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Influence of alterations in loading on mitral annular velocity by tissue doppler echocardiography and its associated ability to predict filling pressures

Jacques, DC and Pinsky, MR and Severyn, D and Gorcsan, J (2004) Influence of alterations in loading on mitral annular velocity by tissue doppler echocardiography and its associated ability to predict filling pressures. Chest, 126 (6). 1910 - 1918. ISSN 0012-3692

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Study objectives: Early diastolic mitral annular velocity (E') by tissue Doppler echocardiography (TD) has been reported to be a load-independent index of left ventricular (LV) diastolic function, allowing the early diastolic mitral inflow velocity (E)/E' ratio to be used clinically to predict LV filling pressures. However, preload independence of E' has remained controversial, and E/E' may not consistently be predictive of LV filling pressures. Our objectives were to test the hypotheses that E' is affected by preload, and that alterations of preload, afterload, and contractility also affect E/E'. Design, interventions, and measurements: An open-chest dog model was used (n = 8). High-fidelity pressure and conductance catheters were used for pressure-volume relations, and E' was obtained by pulsed TD from the apical four-chamber view. Changes in preload and afterload were induced by vena caval and partial aortic occlusions, respectively. Data were collected during control phase and during infusions of dobutamine and esmolol to alter contractility. Results: E' was consistently and significantly associated with acute decreases in LV end-diastolic pressure in each dog (n = 200 beats; r = 0.93 ± 0.06 [mean ± SD]). Similar results occurred with dobutamine and esmolol infusions. This preload sensitivity was reflected in E/E', which was inversely (rather than directly) correlated with LV diastolic pressure (r = - 0.67). E/E' was less affected by preload when diastolic dysfunction was induced by sustained partial aortic occlusion (time constant of relaxation increased from 46 ± 19 to 53 ± 21 ms, p < 0.001). Conclusions: E' was significantly influenced by preload with preserved LV function and low filling pressures (< 12 mm Hg); accordingly, E/E' was less predictive of LV filling pressures in this scenario. E/E' was more predictive of LV filling pressures in the presence of diastolic dysfunction.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Jacques, DC
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Severyn, D
Gorcsan, Jgorcsan@pitt.eduGORCSAN
Date: 1 January 2004
Date Type: Publication
Journal or Publication Title: Chest
Volume: 126
Number: 6
Page Range: 1910 - 1918
DOI or Unique Handle: 10.1378/chest.126.6.1910
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0012-3692
PubMed ID: 15596692
Date Deposited: 05 Apr 2012 21:57
Last Modified: 30 Jan 2020 16:55


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