Search

Background The peak velocity of early diastolic mitral annular motion (e') is believed to provide sensitive detection of left ventricular (LV) diastolic dysfunction in hypertrophic cardiomyopathy (HCM), but other aspects of LV long-axis function in HCM have received less attention. Systolic mitral annular excursion (SExc) is also reduced in HCM and must be an intrinsic limitation to the extent of the subsequent motion during diastole. However, the effects of HCM on excursion during early diastole (EDExc) and atrial contraction (AExc), the duration of early diastolic motion (EDDur), and the relationships of EDExc with SExc, and of e'with EDExc and EDDur, are all unknown. Methods The study group was 22 subjects with HCM and there were 22 age and sex matched control subjects. SExc, EDExc, e', AExc and EDDur were measured from pulsed wave tissue Doppler signals acquired from the septal and lateral walls. In the combined group of HCM and control subjects, multivariate analyses were performed to identify independent predictors of EDExc and e'for both LV walls. Results SExc, EDExc and e'were all lower, and EDDur was longer in the HCM group compared to the control group for both LV walls (p<0.05 for all). In contrast, AExc was lower for the septal wall in the HCM group (p<0.05), but not different between the groups for the lateral wall. In regression analyses of the combined group, EDExc was positively correlated with SExc, and SExc explained 57-86% of the variances in septal and lateral EDExc, e'was positively correlated with EDExc, and EDExc explained 58-68% of the variances of e', whereas the combination of EDExc with EDDur explained 87-92% of the variances in e'. A diagnosis of HCM was not an independent predictor of EDExc when in combination with SExc, but was a minor contributor to the prediction of e'in combination with EDExc and EDDur. Conclusion In HCM, the decrease in LV longitudinal contraction is the major mechanism accounting for a lower EDExc, the lower e'is a

Background Longitudinal left ventricular (LV) contraction can be impaired in the presence of a normal LV ejection fraction (LVEF), and abnormalities have been reported in global longitudinal strain (GLS), long-axis systolic excursion (SExc), and the peak systolic velocity (s') of mitral annular motion using tissue Doppler imaging (TDI). However, the relationships of GLS with s' and SExc have not been systematically evaluated in subjects with a normal LVEF, and whether these relationships might be affected by variations in LV end-diastolic length (LVEDL) and heart rate is unknown. Methods We investigated the univariate and multivariate correlations of GLS with TDI measurements of s' and SExc (both using averages of the septal and lateral walls), LVEDL and heart rate in subjects with a normal LVEF (>50%) but a low peak early diastolic mitral annular velocity (septal e'<= 7.0 cm/s and lateral e'<= 9 cm/s), and thus an increased risk of a future cardiac event. Results 84 subjects (age 66+/-8 years, 29 males) with a LVEF of 62+/-6% and GLS of -17.5+/-2.3% were studied. On univariate analysis the absolute value of GLS was positively correlated with s'(r = 0.28, p<0.01) and SExc (r = 0.50, p<0.001) and inversely correlated with heart rate (r = -0.36, p = 0.001), but was not correlated with LVEDL (r = -0.15). In multivariate models, SExc explained more of the variance in GLS than s', and absolute GLS was not only positively correlated with SExc, but also inversely correlated with LVEDL. Heart rate was an independent inverse correlate of GLS in conjunction with LVEDL and either s' or SExc, but made a larger contribution in models which included s'. Interobserver correlations were close for s' and SExc (r = 0.89-0.93), but only moderate for GLS (r = 0.71). Conclusion In subjects with a normal LVEF but reduced e', the absolute value of GLS is more closely related to SExc than s', and is also independently and inversely related to LVEDL and heart rate. Measurement of SExc may p

Introduction Although a concentric pattern of left ventricular (LV) geometry appears to be common in Friedreich ataxia (FRDA), there is no accepted method for diagnosing LV abnormalities in FRDA, sex and body size have often not been taken into consideration, and it has not been clear whether children and adults should be classified using the same criteria. The aim of this study was to better define the LV geometric changes in FRDA with respect to sex, body size and subject age, and to investigate the relationship of LV changes with genetic severity, as assessed by GAA repeat length within the shorter allele of the FXN gene (GAA1). Methods Echocardiography was performed in 216 subjects (68 children, 148 adults), measurements were made at end-diastole of LV internal diameter (LVEDID), septal wall thickness (SWT), LV length (LVEDL) and LV volume (LVEDV), and calculations were made of relative wall thickness (RWT), LV mass and LV ejection fraction (LVEF). Results The most common LV abnormalities in both adults and children with FRDA were increases in RWT and age-normalized RWT. In adults with a normal LVEF, all LV variables other than RWT were larger in males independent of body surface area (BSA), and all LV variables other than SWT and RWT were positively correlated with BSA. After adjustment for sex and BSA, GAA1 was a positive correlate of SWT and RWT (but not of LV mass), and was an inverse correlate of LVEDID, LVEDL and LVEDV. In children with a normal LVEF, SWT, LV mass and LVEDL were larger in males than females after adjusting for BSA, and in combination with sex, BSA was a positive correlate of all the LV variables except SWT and RWT. In children there were no correlations of GAA1 with any of the LV variables. Conclusion In FRDA, increases in RWT and age-normalized RWT are the most frequent LV structural abnormalities, sex and body size are important determinants of most other LV structural variables in both children and adults, and increased genetic severity

