methods:
We performed comprehensive 2D echocardiography in 214 ambulatory patients with chronic systolic heart failure (LVEF ≤35%, NYHA II-III). Diastolic staging was determined from patterns of transmitral and pulmonary vein flows.
Results:
In our study population (mean age 57 years, 73% male mean left ventricular end-diastolic volume [LVEDV] 228 ml, mean LVEF 25%)
,
the median lateral and septal Ea were 6.9 cm/s and 4.5 cm/s, respectively. The median E/lateral Ea, E/septal Ea, and E/average Ea [inter-quartile range] were 10.8 [7.1–15.1], 16.1 [11.1–23.0], and 12.7 [8.8–17.7], respectively. In the first two tertiles of indexed LVEDV (LVEDVi<92.6 ml/m
2
and 92.6–129.5 ml/m
2
), all three E/Ea indices increased with increasing diastolic stages (all p<0.001). However, in the highest tertile of LVEDVi (>129.5 ml/m
2
), E/septal Ea (but not E/lateral Ea) increased with increasing diastolic stages (Figure
).
Conclusions:
Unlike E/septal Ea, E/lateral Ea did not increase with increasing diastolic stage in patients with chronic systolic heart failure presenting with LV dilatation. These observations may suggest that the E/septal Ea measurements may be more reliable than E/lateral Ea to assess diastolic dysfunction in patients with enlarged ventricles.
Circulating level of endothelin-1 in patients with chronic systolic heart failure correlates with the degree of diastolic dysfunction and type 2 diabetes co-morbidity