Echocardiographic predictors of elevated left ventricular end diastolic pressure in adolescent and adult patients with repaired tetralogy of Fallot

2019 ◽  
Vol 29 (8) ◽  
pp. 1020-1024
Author(s):  
Adam M. Lubert ◽  
Timothy B. Cotts ◽  
Jeffrey D. Zampi ◽  
Sunkyung Yu ◽  
Mark D. Norris
Keyword(s):  
Tetralogy Of Fallot ◽  
Diastolic Pressure ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Repaired Tetralogy Of Fallot ◽  
Ventricular Diastolic Dysfunction ◽  
History Of ◽  
Anterior Posterior ◽  
Atrial Area ◽  
Made In

AbstractElevated left ventricular end diastolic pressure is a risk factor for ventricular arrhythmias in patients with tetralogy of Fallot. The objective of this retrospective study was to identify echocardiographic measures associated with left ventricular end diastolic pressure >12 mmHg in this population. Repaired tetralogy of Fallot patients age ≥13 years, who underwent a left heart catheterisation within 7 days of having an echocardiogram were evaluated. Univariate comparison was made in echocardiographic and clinical variables between patients with left ventricular end diastolic pressure >12 versus ≤12 mmHg. Ninety-four patients (54% male) with a median age of 24.6 years were included. Thirty-four (36%) had left ventricular end diastolic pressure >12 mmHg. Patients with left ventricular end diastolic pressure >12mmHg were older (median 32.9 versus 24.0 years, p = 0.02), more likely to have a history of an aortopulmonary shunt (62% versus 38%, p = 0.03), and have a diagnosis of hypertension (24% versus 7%, p = 0.03) compared to those with left ventricular end diastolic pressure ≤12 mmHg. There were no significant differences in mitral valve E/A ratio, annular e’ velocity, or E/e’ ratio between patients with left ventricular end diastolic pressure >12 versus ≤12 mmHg. Patients with left ventricular end diastolic pressure >12mmHg had larger left atrial area (mean 17.7 versus 14.0 cm2, p = 0.03) and larger left atrium anterior–posterior diameter (mean 36.0 versus 30.6 mm, p = 0.004). In conclusion, typical echocardiographic measures of left ventricular diastolic dysfunction may not be reliable in tetralogy of Fallot patients. Prospective studies with the use of novel echocardiographic measures are needed.

Estimation of Left Ventricular Wall Stiffness by Analysis of Late Diastolic Pressure Components

2011 ◽  
Author(s):  
Casandra L. Niebel ◽  
Kelley C. Stewart ◽  
Takahiro Ohara ◽  
John J. Charonko ◽  
Pavlos P. Vlachos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Diastolic Dysfunction ◽  
Diastolic Pressure ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Wall ◽  
Ventricular Relaxation ◽  
Wall Stiffness ◽  
Ventricular Diastolic Dysfunction

Left ventricular diastolic dysfunction (LVDD) is any abnormality in the filling of the left ventricle and is conventionally evaluated by analysis of the relaxation driven phase, or early diastole. LVDD has been shown to be a precursor to heart failure and the diagnosis and treatment for diastolic failure is less understood than for systolic failure. Diastole consists of two filling waves, early and late and is primarily dependent on ventricular relaxation and wall stiffness.

scholarly journals Preload-corrected dynamic Starling mechanism in patients with heart failure with preserved ejection fraction

2018 ◽  
Vol 124 (1) ◽  
pp. 76-82 ◽  
Author(s):  
Michinari Hieda ◽  
Erin Howden ◽  
Shigeki Shibata ◽  
Takashi Tarumi ◽  
Justin Lawley ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Diastolic Pressure ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Dynamic Modulation ◽  
Power Spectral ◽  
Ventricular Diastolic Dysfunction

