Doppler stress echocardiography of the left and right ventricle: a new echo device to quantify left ventricular backward failure.
OBJECTIVE
A novel non-invasive procedure which evaluates left-right ventricular interaction is introduced. This procedure is suitable for the classification of congestive heart failure.


METHODS
In 48 patients showing mild, moderate or advanced stage congestive heart failure (NYHA I-III) Doppler echocardiography was performed at rest, during and after submaximal bicycle exercise. Mitral (m) and tricuspid (t) filling parameters were determined: early diastolic (VEm, VEt) and atrial maximal velocities (VAm, VAt), the velocity integrals (Em, Et, Am, At) and the corresponding ratios (VE/VAm, VE/VAt, E/Am, E/At). Group 1 (n = 29) was composed of those patients presenting with a VE/VAm < 1 at rest. Four individuals (group 2) were found to have a VE/VAm ratio < 1 during exercise only. Six other patients showing a dilated left ventricle or an ejection fraction of less than 40% produced false negative results in left ventricular Doppler examination (VE/VAm > 1) at rest and during exercise (group 3). In 9 cases (group 4) systolic function, size and Doppler echocardiographic parameters of the left ventricle were proven to be normal.


RESULTS
The VE/VAt-ratio decreased notably during exercise (p < 0.05) but increased again after exercise in group 3. In the groups 1 and 2 similar changes occurred as well, however not to a significant degree. In group 4, exercise VE/VAt ratio did not differ from values seen at rest or during recovery (variability 4%).


CONCLUSIONS
The results of this study indicate, that high sensitivity towards left ventricular backward failure can be achieved for Doppler stress echocardiography by extending the examination to right-sided diastolic parameters.
Bartel
T
T
Department of Internal Medicine, Medical Faculty (Charité), Humboldt-University of Berlin, Germany.
Müller
S
S
Borges
A C
AC
Förster
A
A
D000293:Adolescent; D000328:Adult; D015150:Echocardiography, Doppler / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left / Q000502:physiology*