Importance of adjusting left ventricular diastolic peak filling rate for heart rate

doi:10.1016/0002-9149(88)90321-9

The American Journal of Cardiology

Volume 61, Issue 6, 15 February 1988, Pages 489-491

https://doi.org/10.1016/0002-9149(88)90321-9 Get rights and content

Abstract

Recently, the importance of left ventricular (LV) diastolic function for cardiac performance in various diseases has been reported in studies using both digitized M-mode echocardiography^1,2 and radionuclide ventriculography.³ However, the potential influence of physiologic factors, including heart rate (HR), loading conditions and LV systolic function, on diastolic function variables is currently debated.^4–6 Although Bianco et al⁵ found the LV peak diastolic filling rate to be positively related to HR when subjects were studied at rest,⁵ others found contrary results.^4,6 Atrial pacing⁷ and exercise studies⁵ do suggest such an association. Further, a positive relation between LV systolic function and diastolic relaxation has both been reported^4,5 and refuted.⁶ In addition, both preload and afterload may influence LV diastolic properties.⁸ We used digitized M-mode echocardiography to evaluate the changes in peak diastolic filling rate during moderate exercise in normal subjects and the physiologic factors influencing it.

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Consequences of increasing heart rate on deceleration time, the velocity-time integral, and E/A
2006, American Journal of Cardiology
Citation Excerpt :
Our measurements also indicate that the total VTI had no statistically significant increase (r = 0.039, p = 0.60), whereas HR doubled. This is in immediate contrast to previous studies that showed that stroke volume, cardiac output, and peak flow rate (in milliliters per second) increase as a function of HR.25,26 Because flow rate is the product of valve area and flow velocity, a change in flow rate can be accommodated by a change (increase) in effective mitral valve area.
The ascendancy of diastolic heart failure to “epidemic” proportions has increased the use of and reliance on Doppler echocardiography as a source for diagnosis and as the preferred method for determining indexes of diastolic function (DF). Current indexes are primarily derived from shape-based features of Doppler E and A waves, such as their amplitudes, slopes, durations, and areas. Load dependence and pathologic correlates of these indexes have been considered, but DF indexes are not routinely corrected for heart rate (HR). To determine the dependence of selected Doppler-derived indexes of DF on HR, transmitral Doppler flow velocities and electrocardiograms were simultaneously recorded during supine bicycle exercise in 21 young, healthy volunteers. Standard E- and A-wave shape-based indexes (acceleration time, deceleration time [DT], peak E, peak A) were measured using triangle approximation. Velocity–time integrals (VTIs) were calculated by trapezoidal and triangular approximations. A-wave peak velocity (A) was measured conventionally, relative to baseline, and also using 2 alternative methods: A*, measured relative to the E@A velocity, and Ac, relative to the E-wave deceleration value at peak A-wave velocity. E/A was calculated conventionally and by using A* and Ac. The results showed that DF indexes derived from individual E waves are essentially HR independent. DT showed a mere 20% decrease for a 100% increase in HR. A triangular approximation for the E-wave VTI and the corrected E/Ac were found to be nearly HR independent. In conclusion, on the basis of the established continuity of cardiac output as a function of increasing HR and the observed data, Doppler-derived indexes of DF (DT, VTIs, E/Ac) can be treated as essentially HR independent only if the VTI and A-wave peak are corrected for HR as described.
Left ventricular diastolic function in patients with advanced cystic fibrosis
2003, Chest
Citation Excerpt :
The indexes of diastolic function used in this study were derived from changes in chamber volume over time measured by radionuclide ventriculography. These indexes have been shown previously to be dependent on loading conditions, ejection fraction, and heart rate.28293031 We found no significant differences among the groups with respect to BP or LVEF at rest.
To assess left ventricular systolic and diastolic function in adult patients with cystic fibrosis using radionuclide ventriculography.
Although myocardial fibrosis has been described in autopsy specimens of patients with cystic fibrosis, the possibility that myocardial dysfunction may occur during life in adult patients with cystic fibrosis has not been explored.
To assess the possibility of cardiac dysfunction occurring in cystic fibrosis, we studied 40 patients with advanced cystic fibrosis with first-pass radionuclide ventriculography and compared them to 9 patients with advanced bronchiectasis and 18 normal control subjects.
Indexes of right ventricular systolic function were similarly impaired in patients with cystic fibrosis and patients with bronchiectasis. Left ventricular ejection fraction of patients with cystic fibrosis, patients with bronchiectasis, and normal control subjects did not differ. Fractional left ventricular filling at 50% of diastole, an index of diastolic function, was significantly lower in patients with cystic fibrosis (54 ± 13%, mean ± SD) in comparison to patients with bronchiectasis (66 ± 4%, p = 0.009) or normal control subjects (69 ± 14, p = 0.0002). The contribution of atrial systole to total diastolic left ventricular filling was greater in patients with cystic fibrosis (38 ± 18%) than in patients with bronchiectasis (21 ± 4%, p = 0.01) or normal control subjects (25 ± 12%, p = 0.01).
