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European Heart Journal 2000 21(16):1376-1386; doi:10.1053/euhj.1999.2036
Copyright © 2000 by the European Society of Cardiology.
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Mitral flow derived Doppler indices of left ventricular diastolic function in a general population. The Tromsø study

H Schirmera,f1, P Lundeb and K Rasmussenb

a Institute of Community Medicine, Institute of Clinical Medicine, University of Tromsø Norway
b Institute of Clinical Medicine, University of Tromsø Norway

revised December 13, 1999; accepted December 15, 1999

Abstract

Aims Left ventricular diastolic dysfunction has been proposed as the basis of heart failure in patients with normal left ventricular systolic function. Doppler indices of mitral inflow have been widely used to diagnose this condition and have been shown to correlate well with increased left atrial pressure in patients with cardiovascular disease. We wanted to establish age-specific criteria for normality of these indices in a large population and to determine the association of abnormal values to age and cardiovascular disease.

Methods and Results In our sample of subjects aged 25–85 years, 3022 had pulsed Doppler measurements of mitral inflow velocities and early inflow deceleration time. The association of these indices to age and gender were established in a ‘healthy’ reference subsample of 949 subjects. Age-specific percentiles showed a significant decline with increasing age for peak early mitral inflow velocity and the ratio of peak early and atrial inflow velocities (E/A ratio), whereas early inflow deceleration time and peak atrial inflow velocity showed a significant increase with increasing age. According to current criteria for diastolic dysfunction, the prevalence of dysfunction decreases with increasing age in the general population, as well as in the subgroup with cardiovascular disease. Only 7% of the variance in deceleration time was explained by cardiovascular disease or risk factors. For the E/A ratio, however, 41 and 48% of the variance were explained for men and women, respectively.

Conclusion Age- and gender-specific criteria for normality are provided. Our data confirm the existence of a significant effect of age and gender on mitral Doppler indices of diastolic dysfunction. However, Doppler criteria for diastolic dysfunction based on these measurements need revision.

Key Words: Echocardiography, population, Doppler, heart failure, diastolic function

f1 Correspondence: Henrik Schirmer, Institute of Community Medicine, University of Tromsø, 9037 Tromsø, Norway.

