No abstract available.
Diastole

BACKGROUND AND OBJECTS: Mitral annulus velocity by Pulsed Wave Doppler has been used as method of evaluation of left ventricular diastolic function. However, it is unknown how this is altered in the patients with left ventricular hypertrophy (LVH). this study was aimed to compare a group of healthy subjects with a group of patients with LVH. METHODS: Subjects were 80 patients with LVH (left ventricular mass index125 g/m2) and 163 controls with normal left ventricular mass index (<125 g/m2). For measuring the mitral annulus velocities by doppler tissue imaging (=DTI), we used the 2.5 MHz probe (Sequoia, Accuson) in apical 4 chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocity in diastole is easily recorded by DTI in all subjects. in LVH group, mitral annulus E've#locity was significantly lower than controls (5.2+/-1.3 cm/sec vs 6.2+/-1.7 cm/sec, p(<0.001) and mitral annulus A' velocity was also significantly higher than controls (8.5+/-1.3 cm/sec vs 8.0+/-1.1 cm/sec, p<0.02). annular displacement measured by DTI-TVI (time velocity integral), also In LVH group, mitral annulus E'-TVI was significantly lower than controls (5.7+/-1.8 mm vs 6.8+/-2.2 mm, p<0.001). CONCLUSION: Mitral annulus velocity determined by DTI could be used as one of the parameters in evaluating diastolic function in patient with LVH.
Diastole ; Humans ; Hypertrophy, Left Ventricular*

OBJECTIVES: Visualization of the left atrial appendage(LAA) by the transesophageal echocardiography(TEE) is excellent, but it is difficult to visualize the LAA by the modified parasternal short-axis view(MPSA) in transthoracic echocardiography(TTE). We studied to determine the usefulness of the apical horizontal view(AHV) abtained by the apical rotation method of the transducer for the detection of the LAA. METHODS: We studied the MPSA and AHV in 602 patients, The LAA was observed during diastole of the LAA. We obtained an apical horizontal view by 45 degree clockwise rotation of the transducer from the apical 2 chamber view and compared with the visualization of the LAA in AHV and MPSA. RESULTS: Among 602 patients, LAA could not be visualized in 88(14.6%) because of a poor echo-window. LAA was more clearly visualized in 222 patients by the AHV than the MPSA and 56 patients by the MPSA than the AHV. LAA was same degree visualization in patients by the AHV and MPSA. In male and female, more than 55 ages and less than 55 ages, visualization of inner margin of the LAA by the AHV was more clear than by the MPSA. CONCLUSION: The AHV was a useful, noninvasive and reproducible method for the visualization of the LAA.
Atrial Appendage* ; Diastole ; Female ; Humans ; Male ; Transducers*

BACKGROUND AND OBJECTIVES: A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. SUBJECTS AND METHODS: We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E' ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction<50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a') minus the duration of the systolic wave (b') divided by b', which is (a'-b')/b', is defined as the TDI-tei index. RESULTS: The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. CONCLUSION: We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults.
Adult* ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Humans ; Ventricular Function

BACKGROUND: Recently, it is substituted automatic sphygmomanometer for mercury sphygmomanometer. But it seems to be insufficient for data of its accuracy. A sample accurate automatic sphygmomanometer could have an important role in the management of hypertension. The aim of this study is to assess the accuracy of the automatic sphygmomanometer that is used common practice and at home. METHODS: We collected 247 patients who visited the department of Famiiy Practice of Taegu medical center from April to August 1996. BP was measured sequentially same arm by standard device(mercury. sphygmomanometer), test device A(A&D TM-2650), test device B(seine SE-2000). We assessed the automatic sphygmomanometer according to the standards set out by the British Hypertension Society(BHS) protocol and the American Association for the Advancement of Medical Instrumentation(AAMI). These data were analysed using pearson' correlation and paired t-test. RESULTS: Test device A was highly correlated to mercury sphygmomanometer in systolic and diastolic BP(r=0.90, r=0.88). Also test device B was highly correlated to that(r=0.90, r=0.87). The mean difference between BP value obtained by the standard device and those obtained by the test device A were 0.59+/-7.66mmHg systole(mean+/-SD) and 3.83+/-6.43mmHg diast.ole, whereas the difference between the former and those obtained by the test device B were 1.70+/-7.99mmHg systole.and 5.58+/-6.38mmHg diastole. Comparing to standard device, there were a signifioant difference except systolic BP of test device A(P<0.05). According to the criteria of the AAMI, the diastolic BP of test device B was not enough and according to the criteria of the BHS, the diastolic BP of both test device were not enough. CONCLUSIONS: Both test device were highly correlated to mercury sphygmomanometer. But according to the criteria of the BHS and AAMI, there were not enough. Because the use of automatic sphygmomanometer was popularized, I think that further study will be required to assess of accuracy.
Arm ; Blood Pressure* ; Daegu ; Diastole ; Humans ; Hypertension ; Sphygmomanometers*

