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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

Dipyridamole stress echo (0.84 mg/kg in 6', accelerated protocol). Systolic (pink lines) and diastolic (black lines) times as a function of HR. Dipyridamole results in adenosine receptor-mediated systemic as well coronary vasodilatation, often accompanied by a reflex increase in heart rate. With moderate stress induced HR increase (up to 110–100 bpm, upper and middle panel) diastolic time critically shortens, equalling systolic time. With mild induced HR increase (up to 70 bpm, lower panel) diastole has longer duration.
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Figure 5: Dipyridamole stress echo (0.84 mg/kg in 6', accelerated protocol). Systolic (pink lines) and diastolic (black lines) times as a function of HR. Dipyridamole results in adenosine receptor-mediated systemic as well coronary vasodilatation, often accompanied by a reflex increase in heart rate. With moderate stress induced HR increase (up to 110–100 bpm, upper and middle panel) diastolic time critically shortens, equalling systolic time. With mild induced HR increase (up to 70 bpm, lower panel) diastole has longer duration.

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)

Dipyridamole stress echo (0.84 mg/kg in 6', accelerated protocol). Systolic (pink lines) and diastolic (black lines) times as a function of HR. Dipyridamole results in adenosine receptor-mediated systemic as well coronary vasodilatation, often accompanied by a reflex increase in heart rate. With moderate stress induced HR increase (up to 110–100 bpm, upper and middle panel) diastolic time critically shortens, equalling systolic time. With mild induced HR increase (up to 70 bpm, lower panel) diastole has longer duration.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Dipyridamole stress echo (0.84 mg/kg in 6', accelerated protocol). Systolic (pink lines) and diastolic (black lines) times as a function of HR. Dipyridamole results in adenosine receptor-mediated systemic as well coronary vasodilatation, often accompanied by a reflex increase in heart rate. With moderate stress induced HR increase (up to 110–100 bpm, upper and middle panel) diastolic time critically shortens, equalling systolic time. With mild induced HR increase (up to 70 bpm, lower panel) diastole has longer duration.
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