The imbalance of Starling’s forces was investigated in 25 elderly patients hospitalized for acute diastolic heart failure. Tissue Doppler evidence of elevated left ventricular filling pressures was present on admissi...The imbalance of Starling’s forces was investigated in 25 elderly patients hospitalized for acute diastolic heart failure. Tissue Doppler evidence of elevated left ventricular filling pressures was present on admission in 17 patients with high B-type natriuretic peptide(BNP) levels. Serum proteins concentrations and colloid osmotic pressure, related to malnutrition and severe sepsis, were significantly less in the 8 patients without tissue Doppler evidence of elevated filling pressures, and a high level of BNP was consistent with paroxysmal elevation in filling pressures in this setting.展开更多
This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular...This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular dysfunction. Left atrial volume indexed to body surface area(LAVi), an indicator of chronic LV filling pressure, was correlated with BNP(r=0.692, p< 0.001) and was the strongest independent predictor of elevated levels in this cohort. LAVi was also the best predictor of BNP ≥100 pg/ml, with an area under the receiver-operating characteristic curve of 0.85(95%confidence interval 0.74 to 0.96, p< 0.001). Using the optimal cutoff of >31 ml/m2, LAVi had a sensitivity of 92%and a specificity of 65%for BNP ≥100 pg/ml. Patients with LAVi >31 ml/m2 had a median BNP of 122 pg/ml, compared with 21 pg/ml in patients with LAVi ≤31 ml/m2(p< 0.001). These findings suggest that in patients with stable heart failure, BNP levels are related to chronic LV filling pressures. This may help explain the relatively modest correlation between BNP and acute measures of LV filling and the heterogeneity in BNP levels in patients with stable heart failure.展开更多
The diagnostic usefulness of the mitral E/E′ratio(derived from tissue Doppler imaging) as an estimate of left ventricular filling pressures was studied in 28 patients with diastolic heart failure(defined by heart fai...The diagnostic usefulness of the mitral E/E′ratio(derived from tissue Doppler imaging) as an estimate of left ventricular filling pressures was studied in 28 patients with diastolic heart failure(defined by heart failure signs and symptoms but with preserved ejection fraction) and in 46 patients with systolic heart failure(heart failure signs and symptoms and reduced ejection fraction). E/E′was reflective of filling pressures in subjects with diastolic and systolic heart failure and may be of special use in ruling out elevated filling pressures in subjects with suspected diastolic heart failure.展开更多
Slowed heart rate(HR) recovery after exercise is strongly predictive of increased long-term mortality. The factors responsible for impaired HR regulation are not fully understood. We performed echocardiography with ti...Slowed heart rate(HR) recovery after exercise is strongly predictive of increased long-term mortality. The factors responsible for impaired HR regulation are not fully understood. We performed echocardiography with tissue Doppler imaging in 121 patients before maximal exercise testing. HR recovery was measured 1 minute after the end of exercise in the supine position. The best echocardiographic correlate of HR recovery was the ratio of early mitral flow velocity(E) to early diastolic mitral annular velocity(Ea; r=-0.781, p< 0.001). This correlation was not affected by the use of negative chronotropic agents. Patients whose E/Ea was < 10 had a faster 1-minute HR recovery and a greater chronotropic response during exercise than did those whose E/Ea was ≥10. Receiver-operator characteristic analysis showed that an E/Ea ≥10.3 predicted 1-minute HR recovery of ≤18 beats/min, with 83%sensitivity and 100%specificity. Neither left ventricular ejection fraction nor the presence of a “slow relaxation”mitral inflow pattern(E/A <1.0) was predictive of impaired HR recovery. Thus, slowed HR recovery is strongly associated with increased E/Ea, a marker of increased left ventricular filling pressures. E/Ea at rest may become a simple, reliable, and sensitive predictor of increased long-term mortality, even in the absence of overt heart failure.展开更多
文摘The imbalance of Starling’s forces was investigated in 25 elderly patients hospitalized for acute diastolic heart failure. Tissue Doppler evidence of elevated left ventricular filling pressures was present on admission in 17 patients with high B-type natriuretic peptide(BNP) levels. Serum proteins concentrations and colloid osmotic pressure, related to malnutrition and severe sepsis, were significantly less in the 8 patients without tissue Doppler evidence of elevated filling pressures, and a high level of BNP was consistent with paroxysmal elevation in filling pressures in this setting.
文摘This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular dysfunction. Left atrial volume indexed to body surface area(LAVi), an indicator of chronic LV filling pressure, was correlated with BNP(r=0.692, p< 0.001) and was the strongest independent predictor of elevated levels in this cohort. LAVi was also the best predictor of BNP ≥100 pg/ml, with an area under the receiver-operating characteristic curve of 0.85(95%confidence interval 0.74 to 0.96, p< 0.001). Using the optimal cutoff of >31 ml/m2, LAVi had a sensitivity of 92%and a specificity of 65%for BNP ≥100 pg/ml. Patients with LAVi >31 ml/m2 had a median BNP of 122 pg/ml, compared with 21 pg/ml in patients with LAVi ≤31 ml/m2(p< 0.001). These findings suggest that in patients with stable heart failure, BNP levels are related to chronic LV filling pressures. This may help explain the relatively modest correlation between BNP and acute measures of LV filling and the heterogeneity in BNP levels in patients with stable heart failure.
文摘The diagnostic usefulness of the mitral E/E′ratio(derived from tissue Doppler imaging) as an estimate of left ventricular filling pressures was studied in 28 patients with diastolic heart failure(defined by heart failure signs and symptoms but with preserved ejection fraction) and in 46 patients with systolic heart failure(heart failure signs and symptoms and reduced ejection fraction). E/E′was reflective of filling pressures in subjects with diastolic and systolic heart failure and may be of special use in ruling out elevated filling pressures in subjects with suspected diastolic heart failure.
文摘Slowed heart rate(HR) recovery after exercise is strongly predictive of increased long-term mortality. The factors responsible for impaired HR regulation are not fully understood. We performed echocardiography with tissue Doppler imaging in 121 patients before maximal exercise testing. HR recovery was measured 1 minute after the end of exercise in the supine position. The best echocardiographic correlate of HR recovery was the ratio of early mitral flow velocity(E) to early diastolic mitral annular velocity(Ea; r=-0.781, p< 0.001). This correlation was not affected by the use of negative chronotropic agents. Patients whose E/Ea was < 10 had a faster 1-minute HR recovery and a greater chronotropic response during exercise than did those whose E/Ea was ≥10. Receiver-operator characteristic analysis showed that an E/Ea ≥10.3 predicted 1-minute HR recovery of ≤18 beats/min, with 83%sensitivity and 100%specificity. Neither left ventricular ejection fraction nor the presence of a “slow relaxation”mitral inflow pattern(E/A <1.0) was predictive of impaired HR recovery. Thus, slowed HR recovery is strongly associated with increased E/Ea, a marker of increased left ventricular filling pressures. E/Ea at rest may become a simple, reliable, and sensitive predictor of increased long-term mortality, even in the absence of overt heart failure.