References

  1. Rodeheffer RJ, Jacobsen SJ, Gersh BJ. The incidence and prevalence of congestive heart failure in Rochester, Minnesota. Mayo Clin Proc. 1993;68:1143–1150[Web of Science][Medline]
  2. Dougherty AH, Naccarelli GV, Gray EL, Hicks CH, Goldstein RA. Congestive heart failure with normal systolic function. Am J Cardiol. 1984;54:778–782[CrossRef][Web of Science][Medline]
  3. Dodek A, Kassebaum DG, Bristow JD. Pulmonary edema in coronary-artery disease without cardiomegaly: paradox of the stiff heart. N Engl J Med. 1972;286:1347–1350[Web of Science][Medline]
  4. Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol. 1995;26:1565–1574[Abstract]
  5. Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta Stone. J Am Coll Cardiol. 1997;30:8–18[Abstract]
  6. Nishimura RA, Appleton CP, Redfield MM, Ilstrup DM, Holmes DR J, Tajik AJ. Noninvasive doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol. 1996;28:1226–1233[Abstract]
  7. Alpert MA, Terry BE, Mulekar M. Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol. 1997;80:736–740[CrossRef][Web of Science][Medline]
  8. Cecconi M, Manfrin M, Zanoli R. Doppler echocardiographic evaluation of left ventricular end-diastolic pressure in patients with coronary artery disease. J Am Soc Echocardiogr. 1996;9:241–250[CrossRef][Medline]
  9. Eur Heart J. 1998;19:990–1003[Free Full Text]
  10. Giannuzzi P, Imparato A, Temporelli PL. Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 1994;23:1630–1637[Abstract]
  11. Yamamoto K, Nishimura RA, Chaliki HP, Appleton CP, Holmes DR J, Redfield MM. Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: critical role of left ventricular systolic function. J Am Coll Cardiol. 1997;30:1819–1826[Abstract]
  12. Giannuzzi P, Temporelli PL, Bosimini E. Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction. J Am Coll Cardiol. 1996;28:383–390[Abstract]
  13. Temporelli PL, Corra U, Imparato A, Bosimini E, Scapellato F, Giannuzzi P. Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure. J Am Coll Cardiol. 1998;31:1591–1597[Abstract/Free Full Text]
  14. Poulsen SH, Jensen SE, Gotzsche O, Egstrup K. Evaluation and prognostic significance of left ventricular diastolic function assessed by Doppler echocardiography in the early phase of a first acute myocardial infarction. Eur Heart J. 1997;18:1882–1889[Abstract/Free Full Text]
  15. Nijland F, Kamp O, Karreman AJ, van EM, Visser CA. Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: a serial Doppler echocardiographic study. J Am Coll Cardiol. 1997;30:1618–1624[Abstract]
  16. Benjamin EJ, Levy D, Anderson KM. Determinants of Doppler indexes of left ventricular diastolic function in normal subjects (the Framingham Heart Study). Am J Cardiol. 1992;70:508–515[CrossRef][Web of Science][Medline]
  17. Mantero A, Gentile F, Gualtierotti C. Left ventricular diastolic parameters in 288 normal subjects from 20 to 80 years old. Eur Heart J. 1995;16:94–105[Abstract/Free Full Text]
  18. Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc. 1994;69:212–224[Web of Science][Medline]
  19. Yu CM, Sanderson JE. Right and left ventricular diastolic function in patients with and without heart failure: effect of age, sex, heart rate, and respiration on Doppler-derived measurements. Am Heart J. 1997;134:426–434[CrossRef][Web of Science][Medline]
  20. Mureddu GF, de SG, Greco R, Rosato GF, Contaldo F. Left ventricular filling pattern in uncomplicated obesity. Am J Cardiol. 1996;77:509–514[CrossRef][Web of Science][Medline]
  21. Bjartveit K, Foss OP, Gjervig T, Lund-Larsen PG. The Cardiovascular Disease Study. Acta Med Scand. 1979;:1–70
  22. Thelle DS, Førde OH, Try K, Lehmann EH. The Tromsø heart study. Methods and main results of the cross-sectional study. Acta Med Scand. 1976;200:107–118[Web of Science][Medline]
  23. Bønaa KH, Thelle DS. Association between blood pressure and serum lipids in a population. The Tromsø Study. Circulation. 1991;83:1305–1314[Abstract/Free Full Text]
  24. Bønaa KH, Arnesen E. Association between heart rate and atherogenic blood lipid fractions in a population. The Tromsø Study. Circulation. 1992;86:394–405[Abstract/Free Full Text]
  25. Stensland-Bugge E, Bønaa KH, Joakimsen O. Reproducibility of ultrasonographicaly determined intima-media thickness is dependent on arterial wall thickness. The Tromsø Study. Stroke. 1997;28:1972–1980[Abstract/Free Full Text]
  26. Schirmer H, Lunde P, Rasmussen K. Prevalence of left ventricular hypertrophy in a general population. The Tromsø Study. Eur Heart J. 1999;20:429–438[Abstract/Free Full Text]
  27. Knutsen SF, Knutsen R. The Tromso Heart Study: family approach to intervention on CHD. Feasibility of risk factor reduction in high-risk persons—project description. Scand J Soc Med. 1989;17:109–119[Web of Science][Medline]
  28. Tribouilloy C, Shen WF, Slama M. Assessment of severity of aortic regurgitation by M-mode colour Doppler flow imaging. Eur Heart J. 1991;12:352–356[Abstract/Free Full Text]
  29. Abbasi AS, Allen MW, DeCristofaro D, Ungar I. Detection and estimation of the degree of mitral regurgitation by range-gated pulsed doppler echocardiography. Circulation. 1980;61:143–147[Abstract/Free Full Text]
  30. Otto CM, Nishimura RA, Davis KB, Kisslo KB, Bashore TM. Doppler echocardiographic findings in adults with severe symptomatic valvular aortic stenosis. Balloon Valvuloplasty Registry Echocardiographers. Am J Cardiol. 1991;68:1477–1484[CrossRef][Web of Science][Medline]
  31. Schirmer H, Lunde P, Rasmussen K. What determines echogensity in the general population? The Tromsø Study. J Am Soc Echocardiogr. 1999;12:314–318[CrossRef][Web of Science][Medline]
  32. Lindberg W, Natvig H, Rygh A, Svendsen K. Height and weight screening in adult men and women; A proposal to new Norwegian middle weight by height tables. Tidsskr Nor Lægeforen. 1956;11:361–368
  33. SAS Institute Inc
  34. MacFadyen RJ, McLeod CJ, Shiels P, Smith WR, MacDonald TM. Community diagnosed breathlessness and symptomatic isolated diastolic dysfunction (The Arbroath Study) (Abstr). Circulation. 1997;96:I-642
  35. Shiels P, MacDonald TM. Isolated diastolic heart failure—what is it? Postgrad Med J. 1998;74:451–454[Abstract/Free Full Text]
  36. Oh JK, Appleton CP, Hatle LK, Nishimura RA, Seward JB, Tajik AJ. The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 1997;10:246–270[CrossRef][Web of Science][Medline]
  37. Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol. 1998;32:865–875[Abstract/Free Full Text]
  38. Garcia MJ, Rodriguez L, Ares M. Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. Am Heart J. 1996;132:648–656[CrossRef][Web of Science][Medline]
  39. Caruana L, Davie AP, Petrie M, McMurray J. Diagnosing heart failure. Eur Heart J. 1999;20:393[Free Full Text]
  40. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36[Abstract/Free Full Text]

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