Background Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative condition which also has effects on the heart. In 96% of affected individuals FRDA is due to homozygosity of a GAA repeat expansion in intron 1 of the frataxin (FXN) gene. The number of GAA repeats have been shown to relate to disease severity in FRDA, this thought to be via an inverse relationship of GAA repeat number and cellular frataxin levels. We investigated the effects of FRDA on regional long axis function of the left and right ventricles, and also the relationship of long axis systolic (s') and early diastolic (e') peak velocities with GAA repeat number on the shorter (GAA1) and longer FXN alleles (GAA2). Methods The study group of 78 adult subjects (age 32+/-9 years) with FRDA and normal left ventricular (LV) ejection fraction were compared to 54 healthy control subjects of similar age, sex and body size. Tissue Doppler imaging (TDI) signals were recorded at the mitral annulus for measurement of s'and e'of the septal, lateral, anterior and inferior walls and at the tricuspid annulus for measurement of right ventricular (RV) s'and e'. Results All the regional LV s'and e', and both RV s'and RV e', were lower in individuals with FRDA compared to controls (p<0.001 for all). On multivariate analysis, which included LV septal wall thickness (SWT), RV s'and RV e'were both inversely correlated with GAA1 (beta = -0.32 & -0.33, respectively, p = 0.01), but not with GAA2, whereas anterior and lateral s'were both inversely correlated with GAA2 (beta = -0.25 and beta = -0.28, p = 0.02) but not with GAA1. Increasing SWT was the most consistent LV structural correlate of lower s'and e', whereas age was a consistent inverse correlate of e'but not of s'. Conclusion There are generalized abnormalities of both LV regional and RV long axis function in FRDA, but there are also regional differences in the association of this dysfunction with the smaller and larger GAA repeats in the FXN gene.Copyrig

INTRODUCTION: Although a concentric pattern of left ventricular (LV) geometry appears to be common in Friedreich ataxia (FRDA), there is no accepted method for diagnosing LV abnormalities in FRDA, sex and body size have often not been taken into consideration, and it has not been clear whether children and adults should be classified using the same criteria. The aim of this study was to better define the LV geometric changes in FRDA with respect to sex, body size and subject age, and to investigate the relationship of LV changes with genetic severity, as assessed by GAA repeat length within the shorter allele of the FXN gene (GAA1). METHODS: Echocardiography was performed in 216 subjects (68 children, 148 adults), measurements were made at end-diastole of LV internal diameter (LVEDID), septal wall thickness (SWT), LV length (LVEDL) and LV volume (LVEDV), and calculations were made of relative wall thickness (RWT), LV mass and LV ejection fraction (LVEF). RESULTS: The most common LV abnormalities in both adults and children with FRDA were increases in RWT and age-normalized RWT. In adults with a normal LVEF, all LV variables other than RWT were larger in males independent of body surface area (BSA), and all LV variables other than SWT and RWT were positively correlated with BSA. After adjustment for sex and BSA, GAA1 was a positive correlate of SWT and RWT (but not of LV mass), and was an inverse correlate of LVEDID, LVEDL and LVEDV. In children with a normal LVEF, SWT, LV mass and LVEDL were larger in males than females after adjusting for BSA, and in combination with sex, BSA was a positive correlate of all the LV variables except SWT and RWT. In children there were no correlations of GAA1 with any of the LV variables. CONCLUSION: In FRDA, increases in RWT and age-normalized RWT are the most frequent LV structural abnormalities, sex and body size are important determinants of most other LV structural variables in both children and adults, and increased genetic seve

