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Diastolic time - frequency relation in the stress echo lab: filling timing and flow at different heart rates.

Bombardini T, Gemignani V, Bianchini E, Venneri L, Petersen C, Pasanisi E, Pratali L, Alonso-Rodriguez D, Pianelli M, Faita F, Giannoni M, Arpesella G, Picano E - Cardiovasc Ultrasound (2008)

Bottom Line: Diastolic filling rate was calculated as echo-measured mitral filling volume/sensor-monitored diastolic time.Diastolic time decreased during stress more markedly than systolic time.Cardiological systolic and diastolic duration can be monitored during stress by using an acceleration force sensor.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Echocardiography, Institute of Clinical Physiology, National Council of Research, Pisa, Italy. tbombardini@yahoo.it

ABSTRACT

Unlabelled: A cutaneous force-frequency relation recording system based on first heart sound amplitude vibrations has been recently validated. Second heart sound can be simultaneously recorded in order to quantify both systole and diastole duration.

Aims: 1- To assess the feasibility and extra-value of operator-independent, force sensor-based, diastolic time recording during stress.

Methods: We enrolled 161 patients referred for stress echocardiography (exercise 115, dipyridamole 40, pacing 6 patients).The sensor was fastened in the precordial region by a standard ECG electrode. The acceleration signal was converted into digital and recorded together with ECG signal. Both systolic and diastolic times were acquired continuously during stress and were displayed by plotting times vs. heart rate. Diastolic filling rate was calculated as echo-measured mitral filling volume/sensor-monitored diastolic time.

Results: Diastolic time decreased during stress more markedly than systolic time. At peak stress 62 of the 161 pts showed reversal of the systolic/diastolic ratio with the duration of systole longer than diastole. In the exercise group, at 100 bpm HR, systolic/diastolic time ratio was lower in the 17 controls (0.74 +/- 0.12) than in patients (0.86 +/- 0.10, p < 0.05 vs. controls). Diastolic filling rate increased from 101 +/- 36 (rest) to 219 +/- 92 ml/m2* s-1 at peak stress (p < 0.5 vs. rest).

Conclusion: Cardiological systolic and diastolic duration can be monitored during stress by using an acceleration force sensor. Simultaneous calculation of stroke volume allows monitoring diastolic filling rate.Stress-induced "systolic-diastolic mismatch" can be easily quantified and is associated to several cardiac diseases, possibly expanding the spectrum of information obtainable during stress.

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Related in: MedlinePlus

Exercise stress echo. Systolic (pink lines) and diastolic (black lines) times as a function of HR. Upper panel, a normal subject: systolic duration plotted as a function of HR demonstrates a slight linear decrease; duration of diastole demonstrates the most significant change. Middle panel, a patient with severe mitral regurgitation and stress induced severe pulmonary hypertension; the test was stopped at low stress load due to limiting dyspnoea without stress induced ischemia: prolonged systolic time with systolic/diastolic time reversal occurred during stress. Lower panel, a patient with stress induced ischemia at low stress load: at ischemia systole lengthens with systolic/diastolic time reversal.
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Figure 4: Exercise stress echo. Systolic (pink lines) and diastolic (black lines) times as a function of HR. Upper panel, a normal subject: systolic duration plotted as a function of HR demonstrates a slight linear decrease; duration of diastole demonstrates the most significant change. Middle panel, a patient with severe mitral regurgitation and stress induced severe pulmonary hypertension; the test was stopped at low stress load due to limiting dyspnoea without stress induced ischemia: prolonged systolic time with systolic/diastolic time reversal occurred during stress. Lower panel, a patient with stress induced ischemia at low stress load: at ischemia systole lengthens with systolic/diastolic time reversal.

Mentions: A consistent first heart sound and second heart sound signal was obtained in 161 out of 164 patients at rest and during stress. In 3 patients (2% of the examinations) data were discarded because of a low signal to noise ratio which was related to both small amplitude of the signal and the presence of several artefacts due to heavy movements and/or speaking of the patient. A typical systolic and diastolic times trend during exercise, dipyridamole and pacing stress is shown in Figure 4, 5 and 6.


