Key result
Doppler mitral flow velocity patterns correlate with hemodynamics to noninvasively assess LV diastolic function.
Why the study?
The study was conducted to determine what clinically useful information regarding left ventricular diastolic function can be inferred noninvasively with pulsed wave Doppler echocardiography.
Can clinically useful information regarding left ventricular diastolic function be inferred noninvasively with pulsed wave Doppler echocardiography compared to invasive hemodynamics?
Observational (n=100)
Can clinically useful information regarding left ventricular diastolic function be inferred noninvasively with pulsed wave Doppler echocardiography compared to invasive hemodynamics?
Doppler echocardiography of mitral flow velocity provides a noninvasive, dynamic assessment of left ventricular diastolic function, though patterns can be confounded by elevated left atrial pressure.
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“Empagliflozin did not significantly reduce the risk of time to first hospitalization for heart failure or all-cause death following AMI. A deeper dive into heart failure hospitalizations, however, suggested that empagliflozin is helping in at least some patients—the key is identifying who will benefit.”
“Don't give up on SGLT2 inhibitors post-MI. We just need to find the right populations to target, and I think it will be helpful in preventing heart failure in those groups. But we haven't specifically found that yet with this trial, although we do have some good signals of where to look.”
“Our study will help to fill a key gap in the understanding of the clinical use of SGLT2 inhibitors in people who have suffered a heart attack. By reassuring physicians of the safety and efficacy of empagliflozin early after a heart attack, EMPACT-MI has enormous implications for treating a very vulnerable population of patients with cardiovascular disease worldwide.”
Supports noninvasive diastolic evaluation in routine care; leaves open refinement with strain and multimodality imaging.
In an effort to determine what clinically useful information regarding left ventricular diastolic function can be inferred noninvasively with pulsed wave Doppler echocardiography, mitral flow velocity patterns and measured variables were correlated with hemodynamic findings in 70 patients: 30 with coronary artery disease, 20 with idiopathic congestive cardiomyopathy, 14 with a restrictive myocardial process and 6 without significant cardiac disease. The effect of sudden changes in hemodynamics on the mitral flow velocity pattern was also investigated in a subgroup of patients who had simultaneous recording of mitral flow velocity and left ventricular pressure before and after left ventriculography. Mitral flow velocity recordings from 30 healthy adults served as a reference group. This analysis suggests that 1) the majority of patients with these cardiac disorders demonstrate abnormal mitral flow velocity patterns or variables; 2) markedly different flow velocity patterns can be seen in patients with impaired left ventricular relaxation; 3) the different mitral patterns appear to relate more to myocardial function and hemodynamic status than to the type of disease process present; 4) certain mitral patterns suggest different filling pressures and rates of early diastolic left ventricular filling; 5) an increase in left atrial pressure can "normalize" an abnormal mitral flow velocity pattern and "mask" a left ventricular relaxation abnormality; and 6) the different patterns appear to represent a dynamic continuum with the potential to change from one to another as a result of disease progression, medical therapy or sudden changes in hemodynamics. It is concluded that, despite the indirect method of estimation and certain limitations, mitral flow velocity recordings have clinical potential in assessing left ventricular diastolic function that merits further investigation.
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Appleton et al. (1988) conducted an observational in Cardiac disorders (coronary artery disease, cardiomyopathy, restrictive myocardial process) (n=100). Pulsed wave Doppler echocardiography (mitral flow velocity patterns) vs. Hemodynamic findings was evaluated on Correlation of mitral flow velocity patterns with hemodynamic findings. Mitral flow velocity patterns assessed by Doppler echocardiography correlate with hemodynamic status and myocardial function, offering a noninvasive assessment of left ventricular diastolic function.
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