BACKGROUNS AND OBJECTIVES: Mitral annulus velocity measured by Pulsed Wave Doppler Tissue Imaging has been used as method of evaluation of left ventricular diastolic function. However, there are few reports of mitral annulus velocity measured by doppler tissue imaging in healthy normal people. the puopose of this study is to know normal values of mitral annulus velocity in healthy korean people. SUBJECTIVES AND METHODS: Subjectives were 100 healthy normal korean (men : 58 and women : 42 average : 51+/-7, range : 41-67) without hyper-tension and heart disease. subjectives were divided three groups according to age, group I which are forties (n=42), group II which are fifties (n=46), and group III which are sixties (n = 14). For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical 4 chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocity in diastole is easily recorded by DTI in all subjectives. mitral annulus E'velocities were significantly decrease with aging (group I * 7.5+/-l.3 cm/sec, group II 5.7+/-1.3 cm/sec, group III 5.1+/-1.3 cm/sec. *p <0.001 in group I vs group lI and group I vs group III ) and also E'/A' ratios were significantly decrease with aging (group I * 1.0+/-0.2, group #II 0.8+/-0.2, group III 0.6+/-0.2. *p<0.001 in group I vs group ll and group I vs group III). mitral annulus A' velocities were increase with aging but has no statistical significance (group I 7.8+/-1.0 cm/sec, group II 7.9+/-1.2 cm/sec, group III 8.3+/-0.8 cm/sec. p=NS). mitral annulus E'velocities were correlated with age (r=-0.686, p <0.01) CONCLUSION: This results shows that mitral annulus E'velocities and E'/A' ratios were significantly decrease with aging and mitral annulus A' velocities were increase with aging, also there are good correlation between mitral annulus E' velocities and aging.
Aging ; Diastole ; Female ; Heart Diseases ; Humans ; Reference Values

BACKGROUND: Abnormalities of the left ventricular (LV) diastolic dysfunction are common in patients with end-stage renal disease (ESRD). Recently, Doppler tissue imaging (DTI) has been introduced as a method to evaluate diastolic function or myocardial relaxation by measuring mitral annulus velocity during diastole. This study was undertaken to assess resting diastolic function and diastolic functional reserve during exercise in ESRD patients starting dialysis treatment. METHODS: Mitral inflow velocities by Doppler echocardiography and septal mitral annular velocities by DTI were measured at rest and during supine bicycle exercise in 22 new ESRD patients and 23 age- and sex-matched subjects with normal renal function as a control. RESULTS: LV end-diastolic and end-systolic dimensions, septal thickness, and left atrial volume index were significantly higher in patients with ESRD compared with those of controls (p<0.01). LV ejection fraction was significantly lower in ESRD group (p<0.05). There were no significant differences in mitral inflow velocities (E, E/A, DT) between the two groups except A velocity, which was significantly higher in ESRD group (p<0.01). However, early diastolic mitral annular velocity (E') at rest (5.3+/-1.3 cm/sec vs. 6.5+/-1.5 cm/sec, p=0.013) and augmentation of E' with exercise (deltaE') were significantly lower in ESRD group compared with controls (at 25W exercise, 1.3+/-1.6 cm/sec vs. 4.0+/-3.0 cm/sec, p=0.002; at 50W exercise, 3.3+/-2.3 cm/sec vs. 6.5+/-5.3 cm/sec, p=0.030). CONCLUSION: Unlike conventional mitral inflow parameters, longitudinal resting diastolic function and diastolic functional reserve during exercise assessed by DTI were significantly reduced in ESRD patients starting dialysis treatment.
Dialysis* ; Diastole ; Echocardiography, Doppler ; Humans ; Kidney Failure, Chronic* ; Relaxation