Diastolic time - frequency relation in the stress echo lab: filling timing and flow at different heart rates.

Bombardini T, Gemignani V, Bianchini E, Venneri L, Petersen C, Pasanisi E, Pratali L, Alonso-Rodriguez D, Pianelli M, Faita F, Giannoni M, Arpesella G, Picano E - Cardiovasc Ultrasound (2008)

Exercise stress echo. Systolic (pink lines) and diastolic (black lines) times as a function of HR. Upper panel, a normal subject: systolic duration plotted as a function of HR demonstrates a slight linear decrease; duration of diastole demonstrates the most significant change. Middle panel, a patient with severe mitral regurgitation and stress induced severe pulmonary hypertension; the test was stopped at low stress load due to limiting dyspnoea without stress induced ischemia: prolonged systolic time with systolic/diastolic time reversal occurred during stress. Lower panel, a patient with stress induced ischemia at low stress load: at ischemia systole lengthens with systolic/diastolic time reversal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2365937&req=5

Figure 4: Exercise stress echo. Systolic (pink lines) and diastolic (black lines) times as a function of HR. Upper panel, a normal subject: systolic duration plotted as a function of HR demonstrates a slight linear decrease; duration of diastole demonstrates the most significant change. Middle panel, a patient with severe mitral regurgitation and stress induced severe pulmonary hypertension; the test was stopped at low stress load due to limiting dyspnoea without stress induced ischemia: prolonged systolic time with systolic/diastolic time reversal occurred during stress. Lower panel, a patient with stress induced ischemia at low stress load: at ischemia systole lengthens with systolic/diastolic time reversal.
Mentions: A consistent first heart sound and second heart sound signal was obtained in 161 out of 164 patients at rest and during stress. In 3 patients (2% of the examinations) data were discarded because of a low signal to noise ratio which was related to both small amplitude of the signal and the presence of several artefacts due to heavy movements and/or speaking of the patient. A typical systolic and diastolic times trend during exercise, dipyridamole and pacing stress is shown in Figure 4, 5 and 6.

Bottom Line: Diastolic filling rate was calculated as echo-measured mitral filling volume/sensor-monitored diastolic time.Diastolic time decreased during stress more markedly than systolic time.Cardiological systolic and diastolic duration can be monitored during stress by using an acceleration force sensor.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Echocardiography, Institute of Clinical Physiology, National Council of Research, Pisa, Italy. tbombardini@yahoo.it

ABSTRACT

Unlabelled: A cutaneous force-frequency relation recording system based on first heart sound amplitude vibrations has been recently validated. Second heart sound can be simultaneously recorded in order to quantify both systole and diastole duration.

Aims: 1- To assess the feasibility and extra-value of operator-independent, force sensor-based, diastolic time recording during stress.

Methods: We enrolled 161 patients referred for stress echocardiography (exercise 115, dipyridamole 40, pacing 6 patients).The sensor was fastened in the precordial region by a standard ECG electrode. The acceleration signal was converted into digital and recorded together with ECG signal. Both systolic and diastolic times were acquired continuously during stress and were displayed by plotting times vs. heart rate. Diastolic filling rate was calculated as echo-measured mitral filling volume/sensor-monitored diastolic time.

Results: Diastolic time decreased during stress more markedly than systolic time. At peak stress 62 of the 161 pts showed reversal of the systolic/diastolic ratio with the duration of systole longer than diastole. In the exercise group, at 100 bpm HR, systolic/diastolic time ratio was lower in the 17 controls (0.74 +/- 0.12) than in patients (0.86 +/- 0.10, p < 0.05 vs. controls). Diastolic filling rate increased from 101 +/- 36 (rest) to 219 +/- 92 ml/m2* s-1 at peak stress (p < 0.5 vs. rest).

Conclusion: Cardiological systolic and diastolic duration can be monitored during stress by using an acceleration force sensor. Simultaneous calculation of stroke volume allows monitoring diastolic filling rate.Stress-induced "systolic-diastolic mismatch" can be easily quantified and is associated to several cardiac diseases, possibly expanding the spectrum of information obtainable during stress.

Show MeSH
Related in: MedlinePlus