The beat-to-beat dynamic Starling mechanism (DSM), the dynamic modulation of stroke volume (SV) because of breath-by-breath changes in left-ventricular end-diastolic pressure (LVEDP), reflects ventricular-arterial coupling. The purpose of this study was to test whether the LVEDP-SV relationship remained impaired in heart failure with preserved ejection fraction (HFpEF) patients after normalization of LVEDP. Right heart catheterization and model-flow analysis of the arterial pressure waveform were performed while preload was manipulated using lower-body negative pressure to alter LVEDP. The DSM was compared at similar levels of LVEDP between HFpEF patients ( n = 10) and age-matched healthy controls ( n = 12) (HFpEF vs. controls: 10.9 ± 3.8 vs. 11.2 ± 1.3 mmHg, P = 1.00). Transfer function analysis between diastolic pulmonary artery pressure (PAD) representing dynamic changes in LVEDP vs. SV index was applied to obtain gain and coherence of the DSM. The DSM gain was significantly lower in HFpEF patients than in the controls, even at a similar level of LVEDP (0.46 ± 0.19 vs. 0.99 ± 0.39 ml·m−2·mmHg−1, P = 0.0018). Moreover, the power spectral density of PAD, the input variability, was greater in the HFpEF group than the controls (0.75 ± 0.38 vs. 0.28 ± 0.26 mmHg2, P = 0.01). Conversely, the power spectral density of SV index, the output variability, was not different between the groups ( P = 0.97). There was no difference in the coherence, which confirms the reliability of the linear transfer function between the two groups (0.71 ± 0.13 vs. 0.77 ± 0.19, P = 0.87). The DSM gain in HFpEF patients is impaired compared with age-matched controls even at a similar level of LVEDP, which may reflect intrinsic LV diastolic dysfunction and incompetence of ventricular-arterial coupling. NEW & NOTEWORTHY The beat-to-beat dynamic Starling mechanism (DSM), the dynamic modulation of stroke volume because of breath-by-breath changes in left-ventricular end-diastolic pressure (LVEDP), reflects ventricular-arterial coupling. Although the DSM gain is impaired in heart failure with preserved ejection fraction (HFpEF) patients, it is not clear whether this is because of higher LVEDP or left-ventricular diastolic dysfunction. The DSM gain in HFpEF patients is severely impaired, even at a similar level of LVEDP, which may reflect intrinsic left-ventricular diastolic dysfunction.

The natural history of isolated left ventricular diastolic dysfunction

1992 ◽  
Vol 92 (6) ◽  
pp. 627-630 ◽  
Author(s):  
Walter C. Brogan ◽  
L.David Hillis ◽  
Eduardo D. Flores ◽  
Richard A. Lange
Keyword(s):  
Natural History ◽  
Diastolic Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Diastolic Dysfunction ◽  
History Of

scholarly journals Elevated LVEDP, Chronic Pulmonary Oedema and Valve Disease

2019 ◽  
Vol 15 ◽  
Author(s):  
Prithwish Banerjee
Keyword(s):  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Pulmonary Oedema ◽  
Clinical Decision Making ◽  
Diastolic Pressure ◽  
Clinical Decision ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Diastolic Dysfunction ◽  
Artery Disease

As part of ageing and with increased longevity of older people there has been a rise of those with left ventricular diastolic dysfunction (LVDD) and increased left ventricular end diastolic pressure (LVEDP). Comorbidities like hypertension, diabetes, chronic kidney disease, coronary artery disease and others appear to be contributing to this .  Chronic interstitial pulmonary oedema may be a part of the presentation of those with elevated LVEDP/LVDD. Progressive valvular heart disease may also complicate the picture and make clinical decision-making difficult. This case report discusses these issues.

scholarly journals Changes of the diastolic function of left ventry in patients with arterial hypertension in the process of micardis treatment in the family doctor's conditions

2019 ◽  
Vol 40 (1) ◽  
pp. 45-47
Author(s):  
V. I. Koshlya ◽  
O. S. Kulbachuk ◽  
N. P. Sklyarova ◽  
A. V. Piskun ◽  
O. V. Solovyov
Keyword(s):  
Left Ventricle ◽  
Arterial Hypertension ◽  
Diastolic Function ◽  
Diastolic Pressure ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Control Group ◽  
Maximum Speed ◽  
Ventricular Diastolic Dysfunction

Among 38 patients with arterial hypertension I and II degree, the diastolic function of the left ventricle was studied in the course of a twelve-month treatment with Telmisartan (Micardis). Analysis of the diastolic function of the left ventricle before the treatment with telmisartan showed that in both groups of patients with respect to the control group there was a significant decrease in the maximum speed of early diastolic filling and an increase in the maximum rate of atrial filling with increasing severity of the disease.At the same time, the period of isovolumetric relaxation and the end diastolic pressure in the left ventricle increased, and the E/A and Ei/Ai ratios tended to decrease. At the end of the 12-month period of treatment with micardis, the achievement of target levels of blood pressure and normalization of diastolic function of the left ventricle were noted. Keywords: arterial hypertension, left ventricular diastolic dysfunction, micardis.

Sign in / Sign up

Export Citation Format

Share Document