The hypotensive action of calcium antagonist has been recognized, however, clinical study on the hypotensive effect is not yet extensively carried out. Auther studied the effect of Dilitiazem(Herben(R)) on 23 hypertensive patients. The age of patient was average 58.5(30-75) years. There were 8 male and 15 female patients. Among 23 cases, 20 cases of essential hypertension had no previous medication for hypertension and they were given 90mg of Diltiazem daily in 3 divied doses for 8 weeks. The blood pressure and pulse were measured at one week interval. In 3 cases of hypertension who were refractory to other hypotensive drugs for 2 weeks. The results were as follows; 1) In 20 cases of untreated essential hypertension, the control average blood pressure was 179.8/106.3mmHg and pulse 77.1/min. After the Diltiazem medication average blood pressure in one week was 153.3/97.3mmHg and pulse 76.6/min, in 3 week 153.0/94.0mmHg, and pulse 76.6/min, in 5 week 143.0/92.0mmHg and pulse 75.4/min, and in 8 week 142.3/90.0mmHg and pulse 73.0/min. These data showed that after one week of medication, blood pressure fell significantly in systole and diastole but there was no significant pulse change. 2) The rate of hypotensive effect by grade were as follows; overall effectiveness in systolic pressure which fell more than 5 mmHg was 85% and more than 20mmHg fall was 70%. In diastolic pressure the overall effectiveness which fell more than 5mmHg was 60% and more than 15 mmhg fall was 40%. 3) In 3 cases which were refractory to other hypotensive drugs, the hypertension became normal blood pressure in one day by 90mg Diltiazem and the fall of blood pressure persisted for 2 weeks by continuous medication.
Blood Pressure ; Calcium ; Diastole ; Diltiazem* ; Female ; Humans ; Hypertension* ; Male ; Systole

BACKGROUND AND PURPOSE: Left ventricular (LV) diastolic dysfunction, developed in relation to myocardial dysfunction and remodeling, is documented in 15%-25% of the population. However, its role in functional recovery and recurrent vascular events after acute ischemic stroke has not been thoroughly investigated. METHODS: In this retrospective observational study, we identified 2,827 ischemic stroke cases with adequate echocardiographic evaluations to assess LV diastolic dysfunction within 1 month after the index stroke. The peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e') was used to estimate LV diastolic dysfunction. We divided patients into 3 groups according to E/e' as follows: <8, 8-15, and ≥15. Recurrent vascular events and functional recovery were prospectively collected at 3 months and 1 year. RESULTS: Among included patients, E/e' was 10.6±6.4: E/e' <8 in 993 (35%), 8-15 in 1,444 (51%), and ≥15 in 378 (13%) cases. Functional dependency or death (modified Rankin Scale score ≥2) and composite vascular events were documented in 1,298 (46%) and 187 (7%) patients, respectively, at 3 months. In multivariable analyses, ischemic stroke cases with E/e' ≥15 had increased odds of functional dependence or death at 3 months (adjusted OR [95% CI]: 1.73 [1.27-2.35]) or 1 year (1.47 [1.06-2.06]) and vascular events within 1 year (1.65 [1.08-2.51]). Subgroups with normal ejection fraction or sinus rhythm exhibited a similar overall pattern and direction. CONCLUSIONS: LV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.
Diastole ; Echocardiography ; Humans ; Observational Study ; Prospective Studies ; Retrospective Studies ; Stroke*

BACKGROUND AND OBJECTIVES: The optimal AV delay should allow for the completion of the atrial contraction prior to the ventricular contraction, and provide for the longest diastolic filling and maximal stroke volume. This study evaluated the effects of the AV delay on the changes in heart functions, in patients with a DDD pacemaker and normal systolic function. SUBJECTS AND METHODS: Nineteen patients were enrolled. The pacing rate was set at 70 beats/min. The AV delay was lengthened in 20-25 msec step, from 100 to 250 msec. The stroke volume and diastolic parameters were measured by echocardiography for each AV delay. RESULTS: The changes in the stroke volume associated with the changes in the AV delay were not statistically significant. However, when viewing each individual patient, the optimal AV delay for each patient could be found. When comparing the stoke volumes obtained just before, just after, and during the maximal AV delay, a statistically significant difference was found (p< 0.05). The absolute value of the E/A ratio was less than 1. The pulmonic vein flow pattern was dominated by the systolic flow, but the changes were not statistically significant. There was a tendency for the E wave propagation slope to decrease. However, the absolute value was less than 40 cm/s, and the E/E' absolute ratio was more than 8, but neither showed any significant differences. CONCLUSION: In patients with a DDD pacemaker and normal systolic function, the diastolic parameters were abnormal, and the stroke volume affected by the change in the AV delay.
Diastole ; Dichlorodiphenyldichloroethane* ; Echocardiography ; Heart ; Humans ; Stroke Volume ; Veins