Patients with advanced cystic fibrosis demonstrate impaired left ventricular distensibility when compared to normal control subjects and patients with bronchiectasis. Patients with cystic fibrosis may be at risk of heart failure due to right ventricular dysfunction or left ventricular diastolic dysfunction.
Comparison of Velocity and Volumetric Indexes of Left Ventricular Filling During Increased Heart Rate With Exercise and Amyl Nitrite
1994, Journal of the American Society of Echocardiography
Physiologic variables, such as heart rate, affect the noninvasive indexes of left ventricular filling, complicating the interpretation of these indexes for clinical assessment of diastolic function. We compared the effect in normal subjects of increased heart rate provoked by both exercise and amyl nitrite on noninvasive velocity and volumetric indexes of left ventricular filling. Velocity indexes were affected in a different pattern with exercise compared with amyl nitrite because peak E wave velocity and relative atrial contribution to filling increased with exercise. In contrast, the volumetric index of rapid left ventricular filling increased similarly with both mechanisms. These findings demonstrate the importance of recognizing the different effects on indexes of left ventricular filling when heart rate is increased by different methods.
Verapamil but not nifedipine impairs left ventricular function during exercise in hypertensive patients
1990, American Heart Journal
Calcium antagonists are popular therapeutic agents in the treatment of systemic hypertension. Although these agents have similar antihypertensive efficacy, the have varied effects on left ventricular function at rest in hypertensive patients. The effect of different calcium antagonists on left ventricular function during exercise and on exercise performance in patients with hypertension, however, is less clear. Fifteen patients with essential hypertension (diastolic blood pressure=95 to 110 mm Hg) were enrolled in a placebo-controlled, single-blinded crossover study comparing nifedipine with verapamil for rest/exercise heart rate and blood pressure, exercise performance, and rest/exercise left ventricular function. Each drug was titrated to achieve resting diastolic pressures less than 90 mm Hg. All patients underwent maximal exercise testing and rest/exercise gated radionuclide ventriculography at the end of 3-week placebo, nifedipine, and verapamil treatment periods. Both calcium antagonists significantly reduced blood pressure at rest and during exercise compared with placebo. Neither calcium antagonist altered resting heart rate; however, both verapamil and nifedipine significantly reduced heart rate at maximal exercise. Verapamil but not nifedipine impaired left ventricular peak emptying rate and left ventricular peak filling rate during exercise but not at rest. Neither verapamil nor nifedipine, however, significantly altered rest or exercise global left ventricular ejection fraction (LVEF) compared with placebo. There was a trend, however, for impairment in the LVEF response to exercise (ΔLVEF) in the verapamil treatment group. Exercise capacity was not significantly altered by either calcium antagonist compared with placebo. Thus verapamil but not nifedipine impairs left ventricular function during exercise in hypertensive patients. The clinical relevance of this effect is unclear, since verapamil did not alter exercise performance. The effect of verapamil in hypertensive patients with impaired left ventricular function may warrant further study.
Effect of alteration in loading conditions on both normal and abnormal patterns of left ventricular filling in healthy individuals
1990, The American Journal of Cardiology
Doppler analysis of mitral flow provides a means of analyzing left ventricular (LV) diastolic function. While experimental studies have suggested that changes in left atrial pressure may affect the normal pattern of early diastolic filling, the effect of such changes on abnormal patterns of filling is unknown. Accordingly, the Doppler pattern of LV filling was analyzed in 20 subjects with LV hypertrophy (mean age 59 ± 13 years, ± standard deviation), in 25 healthy normal subjects (29 ± 6 years) and in 11 elderly subjects (68 ± 5 years). All underwent Doppler examination of LV inflow at rest and immediately after postural changes.
In all 3 groups, head-down positioning increased early diastolic flow velocity (E) (p < 0.001), and raised the E to late diastolic flow velocity (A) ratio (p < 0.01). However, an abnormal $E A$ ratio never approached a normal resting value. Likewise, although E and the $E A$ ratio decreased significantly in normal subjects with head-up positioning, it did not become abnormal. The magnitude of change in E, A and $E A$ ratio did not differ among the 3 groups in response to postural changes. Thus, alterations of LV loading conditions alter the pattern of LV filling, whether normal or abnormal at baseline. The magnitude of change appears to be independent of the resting flow pattern. Although loading conditions may affect the Doppler pattern of filling, simple changes in venous return do not “normalize” an abnormal pattern, nor do they “abnormalize” a normal pattern.
Clinical evaluation of left ventricular diastolic performance
1990, Progress in Cardiovascular Diseases

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¹: Dr. Danielsen is the recipient of a fellowship from the Norwegian Council on Cardiovascular Diseases.

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Brief reportImportance of adjusting left ventricular diastolic peak filling rate for heart rate

Abstract

Am J Cardiol

Am J Cardiol

Am J Cardiol

JACC

Chest

Brief report
Importance of adjusting left ventricular diastolic peak filling rate for heart rate