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The Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195
Myocardial tissue
Doppler echocardiography (TDE) has been proposed as a tool for the
assessment of diastolic function. Controversy exists regarding whether
TDE measurements are influenced by preload. In this study, left
ventricular volume and high-fidelity pressures were obtained in
eight closed-chest dogs during intermittent caval occlusion. The time
constant of isovolumic ventricular relaxation (
) was altered
with varying doses of dobutamine and esmolol. Peak early diastolic
myocardial (Em) and transmitral (E)
velocities were measured before and after preload reduction. The
relative effects of changes in preload and relaxation were determined
for Em and compared with their effects on
E. The following results were observed: caval occlusion
significantly decreased E (
E = 16.4 ± 3.3 cm/s, 36.6 ± 13.7%, P < 0.01) and
Em (Em = 1.3 ± 0.4 cm/s, 32.5 ± 26.1%, P < 0.01) under
baseline conditions. However, preload reduction was similar for
E under all lusitropic conditions (P = not
significant), but these effects on Em decreased
with worsening relaxation. At < 50 ms, changes in
Em with preload reduction were significantly
greater (Em = 2.8 ± 0.6 cm/s) than at = 50-65 ms (Em = 1.2 ± 0.2 cm/s) and at >65 ms
(Em = 0.5 ± 0.1 cm/s,
P < 0.05). We concluded that TDE
Em is preload dependent. However, this effect
decreases with worsening relaxation.
tissue Doppler echocardiography; diastolic function; ventricular relaxation
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