Nordin, Mohd Hakimi
(2018)
Comparative study of echocardiagraphic dopppler flow velocities in left ventricular apical, mid and outflow area in patients with heart failure and normal subjects.
Masters thesis, Universiti Sains Malaysia.
Abstract
INTRODUCTION : Heart failure remained as a one of the major contributory factor for
hospitalization and mortality, not only in Malaysia, but the whole world wide as well.
Thus, detection at the earlier phase especially at the preclinical phase is crucial for
preventive measure. Ejection fraction (EF) is one of the ECHO parameters that has been
widely used, particularly to asses systolic LV function. Nevertheless, its value limited in
preclinical phase and load dependence indices, thus regional wall motion abnormality
assessment has been postulated as one of the modalities for LV systolic indices. This has
been proven from the previous study as tissue Doppler imaging has been useful to detect
regional myocardial wall strain and further studies showed myocardial wall strain rate
and speckled tracking image had given an accurate measurements of regional LV wall
contractility and correlate better with the global systolic function.
Unfortunately, those parameters were not widely used as it required high technical skills
and experience. Thus, other modalities to assess regional wall motion abnormality were
studied. This study primarily design to evaluate intraventricular velocities and pressure
gradient that might representing one of the modalities to asses regional LV wall
contractility in a simple way yet accurate. We used earlier animal data illustrating the
usefulness of those parameters in assessment of regional contractile function.
METHOD AND RESULTS : This was comparative cross sectional echocardiography
pilot study. Approximately 42 patients presented to HUSM with heart failure symptoms
were identified and screening ECHO were done. 12 patients were excluded from this
study as not fulfilled inclusion and exclusion criteria. 30 healthy volunteered from
HUSM staff were recruited into normal group after screening ECHO was applied.
We evaluate intraventricular velocities and pressure gradient at 3 area in LV cavity (left
ventricular outflow tract (LVOT), mid and apical) which were sampled by pulse wave
Doppler.
Mean of intraventricular velocities and pressure gradient were recorded highest at LVOT
area compare to other area among heart failure patients (1.51 and 3.01 respectively), also
those values were higher if sampled towards (T) the transducer compare to away (A) the
transducer in each area of LV cavity.
Comparative study between heart failure patients and normal group revealed significant
value (p<0.01) by using intraventricular pressure gradient that was sampled at the LVOT
and mid area (away and towards the transducer). Meanwhile, no significant value in
comparison between those 2 groups by using intraventricular velocities.
There were no significant value in relationship between intraventricular velocities and
pressure gradient with other systolic indices and ECHO parameters.
CONCLUSION : Intraventricular pressure gradient remain as one of the significant
modalities to asses regional wall motion abnormality if sampled at the LVOT and mid
area.
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