Background: The physiological factors which affect left ventricular (LV) long-axis function are not fully defined. We investigated the relationships of resting heart rate and body size with the peak velocities and amplitudes of LV systolic and early diastolic long axis motion, and also with long-axis contraction duration. Method(s): Two groups of adults free of cardiac disease underwent pulsed-wave tissue Doppler imaging at the septal and lateral mitral annular borders. Group 1 (n = 77) were healthy subjects <50 years of age and Group 2 (n = 65) were subjects between 40-80 years of age referred for stress echocardiography. Systolic excursion (SExc), duration (SDur) and peak velocity (s') and early diastolic excursion (EDExc) and peak velocity (e') were measured. Result(s): SExc was not correlated with heart rate, height or body surface area (BSA) for either LV wall in either group, but SDur was inversely correlated with heart rate for both walls and both groups, and after adjustment for heart rate, males in both groups had a shorter septal SDur. Septal and lateral s' were independently and positively correlated with SExc, heart rate and height in both groups, independent of sex and age. There were no correlations of heart rate, height or BSA with either e' or EDExc for either wall in either group. Conclusion(s): Heart rate and height independently modify the relationship between s' and SExc, but neither are related to EDExc or e'. These findings suggest that s' and SExc cannot be used interchangeably for the assessment of LV long-axis contraction.Copyright © 2017 Peverill et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Friedreich ataxia (FRDA) is a progressive neurological disease due to a GAA expansion in both alleles of the frataxin gene, and is commonly also accompanied by a cardiomyopathy. Abnormalities of left ventricular (LV) and left atrial long-axis function can be evident in FRDA before there is any reduction of ejection fraction (EF), with reductions reported in tissue Doppler imaging (TDI) measures of systolic (s'), early diastolic (e') and atrial contraction (a') mitral annular velocities and also in global longitudinal strain (GLS). However, the relation between these long-axis function measures has not been evaluated in FRDA. The study group was 31 subjects with FRDA (17 men) of median age 31 (range 18-70) years. TDI was performed at the septal and lateral walls and the results were averaged. GLS was performed using speckle tracking from the 2, 3, and 4 chamber views. The biplane EF was > 50% in all subjects (61+/-5%), the average GLS was reduced at-15.4+/-2.8%, s' was 8.0+/-1.7 cm/s, e' was 10.1+/-2.3 cm/s and a' was 7.8+/-2.3 cm/s (all mean+/-SD). There was no correlation of EF with GLS, s' or e'. GLS was inversely correlated with s' (r2=0.19) and a' (r2=0.16), but not with e'. However, on multivariate analysis, GLS was inversely correlated with both e' and a' (r2=0.27) and s' was also positively correlated with both e' and a' (r2=0.55). The only correlation with age was an inverse correlation with e' (r2=0.17). In 27 subjects with genetic data, GAA repeats on the smaller allele (GAA1) were not correlated with e', but were positively correlated with GLS (r2=0.23) and inversely correlated with s' (r2=0.15) and a' (r2=0.34). In conclusion, in FRDA there are complex interrelationships between GLS and TDI mitral annular velocities, but the strongest correlate of the severity of the genetic abnormality (GAA1) is a'.

Background The transmitral E wave and the peak velocity of early diastolic mitral annular motion (e) both decrease with age, but the mechanisms underlying these age-related changes are incompletely understood. This study investigated the possible contributions of blood pressure (BP) and left ventricular end-diastolic length (LVEDL) to age-related reductions in E and e. Methods The study group were 82 healthy adult subjects <55 years of age who were not obese or hypertensive. Transmitral flow and mitral annular motion were recorded using pulsed-wave Doppler. LVEDL was measured from the mitral annular plane to the apical endocardium. Results Age was positively correlated with diastolic BP and septal wall thickness (SWT), inversely correlated with LVEDL (beta = -0.25) after adjustment for sex and body surface area, but was not related to left ventricular end-diastolic diameter (LVEDD). Age was also inversely correlated with E (r = -0.36), septal e(r = -0.53) and lateral e(r = -0.53). On multivariable analysis, E was inversely correlated with diastolic BP and LVEDD, septal ewas inversely correlated with diastolic BP and positively correlated with SWT and LVEDL, after adjusting for body mass index, whilst lateral ewas inversely correlated with diastolic BP and positively correlated with LVEDL. Conclusion The above findings are consistent with higher BP being a contributor to age-related reductions in both E and eand shortening of LVEDL with age being a contributor to the agerelated reduction in e. An implication of these findings is that slowing of myocyte relaxationis unlikely to be the sole, and may not be the main, mechanism underlying age-related decreases in E and e.Copyright © 2016 Peverill et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The study aimed to evaluate whether a significant difference exists between tissue harmonic imaging (THI) fundamental imaging (FI) in routine quantitative echocardiographic assessment. We also examined the effects of THI on endocardial definition (ED). Fifty-Eight unselected patients (29 men, 29 women; mean age 53 years) referred for transthoracic echocardiography were studied with use of both FI THI modes. Two independent observers made M-Mode measurements of the following: left atrium, aortic root, left ventricular internal dimensions wall thickness; they also measured left ventricular outflow tract diameter left atrial area from 2-dimensional images. Endocardial definition was assessed with use of an arbitrary scoring system (0 = endocardium not visualized 1 = endocardium visualized but suboptimally, 2 = endocardium well defined) the American Society of Echocardiography 16-segment model. No significant difference existed between cardiac measurements derived from FI and THI. However a highly significant improvement in ED occurred with THI (ED index 1.83 versus 1.70, P < .0001). ED. This study suggests that no systematic differences exist in standard echocardiographic measurements between THI and FI, even in the setting of improved ED.

Background Measurements of systolic mitral annular velocity (S'), early diastolic mitral annular velocity (E'), and late diastolic mitral annular velocity (A') are used to assess left ventricular (LV) function. Objective We sought to investigate the relationship between septal and lateral annular velocities and determine whether these velocities are related to body size (including body mass index [BMI]), heart rate (HR), blood pressure, or LV mass. Methods A total of 60 healthy participants who were normotensive, between age 20 and 52 years, underwent standard echocardiography and measurement of septal and lateral S', E', and A'. Results The lateral velocity exceeded the septal velocity for S', E', and A'. There was only weak to moderate correlation between the velocities at the two sites (r = 0.43-0.60). Septal S' was positively correlated with height and HR, and lateral S' was correlated with HR. Septal E' was negatively correlated with age, BMI, LV mass, and diastolic blood pressure, but lateral E' was only negatively correlated with age and BMI. Septal A' was positively correlated with age, HR, and BMI, whereas lateral A' was only positively associated with age. Conclusions S', E', and A' are not only of different magnitudes at the septal and lateral sites, but are not closely correlated. There are relationships between annular velocities and body size, HR, blood pressure, and LV mass that differ between the septal and lateral annulus, providing a possible explanation for the lack of close correlation in these velocities and suggesting that these variables may need to be considered when interpreting annular velocities.

Assessment of mitral annular motion diastolic velocities by M-mode or tissue Doppler imaging and the propagation velocity of early diastolic filling (Vp) by colour M-mode have been proposed as preload-independent indices of diastolic function. The aim of the present study was to determine the effects of preload reduction by haemodialysis on these new echocardiographic indices and to assess the relationship between these indices. The study group comprised 17 patients with chronic renal failure in sinus rhythm with normal left ventricular systolic function who underwent echocardiography 30 min prior to and 30 min following haemodialysis. Following dialysis there were significant reductions in weight (P < 0.001 ), left atrial diameter (P = 0.001 ), the peak Doppler velocity of early diastolic transmitral flow (P = 0.005) and the ratio of Doppler velocities of early to late diastolic transmitral flow (P = 0.02), consistent with a reduction in intravascular volume. There was no change after dialysis in early diastolic mitral annular velocity using M-mode (P = 0. 19) or tissue Doppler imaging from either the septal or lateral walls (P = 0.88 and P = 0.15 respectively), but there was a reduction in Vp after dialysis (55 to 49 cm/s; P = 0.04). There were only weak correlations between Vp and the early diastolic mitral annular velocities (r < 0.6 for all). We conclude that the assessment of diastolic function by the mitral annular early diastolic velocity appears to be preload-independent, that Vp may be affected by preload and that there is only a weak relationship between Vp and the early diastolic mitral annular velocity.

Objective: Friedreich ataxia (FRDA) is an autosomal recessive condition due to a GAA triplet expansion in the FXN gene that causes increased left ventricular (LV) wall thickness and can progress to LV systolic dysfunction. However, the changes in myocardial function that occur before a reduction in LV ejection fraction are incompletely understood. Method(s): LV long-axis function was assessed by measurement of tissue Doppler imaging (TDI) peak systolic (S'), early diastolic (E'), and atrial velocities (A') at the septal and lateral borders of the mitral annulus in 60 subjects homozygous for a GAA expansion in the FXN gene who had preserved LV ejection fraction. Comparison was made with 60 sex- and age-matched controls. TDI velocities at 5 years were compared with baseline values in 17 FRDA subjects with follow-up studies who still had preserved ejection fraction. Result(s): S' and E' were reduced in FRDA subjects at both the septal and the lateral mitral annular borders. Lateral E' was independently and inversely related to age, blood pressure, septal wall thickness, and the number of GAA repeats in the smaller allele of the FXN gene, whereas septal E' was not correlated with GAA repeat number. At 5 years, there was a reduction in lateral S' and E' but no change in septal TDI velocities. Conclusion(s): Subjects with FRDA have impairment of septal and lateral long-axis LV function, but there also seem to be regional differences in the effects of this condition that are at least partly related to the degree of genetic abnormality. Copyright 2011 by the American Society of Echocardiography.